IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/13049.html
   My bibliography  Save this paper

HIV and Sexual Behavior Change: Why Not Africa?

Author

Listed:
  • Emily Oster

Abstract

The response of sexual behavior to HIV in Africa is an important input to predicting the path of the epidemic and to focusing prevention efforts. Existing estimates suggest limited behavioral response, but fail to take into account possible differences across individuals. A simple model of sexual behavior choice among forward-looking individuals implies that behavioral response should be larger for those with lower non-HIV mortality risks and those who are richer. I estimate behavioral response using a new instrumental variables strategy, instrumenting for HIV prevalence with distance to the origin of the virus. I find low response on average, consistent with existing literature, but larger responses for those who face lower non-HIV mortality and for those who are richer. I also show suggestive evidence, based on a very simple calibration, that the magnitude of behavioral response in Africa is of a similar order of magnitude to that among gay men in the United States, once differences in income and life expectancy are taken into account.

Suggested Citation

  • Emily Oster, 2007. "HIV and Sexual Behavior Change: Why Not Africa?," NBER Working Papers 13049, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:13049
    Note: EH LS
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w13049.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Victor R. Fuchs, 1982. "Economic Aspects of Health," NBER Books, National Bureau of Economic Research, Inc, number fuch82-1.
    2. Feng Gao & Elizabeth Bailes & David L. Robertson & Yalu Chen & Cynthia M. Rodenburg & Scott F. Michael & Larry B. Cummins & Larry O. Arthur & Martine Peeters & George M. Shaw & Paul M. Sharp & Beatric, 1999. "Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes," Nature, Nature, vol. 397(6718), pages 436-441, February.
    3. Oster Emily, 2010. "Estimating HIV Prevalence and Incidence in Africa from Mortality Data," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 10(1), pages 1-46, September.
    4. David Cutler & Angus Deaton & Adriana Lleras-Muney, 2006. "The Determinants of Mortality," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 97-120, Summer.
    5. Gary S. Becker & Tomas J. Philipson & Rodrigo R. Soares, 2005. "The Quantity and Quality of Life and the Evolution of World Inequality," American Economic Review, American Economic Association, vol. 95(1), pages 277-291, March.
    6. Pascaline Dupas, 2011. "Do Teenagers Respond to HIV Risk Information? Evidence from a Field Experiment in Kenya," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 1-34, January.
    7. Angus S. Deaton, 2009. "Instruments of development: Randomization in the tropics, and the search for the elusive keys to economic development," NBER Working Papers 14690, National Bureau of Economic Research, Inc.
    8. Thomas S. Dee & William N. Evans, 2003. "Teen Drinking and Educational Attainment: Evidence from Two-Sample Instrumental Variables Estimates," Journal of Labor Economics, University of Chicago Press, vol. 21(1), pages 178-209, January.
    9. Kevin M. Murphy & Robert H. Topel, 2006. "The Value of Health and Longevity," Journal of Political Economy, University of Chicago Press, vol. 114(5), pages 871-904, October.
    10. Joshua D. Angrist & Alan B. Krueger, 1990. "The Effect of Age at School Entry on Educational Attainment: An Application of Instrumental Variables with Moments from Two Samples," Working Papers 654, Princeton University, Department of Economics, Industrial Relations Section..
    11. Emily Oster, 2005. "Sexually Transmitted Infections, Sexual Behavior, and the HIV/AIDS Epidemic," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 120(2), pages 467-515.
    12. Dupas, Pascaline, 2005. "Relative Risks and the Market for Sex: Teenagers, Sugar Daddies and HIV in Kenya," MPRA Paper 248, University Library of Munich, Germany, revised Aug 2006.
    13. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    14. repec:pri:cheawb:deaton%20instruments%20of%20development%20keynes%20lecture%202009 is not listed on IDEAS
    15. Filmer, Deon & Pritchett, Lant, 1998. "Estimating wealth effects without expenditure data - or tears : with an application to educational enrollments in states of India," Policy Research Working Paper Series 1994, The World Bank.
    16. Fuchs, Victor R. (ed.), 1982. "Economic Aspects of Health," National Bureau of Economic Research Books, University of Chicago Press, number 9780226267852, August.
    17. Sebnem Kalemli-Ozcan, 2012. "AIDS, “reversal” of the demographic transition and economic development: evidence from Africa," Journal of Population Economics, Springer;European Society for Population Economics, vol. 25(3), pages 871-897, July.
    18. Winkelstein Jr., W. & Samuel, M. & Padian, N.S. & Wiley, J.A. & Lang, W. & Anderson, R.E. & Levy, J.A., 1987. "The San Francisco Men's Health Study: III. Reduction in human immunodeficiency virus transmission among homosexual/bisexual men, 1982-86," American Journal of Public Health, American Public Health Association, vol. 77(6), pages 685-689.
    19. repec:pri:cheawb:deaton%20instruments%20of%20development%20keynes%20lecture%202009.pdf is not listed on IDEAS
    20. McKusick, L. & Horstman, W. & Coates, T.J., 1985. "AIDS and sexual behavior reported by gay men in San Francisco," American Journal of Public Health, American Public Health Association, vol. 75(5), pages 493-496.
    21. 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.
    22. Francis, Andrew M., 2008. "The economics of sexuality: The effect of HIV/AIDS on homosexual behavior in the United States," Journal of Health Economics, Elsevier, vol. 27(3), pages 675-689, May.
    23. repec:pri:rpdevs:instruments_of_development.pdf is not listed on IDEAS
    24. Alan D. Lopez & Colin D. Mathers & Majid Ezzati & Dean T. Jamison & Christopher J. L. Murray, 2006. "Global Burden of Disease and Risk Factors," World Bank Publications - Books, The World Bank Group, number 7039.
    25. Tomas J. Philipson & William H. Dow & Xavier Sala-i-Martin, 1999. "Longevity Complementarities under Competing Risks," American Economic Review, American Economic Association, vol. 89(5), pages 1358-1371, December.
    26. Kenkel, Donald S, 1991. "Health Behavior, Health Knowledge, and Schooling," Journal of Political Economy, University of Chicago Press, vol. 99(2), pages 287-305, April.
    27. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    28. Jane Fortson, 2008. "The gradient in sub-saharan Africa: Socioeconomic status and HIV/AIDS," Demography, Springer;Population Association of America (PAA), vol. 45(2), pages 303-322, May.
    29. Pascaline Dupas, 2006. "Relative risks and the market for sex: Teenagers, sugar daddies, and hiv in kenya," Natural Field Experiments 00235, The Field Experiments Website.
    30. Jeffrey Sachs & Pia Malaney, 2002. "The economic and social burden of malaria," Nature, Nature, vol. 415(6872), pages 680-685, February.
    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. Dora L. Costa, 2015. "Health and the Economy in the United States from 1750 to the Present," Journal of Economic Literature, American Economic Association, vol. 53(3), pages 503-570, September.
    2. de Walque, Damien, 2007. "How does the impact of an HIV/AIDS information campaign vary with educational attainment? Evidence from rural Uganda," Journal of Development Economics, Elsevier, vol. 84(2), pages 686-714, November.
    3. David Cutler & Angus Deaton & Adriana Lleras-Muney, 2006. "The Determinants of Mortality," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 97-120, Summer.
    4. Ryan Edwards, 2013. "The cost of uncertain life span," Journal of Population Economics, Springer;European Society for Population Economics, vol. 26(4), pages 1485-1522, October.
    5. Chakraborty, Shankha & Papageorgiou, Chris & Pérez Sebastián, Fidel, 2010. "Diseases, infection dynamics, and development," Journal of Monetary Economics, Elsevier, vol. 57(7), pages 859-872, October.
    6. Roman Hoffmann & Sebastian Uljas Lutz, 2019. "The health knowledge mechanism: evidence on the link between education and health lifestyle in the Philippines," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 27-43, February.
    7. Peter A. Savelyev, 2014. "Psychological Skills, Education, and Longevity of High-Ability Individuals," Vanderbilt University Department of Economics Working Papers 14-00007, Vanderbilt University Department of Economics.
    8. Petter Lundborg & Carl Hampus Lyttkens & Paul Nystedt, 2016. "The Effect of Schooling on Mortality: New Evidence From 50,000 Swedish Twins," Demography, Springer;Population Association of America (PAA), vol. 53(4), pages 1135-1168, August.
    9. Yao Yao, 2022. "Fertility and HIV Risk in Africa," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 45, pages 109-133, July.
    10. Tansel, Aysit & Keskin, Halil Ibrahim, 2017. "Education Effects on Days Hospitalized and Days out of Work by Gender: Evidence from Turkey," IZA Discussion Papers 11210, Institute of Labor Economics (IZA).
    11. Ji, Sisi & Zhu, Zheyi, 2022. "Does higher education matter for health?," Cardiff Economics Working Papers E2022/4, Cardiff University, Cardiff Business School, Economics Section.
    12. Tamara Fioroni, 2010. "Optimal savings and health spending over the life cycle," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 355-365, August.
    13. Borowiecki, Karol Jan & Kavetsos, Georgios, 2015. "In fatal pursuit of immortal fame: Peer competition and early mortality of music composers," Social Science & Medicine, Elsevier, vol. 134(C), pages 30-42.
    14. Nava Ashraf & James Berry & Jesse M. Shapiro, 2010. "Can Higher Prices Stimulate Product Use? Evidence from a Field Experiment in Zambia," American Economic Review, American Economic Association, vol. 100(5), pages 2383-2413, December.
    15. Massimiliano Bratti & Alfonso Miranda, 2010. "Non‐pecuniary returns to higher education: the effect on smoking intensity in the UK," Health Economics, John Wiley & Sons, Ltd., vol. 19(8), pages 906-920, August.
    16. 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.
    17. de Walque, Damien, 2007. "Does education affect smoking behaviors?: Evidence using the Vietnam draft as an instrument for college education," Journal of Health Economics, Elsevier, vol. 26(5), pages 877-895, September.
    18. Fletcher, Jason M. & Frisvold, David E., 2011. "College selectivity and young adult health behaviors," Economics of Education Review, Elsevier, vol. 30(5), pages 826-837, October.
    19. Jürges Hendrik & Meyer Sophie-Charlotte, 2020. "Educational Differences in Smoking: Selection Versus Causation," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), De Gruyter, vol. 240(4), pages 467-492, August.
    20. Aizawa, Toshiaki & Helble, Matthias, 2015. "Health and Home Ownership: Findings for the Case of Japan," ADBI Working Papers 525, Asian Development Bank Institute.

    More about this item

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • J17 - Labor and Demographic Economics - - Demographic Economics - - - Value of Life; Foregone Income
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

    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:nbr:nberwo:13049. 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: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.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.