New study on the links between AIDS and behavior in Africa
Lauren Necochea from the Princeton AIDS Initiative reports on a study by Emily Oster, an economist at the University of Chicago, profiled this week in the New York Times. Oster looks at why there have been minimal changes in sexual behavior in response to HIV risk in Africa. She offers two economic explanations for this. Necochea summarizes the argument:
Oster hopes to show that people are responding to income and life expectancy in the classic utility-maximizing manner and, therefore, economics has something to add to the existing explanations that usually focus on cultural factors like fatalism and low-female bargaining power. This economic argument would explain why in places with higher incomes and higher life expectancy, there has been a greater behavioral response to HIV risk.
In her model, if life expectancy is low (even in the absence of HIV), people have less (if anything) to gain from avoiding risky behavior and are therefore less likely to alter their behavior when confronted by a high HIV risk. She also argues that people with higher income have “more income to lose” from dying prematurely and that is why richer people are more likely to change their sexual behavior.
So, if this model is right, why is that the educated and wealthy classes in Africa are some of the hardest hit by the disease? Shouldn’t the teachers and government bureaucrats who are dying from the disease alter their behavior to reduce their exposure to the disease and thus ensure that their life-long stream of earnings are maximized? Maybe they do more than poor people, but I always thought it was the rich men who had the capability to buy sex. Maybe this should be a gender-specific finding, that poor women don’t alter their behavior either because they can’t or aren’t sufficiently forward-looking while richer, educated guys can resist the temptation to sleep around. Ok, I haven’t read the paper, but something strikes me as fishy here.
The Times piece talks as if the main findings of her paper are that richer people have changed their sexual practices more than poor people. I’m reading her paper to try to find how big a shift it is, but the punchline is sort of buried. If she’s right, then shouldn’t the prevalence of HIV among richer people be less than poor people? If that’s the case, I haven’t find data on this in her paper anywhere.
Filed under: Politics and Policy
Interesting argument. I’m curious how the behavioral response is measured. In studies of voluntary counseling and testing (VCT), the initial effect is strong across high-risk populations in low-income countries but the protection is short-lived as counseled clients revert to old behaviors in months following exposure to VCT. In several studies, couples reported sustaining the behavior change for longer periods than single clients.
As for class distribution of HIV… HIV prevalence in the 2005 Uganda Seroprevalence Survey increases by wealth quintile (.pdf, page 103). In the same study, urban mobile populations have higher prevalence than their lower-income rural counterparts.
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