Susan Godlonton

Responding to Risk: Circumcision, Information, and HIV Prevention

Understanding behavioral responses to changes in actual or perceived risk is important because risk-reduction goals can be undermined by risk-compensating behavior. This paper examines the response to new information about the risk of HIV infection. Approximately 1,200 circumcised and uncircumcised men in rural Malawi are randomly informed that male circumcision reduces the HIV transmission rate, predicting asymmetric behavioral responses. We find no evidence that the information induces circumcised men to engage in riskier sex while uncircumcised men practice safer sex in response to the information. There were no significant effects of the information on child circumcisions after one year.

Employment Risk and Job-Seeker Performance

Using detailed labor recruitment data in combination with randomized variation in individuals’ outside job opportunities, I show that providing job certainty during recruitment leads to substantial job-seeker performance gains. Job-seeker performance is highest and effort lowest among those assigned to receive a guaranteed outside job offer (where employment risk is eliminated), while performance is lowest and effort highest among those receiving no chance of an outside job offer. Performance among those assigned uncertain outside job offers consistently lies between the two extremes. I conjecture that the pattern of results is most consistent with stress-induced performance reductions attributable to job uncertainty. I rule out several other competing theories.

Perceptions of Male Circumcision among Married Couples in Rural Malawi

Voluntary medical male circumcision (VMMC) is being suggested as an essential HIV prevention strategy in high-prevalence areas. These analyses reflect data collected from 360 married couples, 50% of which included a circumcised husband and the other 50% uncircumcised, in rural Malawi. Regardless of their circumcision status, men were more likely to perceive that being circumcised was less painful than having a tooth pulled, giving birth, and having malaria. Men reported having the same sexual pleasure regardless of the circumcision status, while women were 2.0 times more likely to report greater sexual pleasure with a circumcised partner. Participants identified the medical benefits of VMMC and highlighted the potential personal benefits of VMMC. As VMMC has become a promising method of HIV prevention, this study revealed opportunities for intervention development to increase rates of VMMC among men.

Anchoring Bias in Recall Data: Evidence from Central America

&NA; Self‐reported retrospective survey data is widely used in empirical work but may be subject to cognitive biases, even over relatively short recall periods. This paper examines the role of anchoring bias in self‐reports of objective and subjective outcomes under recall. We use a unique panel‐survey dataset of smallholder farmers from four countries in Central America collected over a period of three years. We exploit differences between recalled and concurrent responses to quantify the degree of mental anchoring in survey recall data. We assess whether respondents use their reported value for the most recent period as a cognitive heuristic when recalling the value from a previous period, while controlling for the value they reported earlier. The results show strong evidence of sizeable anchoring bias in self‐reported retrospective indicators for both objective measures (income, wages, and working hours) and subjective measures (reports of happiness, health, stress, and well‐being). We also generally observe a larger bias in response to negative changes for objective indicators and a larger bias in response to positive changes for subjective indicators.

Measuring Postharvest Losses at the Farm Level in Malawi

Reducing food loss and waste are important policy objectives prominently featured in the United Nation’s Sustainable Development Goals. To optimally design interventions targeted at reducing losses, it is important to know where losses are concentrated between the farm and fork. This paper measures farmlevel postharvest losses for three main crops—maize, soy, and groundnuts—among 1,200 households in Malawi. Farmers answered a detailed questionnaire designed to learn about losses during harvest and transport, processing, and storage and which measures both total losses and reductions in crop quality. The findings indicate that fewer than half of households report suffering losses conditional on growing each crop. In addition, conditional on losses occurring, the loss averages between 5 and 12 percent of the farmer’s total harvest. Compared to nationally representative data that measure losses using a single survey question, this study documents a far greater percentage of farmers experiencing losses, though the unconditional proportion lost is similar. We find that losses are concentrated in harvest and processing activities for groundnuts and maize; for soy, they are highest during processing. Existing interventions have primarily targeted storage activities; however, these results suggest that targeting other activities may be worthwhile.

Medical male circumcision: How does price affect the risk-profile of take-up? ☆

OBJECTIVE The benefit of male circumcision is greatest among men who are most at risk of HIV infection. Encouraging this population of men to get circumcised maximizes the benefit that can be achieved through the scale-up of circumcision programs. This paper examines how the price of circumcision affects the risk profile of men who receive a voluntary medical circumcision. METHODS In 2010, 1649 uncircumcised adult men in urban Malawi were interviewed and provided a voucher for a subsidized voluntary medical male circumcision, at randomly assigned prices. Clinical data were collected indicating whether the men in the study received a circumcision. RESULTS Men who took-up circumcision with a zero-priced voucher were 25 percentage points less likely than those who took-up with a positive-price voucher, to be from a tribe that traditionally circumcises (p=0.101). Zero-priced vouchers also brought in men with more sexual partners in the past year (p=0.075) and past month (p=0.003). None of the men who were most at risk of HIV at baseline (those with multiple partners and who did not use a condom the last time they had sex) received a circumcision if they were offered a positive-priced voucher. Lowering the price to zero increased circumcision take-up to 25% for men of this risk group. The effect of price on take-up was largest among those at highest risk (p=0.096). CONCLUSIONS Reducing the price of circumcision surgery to zero can increase take-up among those who are most at risk of HIV infection.

Geospatial analysis of condom availability and accessibility in urban Malawi.

Prevalence of HIV in sub-Saharan African countries persists at alarming rates. There are currently four promoted methods to prevent HIV infection: adherence to antiretroviral therapy, male circumcision, pre-exposure prophylaxis and use of condoms. This study aimed to assess the availability and accessibility of one of the prevention efforts, condoms, in Kawale, Lilongwe, Malawi. A total of 220 potential condom-selling establishments were surveyed in 2012. Data were collected with store owners or staff and locations were geocoded to assess store density. Descriptive analyses were conducted. Of those audited, 96 stores sold condoms, 13 of which distributed free condoms. The stores were most often small shops and located in markets or trading centres. Condoms were most often found at the back of the store in an open space. There were approximately 1.2 stores per ¼ mile; 44% of the businesses in the study region carried condoms. This one method of prevention exhibited multiple barriers in this region: few stores sold condoms, high costs, condom locations within stores and limited availability. The limited accessibility is likely to influence social norms surrounding condom use. Future research should incorporate assessing norms and addressing barriers to uptake of HIV prevention efforts.