HIV /AIDS surveillance and behavioral change in populations affected by the AIDS epidemic: Four essays

Georges Reniers, University of Pennsylvania


Two essays in this dissertation make a contribution to monitoring the HIV/AIDS epidemic and two focus on the behavioral dynamics that feed it. Following advances in medical technology, HIV testing is now often included in community-based surveys and that raised expectations for surveys to become the new gold standard for HIV prevalence estimates. Yet, these data may be subject to bias due to various forms of non-response. In the first paper we evaluate the potential for bias in HIV prevalence estimates due to refusal for testing. We find that bias depends on the study protocol, but it is likely to be negligible if study participants are explicitly offered the possibility to opt out of post-test counseling. While HIV prevalence may remain an important surveillance indicator, it will increasingly confound the magnitude of the epidemic and the success in providing treatment. AIDS mortality figures will become more informative, but they are not as easy to come by. In the second essay, we use a registration of burials in Ethiopia as an exemplary alternative data source for monitoring purposes. Using estimates based on a comparison of observed and projected deaths and extrapolations from lay reports of causes of death, we illustrate that AIDS mortality decreased since the introduction of antiretroviral treatment. We also find that men benefit more from the availability of AIDS drugs than women. If monitoring the HIV/AIDS epidemic turns out to be difficult, understanding its epidemiology is even more complicated. In the last two papers we take an agency perspective and focus on behavioral change in response to the epidemic. Usually behavioral change is conceptualized in terms of the ABC of HIV prevention (Abstinence, Be faithful, Condom use). In contrast, we focus on HIV avoidance behavior related to marriage. We single out positive selection (partner choice) and negative selection (divorce of an unfaithful spouse) strategies, and illustrate that they gathered momentum in the period that the threat of AIDS became increasingly evident. We argue that these strategies are used to regulate exposure to HIV at the individual level, and that they may have contributed to the stabilization of the epidemic.

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Recommended Citation

Reniers, Georges, "HIV /AIDS surveillance and behavioral change in populations affected by the AIDS epidemic: Four essays" (2006). Dissertations available from ProQuest. AAI3211139.