Mental health is globally underfunded. In low-income settings, innovative and layman solutions may constitute alternatives to formal medical systems. We evaluate an innovative program training hairdressers to act as first responders to manifestations of mental health issues. 73 hairdressers were trained in active listening. We find some evidence that the training improved hairdresser-customer interactions, but found no effect on the mental health of customers. We also found that training worsened mental health outcomes for hairdressers, and speculate that this has to do with reduced stigma and improved self-evaluative capacities, showing that both customers and hairdressers updated their beliefs about mental health. These results suggest that training alone in a context with stigma and poor mental health awareness may not be enough to measurably improve mental health outcomes, and future similar interventions may want to consider combining training with subsidized access to care, at least in an initial phase.

A novel coronavirus disease 2019 (COVID-19) has spread to all regions of the world. There is great uncertainty regarding how countries’ characteristics will affect the spread of the epidemic; to date, there are few studies that attempt to predict the spread of the epidemic in African countries. In this paper, we investigate the role of demographic patterns, urbanisation and comorbidities on the possible trajectories of COVID-19 in Ghana, Kenya and Senegal. We use an augmented deterministic Susceptible-Infected-Recovered model to predict the true spread of the disease, under the containment measures taken so far. We disaggregate the infected compartment into asymptomatic, mildly symptomatic and severely symptomatic to match observed clinical development of COVID-19. We also account for age structures, urbanisation and comorbidities (HIV, tuberculosis, anaemia). In our baseline model, we project that the peak of active cases will occur in July, subject to the effectiveness of policy measures. When accounting for the urbanisation, and factoring in comorbidities, the peak may occur between 2 June and 17 June (Ghana), 22 July and 29 August (Kenya) and, finally, 28 May and 15 June (Senegal). Successful containment policies could lead to lower rates of severe infections. While most cases will be mild, we project in the absence of policies further containing the spread, that between 0.78% and 1.03%, 0.61% and 1.22%, and 0.60% and 0.84% of individuals in Ghana, Kenya and Senegal, respectively, may develop severe symptoms at the time of the peak of the epidemic. Compared with Europe, Africa’s younger and rural population may modify the severity of the epidemic. The large youth population may lead to more infections but most of these infections will be asymptomatic or mild, and will probably go undetected. The higher prevalence of underlying conditions must be considered.

What is the impact of foreign aid-funded HIV-prevention programs on the testing decision? Since the 1990s, Malawi has successfully fought HIV, yet it has the 6th HIV prevalence rate (2019) and the 10th HIV incidence rate (2016) worldwide. This empirical paper studies the impact of exposure to a prevention program on screening decision. It matches foreign aid-funded HIV-prevention programs implemented between 1997 and 2017 (AidData and Ministry of Finance of Malawi) to 92,310 respondents from four Demographic and Health Survey (DHS) waves. It finds that exposure to HIV-prevention programs has not increased the likelihood of getting tested. Instead, it has decreased the likelihood of being tested by 3 percent between 2004 and 2010. This impact varies according to the intensity of exposure. The analysis of mechanisms suggests that foreign-funded HIV-prevention programs would have increased stigma without any impact on the level of knowledge about HIV, which was already high. The negative impact is stronger for men than women, encouraging further investigation into the “HIV testing burden” among couples.