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Antiretroviral Therapy and Demand for HIV Testing: Evidence from Zambia

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Abstract

This paper examines the effects of antiretroviral therapy (ART) on demand for HIV testing and of ART-induced testing on demand for risky sexual behavior. I provide a model of sexual behavior decision-making under uncertainty and estimate the structural parameters of the model using nationally representative survey data from Zambia on HIV testing decisions before and after the introduction of ART. The empirical results indicate that although the introduction of ART increased demand for HIV testing, the ART allocation process limited the prevention benefit of ART-induced testing. Simulation results show that eliminating this prevention inefficiency while holding the supply of ART constant would increase the prevention impact of ART-induced testing more than four-fold. More generally, the analysis indicates that existing studies which examine "universal" testing or quasi-experimental testing programs understate the efficacy of standard voluntary counseling and testing programs.

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  • Nicholas Wilson, 2010. "Antiretroviral Therapy and Demand for HIV Testing: Evidence from Zambia," Department of Economics Working Papers 2010-23, Department of Economics, Williams College.
    • Handle: RePEc:wil:wileco:2010-23
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    1. Harsha Thirumurthy & Joshua Graff Zivin, 2012. "Health and Labor Supply in the Context of HIV/AIDS: The Long-Run Economic Impacts of Antiretroviral Therapy," Economic Development and Cultural Change, University of Chicago Press, vol. 61(1), pages 73-96.
    2. 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.
    3. Baranov, Victoria & Bennett, Daniel & Kohler, Hans-Peter, 2015. "The indirect impact of antiretroviral therapy: Mortality risk, mental health, and HIV-negative labor supply," Journal of Health Economics, Elsevier, vol. 44(C), pages 195-211.
    4. 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.
    5. Emily Oster, 2012. "Routes Of Infection: Exports And Hiv Incidence In Sub-Saharan Africa," Journal of the European Economic Association, European Economic Association, vol. 10(5), pages 1025-1058, October.
    6. Amy Kaler & Susan Watkins, 2010. "Asking God about the date you will die: HIV testing as a zone of uncertainty in rural Malawi," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 23(32), pages 905-932.
    7. Harsha Thirumurthy & Joshua Graff Zivin & Markus Goldstein, 2008. "The Economic Impact of AIDS Treatment: Labor Supply in Western Kenya," Journal of Human Resources, University of Wisconsin Press, vol. 43(3), pages 511-552.
    8. Oster, Emily, 2012. "HIV and sexual behavior change: Why not Africa?," Journal of Health Economics, Elsevier, vol. 31(1), pages 35-49.
    9. Jeremy Magruder, 2011. "Marital Shopping and Epidemic AIDS," Demography, Springer;Population Association of America (PAA), vol. 48(4), pages 1401-1428, November.
    10. Darius Lakdawalla & Neeraj Sood & Dana Goldman, 2006. "HIV Breakthroughs and Risky Sexual Behavior," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 121(3), pages 1063-1102.
    11. 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.
    12. Kathleen Beegle & Michelle Poulin & Gil Shapira, 2015. "HIV Testing, Behavior Change, and the Transition to Adulthood in Malawi," Economic Development and Cultural Change, University of Chicago Press, vol. 63(4), pages 665-684.
    13. Lichtenberg, Frank R., 2003. "The effect of new drug approvals on HIV mortality in the US, 1987-1998," Economics & Human Biology, Elsevier, vol. 1(2), pages 259-266, June.
    14. 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.
    15. Jonathan Robinson & Ethan Yeh, 2011. "Transactional Sex as a Response to Risk in Western Kenya," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 35-64, January.
    16. McGough, L.J. & Reynolds, S.J. & Quinn, T.C. & Zenilman, J.M., 2005. "Which patients first? Setting priorities for antiretroviral therapy where resources are limited," American Journal of Public Health, American Public Health Association, vol. 95(7), pages 1173-1180.
    17. Paul Gertler & Manisha Shah & Stefano M. Bertozzi, 2005. "Risky Business: The Market for Unprotected Commercial Sex," Journal of Political Economy, University of Chicago Press, vol. 113(3), pages 518-550, June.
    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. Laura N. Beny & Lisa D. Cook, 2009. "Metals or Management? Explaining Africa's Recent Economic Growth Performance," American Economic Review, American Economic Association, vol. 99(2), pages 268-274, May.
    20. 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.
    21. Zivin, Joshua Graff & Thirumurthy, Harsha & Goldstein, Markus, 2009. "AIDS treatment and intrahousehold resource allocation: Children's nutrition and schooling in Kenya," Journal of Public Economics, Elsevier, vol. 93(7-8), pages 1008-1015, August.
    22. Pindyck, Robert S, 1978. "Gains to Producers from the Cartelization of Exhaustible Resources," The Review of Economics and Statistics, MIT Press, vol. 60(2), pages 238-251, May.
    23. Lucia Corno & Áureo de Paula, 2019. "Risky Sexual Behaviours: Biological Markers and Self‐reported Data," Economica, London School of Economics and Political Science, vol. 86(342), pages 229-261, April.
    24. Alwyn Young, 2005. "The Gift of the Dying: The Tragedy of AIDS and the Welfare of Future African Generations," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 120(2), pages 423-466.
    25. 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.
    26. Lena Edlund & Evelyn Korn, 2002. "A Theory of Prostitution," Journal of Political Economy, University of Chicago Press, vol. 110(1), pages 181-214, February.
    27. 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.
    28. Erick Gong, 2015. "HIV Testing and Risky Sexual Behaviour," Economic Journal, Royal Economic Society, vol. 125(582), pages 32-60, February.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Economic booms and risky sexual behavior (Ref. Zambia)
      by UDADISI in UDADISI on 2012-10-12 02:58:00
    2. Economic Growth and the HIV/AIDS Pandemic
      by Ariel Goldring in Free Market Mojo on 2010-11-21 21:00:01

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    Cited by:

    1. Kotsadam, Andreas & Tolonen, Anja, 2016. "African Mining, Gender, and Local Employment," World Development, Elsevier, vol. 83(C), pages 325-339.
    2. Rebecca Mary Myerson & Darius Lakdawalla & Lisandro D. Colantonio & Monika Safford & David Meltzer, 2018. "Effects of Expanding Health Screening on Treatment - What Should We Expect? What Can We Learn?," NBER Working Papers 24347, National Bureau of Economic Research, Inc.
    3. Tirivayi, Nyasha & Groot, Wim, 2018. "Does integrating AIDS treatment with food assistance affect labor supply? Evidence from Zambia," Economics & Human Biology, Elsevier, vol. 28(C), pages 79-91.
    4. Aureo de Paula & Gil Shapira & Petra E. Todd, 2008. "How Beliefs about HIV Status Affect Risky Behaviors: Evidence from Malawi, Fifth Version," PIER Working Paper Archive 10-023, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania, revised 10 Jul 2010.
    5. Patrick Aylward & Hildah Essendi & Kristen Little & Nicholas Wilson, 2020. "Demand for self‐tests: Evidence from a Becker–DeGroot–Marschak mechanism field experiment," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 489-507, April.
    6. 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.
    7. Okeke, Edward N. & Adepiti, Clement A. & Ajenifuja, Kayode O., 2013. "What is the price of prevention? New evidence from a field experiment," Journal of Health Economics, Elsevier, vol. 32(1), pages 207-218.
    8. Rebecca M. Myerson & Reginald D. Tucker‐Seeley & Dana P. Goldman & Darius N. Lakdawalla, 2020. "Does Medicare Coverage Improve Cancer Detection and Mortality Outcomes?," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 39(3), pages 577-604, June.
    9. Eric N Ouattara & Rachel L MacLean & Christine Danel & Ethan D Borre & Delphine Gabillard & Mingshu Huang & Raoul Moh & A David Paltiel & Serge P Eholié & Rochelle P Walensky & Xavier Anglaret & Kenne, 2019. "Cost-effectiveness and budget impact of immediate antiretroviral therapy initiation for treatment of HIV infection in Côte d’Ivoire: A model-based analysis," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-16, June.
    10. Friedman, Willa Helterline, 2018. "Antiretroviral drug access and behavior change," Journal of Development Economics, Elsevier, vol. 135(C), pages 392-411.
    11. Rebecca Myerson & Darius Lakdawalla & Lisandro D. Colantonio & Monika Safford & David Meltzer, 2018. "Effects of expanding health screening on treatment – What should we expect? What can we learn?," Working Papers 2018-014, Human Capital and Economic Opportunity Working Group.
    12. 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.
    13. Wilson, Nicholas, 2015. "Child mortality risk and fertility: Evidence from prevention of mother-to-child transmission of HIV," Journal of Development Economics, Elsevier, vol. 116(C), pages 74-88.

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    More about this item

    Keywords

    HIV/AIDS; Beliefs; Selection; Rationing; Zambia;
    All these keywords.

    JEL classification:

    • D45 - Microeconomics - - Market Structure, Pricing, and Design - - - Rationing; Licensing
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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