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We investigate the impact of a randomised information intervention about population-level mortality on health investment and subjective health expectations. Our focus is on risky sex in a high-HIV-prevalence environment. Treated individuals are less likely to engage in risky sexual practices one year after the intervention, with, for example, an 8% increase in abstinence. We collected detailed data on individuals' subjective expectations about their own and population survival, as well as other important health outcomes. Our findings emphasise the significance of integrating subjective expectation data in field experiments to identify the pathways that lead to behavioural change. [ABSTRACT FROM AUTHOR]

Child marriage has adverse consequences for young girls. Cross-sectional research has highlighted several potential drivers of early marriage. We analyse drivers of child marriage using longitudinal data from rural Malawi, where rates of child marriage are among the highest in the world despite being illegal. Estimates from survival models show that 26% of girls in our sample marry before age 18. Importantly, girls report high decision-making autonomy vis-à-vis the decision to marry. We use multivariate Cox proportional hazard models to explore the role of 1) poverty and economic factors, 2) opportunity or alternatives to marriage, 3) social norms and attitudes, 4) knowledge of the law and 5) girls’ agency. Only three factors are consistently associated with child marriage. First, related to opportunities outside marriage, girls lagging in school at survey baseline have significantly higher rates of child marriage than their counterparts who were at or near grade level. Second, related to social norms, child marriage rates are significantly lower among respondents whose caregivers perceive that members of their community disapprove of child marriage. Third, knowledge of the law has a positive coefficient, a surprising result. These findings are aligned with the growing qualitative literature describing contexts where adolescent girls are more active agents in child marriages. [ABSTRACT FROM AUTHOR]

Network-based strategies and competencies are probably even more important in poor societies with limited means of communication and less effective formal structures than in developed economies. And they often deal with life and death matters. This paper presents lessons from and insights about the nature of and the impacts of informal social networks in reducing fertility and coping with HIV/AIDS in Kenya and Malawi based on analyses of quantitative longitudinal data and qualitative data that the authors and their collaborators have been collecting and analyzing for over a decade. Specific lessons include the relevance of social networks and informal interactions for many different domains related to health – and thus life and death – in developing countries, the importance of accounting for the endogeneity of network partners in analyzing network effects, that networks are important even with control for endogeneity, that network effects may be nonlinear, that there may be multiple equilibria, that which networks may either reinforce the status quo or help diffuse new options and behaviors, that both the context (e.g., the degree of market development) and the density of networks matter (possibly interactively), and that multiple approaches, including both qualitative and quantitative analyses, can be informative in providing more in-depth understanding of what networks do and how they function.

Objective: To examine the acceptance of repeat population-based voluntary counselingand testing (VCT) for HIV in rural Malawi.Methods: Behavioral and biomarker data were collected in 2004 and 2006 fromapproximately 3,000 adult respondents. In 2004, oral swab specimens were collected andanalyzed using enzyme-linked immunosorbent assay (ELISA) and confirmatory Westernblot tests while finger-prick rapid testing was done in 2006. We use cross-tabulationswith chi-square tests and significance tests of proportions to determine the statisticalsignificance of differences in acceptance of VCT by year, individual characteristics andHIV risk.Results: First, over 90% of respondents in each round accepted HIV test, despitevariations in testing protocols. Second, the percentage of individuals who obtained theirtest results significantly increased from 67% in 2004 when the results were provided inrandomly selected locations several weeks after the specimens were collected, to 98% in2006 when they were made available immediately within the home. Third, whereas therewere significant variations in the socio-demographic and behavioral profiles of those whowere successfully contacted for a second HIV test, this was not the case for those whoaccepted repeat VCT. This suggests that variations in the success of repeat testing mightcome from contacting the individuals rather than from accepting the test or knowing theresults.Conclusions: Repeat HIV testing at home by trained health care workers from outsidethe local area, and with either saliva or blood, is almost universally acceptable in ruralMalawi, and thus likely to be acceptable in similar contexts.

Network-based strategies and competencies are probably even more important in poor societies with limited means of communication and less effective formal structures than in developed economies. And they often deal with life and death matters. This paper presents lessons from and insights about the nature of and the impacts of informal social networks in reducing fertility and coping with HIV/AIDS in Kenya and Malawi based on analyses of quantitative longitudinal data and qualitative data that the authors and their collaborators have been collecting and analyzing for over a decade. Specific lessons include the relevance of social networks and informal interactions for many different domains related to health – and thus life and death – in developing countries, the importance of accounting for the endogeneity of network partners in analyzing network effects, that networks are important even with control for endogeneity, that network effects may be nonlinear, that there may be multiple equilibria, that which networks may either reinforce the status quo or help diffuse new options and behaviors, that both the context (e.g., the degree of market development) and the density of networks matter (possibly interactively), and that multiple approaches, including both qualitative and quantitative analyses, can be informative in providing more in-depth understanding of what networks do and how they function.

We explore how marital aspirations are related to the sexual behaviors of adolescents and young adults in Malawi, where HIV/AIDS prevalence among adults exceeds 10%. We also consider whether the specter of AIDS is shaping ideals about marriage. By combining survey data (N = 1,087) and in-depth interviews (N = 133) with young Malawians from the Malawi Diffusion and Ideational Change Project, we show that looking for and finding a suitable spouse are linked to sexual behaviors and, thus, HIV risks. Moreover, concerns about contracting HIV are closely tied to the ideal characteristics of a future spouse. Our findings draw long-overdue attention to the importance of marital aspirations in understanding adolescent sexual behaviors and risks in the era of AIDS.