Rebecca Thornton University of Michigan and J-PAL

 Medical trials ◦ Treatment of STIs (Rakai, Mwanza, Masaka, Manicaland) ◦ Vaccines ◦ Microbicides  Behavioral trials ◦ Education  Individual training (Awareness and strategies); (Duflo et al. 2007)  Teacher training (Duflo et al. 2007)  Risk knowledge (Dupas 2007)  Staying in school (incentives); (Ozler et al.)  Costs of school (Uniforms); (Duflo et al. 2007) ◦ Knowledge of HIV status ◦ Financial incentives

 Thornton, Rebecca The Demand for and Impact of Learning HIV Results. Evidence from a Field Experiment, 2008  Once people learn their HIV status, they will engage in safer sexual behavior  What is the impact of learning HIV results?  Limitations with existing studies ◦ Self-reported behavior ◦ Selection  Who chooses to test or learn results  Where testing centers are located  Field experiment in rural Malawi

 MDICP (1998, 2001, 2004) ◦ 125 rural villages in three locations ◦ Randomly selected HH; Men, women and adolescents  2004: Offered free HIV and STI tests 91% accepted (2,894)  Randomly assigned voucher to learn HIV results ◦ Between $0-$3.00 (average=$1.04) ◦ 20% received no incentive ◦ Smallest amount: $0.10  Results centers ◦ Randomly placed based on HH GPS and clustered by village ◦ Average distance = 2 km

 Follow-up survey (2 districts) ◦ Reported purchases of condoms (8%) ◦ Sexual activity since VCT (62%) ◦ Actual purchases of condoms  Gave $0.30; sold condoms at half (subsidized) retail price  24% purchased condoms; 3.7 condoms on average  Note ◦ No differential attrition (incentives or distance) ◦ Balanced on observables ◦ Distinguish between sexually active and not

HIV Negatives who had sex at Baseline

HIV Positives who had sex at Baseline

After 2 years (2006) – re-survey respondents No differential attrition Preliminary results (Kohler and Thornton)

 Barriers to learning HIV results can be easily overcome  After 2 months: little change in demand for condoms ◦ Large increase in the likelihood of purchasing condoms (HIV+ with a partner) ◦ However, number of condoms purchased small  After 2 years: no difference in HIV status; little change in reported sexual behavior

 What are an individual’s incentives to change behavior?  Standard economic theory ◦ Benefits vs. costs of an act of unsafe sex  Behavioral economics ◦ Hyperbolic discounting ◦ Difficulty delaying gratification (abstaining, using a condom) ◦ Salience of HIV infection at the time of sexual act  Can conditional financial incentives affect sexual behavior?

 MDICP subsample in rural Malawi (Kohler and Thornton)  Survey and HIV testing: June – August 2006 ◦ 28% tested as a couple; 72% as an individual ◦ Oversample discordant couples: 9.1 HIV positive  Incentives to “maintain” HIV status: August 2006 ◦ Couples: If no longer with spouse or refuse a couple test, automatically enrolled into individual program  Collect sexual diaries throughout the year  Test for HIV and give out financial incentives CoupleIndividual None00 Medium High

 Difference between those who were offered incentives and those who were not

 Preliminary results  Possible considerations: ◦ Not measuring sexual behavior in the right way ◦ Not the right population ◦ Not enough money ◦ Incentive too far out in the future  Another incentives project (Dewalque et al.) ◦ STIs ◦ Quarterly incentives

 What worked: ◦ Reducing the costs to education ◦ Small short-run incentives to learn HIV results  What didn’t work: ◦ Learning about HIV status ◦ Moderate incentives for maintaining HIV status  Increase incentive?  Decrease time to earn incentive?  What other prevention strategies could have important large effects?  HIV is tricky to study ◦ Lots of endogeneity ◦ Measurement of variables