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Internet’s Dirty Secret:

This study examines the impact of Craigslist's entry on HIV prevalence, quantifying the increase in cases and exploring the causal mechanisms. It provides insights for policy formulation by healthcare authorities and internet governance.

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Internet’s Dirty Secret:

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  1. Internet’s Dirty Secret: Assessing the Impact of Online Intermediaries on HIV Transmission Jason Chan New York UniversityStern School of Business • AnindyaGhoseNew York UniversityStern School of Business

  2. Craigslist: Suspect for Raising HIV Trends • Craigslist - classified ads for housing, jobs, items, and personals • Abundant with casual hook ups ads • Major expansion in US: 2000-2005 • Coincided with increase in HIV trends

  3. CL Usage and HIV Prevalence

  4. Study Highlights • Craigslist’s (CL) entry results in 39.5% increase in HIV: approximately 369 new HIV cases/year in a state • Increase in HIV as a result of entry is related to $39.9M to $52.3M worth of annual treatment costs • Every 125 to 164 ads posted lead to one reported case of HIV • Analyses show that increase in HIV is not due to better diagnosis: rate of HIV testing did not increase during the study period • Increase in HIV is attributed to the non-market casual hookups and not market related sexual transactions

  5. Research Question and Goals • The HIV epidemic is a major health concern • Entry of sites may undermine efforts • Assess whether CL’s entry is related to HIV • Quantify entry impact on societal level of HIV prevalence • Understand whether entry leads to actual increase in HIV cases • Unpack casual mechanisms between entry and HIV trends • Provide inputs for policy formulation • Healthcare authorities • Internet governance

  6. Literature Review Online Intermediation Physical Venue Newspaper Online platforms (CL) • No spatial & temporal constraints • Low search costs: Free posting & browsing • Large variety of choices • Need to be physical present at a specific time • Travel cost, effort to solicit, Rejection costs • Variety depends on the day & maybe your luck • Takes long time to post and receive replies • Posting costs, additional • effort to solicit information • Smaller variety of choices compared to free online ads

  7. Literature Review • Related to emerging work examining the link between technology and health/medical related outcomes • Electronic medical records improve neo-natal outcomes (Miller and Tucker, 2011) • Whether online physician ratings reflects physician quality (Gao et al. 2012) • Literature on the interconnectedness of between online activity and markets • Craigslist’s entry results in decline in newspaper circulation share and a shift in advertisers’ pricing strategy (Seamans and Zhu 2012) • Online reviews and pictures of male sex workers affect the prices solicited by workers positively (Logan and Shah 2012)

  8. Data • Created a 11-year panel from 1998 to 2008 for 33 states • HIV data: HIV Surveillance Reports via CDC • Craigslist entry: Craigslist Factsheet/Archive.org • Binary indicator and no. of personal ads (~1.1M ads) • Controls • Age, population size, ethnicity, gender: Surveillance Epidemiology and End Result (SEER) • Income level, Education attainment: U.S. Census • HIV testing trends: Behavioral Risk Factor Surveillance System (BRFSS) via CDC

  9. Empirical Approach • CL enters different states at different periods • Exploit the variation across states and years in natural experiment setting • Difference-in-difference approach (Jin and Leslie 2003; Dranove et al. 2003) • Model specification:

  10. Main Results: CL Entry on HIV

  11. Falsification Tests using Other Diseases

  12. Exogeneity of CL Entry • CL is a classified ads website with multiple sections: jobs, housing, for sale items, services, community, gigs, resumes • Entry unlikely to be driven by user demand for casual sex partners • CL defrays its costs through posting fees for jobs, brokered apartments and therapeutic services • Entry decisions are likely based on population size • Duration models are used to assess the exogeneity of site entry

  13. Robustness Checks: Hazard Model Predicting CL Entry

  14. Does HIV Testing Affect Main Results?

  15. HIV Causing Mechanisms • Is the increase in HIV trends from non market causal hookups or market related transactions? • Non market: no string attached / novelty sex • Market: Prostitution / Escorts • Erotic Services section was launched in 2003 • Usage levels of erotic section varied across states

  16. Personal Ads and Erotic Ads on HIV

  17. Thank youfor your attention!

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