{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T05:07:31Z","timestamp":1783832851647,"version":"3.55.0"},"reference-count":70,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Economics"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Syphilis, a sexually transmitted infection that can lead to serious health complications, was almost eliminated in the United States by 2000. But since then, its incidence began to increase, recently reaching a 60\u2010year peak. We suggest that the introduction of the highly active antiretroviral therapy (HAART) drug regimen, which transformed HIV from a terminal condition into a manageable chronic disease, is partly responsible, as people living with and without HIV altered their sexual behavior after the introduction of HAART. To test this empirically, we exploit variation in HAART takeup based on spatial variation in pre\u2010HAART AIDS prevalence, sex, and time in a triple differences framework. We find that a one standard deviation increase in the pre\u2010HAART AIDS prevalence rate led to a 17.8 percent increase in the syphilis incidence rate, and that in the absence of HAART, there would have been 81 percent fewer syphilis cases between 1996 and 2008. These results highlight the need to consider unintended consequences that could stem from behavioral changes following the introduction of life\u2010saving medical innovations.<\/jats:p>","DOI":"10.1002\/hec.70100","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T07:01:49Z","timestamp":1776841309000},"page":"1118-1130","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unintended Consequences of Life\u2010Saving Pharmaceutical Innovations: How HAART Led to the Resurgence of Syphilis"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7125-0627","authenticated-orcid":false,"given":"David","family":"Beheshti","sequence":"first","affiliation":[{"name":"Department of Economics University of Texas at San Antonio  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0602-2089","authenticated-orcid":false,"given":"Scott","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Department of Economics Baylor University  Waco Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Eilam","sequence":"additional","affiliation":[{"name":"Department of Economics University of North Carolina at Greensboro  Greensboro North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.0272"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/qad.0b013e32832b7dca"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.3944"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000112721.21285.a2"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","unstructured":"Callaway B. A.Goodman\u2010Bacon andP. H. C.Sant\u2019Anna \u201cDifference\u2010In\u2010Differences With a Continuous Treatment \u201d Technical Report National Bureau of Economic Research2024.","DOI":"10.2139\/ssrn.4716682"},{"key":"e_1_2_11_7_1","unstructured":"CDC.1993\u20102006.Behavioral Risk Factor Surveillance System Survey Data."},{"key":"e_1_2_11_8_1","unstructured":"CDC.1995a. \u201cHIV\/AIDS Surveillance Report \u201d5 no.4."},{"key":"e_1_2_11_9_1","unstructured":"CDC.1995b. \u201cHIV\/AIDS Surveillance Report \u201d7 no.2."},{"issue":"6","key":"e_1_2_11_10_1","first-page":"121","article-title":"Update: Mortality Attributable to HIV Infection Among Persons Aged 25\u201044 Years\u2013United States, 1994","volume":"45","author":"CDC","year":"1996","journal-title":"MMWR. Morbidity and mortality weekly report"},{"key":"e_1_2_11_11_1","unstructured":"CDC.2008a.Historical Sexually Transmitted Infections Data: (Received by special request)."},{"issue":"31","key":"e_1_2_11_12_1","first-page":"845","article-title":"Persons Tested for HIV \u2014 United States, 2006","volume":"57","author":"CDC","year":"2008","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"e_1_2_11_13_1","unstructured":"CDC.2020. \u201cSyphilis Elimination Communication Plan.\u201d Accessed on Apr 16 2024.https:\/\/www.cdc.gov\/stopsyphilis\/syphelimcommplanall.pdf."},{"key":"e_1_2_11_14_1","unstructured":"CDC.2022. \u201cIncidence Prevalence and Cost of Sexually Transmitted Infections in the United States.\u201d Accessed on Mar 6 2024.https:\/\/www.cdc.gov\/nchhstp\/newsroom\/fact\u2010sheets\/std\/STI\u2010Incidence\u2010Prevalence\u2010Cost\u2010Factsheet.html."},{"key":"e_1_2_11_15_1","unstructured":"CDC.2023a. \u201cHIV Treatment as Prevention.\u201d Accessed on May 22 2024.https:\/\/www.cdc.gov\/hiv\/risk\/art\/index.html."},{"key":"e_1_2_11_16_1","unstructured":"CDC.2023b. \u201cSyphilis \u2013 CDC Detailed Fact Sheet.\u201d Accessed on Apr 16 2024.https:\/\/www.cdc.gov\/std\/syphilis\/stdfact\u2010syphilis\u2010detailed.htm."},{"key":"e_1_2_11_17_1","unstructured":"CDC.2024a.NCHHSTP Atlasplus. Accessed on Apr 16 2024.https:\/\/www.cdc.gov\/nchhstp\/atlas\/index.htm."},{"key":"e_1_2_11_18_1","unstructured":"CDC.2024b. \u201cSexually Transmitted Infections Surveillance 2022 \u201d Accessed on Apr 16 2024.https:\/\/www.cdc.gov\/std\/statistics\/2022\/default.htm."},{"key":"e_1_2_11_19_1","unstructured":"CDC.2024c. \u201cU.S. STI Epidemic Showed No Signs of Slowing in 2021 \u2013 Cases Continued to Escalate.\u201d Accessed on Jun 2 2024.https:\/\/www.cdc.gov\/media\/releases\/2023\/s0411\u2010sti.html."},{"key":"e_1_2_11_20_1","unstructured":"CDC National Center for Health Statistics.2003. \u201cNational Vital Statistics System Mortality: Compressed Mortality File 1979\u20131998.\u201dhttp:\/\/wonder.cdc.gov\/cmf\u2010icd9.html."},{"key":"e_1_2_11_21_1","unstructured":"CDC National Center for Health Statistics.2021. \u201cNational Vital Statistics System Mortality 1999\u20132020 on CDC WONDER Online Database.\u201d.http:\/\/wonder.cdc.gov\/ucd\u2010icd10.html."},{"key":"e_1_2_11_22_1","unstructured":"CDC National Center for Health Statistics.2024. \u201cNational Vital Statistics System Mortality 2018\u20132023 on CDC WONDER Online Database.\u201dhttp:\/\/wonder.cdc.gov\/ucd\u2010icd10\u2010expanded.html."},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/restud\/rdv053"},{"key":"e_1_2_11_24_1","unstructured":"Chandra A. V. G.Billioux C. E.Copen A.Balaji andE.DiNenno.2012.HIV Testing in the U.S. Household Population Aged 15\u201344: Data from the National Survey of Family Growth 2006\u20132010. Accessed: 2025\u201008\u201010."},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478\u20107547\u20106\u201010"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/olq.0000000000001380"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix326"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1105243"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25355"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.2.224"},{"key":"e_1_2_11_31_1","unstructured":"Davern M. R.Bautista J.Freese P.Herd andS. L.Morgan.2024.\u201cGeneral Social Survey 1972\u20102024 \u201d gssdataexplorer.norc.org. Accessed on Dec 1 2024."},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/olq.0000000000001101"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6613a1"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1257\/aer.20220089"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1086\/719588"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000180571.48799.8d"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu602"},{"key":"e_1_2_11_38_1","volume-title":"Prep and Moral Hazard","author":"Eilam N.","year":"2022"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2005.04.004"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/jleo\/ewae010"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.91.6.959"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126334\u2010200501010\u201000017"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(08)61697\u20109"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/olq.0b013e3181ca3c0a"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2005.070417"},{"key":"e_1_2_11_46_1","unstructured":"HIVinfo.2024. \u201cFDA Approval of HIV Medicines.\u201d Accessed on Apr 18 2024.https:\/\/hivinfo.nih.gov\/understanding\u2010hiv\/infographics\/fda\u2010approval\u2010hiv\u2010medicines."},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000243090.32866.4e"},{"key":"e_1_2_11_48_1","volume-title":"HIV Drug Data","author":"IMS Health","year":"2008"},{"key":"e_1_2_11_49_1","volume-title":"\u201cHIV Testing in the United States,\u201d Fact Sheet","author":"Kaiser Family Foundation","year":"2024"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6806a4"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2005.045567"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1162\/qjec.121.3.1063"},{"key":"e_1_2_11_53_1","unstructured":"Levine R.2024.Syphilis is a Public Health Priority. Accessed on May 20 2024.https:\/\/www.hhs.gov\/blog\/2024\/04\/19\/syphilis\u2010public\u2010health\u2010priority.html."},{"key":"e_1_2_11_54_1","unstructured":"Levy M.2024. \u201cDiscovery of Highly Active Antiretroviral Therapy for HIV.\u201d Accessed on Apr 18 2024.https:\/\/www.acs.org\/education\/whatischemistry\/landmarks\/highly\u2010active\u2010antiretroviral\u2010therapy\u2010hiv.html."},{"key":"e_1_2_11_55_1","unstructured":"NCSD.2024. \u201cOut\u2010Of\u2010Control STI Epidemic Continues to Put Lives at Risk.\u201d Accessed on May 20 2024.https:\/\/www.ncsddc.org\/out\u2010of\u2010control\u2010sti\u2010epidemic\u2010continues\u2010to\u2010put\u2010lives\u2010at\u2010risk\/."},{"key":"e_1_2_11_56_1","unstructured":"NIAID NIH.2018.Antiretroviral Drug Discovery and Development."},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1093\/ectj\/utac010"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens11121546"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461\u2010013\u20100566\u20101"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1586\/14787210.2015.990384"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0277\u20109536(96)00258\u20104"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejm200003303421303"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1093\/restud\/rdad018"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007435\u2010200307000\u201000006"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(00)04007\u20101"},{"key":"e_1_2_11_66_1","unstructured":"Shahid H.2023.An Antidote for Despair: The Effect of Highly Active Antiretroviral Therapy (HAART) on Suicide Rates."},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clindermatol.2013.08.005"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1071\/sh14174"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.4414\/bms.2008.13252"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.1097\/olq.0b013e31824018b5"},{"key":"e_1_2_11_71_1","unstructured":"World Health Organization.2024.Syphilis. Accessed on Dec 23 2024.https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/syphilis."}],"container-title":["Health Economics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hec.70100","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hec.70100","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hec.70100","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T04:48:45Z","timestamp":1783831725000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hec.70100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":70,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/hec.70100"],"URL":"https:\/\/doi.org\/10.1002\/hec.70100","archive":["Portico"],"relation":{},"ISSN":["1057-9230","1099-1050"],"issn-type":[{"value":"1057-9230","type":"print"},{"value":"1099-1050","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]},"assertion":[{"value":"2025-01-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}