The demand for, and impact of, learning HIV status
Monetary incentive change willingness to learn HIV. â Actual cost ... Data collection process. ⢠The data .... nion/links/00b4953344a9a0cb13000000.pdf? origin= ...
The demand for, and impact of, learning HIV status!
By Rebecca Thornton (2008)! Dalia Elsabbagh and Aimee Hare!
Outline ! • Importance of topic! • The research question! • The main contribution! • The data collection method! • Study design! • Results: Part 1 ! • Results: Part 2! • Conclusions! • Comments and critiques!
Why is this topic important?! • Over the last 2 decades, the HIV/AIDS epidemic has influenced millions of individuals.! • Large negative effects à both personal and societal level! • Big expenditures à testing, treatment and prevention!
Basic assumptions! • Two assumptions:! 1) Many believe it is difficult to get people to learn their HIV status, due to psychological or social barriers. ! 2) Many believe that the knowledge of HIV will have a positive effect on sexual behaviour that prevents the spread of disease. !
What is the research question?! • Main idea: ! • “The demand for, and impact of, learning HIV status.” ! !
!
(1) Do monetary incentives change behaviour with regard to learning your HIV status? !
(2) How does knowing your HIV status change your decisions to purchase condoms at a later stage? !
Theoretical considerations! • Monetary incentive change willingness to learn HIV! – Actual cost of the test and transport! – Societal costs and stigma !
• Knowing HIV status can change behaviour ! – Can seek treatment if positive! – More realistic and effective planning for the future! – Change sexual behaviour: ! • Condom use would be empirical question!
Identified problems in the literature! • Self-reporting ! – if they want to know their HIV status (Day et. al, 2003; de Graaf Johnson et. al, 2005; Laver, 2001; Yoder et.al 2004)! – Asking about reported sexual behaviour (Kamenga et. al 1994;
!
!
Weinhardt et. al 1999)!
Identified problems in the literature! • Self-reporting ! – if they want to know their HIV status (Day et. al, 2003; de Graaf Johnson et. al, 2005; Laver, 2001; Yoder et.al 2004)! – Asking about reported sexual behaviour (Kamenga et. al 1994; Weinhardt et. al 1999)!
!
• Self-selection !
Identified problems in the literature! • Self-reporting ! – if they want to know their HIV status (Day et. al, 2003; de Graaf Johnson et. al, 2005; Laver, 2001; Yoder et.al 2004)! – Asking about reported sexual behaviour (Kamenga et. al 1994; Weinhardt et. al 1999)!
!
• Self-selection ! ! Solution: Use an RCT à randomization and instrumentation ! !
How do they set up the RCT?! From $0!
Test!
To $3!
Collect results! Temporary test center ! (randomly placed) !
Random draw!
How do they set up the RCT?! (1) Demand for! From $0!
Test!
To $3!
Collect results! Temporary test center ! (randomly placed) !
Random draw!
How do they set up the RCT?! (1) Demand for! From $0!
Test!
To $3!
Collect results! Temporary test center ! (randomly placed) !
Random draw!
How do they set up the RCT?! (1) Demand for!
(2) Impact of!
From $0!
Test!
To $3!
Collect results! Temporary test center ! (randomly placed) !
Random draw!
Who are they looking at? ! Rumphi!
Mchinji! Balaka!
• 120 villages in 3 districts in Malawi! • 25% of each village was tested!
Data collection process! • The data collection was a part of The Malawi Diffusion and Ideational Change Project (MDICP) ! • Interviews were conducted in 1998; among them the ever-married women and their husbands were re-interviewed in 1998, 2001 and 2004.! • In 2004: a sample of young adults were added in each region!
Characteristics of the sample! • Final sample:! o 2,812 individual in rural Malawi who accepted an HIV test and provided basic demographic data in the 2004 survey, and whose HIV results was not indeterminate !
• Attrition rates:! o due to migration (21%) ! o non acceptance of being re-interviewed (1%)!
• Test refusal: 9% only ! • Biasness control !
Baseline characteristics !
Estimation Part 1: RCT!
GotResults: Attendance to the VCT center! Any: received incentives > 0 ! Amt: dollar amount of the incentive! Dist: number of kilometers from the random set VCT centers!
What are the results?!
What are the results?
Results Part 1!
Results Part 1!
(Only part of Table 4)!
Part 2 of the Results! (1) Demand for!
(2) Impact of!
From $0!
Test!
To $3!
Collect results! Temporary test center ! (randomly placed) !
Random draw!
Part 2 of the Results! (1) Demand for!
(2) Impact of!
From $0!
Test!
To $3!
Collect results! Temporary test center ! (randomly placed) !
Random draw!
Part 2 of the Results!
Part 2 of the Results!
Part 2 of the Results! Estimation strategy:!
Part 2 of the Results! Estimation strategy:!
First stage: !
Part 2 of the Results!
(Only part of Table 6)!
Part 2 of the Results!
(Only part of Table 6)!
Part 2 of the Results!
(Only part of Table 7)!
Part 2 of the Results!
(Only part of Table 7)!
Part 2 of the Results!
(Only part of Table 7)!
Part 2 of the Results!
(Only part of Table 7)!
Part 2 of the Results!
(Only part of Table 7)!
Conclusions! • Incentives:! - High positive impact on results seeking ! - Cover real and psychological costs of testing, and provide a public excuse for attending the centers!
• Distance:! - High negative impact on results seeking !
• HIV status:! - HIV-positives: higher condoms purchase in case of sexual partners for those who knew their statues! - HIV-negatives: little impact on condoms demand!
Conclusions! • The strategy might give positive impact of reducing infection among those HIV-positives who has partners ! • However for this study the effect of learning HIV statues is relatively small! • Money incentives proved being more effective approach for treatment seeking or testing than other methods (i.e. campaigns)!
Comments and critiques (1)! • Interpretation of results! – Significance/not significant ! – First stage of ‘Got results x HIV’ à weak instruments!
• Design ! – STI and HIV incentives in different villages ! – Induced condom buying à linked to Hawthorne effects!
Comments and critiques (2)! • The method – Angus Deaton paper à critiques the “gold standard” ! – Internal validity !
• External validity à specific to Malawi!
References ! • Thornton (2008) ‘The demand for, and the impact of, learning HIV status’ American Economic Review. Vol: 98:5, 1829–1863 ! • Mostly harmless Econometrics: https://www.researchgate.net/profile/Joshua_Angrist/publication/ 51992844_Mostly_harmless_econometrics_An_empiricist's_compa nion/links/00b4953344a9a0cb13000000.pdf? origin=publication_detail ! • Deaton (2016) ‘Understanding and Misunderstanding Randomized Controlled Trials http://scholar.princeton.edu/deaton/publications/understandingand-misunderstanding-randomized-controlled-trials !
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