Sex with stitches: assessing the resumption of sexual activity during the postcircumcision wound-healing period.

OBJECTIVES: This study uses observational data collected as part of Zambia's male circumcision program to measure sexual behavior in the postsurgical healing period and to model its influence on HIV transmission for men and their partners. DESIGN/METHODS: From August to October 2010, 248 men about to undergo male circumcision were recruited to participate. Interviews were conducted at baseline and 6 weeks after circumcision, the recommended period of sexual abstinence for complete wound healing. Logistic and Poisson regression models were used to assess risk factors for early resumption of sex. A static-network deterministic transmission model was constructed to assess the impact of the program given early resumption of sex. RESULTS: Twenty-four percent of circumcised men reported resuming sex prior to 6 weeks after surgery. Of men having sex, 46% had sex in the first 3 weeks, 82% reported at least one unprotected sex act, and 37% reported sex with two or more partners. The model estimates that of the 61,000 men circumcised in 1 year, early resumption of sex leads to 69 extra HIV infections (32 among men, 37 among women), but it estimates a net effect of 230 fewer HIV infections in 1 year, predominantly among men. CONCLUSION: Prevalence of risky sexual behavior during wound healing is high and more likely among those reporting risky sexual behaviors at baseline. Nonetheless, the net effect of the male circumcision intervention is beneficial. The impact on women, however, is very sensitive to the prevalence of early resumption of sex.

Are Conditional Cash Transfers Effective in Urban Areas? Evidence from Mexico.

Conditional cash transfer (CCT) programs have spread worldwide as a new form of social assistance for the poor. Previous evaluations of CCT programs focus mainly on rural settings, and little is known about their effects in urban areas. This paper studies the short-term (one- and two-year) effects of the Mexican Oportunidades CCT program on urban children/youth. The program provides financial incentives for children/youth to attend school and for family members to visit health clinics. To participate, families had to sign up for the program and be deemed eligible. Difference-in-difference propensity score matching estimates indicate that the program is successful in increasing school enrollment, schooling attainment and time devoted to homework for girls and boys and in decreasing working rates of boys.

The longer-term effects of human capital enrichment programs on poverty and inequality: Oportunidades in Mexico.

Previous empirical research has shown that Mexico's Oportunidades program has succeeded in increasing schooling and improving health of disadvantaged children. This paper studies the program's potential longer-term consequences for the poverty and inequality of these children. It adapts methods developed in DiNardo, Fortin and Lemieux (1996) and incorporates existing experimental estimates of the program's effects on human capital to analyze how Oportunidades will affect future earnings of program participants. We nonparametrically simulate earnings distributions, with and without the program, and predict that Oportunidades will increase future mean earnings but have only modest effects on poverty rates and earnings inequality.

Effects of school reformon education and labor market performance: Evidence from Chile's universal voucher system.

This paper studies the effects of school reform in Chile, which adopted a nationwide school voucher program along with school decentralization reforms in 1981. Since then, Chile has had a relatively unregulated, competitive market in primary and secondary education. It therefore provides a unique setting in which to study how these reforms affected school attainment and labor market outcomes. This paper develops and estimates a dynamic model of school attendance and work decisions using panel data from the 2002 and 2004 waves of the Encuesta de Protección Social survey. Some individuals in the sample completed their schooling before the voucher reforms were introduced, while others had the option of using the vouchers over part or all of their schooling careers. The impacts of the voucher reform are identified from differences in the schooling and work choices made and earnings returns received by similar aged individuals who were differentially exposed to the voucher system. Simulations based on the estimated model show that the voucher reform significantly increased the demand for private subsidized schools and decreased the demand for both public and nonsubsidized private schools. It increased high school (grades 9-12) graduation rates by 3.6 percentage points and the percentage completing at least two years of college by 2.6 percentage points. Individuals from poor and non-poor backgrounds on average experienced similar schooling attainment gains. The reform also increased lifetime utility and modestly reduced earnings inequality.

Schooling Impacts of Conditional Cash Transfers on Young Children: Evidence from Mexico.

This paper evaluates impacts of Oportunidades, a Mexican conditional cash transfer program, on educational outcomes 5.5 years after program initiation for a group of children who were age 0 to 8 years pre-program. The oldest children within this age range received educational scholarships. The youngest children did not receive the scholarships because they had not yet started the third grade of school (the initial grade for scholarships), but were beneficiaries of the program's health components that included nutritional supplements for children 24 months of age or younger. All of these children also may have benefitted more generally from increased household income resulting from the program. This paper investigates how the program differentially affected younger and older children within this age range and examines whether the early nutritional intervention led to improvements in subsequent educational performance. The program impact estimates are derived from a randomly assigned treatment and control group, which participated for different lengths of time in the program, and from a matched comparison group that had not participated prior to the collection of data in 2003. The empirical findings show positive program impacts on reducing ages at entering school for the younger children as well as on accumulated grades of schooling after 5.5 years of benefits for older children, with estimates implying a 1 percent reduction in the age of entry to primary and an increase in grades of schooling completed to date of about 8 to 9 percent.

Assessing the Impact of a School Subsidy Program in Mexico: Using a Social Experiment to Validate a Dynamic Behavioral Model of Child Schooling and Fertility.

This paper uses data from a randomized social experiment in Mexico to estimate and validate a dynamic behavioral model of parental decisions about fertility and child schooling, to evaluate the effects of the PROGRESA school subsidy program, and to perform a variety of counterfactual experiments of policy alternatives. Our method of validation estimates the model without using post-program data and then compares the model's predictions about program impacts to the experimental impact estimates. The results show that the model's predicted program impacts track the experimental results. Our analysis of counterfactual policies reveals an alternative subsidy schedule that would induce a greater impact on average school attainment at similar cost to the existing program.