Research

The heterogeneous effects of HIV testing

with Sarah Baird, Craig McIntosh, and Berk Ozler, Journal of Health Economics, Sept 2014, Vol (37): 98-112.

An extensive multi-disciplinary literature examines the effects of learning one’s HIV status on subse-quent risky sexual behaviors. However, many of these studies rely on non-experimental designs; useself-reported outcome measures; or both. In this study, we investigate the effects of a randomly assignedhome based HIV testing and counseling (HTC) intervention on risky sexual behaviors and schooling invest-ments among school-age females in Malawi. We find no overall effects on HIV, Herpes Simplex Virus(HSV-2), or achievement test scores at follow-up. However, among the small group of individuals whotested positive for HIV, we find a large increase in the probability of HSV-2 infection, with this effectbeing stronger among those surprised by their test results. Similarly, those surprised by HIV-negativetest results have significantly higher achievement test scores at follow-up, consistent with increasedreturns to investments in human capital.

HIV TESTING AND RISKY SEXUAL BEHAVIOUR

The Economic Journal, Feb 2015, Vol (125): 32-60.

Awarded the 2015 Austin Robinson Memorial Prize. Vox Video Summary

Using a study that randomly assigns HIV testing in two sites in sub-Saharan Africa, I examine the effects of testing on sexual behaviour. Using sexually transmitted infections as markers of risky sex, I find behavioural responses to HIV tests when tests provide unexpected information. Individuals surprised by an HIV-positive (HIV-negative) test increase (decrease) their risky sexual behaviour. I simulate the effects of testing and find under certain conditions, new HIV infections increase when people are tested. The provision of anti-retrovirals for HIV-positive individuals immediately after testing mitigates these effects and leads to decreases in HIV infections in all cases.

Income Shocks and HIV in sub-Saharan Africa

with Marshall Burke and Kelly Jones, The Economic Journal, June 2015 Vol (125): 1157-1189.

We examine how variation in local economic conditions has shaped the AIDS epidemic in Africa.

Using data from over 200,000 individuals across 19 countries, we match biomarker data on

individuals’ serostatus to information on local rainfall shocks, a large source of income variation for

rural households. We estimate infection rates in HIV-endemic rural areas increase by 11% for every

recent drought, an effect that is statistically and economically significant. Income shocks explain up

to 20% of variation in HIV prevalence across African countries, suggesting existing approaches to

HIV prevention could be bolstered by helping households manage income risk better.

Motivating Agents: How Much Does the Mission Matter?

with Jeff Carpenter, Journal of Labor Economics, January 2016, Vol. 34, No. 1.

Economic theory predicts that agents work harder if they believe in the mission of the organization.We conduct a real-effort experiment with workers whose mission preferences are known, randomly assigning them to organizations with clear missions to create both matches and mismatches. Our estimates suggest that matching is a strong motivator, especially compared to mismatches. Further, we find that performance pay increases effort, though mostly among mismatched workers who substitute pay for matching. Our results suggest the importance of defining a clear mission to an organization and highlight the significance of sorting, screening, and compensation policies.

Conflict and Coffee: Are Higher Coffee Prices Fueling Rebellion in Uganda?

with Katherine Sullivan, Journal of African Economies, July 2017, Vol. 26, Issue 3.

The relationship between income and conflict has been a topic of great interest in the political economy literature. A growing body of research has utilised within-country variation in conflict to address the concerns raised about the cross-country level studies on income and conflict. This study adds to this literature by examining the relationship between coffee prices and conflict across fifty-six districts within Uganda over the 2002–2014 time period. Using a difference-in-difference framework, we find that increases in global coffee prices lead to a higher likelihood of conflict in coffee growing districts. Higher coffee prices may relax credit constraints faced by rebel groups allowing them to finance armed conflicts. In addition, we find that higher coffee prices also lead to greater intensity in conflict as measured by both the number of conflicts and fatalities.

Coping with Risk: Negative Shocks, Transactional Sex, and the Limitations of Conditional Cash Transfers”

with Damien de Walque and William H. Dow, Journal of Health Economics, Sept 2019, Vol. 67. (Working paper)

Transactional sex is an important risk-coping mechanism and a leading contributor to the HIV/AIDS epidemic in sub-Saharan Africa. We use data from a conditional cash transfer (CCT) experiment in rural Tanzania designed to incentivize safer sexual behavior by conditioning transfers on testing negative for sexually transmitted infections (STIs). For women, we find that negative shocks measured by food insecurity lead to a 36% increase in STIs and increases in self-reported risky sexual behavior. We find no significant effects of negative shocks on either STIs or self-reported sexual behavior for men. This CCT design did not appear to mitigate the behavioral response to shocks that we document in women. We propose that this finding can be explained by binding credit constraints and the relatively infrequent timing of the CCTs. When women experience a negative shock, cash needs are immediate, while transfers linked to a CCT are paid out in a specific point in time. If women are unable to access credit during a shock, they may resort to transactional sex even if they face monetary incentives to do otherwise.

The Effect of Promoting Savings on Informal Risk-Sharing: Experimental Evidence from Vulnerable Women in Kenya

Felipe Dizon, Erick Gong, and Kelly Jones, Journal of Human Resources, July 2020, Vol. 55. (Working paper) Web Appendix; Replication Package

An increase in savings can lead to substitution away from informal risk-sharing arrangements (IRSAs), which can reduce the capacity to manage risk. We conduct a field experiment that promoted mobile bank savings among vulnerable women in Kenya. The savings promotion increased mobile bank savings and reduced risk-sharing. However, we show that reduced risk-sharing did not reduce the capacity to manage risk. Promoting savings directly improved the ability of women to cope with negative shocks, and had no adverse spillover effects on the untreated.

Precautionary Savings and Shock-Coping Behaviors: The Effects of Promoting Mobile Bank Savings on Transactional Sex in Kenya

with Kelly Jones. Journal of Health Economics, 2021, Volume 78.

For the vulnerable, even small shocks can have significant short- and long-term impacts. Beneficial shock-coping mechanisms are not widely available in sub-Saharan Africa. We test whether an individual precautionary savings intervention can reduce a shock-coping behavior common in sub-Saharan Africa that has negative spillovers: transactional sex. Among a set of vulnerable women, we randomly assigned an intervention that promoted savings in a mobile banking account labeled for goals and emergency expenses. We find that a majority of individuals adopt the mobile account and the intervention led to reductions in transactional sex as a shock-coping response, and a decrease in symptoms of sexually transmitted infections. Changes are sustained in the medium-term among sex workers, but not among other vulnerable women.