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APHA Scientific Session and Event Listing

Rebecca L. Thornton, Economics, Harvard University, NBER, 1050 Massachusetts Ave, Cambridge, MA 02138, 617-588-0349, rlthornt@fas.harvard.edu

Abstract: Background: It is commonly believed that HIV testing is essential for prevention. Indeed, spending on counseling and testing accounts for over half of the total expenditures on HIV prevention in some African countries. Despite this, there is evidence that most people do not take advantage of testing services, and there is little evidence on the behavioral response to knowing one's status.

Methods: I designed and implemented an experiment to evaluate the demand for learning HIV results and subsequent sexual behavior. In the experiment, over 2,700 individuals in rural Malawi were randomly assigned monetary incentives between zero and three dollars to learn their HIV results after testing. Portable results centers were randomly placed within respondents' communities. Two months after results were available respondents were re-interviewed and given the opportunity to purchase condoms.

Analysis and Results: While less than half of the participants learned their HIV status without any incentive, even a very small incentive (about one-tenth of a day's wage) increased the share by 50%. Distance to results centers reduced learning results. Using the exogenously assigned incentives and distance from results centers as instruments for HIV knowledge, I find that HIV positives with a sexual partner who learn their status are significantly more likely to purchase condoms; however they purchase few.

Conclusions: The barriers to learning HIV status can be easily overcome. Also, based on short-term findings from condom purchases, subsidized population-based testing is not as effective for HIV prevention as other strategies.

Learning Objectives:

• This paper is based on a rigorous experiment conducted in the field. Participants in this seminar will understand how to design such an experiment in order to causally evaluate the effects of learning HIV status, a subject that is normally flawed by endogeneity.

Presenting author's disclosure statement:

Not Answered