Impact of legislation for infectious disease control: evidence from HIV testing in Mali

Abstract This study examines the impact of human immunodeficiency virus (HIV)-specific laws criminalizing HIV non-disclosure, exposure, and transmission on voluntary testing, focusing on the role of HIV stigma. HIV criminalization signals state endorsement of discrimination against HIV-positive individuals, thereby amplifying stigma. I use a regression discontinuity design that exploits the enactment timing of legislation in Mali during a household survey offering voluntary HIV testing, where family members could infer who was tested and speculate that those tested were HIV-positive. Following the legislation, women’s testing uptake declined, especially in rural areas, with stronger effects among those with radios and without completed formal education. Women, being economically dependent on men, are vulnerable to HIV-related mistreatment from family members. Therefore, fear of being considered seropositive by family members might have more strongly discouraged women’s testing uptake compared with men’s.