Subjective expectations in the context of HIV/AIDS in Malawi

Abstract

In this paper we present a newly developed interactive elicitation methodology for collecting probabilistic expectations in a developing country context with low levels of literacy and numeracy, and we evaluate the feasibility and success of this method for a wide range of outcomes in rural Malawi. We find that respondents’ answers about their subjective expectations take into account basic properties of probabilities, and vary meaningfully with observable characteristics and past experience. From a substantive point of view, the elicited expectations indicate that individuals are generally aware of differential risks. For example, individuals with lower incomes and less land rightly feel at greater risk of financial distress than people with higher socioeconomic status (SES), and people who are divorced or widowed rightly feel at greater risk of being infected with HIV than currently married individuals. Meanwhile many expectations—including the probability of being currently infected with HIV—are well-calibrated compared to actual probabilities, but mortality expectations are substantially overestimated compared to life table estimates. This overestimation may lead individuals to underestimate the benefits of adopting HIV risk-reduction strategies. The skewed distribution of expectations about condom use also suggests that a small group of innovators are the forerunners in the adoption of condoms within marriage for HIV prevention.

HIV/AIDS-related Expectations and Risky Sexual Behaviour in Malawi

“…2 In this paper, we use data on probabilistic expectations about a wide range of events that we have collected as part of the 2006 wave of the Malawi Longitudinal Study of Families and Health (MLSFH, Kohler et al, 2014) covering more than 3,000 adult respondents in rural Malawi. 3 In Delavande and Kohler (2009), we find that respondents from Malawi provide meaningful expectations in probabilistic format according to various criteria: most respondents provide probabilities that are consistent with basic properties of probability theory, the subjective expectations are systematically correlated with observable characteristics (such as gender, age, education, and region of residence) in the same way that actual outcomes vary with these variables, and expectations about future events vary across individuals in the same way as individuals' past experience does. Yet, respondents exhibit a lot of heterogeneity in expectations.…”

“…Delavande and Kohler (2009) Nevertheless, 14% of the sample was not found by the team of nurses at the second visit, and were therefore not offered a test (see Table 1). …”

“…technique for subjective expectations that was based on asking respondents to allocate up to ten beans on a plate to express the likelihood that an event will be realized (Delavande and Kohler, 2009). Interviewers introduced the interactive elicitation technique with a short introduction (see Appendix B).…”

Perceived risk of HIV infection and mental health in rural Malawi

“…The respondent's answers to the question can be interpreted as subjective probabilities. This measurement has been demonstrated to be valid in rural Malawi, where levels of literacy and numeracy are low (Delavande and Kohler 2009). Figure 2 presents Men more than three beans.…”

“…When access to HIV testing is limited or there are doubts about its accuracy, individuals use heuristics to assess their HIV status according to their sexual behavior and that of their partner, incomplete knowledge about the disease, and/or observations about the AIDS mortality rate in their community (Kohler, Behrman, and Watkins 2007;Watkins 2004). Because subjective assessments are often biased, particularly in the direction of overestimating the risk of infection when an individual's actual HIV status is negative Delavande and Kohler 2009), false concerns and worries about being infected may lead to a deterioration of mental well-being. Previous research, although mostly based on Western societies, indicates that individuals' uncertainty and fear of contracting HIV increase their levels of anxiety (Brashers et al 1998;Weitz 1989).…”