Cultural norms and HIV risk examined in new paper

Research from a Te Herenga Waka—Victoria University of Wellington lecturer is providing a new perspective on how social and cultural norms regarding premarital fertility affect women’s HIV risk in Sub-Saharan Africa.

Dr Yao Yao stands in front of Rutherford House

In many places in Sub-Saharan Africa, there is a cultural expectation that women will bear premarital children, so they can demonstrate their fertility and facilitate marriage. In a new paper, Dr Yao Yao, a lecturer in the Wellington School of Business and Government’s School of Economics and Finance, independently used economic modelling to examine the way Kenyan women’s HIV risk is affected by this cultural norm. This cultural norm has been widely documented in sociological literature, but has never before been studied using an economics framework.

Dr Yao built a rich life cycle economic model, which examined the decisions individuals make over the course of their lifetime. The model covered aspects of life such as fertility (pre- and post-marriage), sex, education, and marriage, and demonstrated how these factors affect HIV risk.

According to the model, the premarital fertility motive accounted for 13 percent of the HIV prevalence among young Kenyan women. When the premarital fertility motive was combined with the motive of avoiding the cost of contraception, this figure rises to 33 percent.

The findings are important for policy-makers, Dr Yao says, because existing policies aimed at reducing HIV risk in Sub-Saharan Africa focus primarily on the distribution of contraception.

“My paper suggests that this is not enough, because if women have the incentive to bear premarital children, they may intentionally avoid using contraception. Policy-makers need to consider the cultural incentives that are in place for women in Sub-Saharan Africa to engage in premarital fertility.”

Dr Yao used the findings of the rich life cycle model to conduct three policy experiments that examined how different subsidies might affect the HIV risk amongst young Kenyan women.

The first policy experiment, which examined how providing women with an income subsidy would affect their HIV risk, showed this would have a limited impact. The second policy experiment, which examined how providing women with an income subsidy that is conditional on school attendance would reduce their HIV risk, showed this would reduce the HIV prevalence rate amongst young Kenyan women by 14 percent.

The third policy experiment, which examined how providing HIV-infected women with a subsidy to receive antiretroviral therapy (ART) would affect the overall HIV rate amongst young Kenyan women, found it would reduce this rate by 41 percent. It is an effective solution, Dr Yao says, but it is not without its complications.

“The treatment subsidy works well because it is also a prevention. If an HIV positive person is treated with ART, the chance of them passing the virus on to their partner is largely reduced.

“But on the other hand, because this treatment reduces risk, it also encourages risky behaviour, because the virus seems less dangerous. If behaviour had not changed, the same policy would reduce HIV prevalence amongst young Kenyan women by 60 percent.”

Dr Yao’s solo-authored paper ‘Fertility and HIV Risk in Africa’, is available in the latest edition of the Review of Economic Dynamics.