Fertility and HIV risk in Africa

Abstract

This paper examines the role of social and cultural norms regarding fertility in women's HIV risk in Sub-Saharan Africa. Fertility is highly valued in most African societies, and premarital fertility is often encouraged to facilitate marriage. This incentivizes unprotected premarital sex and escalates HIV risk. I build a rich lifecycle model linking women's decisions concerning sex, fertility and education to HIV infection and calibrate it to match Kenyan data. Quantitative results show that premarital fertility motives account for 13 percent of HIV prevalence among young Kenyan women and that a combination of fertility motives and contraception cost accounts for nearly one-third of this prevalence. Various policies are evaluated. While an HIV treatment subsidy would reduce HIV prevalence to the greatest extent, its effectiveness would be severely mitigated by increased risky sex.