Fertility and HIV risk in Africa

This paper examines the role of social and cultural norms regarding fertility in women’s HIV risk in Sub-Saharan Africa. Fertility, or the ability to bear children, is highly valued in most African societies, and premarital fertility is often encouraged in order to facilitate marriage. This, however, increases women’s exposure to HIV risk by increasing unprotected premarital sexual activity. I construct a lifecycle model that relates a woman’s decisions concerning sex, fertility and education to HIV risk. The model is calibrated to match Kenyan women’s data on fertility, marriage and HIV prevalence. Quantitative results show that fertility motives play a substantial role in women’s, especially young women’s, HIV risk. If premarital births did not facilitate marriage, the HIV prevalence rate of young women in Kenya would be one-third lower. Policies that subsidize income, education, and HIV treatment are evaluated. I find that education subsidy would reduce young women’s HIV risk most effectively by raising the opportunity cost of premarital childrearing.