APL (Ajiken Power Lunch)

Thursday, 27th of February, 12:00 to 1:15 p.m.

IDE-JETRO C22 Meeting Room 　

This paper examines whether expanding access to antiretroviral therapy (ART) leads to reduced HIV prevention efforts in high-prevalence settings. We first develop a parsimonious behavioural model and show that free ART provision does not necessarily crowd out preventive behaviours, as the response depends on how ART affects HIV transmission probabilities. We then analyse the impacts of Botswana’s pioneering nationwide free ART programme initiated in 2002, exploiting the gradual spatial expansion of ART-providing facilities in a difference-in-differences framework. Unlike previous studies finding increased risky behaviours in other African countries, our empirical analysis shows that proximate ART availability did not significantly increase unprotected sex or pregnancy rates among women aged 15-18 years. These results suggest that expanding treatment access may not inevitably lead to risk compensation. It is also suggested that Botswana’s achievement of the ambitious 95-95-95 goal in 2021 is likely supported by its free ART provision.

Masaru Nagashima

Ian Coxhead