Why did HIV decline in Uganda?

Uganda is widely viewed as a public health success for curtailing its HIV/AIDS epidemic in the early 1990s. We investigate the factors contributing to this decline. We first build a model of HIV transmission. Calibration of the model indicates that reduced pre-marital sexual activity among young women is the most important factor in the decline in HIV. We next explore what led young women to change their behavior. We estimate that approximately one-third the reduction in HIV in this cohort and almost 20 percent of the overall HIV decline was due to a gender-targeted education policy.

The Effect of Population Health on Foreign Direct Investment

We conduct a panel data analysis of 74 countries over 1980 2000 to investigate whether population health affects foreign direct investment inflows. Our main finding is that health has a positive and significant effect on such inflows for low- and middle-income countries. This finding is consistent with the view that health is an integral component of human capital in developing countries.

The Consequences of Population Health for Economic Performance

This chapter goes beyond the traditional economic thinking about the relationship between health and income – simply stated: wealth is needed to achieve health – by presenting evidence that population health is an important factor in strengthening economies and reducing poverty. The world's overarching framework for reducing poverty is expressed in the UN's eight Millennium Development Goals. Three of these eight goals pertain to health: reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria, and other diseases. These potentially huge improvements in health are extremely important goals in themselves, and they serve as beacons toward which numerous development efforts are oriented. But these potential improvements in health are not only endpoints that we seek through a variety of means. The improvements are actually instruments for achieving economic growth and poverty reduction. That is, better health does not have to wait for an improved economy; measures to reduce the burden of disease, to give children healthy childhoods, to increase life expectancy will in themselves contribute to creating healthier economies.health, economic growth, developmennt, income, burden of disease

A Commitment Contract to Achieve Virologic Suppression in Poorly Adherent Patients with HIV/AIDS

Objective: Assess whether a commitment contract informed by behavioral economics leads to persistent virologic suppression among HIV-positive patients with poor antiretroviral therapy (ART) adherence. Design: Single-center pilot randomized clinical trial and a nonrandomized control group. Setting: Publicly funded HIV clinic in Atlanta, Georgia, USA. Intervention: The study involved three arms. First, participants in the provider visit incentive (PVI) arm received $30 after attending each scheduled provider visit. Second, participants in the incentive choice arm were given a choice between the above arrangement and a commitment contract that made the$30 payment conditional on both attending the provider visit and meeting an ART adherence threshold. Third, the passive control arm received routine care and no incentives. Participants: A total of 110 HIV-infected adults with a recent plasma HIV-1 viral load more than 200 copies/ml despite ART. The sample sizes of the three groups were as follows: PVI, n=21; incentive choice, n=19; and passive control, n=70. Main outcome measure: Virologic suppression (plasma HIV-1 viral load<=200 copies/ml) at the end of the incentive period and at an unanticipated postincentive study visit approximately three months later. Results: The odds of suppression were higher in the incentive choice arm than in the passive control arm at the postincentive visit (adjusted odds ratio 3.93, 95% confidence interval 1.19–13.04, P=0.025). The differences relative to the passive control arm at the end of the incentive period and relative to the PVI arm at both points in time were not statistically significant. Conclusion: Commitment contracts can improve ART adherence and virologic suppression

Infectious Diseases and Economic Development

This dissertation contains three essays analyzing how disease (particularly communicable disease) and development interact. The first chapter explores how TseTse-transmitted Trypanosomiasis influenced African development. The second essay seeks to understand why the HIV epidemic declined in Uganda. The third study investigates the effect of population health on foreign direct investment. In the first essay, I examine the effect of the TseTse fly on African historical development. African ethnicities in TseTse suitable areas are found to be more reliant on indigenous slavery, shifting agriculture and are less urbanized as of the 19th century. TseTse suitability does not predict such correlations outside of Africa, where the fly does not exist. Africa would have been more similar to Eurasia in the absence of the fly. Current economic performance appears to be affected by the fly through its effect on historical institutions. In the second essay, David Cutler and I study how and why the HIV epidemic declined in Uganda. We identify reduced pre-marital sexual activity among young women as the most important factor leading to the decline in HIV. We next explore why young women would have changed their behavior. Using two-stage least-squares and difference-in-difference estimators, we find increases in girls’ secondary school enrollment, brought about by a targeted education policy, explains half the reduction in HIV in this cohort and approximately one-third of the overall decline. In the last essay, David Bloom, David Canning and I investigate the role of population health on foreign direct investment (FDI). We conduct a panel data analysis of 74 industrialized and developing countries over 1980-2000. Our main finding is that gross inflows of FDI are positively and significantly influenced by low population health in low- and middle-income countries. Our estimates suggest that raising life expectancy by one year increases gross FDI inflows by 9%, after controlling for other relevant variables. These findings are consistent with the view that health is an integral component of human capital for developing countries.Economic

Replication Data for: "Tuskegee and the Health of Black Men"

The data and programs replicate tables and figures from "Tuskegee and the Health of Black Men", by Alsan and Wanamaker. Please see the Readme file for additional details

Experimental evidence on the effectiveness of nonexperts for improving vaccine demand

We experimentally vary signals and senders to identify which combination will increase vaccine demand among a disadvantaged population in the United States—Black and White men without a college education. Our main finding is that laypeople (nonexpert concordant senders) are most effective at promoting vaccination, particularly among those least willing to become vaccinated. This finding points to a trade-off between the higher qualifications of experts on the one hand and the lower social proximity to low-socioeconomic-status populations on the other hand, which may undermine credibility in settings of low trust