Antiretroviral Drug Access and Behavior Change

Willa Friedman, 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. Measuring the impact requires estimating the behavioral response 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 surveys to estimate the impact of proximity to an ARV provider on risky sexual behavior. Using a difference-in-differences strategy, I find a relative increase in risky behavior as reflected in pregnancy rates (82%) and self-reported recent sexual activity (40%) among young women in areas in which ARVs were introduced. The full impact on new infections is estimated through a simulation combining estimated behavioral responses to ARVs with medical evidence regarding HIV transmission. An increase in ARV drug access is predicted to reduce new infections despite the induced increase in risk-taking.