IDEAS home Printed from https://ideas.repec.org/p/pen/papers/11-005.html
   My bibliography  Save this paper

How Beliefs about HIV Status Affect Risky Behaviors: Evidence from Malawi, Sixth Version

Author

Listed:
  • Aureo de Paula

    (Department of Economics, University of Pennsylvania)

  • Gil Shapira

    (Department of Economics, University of Pennsylvania)

  • Petra E. Todd

    (Department of Economics, University of Pennsylvania)

Abstract

This paper examines how beliefs about own HIV status affect decisions to engage in risky sexual behavior (as measured by extramarital affairs) and analyzes the potential for interventions that influence beliefs, such as HIV testing and informational campaigns, to reduce transmission rates. The empirical analysis is based on a panel survey of married males for years 2006 and 2008 from the Malawi Diffusion and Ideational Change Project (MDICP). In the data, beliefs about HIV status vary significantly geographically and over time, in part because of newly available testing opportunities and because of cultural differences. We estimate the effect of beliefs on risky behavior using Arellano and Carrasco’s (2003) semiparametric panel data estimator, which accommodates unobserved heterogeneity and belief endogeneity. Results show that changes in the belief of being HIV positive induce changes in risky behavior. Downward revisions in beliefs increase risky behavior and upward revisions decrease it. We modify Arellano and Carrasco’s (2003) estimator to allow for underreporting of extramarital affairs and find the estimates to be robust. Using the estimates and a prototypical epidemiological model of disease transmission, we show that better informing people about their HIV status on net reduces the population HIV transmission rate.

Suggested Citation

  • Aureo de Paula & Gil Shapira & Petra E. Todd, 2010. "How Beliefs about HIV Status Affect Risky Behaviors: Evidence from Malawi, Sixth Version," PIER Working Paper Archive 11-005, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania, revised 21 Feb 2011.
  • Handle: RePEc:pen:papers:11-005
    as

    Download full text from publisher

    File URL: https://economics.sas.upenn.edu/sites/default/files/filevault/working-papers/11-005.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Duncan Thomas & Elizabeth Frankenberg & James P. Smith, 2001. "Lost but Not Forgotten: Attrition and Follow-up in the Indonesia Family Life Survey," Journal of Human Resources, University of Wisconsin Press, vol. 36(3), pages 556-592.
    2. Wilson, Nicholas, 2016. "Antiretroviral therapy and demand for HIV testing: Evidence from Zambia," Economics & Human Biology, Elsevier, vol. 21(C), pages 221-240.
    3. Oster, Emily, 2012. "HIV and sexual behavior change: Why not Africa?," Journal of Health Economics, Elsevier, vol. 31(1), pages 35-49.
    4. Orazio P. Attanasio, 2009. "Expectations and Perceptions in Developing Countries: Their Measurement and Their Use," American Economic Review, American Economic Association, vol. 99(2), pages 87-92, May.
    5. David Canning, 2006. "The Economics of HIV/AIDS in Low-Income Countries: The Case for Prevention," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 121-142, Summer.
    6. Heckman, James J. & Urzúa, Sergio, 2010. "Comparing IV with structural models: What simple IV can and cannot identify," Journal of Econometrics, Elsevier, vol. 156(1), pages 27-37, May.
    7. Tomas J. Philipson & Richard A. Posner, 1995. "A Theoretical and Empirical Investigation of the Effects of Public Health Subsidies for STD Testing," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 110(2), pages 445-474.
    8. Wenger, N.S. & Linn, L.S. & Epstein, M. & Shapiro, M.F., 1991. "Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: A randomized clinical trial," American Journal of Public Health, American Public Health Association, vol. 81(12), pages 1580-1585.
    9. Philipson, Tomas, 2000. "Economic epidemiology and infectious diseases," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 33, pages 1761-1799, Elsevier.
    10. Hausman, J. A. & Abrevaya, Jason & Scott-Morton, F. M., 1998. "Misclassification of the dependent variable in a discrete-response setting," Journal of Econometrics, Elsevier, vol. 87(2), pages 239-269, September.
    11. Weinhardt, L.S. & Carey, M.P. & Johnson, B.T. & Bickham, N.L., 1999. "Effects of HIV counseling and testing on sexual risk behavior: A meta- analytic review of published research, 1985-1997," American Journal of Public Health, American Public Health Association, vol. 89(9), pages 1397-1405.
    12. Delavande, Adeline & Giné, Xavier & McKenzie, David, 2011. "Measuring subjective expectations in developing countries: A critical review and new evidence," Journal of Development Economics, Elsevier, vol. 94(2), pages 151-163, March.
    13. Chimbiri, Agnes M., 2007. "The condom is an 'intruder' in marriage: Evidence from rural Malawi," Social Science & Medicine, Elsevier, vol. 64(5), pages 1102-1115, March.
    14. Rebecca L. Thornton, 2008. "The Demand for, and Impact of, Learning HIV Status," American Economic Review, American Economic Association, vol. 98(5), pages 1829-1863, December.
    15. Philip Anglewicz & Hans-Peter Kohler, 2009. "Overestimating HIV infection:," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 20(6), pages 65-96.
    16. Michael Kremer, 1996. "Integrating Behavioral Choice into Epidemiological Models of AIDS," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 549-573.
    17. Douglas Staiger & James H. Stock, 1997. "Instrumental Variables Regression with Weak Instruments," Econometrica, Econometric Society, vol. 65(3), pages 557-586, May.
    18. Michael A. Boozer & Tomas J. Philipson, 2000. "The Impact of Public Testing for Human Immunodeficiency Virus," Journal of Human Resources, University of Wisconsin Press, vol. 35(3), pages 419-446.
    19. Arellano, Manuel & Carrasco, Raquel, 2003. "Binary choice panel data models with predetermined variables," Journal of Econometrics, Elsevier, vol. 115(1), pages 125-157, July.
    20. Mechoulan Stéphane, 2004. "HIV Testing: a Trojan Horse?," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 4(1), pages 1-26, August.
    21. Georges Reniers, 2003. "Divorce and Remarriage in Rural Malawi," Demographic Research Special Collections, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 1(6), pages 175-206.
    22. Arellano, Manuel, 2003. "Panel Data Econometrics," OUP Catalogue, Oxford University Press, number 9780199245291.
    23. Chamberlain, Gary, 1987. "Asymptotic efficiency in estimation with conditional moment restrictions," Journal of Econometrics, Elsevier, vol. 34(3), pages 305-334, March.
    24. Adeline Delavande & Hans-Peter Kohler, 2012. "The Impact of HIV Testing on Subjective Expectations and Risky Behavior in Malawi," Demography, Springer;Population Association of America (PAA), vol. 49(3), pages 1011-1036, August.
    25. Michael Kremer, 1996. "Integrating Behavioral Choice into Epidemiological Models of the AIDS Epidemic," NBER Working Papers 5428, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Aureo de Paula & Gil Shapira & Petra E. Todd, 2008. "How Beliefs about HIV Status Affect Risky Behaviors: Evidence from Malawi1, Second Version," PIER Working Paper Archive 09-031, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania, revised 01 Aug 2009.
    2. Áureo De Paula & Gil Shapira & Petra E. Todd, 2014. "How Beliefs About Hiv Status Affect Risky Behaviors: Evidence From Malawi," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 29(6), pages 944-964, September.
    3. Jeremy Greenwood & Philipp Kircher & Cezar Santos & Michèle Tertilt, 2019. "An Equilibrium Model of the African HIV/AIDS Epidemic," Econometrica, Econometric Society, vol. 87(4), pages 1081-1113, July.
    4. Baird, Sarah & Gong, Erick & McIntosh, Craig & Özler, Berk, 2014. "The heterogeneous effects of HIV testing," Journal of Health Economics, Elsevier, vol. 37(C), pages 98-112.
    5. David Mmopelwa & Oliver Morrissey & Trudy Owens, 2021. "HIV/AIDS and sexual behaviour in Botswana," Discussion Papers 2021-03, University of Nottingham, CREDIT.
    6. Wilson, Nicholas, 2016. "Antiretroviral therapy and demand for HIV testing: Evidence from Zambia," Economics & Human Biology, Elsevier, vol. 21(C), pages 221-240.
    7. Neeraj Sood & Yanyu Wu, 2013. "The Impact of Insurance and HIV Treatment Technology on HIV Testing," NBER Working Papers 19397, National Bureau of Economic Research, Inc.
    8. Adeline Delavande & Dana Goldman & Neeraj Sood, 2010. "Criminal Prosecution and Human Immunodeficiency Virus-Related Risky Behavior," Journal of Law and Economics, University of Chicago Press, vol. 53(4), pages 741-782.
    9. Alexander E. Saak & David A. Hennessy, 2018. "A model of reporting and controlling outbreaks by public health agencies," Economic Theory, Springer;Society for the Advancement of Economic Theory (SAET), vol. 66(1), pages 21-64, July.
    10. Adeline Delavande & Hans-Peter Kohler, 2012. "The Impact of HIV Testing on Subjective Expectations and Risky Behavior in Malawi," Demography, Springer;Population Association of America (PAA), vol. 49(3), pages 1011-1036, August.
    11. Sterck Olivier, 2013. "Why are Testing Rates so Low in Sub-Saharan Africa? Misconceptions and Strategic Behaviors," Forum for Health Economics & Policy, De Gruyter, vol. 16(1), pages 1-39, September.
    12. Adeline Delavande, 2012. "HIV/AIDS-related Expectations and Risky Sexual Behavior in Malawi," 2012 Meeting Papers 90, Society for Economic Dynamics.
    13. Hans-Peter Kohler & Rebecca L. Thornton, 2012. "Conditional Cash Transfers and HIV/AIDS Prevention: Unconditionally Promising?," The World Bank Economic Review, World Bank, vol. 26(2), pages 165-190.
    14. Manuela Angelucci & Daniel Bennett, 2021. "Adverse Selection in the Marriage Market: HIV Testing and Marriage in Rural Malawi [Marrying Up: The Role of Sex Ratio in Assortative Matching]," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 88(5), pages 2119-2148.
    15. Ruben Castro & Jere Behrman & Hans-Peter Kohler, 2015. "Perception of HIV risk and the quantity and quality of children: the case of rural Malawi," Journal of Population Economics, Springer;European Society for Population Economics, vol. 28(1), pages 113-132, January.
    16. Chinhui Juhn & Sebnem Kalemli-Ozcan & Belgi Turan, 2013. "HIV and fertility in Africa: first evidence from population-based surveys," Journal of Population Economics, Springer;European Society for Population Economics, vol. 26(3), pages 835-853, July.
    17. Jérôme Adda, 2016. "Economic Activity and the Spread of Viral Diseases: Evidence from High Frequency Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(2), pages 891-941.
    18. Wilson, Nicholas, 2018. "Altruism in preventive health behavior: At-scale evidence from the HIV/AIDS pandemic," Economics & Human Biology, Elsevier, vol. 30(C), pages 119-129.
    19. David E. Bloom & Michael Kuhn & Klaus Prettner, 2022. "Modern Infectious Diseases: Macroeconomic Impacts and Policy Responses," Journal of Economic Literature, American Economic Association, vol. 60(1), pages 85-131, March.
    20. Adeline Delavande & Hans-Peter Kohler, 2009. "Subjective expectations in the context of HIV/AIDS in Malawi," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 20(31), pages 817-875.

    More about this item

    Keywords

    Malawi; HIV; beliefs;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:pen:papers:11-005. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Administrator (email available below). General contact details of provider: https://edirc.repec.org/data/deupaus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.