Do Income Shocks Lead to Higher Risk of HIV Infection?

The HIV/AIDS epidemic continues to plague the African continent, causing widespread human suffering and creating a stumbling block to economic development. In SSA, over a million people become newly infected with the disease every year (UNAIDS, 2010). While access to proper medical care and education about safe sexual practices clearly play a role in preventing further spread of and deaths from the HIV virus, a new paper in The Economic Journal suggests that protecting people’s incomes could help decrease the spread of the disease as well.

The majority of people in SSA rely on agriculture for their livelihoods, and the majority of that agriculture is rain-fed. This means that weather shocks that hurt agricultural production, such as droughts, pose a major challenge to economic stability and well-being in the region. In an effort to smooth these drought-driven income shocks, people may turn to other ways of making money, including riskier sexual behaviors that could increase the spread of diseases like HIV.  

Income Shocks and HIV in Africa looks at 2,000 people across 19 African countries and finds that infection rates in HIV-endemic rural areas increase by 11 percent for every recent drought over the past 10 years. Significantly, these individual-level findings seem to hold at the country level as well, with exposure to drought explaining 14-21 percent of the cross-country variation in HIV prevalence across the region.

While the authors don’t directly investigate the ways in which HIV is spread in these areas, their findings do provide some clues as to the role that sexual behavioral changes may play. One important behavioral change could be an increase in the number of women engaging in “transactional sex,” or sexual activity to obtain cash or in-kind transfers from their male partners. In areas hit by drought, the highest HIV rates were found among female agricultural workers and male non-agricultural workers. This seems to suggest that when faced with economic hardship due to agricultural shocks, women may turn to other means of augmenting their incomes - namely, transactional sex with men who don’t work in agriculture and are thus less hard hit economically by drought conditions. Nonetheless, it should be noted that the authors are not able to fully rule out other pathways that may contribute to the observed effects, such as girls dropping out of school or marrying at earlier ages or workers temporarily migrating from rural to urban areas.

Whatever the transmission pathway, the study’s findings have strong policy implications. Agriculture is still the economic mainstay in Africa south of the Sahara, and protecting agricultural incomes could have significant impacts that extend beyond economic growth. Targeted programs like weather-indexed crop insurance or increased access to credit and savings could in fact help slow the spread of HIV by making agricultural households less sensitive to weather-based income shocks and less likely to turn to risky behaviors to supplement their incomes. Not only would this be an important health benefit, it would also spur further economic development in the region by reducing the amount of labor lost to illness and death. 

By: Sara Gustafson, IFPRI

Photo credit:Flickr: Jon Rawlinson