Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial
AbstractHIV-prevention strategies have yielded only limited success so far in slowing down the AIDS epidemic. This paper examines novel intervention strategies that use incentives to discourage risky sexual behaviors. Widely-adopted conditional cash transfer programs that offer payments conditioning on easily monitored behaviors, such as well-child health care visits have shown positive impact on health outcomes. Similarly, contingency management approaches have successfully used outcome-based rewards to encourage behaviors that aren’t easily monitored, such as stopping drug abuse. These strategies have not been used in the sexual domain, so we assess how incentives can be used to reduce risky sexual behavior. After discussing theoretical pathways, we discuss the use of sexual-behavior incentives in the Tanzanian RESPECT trial. There, participants who tested negative for sexually transmitted infections are eligible for outcome-based cash rewards. The trial was well-received in the communities, with high enrollment rates and over 90% of participants viewing the incentives favorably. After one year, 57% of enrollees in the “low-value” reward arm stated that the cash rewards “very much” motivated sexual behavioral change, rising to 79% in the “high-value” reward arm. Despite its controversial nature, we argue for further testing of such incentive-based approaches to encouraging reductions in risky sexual behavior.
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Bibliographic InfoPaper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 17865.
Date of creation: Feb 2012
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Publication status: Forthcoming: Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial , Damien de Walque, William H. Dow, Carol Medlin, Rose Nathan. in African Successes: Human Capital , Edwards, Johnson, and Weil. 2014
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- Damien de Walque & William H. Dow & Carol Medlin & Rose Nathan, 2014. "Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial," NBER Chapters, in: African Successes: Human Capital National Bureau of Economic Research, Inc.
- de Walque, Damien & Dow, William H. & Medlin, Carol & Nathan, Rose, 2012. "Stimulating demand for AIDS prevention : lessons from the RESPECT trial," Policy Research Working Paper Series 5973, The World Bank.
- I12 - Health, Education, and Welfare - - Health - - - Health Production
- I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
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- Sarah Baird & Ephraim Chirwa & Craig McIntosh & Berk Özler, 2010.
"The short‐term impacts of a schooling conditional cash transfer program on the sexual behavior of young women,"
John Wiley & Sons, Ltd., vol. 19(S1), pages 55-68, September.
- Baird, Sarah & Chirwa, Ephraim & McIntosh, Craig & Ozler, Berk, 2009. "The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women," Policy Research Working Paper Series 5089, The World Bank.
- Schady, Norbert & Rosero, Jose, 2007.
"Are cash transfers made to women spent like other sources of income?,"
Policy Research Working Paper Series
4282, The World Bank.
- Schady, Norbert & Rosero, José, 2008. "Are cash transfers made to women spent like other sources of income?," Economics Letters, Elsevier, vol. 101(3), pages 246-248, December.
- Paul Gertler, 2004. "Do Conditional Cash Transfers Improve Child Health? Evidence from PROGRESA's Control Randomized Experiment," American Economic Review, American Economic Association, vol. 94(2), pages 336-341, May.
- Rebecca L. Thornton, 2008. "The Demand for, and Impact of, Learning HIV Status," American Economic Review, American Economic Association, vol. 98(5), pages 1829-63, December.
- Kahneman, Daniel & Tversky, Amos, 1979.
"Prospect Theory: An Analysis of Decision under Risk,"
Econometric Society, vol. 47(2), pages 263-91, March.
- Amos Tversky & Daniel Kahneman, 1979. "Prospect Theory: An Analysis of Decision under Risk," Levine's Working Paper Archive 7656, David K. Levine.
- Jonathan Robinson & Ethan Yeh, 2011.
"Transactional Sex as a Response to Risk in Western Kenya,"
American Economic Journal: Applied Economics,
American Economic Association, vol. 3(1), pages 35-64, January.
- Robinson, Jonathan & Yeh, Ethan, 2008. "Transactional Sex as a Response to Risk in Western Keny," MPRA Paper 7350, University Library of Munich, Germany.
- Robinson, Jonathan & Yeh, Ethan, 2009. "Transactional sex as a response to risk in western Kenya," Policy Research Working Paper Series 4857, The World Bank.
- Medlin, Carol & de Walque, Damien, 2008. "Potential applications of conditional cash transfers for prevention of sexually transmitted infections and HIV in Sub-Saharan Africa," Policy Research Working Paper Series 4673, The World Bank.
- Paul Gertler & Manisha Shah & Stefano M. Bertozzi, 2005. "Risky Business: The Market for Unprotected Commercial Sex," Journal of Political Economy, University of Chicago Press, vol. 113(3), pages 518-550, June.
- Sarah Baird & Craig McIntosh & Berk �zler, 2011.
"Cash or Condition? Evidence from a Cash Transfer Experiment,"
The Quarterly Journal of Economics,
Oxford University Press, vol. 126(4), pages 1709-1753.
- Baird, Sarah & Mcintosh, Craig & Ozler, Berk, 2010. "Cash or condition ? evidence from a cash transfer experiment," Policy Research Working Paper Series 5259, The World Bank.
- Gopalan, Saji S. & Mutasa, Ronald & Friedman, Jed & Das, Ashis, 2014. "Health sector demand-side financial incentives in low- and middle-income countries: A systematic review on demand- and supply-side effects," Social Science & Medicine, Elsevier, vol. 100(C), pages 72-83.
- de Walque, Damien & Dow, William H. & Gong, Erick, 2014. "Coping with risk : the effects of shocks on reproductive health and transactional sex in rural Tanzania," Policy Research Working Paper Series 6751, The World Bank.
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