2013. 43 p.
Friedman, Willa
Access to antiretroviral (ARV) drugs in Sub-Saharan Africa has rapidly expanded - from fewer than 10,000 people treated in 2000 to more than 8 million in 2011. To measure the impact of this expansion, it is necessary to identify the behavioral response of individuals to drug access. This paper combines geocoded information about the timing of introduction of ARVs in all Kenyan health facilities with two waves of geocoded population surveys to estimate the impact of proximity to an ARV provider on risky sexual behavior. Using a difference in differences strategy that matches survey clusters geographically across waves, the autoh fonds a relative increase in risky behavior as reflected in pregnancy rates (increase of 82%) and self-reported recent sexual activity (increase of 40%) among young women in areas in which ARVs were introduced between 2004 and 2008. The full impact of ARV access on new infections is estimated through a simulation procedure that combines estimated behavioral responses to ARVs with medical evidence regarding HIV transmission. An increase in ARV drug access is predicted to reduce the rate of new infections despite the induced increase in risk-taking.
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