Publication: The Heterogeneous Effects of HIV Testing
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2014-09
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2014-12-11
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An extensive multi-disciplinary literature examines the effects of learning one's HIV status on subsequent risky sexual behaviors. However, many of these studies rely on non-experimental designs; use self-reported outcome measures; or both. In this study, we investigate the effects of a randomly assigned home based HIV testing and counseling (HTC) intervention on risky sexual behaviors and schooling investments 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 who tested positive for HIV, we find a large increase in the probability of HSV-2 infection, with this effect being stronger among those surprised by their test results. Similarly, those surprised by HIV-negative test results have significantly higher achievement test scores at follow-up, consistent with increased returns to investments in human capital.
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Publication The Heterogeneous Effects of HIV Testing(World Bank, Washington, DC, 2014-03)An extensive multi-disciplinary literature examines the effects of learning one's HIV status on subsequent risky sexual behaviors. However, many of these studies rely on non-experimental designs; use self-reported outcome measures, or both. This study investigates the effects of a randomly assigned home based HIV testing and counseling (HTC) intervention on risky sexual behaviors and schooling investments among school-age females in Malawi. The study finds no overall effects on HIV, Herpes Simplex Virus (HSV-2), or achievement test scores at follow-up. However, among the small group of individuals who tested positive for HIV, a large increase in the probability of contracting HSV-2 is found, with this effect stronger among those surprised by their test results. Similarly, those surprised by HIV-negative test results see a significant improvement in achievement test scores, consistent with increased returns to investments in human capital. The finding of increased HSV-2 prevalence among HIV-positive individuals suggests that the conventional wisdom that those who learn they are HIV-positive will adopt safer sexual practices should be treated with caution.Publication The Short-Term Impacts of a Schooling Conditional Cash Transfer Program on the Sexual Behavior of Young Women(2009-10-01)Recent evidence suggests that conditional cash transfer programs for schooling are effective in raising school enrollment and attendance. However, there is also reason to believe that such programs can affect other outcomes, such as the sexual behavior of their young beneficiaries. Zomba Cash Transfer Program is a randomized, ongoing conditional cash transfer intervention targeting young women in Malawi that provides incentives (in the form of school fees and cash transfers) to current schoolgirls and recent dropouts to stay in or return to school. An average offer of US$10/month conditional on satisfactory school attendance plus direct payment of secondary school fees led to significant declines in early marriage, teenage pregnancy, and self-reported sexual activity among program beneficiaries after just one year of program implementation. For program beneficiaries who were out of school at baseline, the probability of getting married and becoming pregnant declined by more than 40 percent and 30 percent, respectively. In addition, the incidence of the onset of sexual activity was 38 percent lower among all program beneficiaries than the control group. Overall, these results suggest that conditional cash transfer programs not only serve as useful tools for improving school attendance, but may also reduce sexual activity, teen pregnancy, and early marriage.Publication Cash or Condition? Evidence from a Cash Transfer Experiment(2010-03-01)Conditional Cash Transfer programs are "...the world's favorite new anti-poverty device," (The Economist, July 29 2010) yet little is known about the specific role of the conditions in driving their success. In this paper, we evaluate a unique cash transfer experiment targeted at adolescent girls in Malawi that featured both a conditional (CCT) and an unconditional (UCT) treatment arm. We find that while there was a modest improvement in school enrollment in the UCT arm in comparison to the control group, this increase is only 43 percent as large as the CCT arm. The CCT arm also outperformed the UCT arm in tests of English reading comprehension. The schooling condition, however, proved costly for important non-schooling outcomes: teenage pregnancy and marriage rates were substantially higher in the CCT than the UCT arm. Our findings suggest that a CCT program for early adolescents that transitions into a UCT for older teenagers would minimize this trade-off by improving schooling outcomes while avoiding the adverse impacts of conditionality on teenage pregnancy and marriage.Publication Designing Cost-Effective Cash Transfer Programs to Boost Schooling among Young Women in Sub-Saharan Africa(2009-10-01)As of 2007, 29 developing countries had some type of conditional cash transfer program in place, with many others planning or piloting one. However, the evidence base needed by a government to decide how to design a new conditional cash transfer program is severely limited in a number of critical dimensions. This paper presents one-year schooling impacts from a conditional cash transfer experiment among teenage girls and young women in Malawi, which was designed to address these shortcomings: conditionality status, size of separate transfers to the schoolgirl and the parent, and village-level saturation of treatment were all independently randomized. The authors find that the program had large impacts on school attendance: the re-enrollment rate among those who had already dropped out of school before the start of the program increased by two and a half times and the dropout rate among those in school at baseline decreased from 11 to 6 percent. These impacts were, on average, similar in the conditional and the unconditional treatment arms. Although most schooling outcomes examined here were unresponsive to variation in the size of the transfer to the parents, higher transfers given directly to the schoolgirls were associated with significantly improved school attendance and progress - but only if the transfers were conditional on school attendance. There were no spillover effects within treatment communities after the first year of program implementation. Policymakers looking to design cost-effective cash transfer programs targeted toward young women should note the relative insensitivity of these short-term program impacts with respect to conditionality and total transfer size.Publication Designing Experiments to Measure Spillover Effects(World Bank, Washington, DC, 2014-03)This paper formalizes the design of experiments intended specifically to study spillover effects. By first randomizing the intensity of treatment within clusters and then randomly assigning individual treatment conditional on this cluster-level intensity, a novel set of treatment effects can be identified. The paper develops a formal framework for consistent estimation of these effects, provides explicit expressions for power calculations, and shows that the power to detect average treatment effects declines precisely with the quantity that identifies the novel treatment effects. A demonstration of the technique is provided using a cash transfer program in Malawi.
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