Working Paper

2015-05-28

University of Cape Town

Poverty may influence HIV risk by increasing vulnerability to economic shocks and thereby preventing key health investments. We explored this by examining the relationship between household shocks and the timing of traditional male circumcision, a practice associated with considerable expense and whose HIV‐prevention benefits are larger when done earlier, even within young adulthood. Using unique data on a sample of Xhosa men, a group that almost universally practice traditional circumcision, we found that respondents in the poorest households delayed circumcision by two years if a household member experienced loss of income or death and/or illness. The impact of these shocks declined with increasing household income. Our findings suggest that interventions that work to mitigate the impact of shocks among the poor may be useful in HIV prevention efforts. More generally, they illustrate that the relationship between HIV and wealth may be more nuanced than assumed in previous work.

Sources of Support: The Cape Area Panel Study was supported by the United States National Institute for Child Health and Human Development, the Andrew W. Mellon Foundation, the National Institute on Aging, the Health Economics & HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal, and the European Union.

Acknowledgements We would like to thank Cally Ardington, Murray Leibbrandt, Nicoli Nattrass, Vimal Ranchhod, Jeremy Seekings, and seminar participants at the Center for Social Science Research in Cape Town, South Africa for useful comments and suggestions on an earlier version of this work. Brendan Maughan-Brown is grateful for funding from the NRF Research Chair in Poverty and Inequality Research for his Postdoctoral Research Fellowship. Atheendar Venkataramani is grateful for the Massachusetts General Hospital Department of Medicine Global Primary Care and Center for Global Health for supporting research and travel to South Africa. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All errors are our own.