90357 enGender Impact: The World Bank’s Gender Impact Evaluation Database The Heterogeneous Effects of HIV Testing Author(s) Sarah Baird, Erick Gong, Craig McIntosh, Berk Ozler Contact bozler@worldbank.org Country Malawi Organizing Theme Women's Health and Education and Skills Status Completed Intervention Category HIV testing and counseling Sector Health, Nutrition & Population An extensive multi-disciplinary literature examines the effects of learning one's HIV status on subsequent risky sexual behaviors. However, many of these studies rely on non-experimental designs; use self-reported outcome measures, or both. This study investigates the effects of a randomly assigned home based HIV testing and counseling (HTC) intervention on risky sexual behaviors and schooling investments among school-age females in Malawi. The study finds no overall effects on HIV, Herpes Simplex Virus (HSV-2), or achievement test scores at follow-up. However, Abstract among the small group of individuals who tested positive for HIV, a large increase in the probability of contracting HSV-2 is found, with this effect stronger among those surprised by their test results. Similarly, those surprised by HIV-negative test results see a significant improvement in achievement test scores, consistent with increased returns to investments in human capital. The finding of increased HSV-2 prevalence among HIV-positive individuals suggests that the conventional wisdom that those who learn they are HIV-positive will adopt safer sexual practices should be treated with caution. Gender Connection Gender Focused Intervention Gender Outcomes Risky sexual behaviors and schooling investments among school-age females IE Design Clustered Randomized Controlled Trial HIV testing and counseling (HTC) took place at the homes of the core respondents where they were invited to receive counseling and rapid testing for HIV, HSV-2, and syphilis by a trained counselor. Malawian nurses and counselors certified in conducting rapid HIV tests through the Ministry of Health HIV Unit HCT Counselor Certification Program conducted HTC. Testing and counseling was Intervention performed in a private location at or near the participant’s house. Whole blood samples were obtained using a finger-stick. The teams conducting HTC at follow-up were blinded to the testing treatment status of the subjects and were independent of the survey teams that conducted household surveys and administered achievement tests. Intervention Period 2009-2010 Last updated: 2 September 2014 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database 1948 females aged 13-22 in Zomba District, Southern Malawi. 88 enumeration areas Sample population in urban and rural areas of Zomba Comparison No treatment. Comparison group received HTC 10 months after the treatment conditions group Unit of analysis Individual level Evaluation Period 2009-2010 While HIV testing plays an unambiguously important role as a gateway to ART and, hence, would have indirect effects on HIV transmission through suppressed infectiousness after the start of therapy, its direct behavioral effects appear to be complex and not uniformly protective. Our main finding is that while HTC has no Results overall effect on STI risk or achievement test scores, it does have, consistent with economic theory, heterogeneous effects in subgroups. Among those who discover that they are HIV-positive, the risk of HSV-2 infection at follow-up increases substantially. On the other hand, individuals surprised by HIV-negative test results experienced a significant improvement in achievement test scores. The study's main finding that HIV-positive tests lead to increases in HSV-2 rates suggesting increases in unprotected sex, warrants some caution given that it is based Primary study on a small sample size (N=73). Study design prevents the collection blood samples limitations from all study participants (including comparison group) at the baseline. The study does not measure subsequent HIV transmission to sexual partners. Global Development Network, Bill & Melinda Gates Foundation, National Bureau of Economic Research Africa Project, World Bank’s Research Support Budget, Funding Source Gender Action Plan, Knowledge for Change Program, and Spanish Impact Evaluation fund Baird, S., Gong, E., McIntosh, C., & Ozler, B. (2014) The heterogeneous effects of Reference(s) HIV testing, Welfare impacts of rural electrification: evidence from Vietnam. World Bank Policy Research Working Paper No 6823 Link to Studies http://www- wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2014/03/31/ 000158349_20140331124130/Rendered/PDF/WPS6823.pdf Microdata Last updated: 2 September 2014 2