HIV/AIDS Knowledge and Behaviour: Have Information Campaigns Reduced HIV Infection? The Case of Kenya*

Abstract: AIDS continues to have a devastating effect on developing countries, particularly in sub‐Saharan Africa. The lack of a proven effective vaccine to stop HIV transmission has led to much of public policy putting an emphasis on information campaigns in order to reduce HIV‐prevalence. In this paper we examine the impact of HIV/AIDS‐knowledge from two sides. First, we examine to what extent the campaigns have been successful at inducing the expected behavioural change with regards to HIV‐related attitudes. Second, we examine the impact of HIV/AIDS knowledge on HIV status. The basic policy issue can be expressed as follows: even if individuals have acquired sufficient and necessary information on the basic facts about AIDS, factors such as innate risk attitudes or cultural background could undermine the effects of the campaigns. Using the Kenya Demographic and Health Survey (2003) we elicit empirical evidence on the relation between declared HIV/AIDS‐knowledge, behavioural attitudes related to HIV/AIDS situations and the relation between knowledge and observed HIV‐status. Overall, our empirical findings suggest that information campaigns have been effective at equipping the adult population in Kenya with the required knowledge to avoid becoming HIV‐positive. However, when HIV‐status is measured objectively we find that the relation between correctly declared attitudes and actual behaviour is only statistically significant for females who have arrived into sexuality late enough to benefit from such campaigns: it is for these females that the impact of the information campaigns has been to statistically reduce the probability of becoming HIV positive, as intended. In the case of males we find that there is no statistical relation between either knowledge or timing of the information campaigns and a positive HIV status. Nevertheless, another important finding refers to the selection bias induced by males who are sampled randomly but decline to take the HIV test. The consequences of this bias are twofold; first, the estimated policy parameters for males should be interpreted with caution, but more importantly, estimating the population level HIV‐prevalence for Kenyan males based on the DHS implies underestimating the true and unknown prevalence rate. Our analysis controls for individual characteristics, selection bias and endogeneity effects, thus allowing us to make inferences for the full population and with regards to policy implementation.     

DETERMINANTS OF CHILD NUTRITION IN MALAWI

This paper investigates factors that determine child malnutrition in Malawi. Measuring child nutrition using anthropometric measures, the study finds that child malnutrition worsens with age until a certain critical age beyond which it starts to improve and that boys are more at risk than girls. We also find evidence that child malnutrition is more prevalent in children that fall sick regularly and in households that draw water from a well, protected or not. In addition, children who come from households that have mother/female household heads who are economically empowered, in terms of being in salaried employment or working in a family business, tend to be better nourished.     

THE RELATIONSHIP BETWEEN LABOUR MARKET DYNAMICS AND HIV/AIDS PREVALENCE IN SOUTH AFRICA ‐ A LITERATURE REVIEW1

The aim of this literature review is to analyse the contribution of current research and literature to an understanding of the relationship between labour market dynamics and HIV/AIDS prevalence in South Africa. It highlights and assesses the extent to which those factors that are regarded as determinants of HIV susceptibility, AIDS vulnerability and prevalence, interact with differentiation in the labour market. The conclusion is that current research studies do not sufficiently consider a more nuanced relationship between complex labour market dynamics and socio‐economic risk factors driving HIV/AIDS susceptibility and vulnerability.     

Fertility in Sub‐Saharan African Countries with Consideration to Health and Poverty*

Abstract: Fertility has begun to fall in sub‐Saharan Africa but it remains high on average and particularly for a few countries. This paper examines African fertility using a panel data set of 47 sub‐Saharan countries between 1962 and 2003. Fixed and random country effect estimates are made in models where the explanatory variables are suggested by the theory of the demographic transition as modified by Caldwell (1982) . Special attention is paid to the economic status of women, urbanization, the poverty level, and the health of the population including total health expenditures and the prevalence of HIV/AIDS. The results support Caldwell's hypothesis and are generally supportive of hypothesis that a fertility transition is occurring. HIV/AIDS is found to have a negative impact on fertility.     

WHO DEVELOPS INNOVATIONS IN MEDICINE FOR THE POOR? TRENDS IN PATENT APPLICATIONS RELATED TO MEDICINES FOR HIV/AIDS,TUBERCULOSIS, MALARIA,AND NEGLECTED DISEASES

This paper analyzes patent data of medicines and vaccines for diseases spreading in low‐income countries. The data were retrieved from a database of the Japan Patent Office. Who invents medicines for the poor of the world? This is the main question that the paper addresses. Results indicate that not only public institutions but also private firms have played an important role in developing innovations for fighting both global diseases such as HIV/AIDS and tuberculosis, and so‐called neglected diseases including malaria, which seem to spread almost exclusively in low‐income countries. Moreover, the basic mechanism of innovation is similar between the development of medicines for HIV/AIDS and those for neglected diseases. Finally, among firms, infectious disease fighting innovations are quite diverse. R&D stock and economies of scope are used to explain frequent patent applications by a high‐performing pharmaceutical firm.     

Cities,market integration,and going to sea: stunting and the standard of living in early nineteenth‐century England and Wales1

A new source, 1840s Admiralty seamen's tickets, is used to explore three anthropometric issues. First, did being born in a city, with its associated disamenities, lead to stunting? Second, did being born near a city, whose markets sucked away foodstuffs, lead to stunting? Third, did child labour lead to stunting? We find that only those born in very large cities suffered a level of stunting that contemporaries could have observed. Being born near a city, which gave parents opportunities to trade away family calories, and perhaps increased exposure to disease, did not cause stunting. Britain was a well‐integrated market; all families, whatever their locations, had options to trade and faced similar disease environments. Finally, although adults who had gone to sea young were shorter than those who did not enlist until fully grown, going to sea did not stunt. Instead, plentiful food at sea attracted stunted adolescents, who reversed most of their stunting as a result. But child labour at sea was different from other forms of children's work because wages were largely hypothecated to the child as food and shelter onboard. In contrast, where wages were paid to the child or his parents in cash, they became submerged in the household economy and their benefits were shared with other family members.     

Does financial development contribute to the achievement of the “Zero Hunger” goal in Africa?

This study examines the effects of financial development on undernourishment with panel data from 40 African countries. We show that financial development in all its dimensions reduces undernourishment. In addition, financial development, financial institutions, the financial market, and financial market depth reduce child stunting. We also identify education, health expenditure, access to electricity, and control of corruption as the main transmission channels through which financial development reduces undernourishment. These results have important implications for the achievement of the “Zero Hunger” goal in Africa and for improving child nutrition.     

The effects of female HIV/AIDS status on fertility and child health in Cambodia

Although Cambodia has been on a higher growth track, it still faces a great challenge in public health. Public health is closely related to the standard of living of the people and is indispensable for further economic development. This paper considers a serious public health problem, the HIV/AIDS epidemic in Cambodia. Specifically, it presents two testable hypotheses derived from a simple model and then empirically demonstrates these hypotheses, using data of more than 8000 women from the 2005 Cambodia Demographic and Health Survey (DHS). One hypothesis is the negative effect of female HIV on fertility, and the other is the positive effect of maternal HIV on child health status. Our estimation results are consistent with these hypotheses, implying that women infected with HIV tend to bear fewer children and their children are in better health.     

Intrahousehold and Interhousehold Child Nutrition Inequality in Malawi

This paper investigates whether child nutrition inequalities are attributable to differences between households or differences within households in Malawi. Child nutrition is measured using height‐for‐age z‐scores. The empirical analysis uses the 2006 Multiple Indicator Cluster Survey data. We find evidence of within household nutritional differences along gender, age and birth order lines in Malawi. The results for rural and urban areas as well as religious groups show that nutrition inequalities largely stem from differences within households. Both intrahousehold and interhousehold nutrition inequalities are unexplained by observable factors.     

Poverty,HIV/AIDS and the old age pension in Bhambayi,Kwazulu-Natal,South Africa

To date the international community has tended to direct HIV prevention programmes, treatment, care and supportive services to young adults and children, with little concern about the impact on older people. Since empirical evidence on the socioeconomic impact of HIV/AIDS on households with older persons is lacking, this paper attempts to fill this gap, using data from a household-based survey conducted in Bhambayi, a mixed formal and informal settlement north of eThekwini, KwaZulu-Natal. The findings highlight the links between the uptake of the South African old age pension, poverty and HIV/AIDS in households with older persons. The paper makes recommendations for both government and non-governmental organisations in respect of community-based support systems for such households affected by HIV/AIDS.     

Millennium Development Goal shortfalls in Zimbabwe: Analysing the impact of access to water and sanitation on early childhood morbidity

ABSTRACT

An Africana feminist framework is presented that considers the ways in which inequality resulting from a historical legacy of political conflict and other dimensions intersect to impact upon the accomplishment of Millennium Development Goals with regards to environmental sustainability and child malnutrition in Zimbabwe. Demographic and Health Surveys are analysed from 1988 to 2011 to examine whether differential access to water and sanitation is predicted by ethnic differences in Zimbabwe, and is predictive of chronic malnutrition. Safe water and sanitation are in short supply, and logistic regression analyses provide evidence that residents in Shona and Ndebele-dominated provinces generally have better access to these resources. Uneven distribution of these development resources has a deleterious impact on early childhood nutrition. This work elicits results that give rise to child health-related policy recommendations that may inform post-2015 discussions of Sustainable Development Goals, namely that within-country ethnic differences must be taken into account.     

THE ROLE OF SOCIAL GRANTS IN MITIGATING THE SOCIO‐ECONOMIC IMPACT OF HIV/AIDS IN TWO FREE STATE COMMUNITIES1

Social grants may play an important role in mitigating the impact of HIV/AIDS. Eligibility for these grants is driven in part by the increasing burden of chronic illness, the mounting orphan crisis and the impoverishment of households associated with the epidemic. This article investigates the role of social grants in mitigating the socio‐economic impact of HIV/AIDS in South Africa, using data from a panel study on the household impact of the epidemic. Social grants reduce inequality and decrease the prevalence, depth and severity of poverty in affected households. However, these transfers also have disincentive effects on employment, while non‐uptake is in some cases higher amongst the poorest.     

Migration and HIV/AIDS in South Africa

Although migration and HIV/AIDS have been examined separately in South Africa, researchers are still far from understanding in detail just how and to what extent the two are interconnected. The connections are difficult to unravel because HIV/AIDS arrived in the country at a time when population mobility and systems of labour migration were undergoing rapid transformation. Without a proper understanding of the complexity of the country's new migration regime, it will not be possible to understand either the role of mobility in the spread of the pandemic or the vulnerability to infection of mobile populations. This paper reviews the current state of knowledge on the interconnections between mobility and HIV and argues for more research that will further understanding of migrant vulnerability and the development of appropriate policies and models of intervention and care.     

Why HIV/AIDS prevention strategies fail in Botswana: considering discourses of sexuality

A phenomenological study that was carried out among five ethnic groups of Botswana revealed the importance of taking into account culturally situated sexual realities when prevention policies for HIV/AIDS are considered and implemented. Furthermore the study threw light on the ineffectiveness of the current national HIV/AIDS prevention strategy of ‘Abstain, Be faithful, or use a Condom’ (ABC), a strategy that has been externally imposed on communities, without sufficiently engaging the behavioural practices and values of the communities themselves. This paper therefore advocates educational strategies for HIV/AIDS prevention that take into consideration localised social relations and value systems. Devising policies that engage with the discourses that are dominant in each ethnic group can make a difference in a country that has been hard-hit by the HIV/AIDS epidemic.     

THE ECONOMIC IMPACT OF HIV/AIDS ON SMALL,MEDIUM AND LARGE ENTERPRISES1

Based on the Bureau of Economic Research (BER's) 2005 HIV/AIDS survey, this paper provides a snapshot view of the nature and the extent of the impact of HIV/AIDS on companies of different sizes in South Africa, as well as their response to the epidemic. Whereas the focus of most of the previous workplace surveys has been on “evaluating workplace responses”, the present study also considers the economic impact of HIV/AIDS. This study provides evidence of the impact of HIV/AIDS on the largest sample of small, medium and large companies in South Africa to date. The survey results suggest that employer responses are strongly linked to company size, with the majority of medium and large companies indicating that they have an HIV/AIDS policy in place and small companies having done little in the way of action against the epidemic.     

Restless worlds of work,health and migration: domestic workers in Johannesburg

The lives of migrant women have generally received far less attention than those of their male counterparts. Similarly, male migrants have been the focus of research on the relationship between migration and HIV/AIDS. Little attention has been paid to the vulnerability of female migrants themselves to HIV infection and their access to health care and treatment. Domestic work is the second largest sector of employment for black women in South Africa, and the largest for black women in Johannesburg and, as this article shows, most of these workers are migrants. Based on a survey of 1100 domestic workers in Johannesburg, the article explores the lives of domestic workers, focusing on their experience as migrants, their working conditions, use of health-care services and knowledge of and possible vulnerability to HIV/AIDS.     

HIV/AIDS AND POVERTY IN SOUTH AFRICA: A BAYESIAN ESTIMATION OF SELECTION MODELS WITH CORRELATED FIXED‐EFFECTS

In this paper, we estimate the causal impact of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) on monetary poverty using a panel database from South Africa. We treat endogeneity and selection problems associated with HIV/AIDS by a selection model that includes correlated fixed effects both in the level and in the participation equations, which are estimated simultaneously via original Bayesian methods. We model the consequences of the illness on both labour income and income transfers, and disentangle between urban and rural households. While no significant impact of HIV/AIDS on labour income is found because of households' recomposition, we find a substantial fall in received transfers among rural population and a dramatic increase in chronic poverty.     

Determinants of HIV Knowledge and Condom Use among Women in Madagascar: An Analysis Using Matched Household and Community Data

Abstract: We estimate the determinants of HIV/AIDS knowledge and related behavior (use of condoms) among women in Madagascar, a country where prevalence remains low but conditions are ripe for a rapid increase in infections. In both rural and urban areas, more educated and wealthier women are more likely to know about means of preventing infection, less likely to have misconceptions about transmission, and more likely to use condoms. Community factors such as availability of health centers and access to roads also are associated with greater HIV knowledge. However, most of the large rural‐urban difference in mean knowledge is due not to location per se but to differences in schooling and wealth; rather than simply being geographically targeted, AIDS education efforts must be designed to target and be understood by uneducated and poor subpopulations.     

Livestock as a buffer against HIV and AIDS income shocks in the rural households of Zimbabwe

The objective of this study was to determine the extent to which households use livestock sales to mitigate the impact of HIV/AIDS income shocks. Using survey data from the Muzarabani and Bindura districts of Mashonaland Central Province in Zimbabwe, the econometric analysis indicated that livestock, particularly poultry and small stock, play a significant role in smoothing income fluctuations due to HIV/AIDS. Cattle sales compensate for 71 per cent of income shortfalls due to HIV/AIDS. About 90 per cent of HIV/AIDS-afflicted households, headed mainly by women or children, used poultry and goats as consumption-smoothing strategies when faced with negative income shocks. Government and other stakeholders were advised to support the use of small stock as a strategy for coping with HIV/AIDS economic shock in female- or child-headed households in rural areas.     

Dynamics of Child Malnutrition in Rural and Small‐Town Ethiopia

Improving the status of malnourished children, and preventing children from becoming malnourished, lies at the heart of several of the Sustainable Development Goals. While many cross‐sectional studies examine correlates of stunting, they largely cannot identify drivers of change in stunting. We use two waves of panel data from Ethiopia and incrementally larger sets of fixed effects to control for time‐variant observable characteristics and time‐invariant unobservable characteristics. After controlling for these potential confounders, our analysis reveals that many factors that are associated with stunting in the cross‐section do not impact stunting dynamics. We also estimate individual fixed‐effects regressions, separately, according to baseline stunting status. We find evidence suggesting that while improved societal conditions drive many children out of a stunted state, certain exogenous factors may lead previously healthy children to become stunted. Overall, policymakers and practitioners would be wise to consult research utilising both cross‐sectional and panel data analyses in order to more effectively target already stunted children as well as vulnerable children who may be at risk of becoming stunted.