81472 enGender Impact: The World Bank’s Gender Impact Evaluation Database The Economic Impact of AIDS Treatment: Labor Supply in Western Kenya Author(s) Harsha Thirumurthy, Joshua Graff Zivin and Markus Goldstein Contact mgoldstein@worldbank.org Country Kenya Organizing Theme Health, Economic Opportunities and Access to Assets Status Completed Intervention Category Antiretroviral Treatment Sector Health, Nutrition & Population Using longitudinal survey data collected in collaboration with a treatment program, this paper estimates the economic impacts of antiretroviral treatment. The responses in two outcomes are studied: (1) labor supply of treated adult AIDS patients; and (2) labor supply of individuals in patients’ households. Within six months after treatment initiation, there is Abstract a 20 percent increase in the likelihood of the patient participating in the labor force and a 35 percent increase in weekly hours worked. Young boys in treated patients’ households work significantly less after treatment initiation, while girls and adult household members do not change their labor supply. Gender Connection Gender Focused Intervention Gender Outcomes Reproductive health, female labor force participation IE Design Difference in Difference This paper uses survey data from Kenya to examine the impact of (free) antiretroviral (ARV) treatment on the time allocated to various household tasks by treated HIV-positive Intervention patients and their household members. An increase in funding in late 2003 enabled the Mosoriot HIV clinic to grow rapidly with the number of patients rising from 150 to 3714. Intervention Period Late 2003- present The survey sample contains two different groups of households. The first group comprises 503 households chosen randomly from a census of all households in Kosirai Division without a patient receiving HIV/AIDS treatment (AMPATH). The second group Sample population comprises 200 households that were chosen at the clinic and contained at least one adult HIV-positive AMPATH patient who began receiving ARV therapy (ARV households) prior to Round 2. The study compares the difference in the labor supply changes between adults who receive Comparison conditions ARV treatment, and a random sample of adults who do not have AIDS and do not receive ARV treatment. Unit of analysis Individual Level Evaluation Period March 2004-Feb2005; There were 6 months in between each survey round Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database Provision of ARV therapy leads to a large and significant increase in the labor supply of AIDS patients. This increase occurs very soon after the initiation of ARV therapy: within six months, there is a 20 percent increase in the likelihood of participating in the labor force and a 35 percent increase in hours worked during the past week. For women, there is a large and significant increase of 20.8 percentage points in the labor force participation rate, but no significant increase in weekly hours worked. Combining these results with baseline observations provides an intuitive explanation for this pattern. Since men have high levels of baseline participation to begin with, most of their response to improved health takes the form of additional hours worked. For women, baseline participation is low, so labor supply is the natural margin for change. For other household members, soon after Results initiation of ARV treatment for adult patients, there is a negative but insignificant change in the labor force participation rates of adults in the patients’ households. For women in these households, the decline in labor supply is greater but not significant. The paper finds that the labor supply of younger boys in patients’ households declines after the initiation of ARV therapy. In multiple patient households, both younger and older boys, as well as other adults in the household, work less after patients receive treatment (Girls do not significantly change their labor supply, regardless of age). The effects on the labor supply of younger children are particularly important since they suggest, among other things, potential schooling impacts from treatment, and the returns to primary school education are especially large in developing countries. It is difficult to measure the total impact of the treatment because there is no control group Primary study limitations of AIDS patients who do not receive treatment. Economic and Social Research Council, Pfizer, The World Bank, Yale University's Center Funding Source for Interdisciplinary Research on AIDS, The National Institute of Mental Health, The Social Science Research Council, and the Calderone Program at Columbia University Thirumurthy, H., Zivin, J. G., & Goldstein, M. (2008). The economic impact of AIDS Reference(s) treatment labor supply in Western Kenya. Journal of Human Resources, 43(3), 511-552. Link to Studies http://jhr.uwpress.org/content/43/3/511.short Microdata Last updated: 14 August 2013 2