HIV

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Do Capitalists or Communists Promote Aid to Africa?

August 19, 2011 in Economics - General, Quotation | No comments

“It is significant that none of the most passionate advocates of aid for Africa are African.  Aid can speed up development that people have already decided to carry out for themselves and have the capacity to do.  It is also essential for vaccination campaigns and for ARVs to combat HIV/AIDS.  Emergency aid is obviously vital to help the victims of war or natural disasters, but that is as true in Surrey as in Somalia.  Small amounts of aid can also work well in local contexts.   But aid from the outside cannot transform whole societies, whole countries.  That can only come about through producing things and trading them or doing something someone else wants to pay for.  Ironically, it is the capitalist West that still sees Africa as a continent that needs aid, while Communist and former Socialist governments like China and India see it as a business opportunity.”

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AIDS turns 30

June 6, 2011 in Contagious Disease | 1 comment

The Center for Disease Control issued the first official notice of the disease that would become known as AIDS 30 years ago on June 5.  My current home, San Francisco, was especially hard hit.  NPR interviews physicians at the San Francisco General Hospital and the Center of AIDS Research at University of California, San Francisco.

“At the beginning, we knew all of the patients that we took care of in San Francisco and we knew all the patients in San Francisco with the disease. But then the numbers started to increase, increase, increase, even in those early years and then we didn’t know their names. And then I said, wow, this is big. I think, let’s say, 1991, San Francisco was just devastated. I mean, men were walking around in the Castro as skeletons suffering from the wasting syndrome.

I remember on a TV interview telling the woman interviewing me that my grandmother complained that all of her friends were demented or dying. And I said, yeah, grandma, so were mine and I’m, you know, quite a bit younger than you are. But it was exhausting but we fought on.”

To help fight to cure AIDS, you can donate to UCSF’s AIDS Research Institute or the International AIDS Vaccine Initiative (IAVI).

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World AIDS Day + CoR

December 1, 2010 in Carnivals, Current Events | No comments

Today is World’s AIDS Day.  Typically this is a day for bad news, but there are some positive trends in the AIDS epidemic.  Time notes that “The number of new infections is falling, as are AIDS-related deaths. Overall, 33 countries have seen their infection rate drop by more than 25% between 2001 and 2009, thanks, in part, to HIV prevention efforts. ”  In addition, condom usage is gaining ground even around conservative cultural circles.  This year, the Pope stated that there are some cases where condoms are acceptable.  Nevertheless, over 33 million people are still living with HIV or AIDS, including 2.6 million people who were newly infected in 2009.

In other reading, the Huffington Post has gathered a list of the seven best books about HIV/AIDS.

On a lighter note, for those of you wanting to engage in risky behavior…head over to Insurance Coverage Law in Massachusetts blog for the latest edition of the Cavalcade of Risk.

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Do for-profit hospitals reduce safety net services?

July 14, 2009 in Managed Care | 1 comment

Social safety net services are necessary, but often unprofitable for hospitals. Is the expansion of HMOs and for-profit hospitals jeopardizing these safety net servies? This is the question researcher Yu-Chu Shen investigates.

To test this hypothesis, Shen examines how changes in the market share of HMOs and for-profit HMOs affects probability of shutting down following safety net services: emergency department, HIV/AIDS services, inpatient substance abuse services, and outpatient substance abuse services. “Safety net services rely more on public finance than other types of hospital services. For example, almost two- thirds of revenue for substance abuse treatments comes from public sector…and less than 40% of emergency department revenue comes from private health insurance.”

HMO penetration is calculated using Laurence Baker‘s data. A proportional hazard specification models the probability each of the 4 safety net services shuts down as a function of whether the hospital is in a market with a high level of managed care and whether or not the hospital is for-profit.

The author finds that HMO penetration in a local market has no effect on the probability safety net services are offered. However, the probability of “shutting down safety net services do differ by levels of for-profit HMO share. In particular, in the current environment (post-2000), a higher for-profit HMO presence is associated with a higher risk of shutting down all safety net services examined in this study except for HIV/AIDS services.”

  • Yu-Chu Shen (2009) “Do HMO and its for-profit expansion jeopardize the survival of hospital safety net services?” Health Economics, 18(3):305-320.

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AIDS Crowds-Out

May 27, 2009 in Contagious Disease, Health Care in Developing Nations | 1 comment

Case and Paxson (2009):

“We document the impact of the AIDS crisis on non-AIDS related health services in fourteen sub-Saharan African countries…Regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions currently shouldering the heaviest burdens have seen the largest erosion in treatment for pregnant women and children.“

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The Intensive and Extensive Margins of Teenage Sex

March 12, 2009 in Contagious Disease, Public Policy | No comments

HIV is a huge health issue around the world and especially in sub-Saharan Africa.  Many American NGOs have promoted abstinence programs as a way to prevent the spread of HIV/AIDS.  However, most evidence finds that this approach has been ineffective.

An NBER working paper by Dupas (2009) adds more support that abstinence programs do not work.  In the paper, the author used a

“…randomized fi…eld experiment involving 328 primary schools to compare the effects of providing abstinence-only versus detailed HIV risk information on teenage sexual behavior. Half of the schools, randomly selected, received teacher training on the national HIV/AIDS curriculum, which focuses on abstinence until marriage, but does not discuss risk reduction strategies (such as condom use or selection of safer partners). In 71 schools, randomly selected after stratifying by teacher training status, an information campaign provided teenagers with information on the prevalence of HIV disaggregated by age and gender group (the relative risks information campaign).”

The authors finds that the abstinence program had no effect on pregnancy rates.  However, the “risk reduction” educational program decreased the probability a girl had started childbearing within a year by 28%.  The decreased pregnancy rates were not, however, due to less frequent sexual activity.  Instead, teenage girls switched their sexual partners from older partners to teenage boys in their age cohort.

This leads to the finding that teenage girls are having the same amount of sex, teenage boys are having more sex, but pregnancies are decreasing.  Why is this?

The author explains that when teenage girls have sex with teenage boys, “…teenage girls report higher rates of condom use, presumably in order to avoid pregnancy with resource-constrained teenagers.”  It is also possible that teenage girls can more easily convince boys of their same age to wear a condom whereas it may be more difficult to convince older men to use a condom.

Thus, we see that these “relative risk” educational programs do not decrease sexual activity on the extensive margin (teenage girls are having the same amount of sex), but do decrease risky behaviors on the intensive margin (more condom use when teenage girls have sex with people of their same age).

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