University of California, Berkeley
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 - a great achievement. But some are concerned that increased access to ARVs may also have undesirable consequences, leading individuals to feel protected from HIV and increase their risky behavior. In her new paper, Willa Friedman explores this dynamic by identifying the behavioral response of individuals to drug access. Friedman uses geocoded information about the timing of introduction of ARVs in all Kenyan health facilities and two waves of geocoded population surveys to estimate the impact of proximity to an ARV provider on risky sexual behavior. She finds a relative increase in risky behavior, measured through 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. To examine the overall effect, Friedman constructs a model that combines estimated behavioral responses to ARVs with medical evidence regarding HIV transmission. She finds that increased access to ARVs does reduce the rate of new infections, despite the induced increase in risk-taking.