Ruchi Mahadeshwar

"Wealth of Information: Reducing the risk-income tradeoff in transactional sex with HIV self-tests", with Kawango Agot and Harsha Thirumurthy. In review. [BREAD Presentation]

Abstract: In high HIV prevalence settings where transactional sex is common, we study how access to HIV self-tests impacts condom use and earnings by changing the trade-off that women face between HIV risk and income. By facilitating partner testing, self-tests may decrease HIV risk in transactional sex encounters by enabling women to avoid sex or use condoms with high-risk partners. Using data from a randomized trial in Kenya that included information on over 11,000 transactional sex encounters, we find that sustained access to free self-tests among HIV-negative women engaged in transactional sex does indeed have these intended behavioral responses. However, consistent with a bargaining model in which women receive higher compensation for unprotected sex, we also observe unintended consequences as women report lower condom use in transactional sex encounters. The reduction in condom use is accompanied by higher earnings for women and no adverse effects on their health outcomes. These unintended consequences appear to be explained by the access to self-tests having enabled women to learn their partners’ HIV-negative status. The results imply that, over time, sustained access to self-tests may lower HIV risk in transactional sex markets.