What is it about?

Risk compensation is a phenomenon in which people modify their behavior based on their perception of risk, sometimes leading to unintended negative outcomes. This is particularly relevant in public health contexts, where understanding these behavioral shifts is crucial for creating effective health policies. In this study, I delve into the impact of HIV therapy on the sexual behavior of HIV-positive patients in South Africa. Specifically, I look into how access to improved therapy might influence the number of sexual partners' likelihood of using condoms during intercourse. My findings are startling. From data collected between 2007 and 2010, I observe that those on HIV therapy tend to have nearly one more sexual partner than the average at the beginning of the study. Furthermore, these individuals are 33% less likely to use a condom during their encounters. Despite the increased viral suppression due to the therapy (as noted by Cohen et al., 2011), this elevated risky behavior doesn't seem to exacerbate the spread of the HIV epidemic. While HIV therapy offers significant health benefits, it appears to be linked with riskier sexual behavior among HIV-positive individuals in South Africa. Policymakers must be aware of these behavioral responses when designing public health interventions.

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Why is it important?

HIV/AIDS remains a major health crisis in Sub-Saharan Africa, particularly in South Africa, which has one of the highest prevalence rates globally. As governments pour billions into treatment and prevention efforts, it's imperative for social scientists to understand the broader behavioral implications of such interventions on human well-being. South Africa, despite its robust HIV therapy programs and extensive preventative measures, still grapples with alarming HIV/AIDS statistics. Nearly one in five adults aged 15-49 has the disease, and over 7.2 million people live with HIV. Such numbers are staggering, especially considering the nation's commitment to treating nearly 80% of HIV-positive adults and achieving a mother-to-child transmission prevention rate exceeding 95%. Given this backdrop, South Africa becomes a crucial focal point for studying risk compensation behaviors related to HIV therapy. Investigating the behavioral responses to HIV therapy in a country with both a high disease burden and comprehensive treatment programs offers invaluable insights. These findings deepen our understanding of human behavior in the face of life-threatening diseases and inform future health interventions and policies. In essence, studying the behavioral ramifications of HIV therapy in South Africa isn't just about numbers or statistics; it's about enhancing human well-being, guiding efficient resource allocation, and ensuring that interventions are holistically effective. For the social sciences, such endeavors are vital in shaping a healthier, more informed future for millions.

Perspectives

This paper contributes to the applied microeconomic literature by providing empirical evidence on behavioral responses in the context of a significant drug policy intervention in Sub-Saharan Africa. It advances this literature in several ways. First, previous compensatory behavioral response studies primarily address car safety regulations in the US and find evidence consistent with riskier behavior in response to safety improvements. Second, in the context of compensatory behavioral responses to HIV therapy among HIV-positive individuals, the best causal empirical evidence comes from the US and uses a unique study population (Lakdawalla, Sood, & Goldman, 2006).10 Lakdawalla et al. (2006) examine the effect of HIV therapy breakthroughs on the sexual activity of Medicaid-eligible patients in the US. The study finds that access to HIV therapy increases a compensatory effect with more sexual activity. Third, in the context of HIV in Africa, recent economic studies focus on HIV-related issues, but none examine the impact of treatment provision on HIV-positive individuals. Previous studies in developing countries generally examine behavioral responses to information or preventive measures rather than treatment (Godlonton, Munthali, & Thornton, 2016).11 Finally, a significant contribution of this paper is its robust causal estimation, facilitated by the study’s experimental design. To date, no experimental evidence investigates the effects of behavioral responses to HIV drug therapy on sexual behavior in a developing country; this study fills that gap.12 Since I use a field experiment, I can identify the causal effects of therapy on the two behavioral outcomes.

Dr. Plamen Nikolov
Harvard Institute for Quantitative Social Science

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This page is a summary of: Risk Compensation and HIV Therapy: A Field Experiment in South Africa, The Journal of Development Studies, August 2022, Taylor & Francis,
DOI: 10.1080/00220388.2022.2075732.
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