Male Circumcision and AIDS: The Macroeconomic Impact of a Health Crisis
Eric D. Werker, Amrita Ahuja, and Brian Wendell
Theories abound on the potential macroeconomic impact of AIDS in Africa, yet there have been surprisingly few empirical studies to test the mixed theoretical predictions. In this paper, we examine the impact of the AIDS epidemic on African nations through 2002 using the male circumcision rate to identify plausibly exogenous variation in HIV prevalence. Medical researchers have found significant evidence that male circumcision can reduce the risk of contracting HIV. We find that national male circumcision rates for African countries are both a strong predictor of HIV/AIDS prevalence and uncorrelated with other determinants of economic outcomes. Two-stage least squares regressions do not support the hypotheses that AIDS has had any measurable impact on economic growth, savings, or fertility behavior in African nations. However we do find weak evidence that AIDS has led to a slow-down in education gains, as measured by youth literacy, and a rise in poverty, as measured by malnutrition.
2 comments:
If circumcision significantly prevented HIV/AIDS, the points on those graphs would fall in a line running from top left to bottom right, and the points in the second graph, after the corrections had been made, would cluster more closely along the line than the first. Instead, there's a LOT of scatter (and not much less in the second graph), suggesting the correlation is not all that good.
It may be that circumcision does reduce the rate of HIV/AIDS transmission somewhat, just because there's now less surface area involved. The three much-touted random controlled trials were led by circumcision-enthusiasts; they were unblinded so there could easily be experimenter and experimentee effects (miscounting in the desired direction); there was a high dropout rate, 45% in Kenya (with the circumcised men who got HIV doubtless being the most disillusioned and least likely to come back). So the 50-60% reduction claimed from the trials (much less than condoms) is unlikely to be achieved in mass circumcision campaigns. The money and effort would be better spent on other health care. In particular, infant circumcision would be poor economy when the infant mortality rate is so high.
What a striking visualisation of the protective effect of circumcision!
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