Refusal Bias in the Estimation of HIV Prevalence

Wendy Janssens, Jacques Gaag (), Tobias Rinke de Wit () and Zlata Tanović ()

Demography, 2014, vol. 51, issue 3, 1157 pages

Abstract: In 2007, UNAIDS corrected estimates of global HIV prevalence downward from 40 million to 33 million based on a methodological shift from sentinel surveillance to population-based surveys. Since then, population-based surveys are considered the gold standard for estimating HIV prevalence. However, prevalence rates based on representative surveys may be biased because of nonresponse. This article investigates one potential source of nonresponse bias: refusal to participate in the HIV test. We use the identity of randomly assigned interviewers to identify the participation effect and estimate HIV prevalence rates corrected for unobservable characteristics with a Heckman selection model. The analysis is based on a survey of 1,992 individuals in urban Namibia, which included an HIV test. We find that the bias resulting from refusal is not significant for the overall sample. However, a detailed analysis using kernel density estimates shows that the bias is substantial for the younger and the poorer population. Nonparticipants in these subsamples are estimated to be three times more likely to be HIV-positive than participants. The difference is particularly pronounced for women. Prevalence rates that ignore this selection effect may be seriously biased for specific target groups, leading to misallocation of resources for prevention and treatment. Copyright Population Association of America 2014

Keywords: HIV prevalence; Population-based survey; Refusal bias; Heckman selection model; Namibia (search for similar items in EconPapers)
Date: 2014
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (6)

Downloads: (external link)
http://hdl.handle.net/10.1007/s13524-014-0290-0 (text/html)
Access to full text is restricted to subscribers.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:spr:demogr:v:51:y:2014:i:3:p:1131-1157

Ordering information: This journal article can be ordered from
http://www.springer.com/economics/journal/13524

DOI: 10.1007/s13524-014-0290-0

Access Statistics for this article

Demography is currently edited by John D. Iceland, Stephen A. Matthews and Jenny Van Hook

More articles in Demography from Springer, Population Association of America (PAA)
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().