IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/17865.html
   My bibliography  Save this paper

Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial

Author

Listed:
  • Damien de Walque
  • William H. Dow
  • Carol Medlin
  • Rose Nathan

Abstract

HIV-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.

Suggested Citation

  • Damien de Walque & William H. Dow & Carol Medlin & Rose Nathan, 2012. "Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial," NBER Working Papers 17865, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:17865
    Note: EH
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w17865.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. 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.
    2. 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," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 55-68, September.
    3. Nanak Kakwani & Fabio Veras Soares & Hyun H. Son, 2005. "Conditional cash transfers in African countries," Working Papers 9, International Policy Centre for Inclusive Growth.
    4. Bernd Schubert & Rachel Slater, 2006. "Social Cash Transfers in Low-Income African Countries: Conditional or Unconditional?," Development Policy Review, Overseas Development Institute, vol. 24(5), pages 571-578, September.
    5. Kahneman, Daniel & Tversky, Amos, 1979. "Prospect Theory: An Analysis of Decision under Risk," Econometrica, Econometric Society, vol. 47(2), pages 263-291, March.
    6. 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.
    7. de Walque, Damien & Dow, William H & Nathan, Rose & Abdul, Ramadhani & Abilahi, Faraji & Gong, Erick & Isdahl, Zachary & Jamison, Julian & Jullu, Boniphace & Krishnan, Suneeta & Majura, Albert & Migue, 2012. "Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania," Department of Economics, Working Paper Series qt4vw984q0, Department of Economics, Institute for Business and Economic Research, UC Berkeley.
    8. 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.
    9. Rebecca L. Thornton, 2008. "The Demand for, and Impact of, Learning HIV Status," American Economic Review, American Economic Association, vol. 98(5), pages 1829-1863, December.
    10. 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.
    11. Sarah Baird & Craig McIntosh & Berk Özler, 2011. "Cash or Condition? Evidence from a Cash Transfer Experiment," The Quarterly Journal of Economics, Oxford University Press, vol. 126(4), pages 1709-1753.
    12. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Jan Ostermann & Derek Brown & Axel Mühlbacher & Bernard Njau & Nathan Thielman, 2015. "Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania," Health Economics Review, Springer, vol. 5(1), pages 1-11, December.
    2. 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.
    3. Laura Packel & Ann Keller & William H Dow & Damien de Walque & Rose Nathan & Sally Mtenga, 2012. "Evolving Strategies, Opportunistic Implementation: HIV Risk Reduction in Tanzania in the Context of an Incentive-Based HIV Prevention Intervention," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-10, August.
    4. 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.
    5. Jobiba Chinkhumba & Manuela De Allegri & Jacob Mazalale & Stephan Brenner & Don Mathanga & Adamson S Muula & Bjarne Robberstad, 2017. "Household costs and time to seek care for pregnancy related complications: The role of results-based financing," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-18, September.
    6. Packel, Laura J. & de Walque, Damien & Feeney, Kevin C. & Balampama, Marianna P. & Cooper, Jan E. & Kalolella, Admirabilis & Wechsberg, Wendee M. & Dow, William H., 2021. "A randomized trial of cash incentives for sexual behavior change among female sex workers in Dar es Salaam," Social Science & Medicine, Elsevier, vol. 272(C).
    7. Corrina Moucheraud & Rifat Hasan, 2016. "Beginning a Family and Adopting a Healthy Lifestyle," World Bank Publications - Reports 24573, The World Bank Group.
    8. Corrina Moucheraud & Rifat Hasan, 2015. "Beginning a Family and Adopting a Healthy Lifestyle," World Bank Publications - Reports 23870, The World Bank Group.
    9. de Walque, Damien & Dow, William H. & Nathan, Rose, 2014. "Rewarding safer sex : conditional cash transfers for HIV/STI prevention," Policy Research Working Paper Series 7099, The World Bank.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. de Walque, Damien, 2020. "The use of financial incentives to prevent unhealthy behaviors: A review," Social Science & Medicine, Elsevier, vol. 261(C).
    2. Packel, Laura J. & de Walque, Damien & Feeney, Kevin C. & Balampama, Marianna P. & Cooper, Jan E. & Kalolella, Admirabilis & Wechsberg, Wendee M. & Dow, William H., 2021. "A randomized trial of cash incentives for sexual behavior change among female sex workers in Dar es Salaam," Social Science & Medicine, Elsevier, vol. 272(C).
    3. Omar Galárraga & Sandra Sosa-Rubí & César Infante & Paul Gertler & Stefano Bertozzi, 2014. "Willingness-to-accept reductions in HIV risks: conditional economic incentives in Mexico," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(1), pages 41-55, January.
    4. de Walque, Damien & Dow, William H. & Nathan, Rose, 2014. "Rewarding safer sex : conditional cash transfers for HIV/STI prevention," Policy Research Working Paper Series 7099, The World Bank.
    5. Marshall Burke & Erick Gong & Kelly Jones, 2015. "Income Shocks and HIV in Africa," Economic Journal, Royal Economic Society, vol. 125(585), pages 1157-1189, June.
    6. 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.
    7. van den Bold, Mara & Quisumbing, Agnes R. & Gillespie, Stuart, 2013. "Women’s empowerment and nutrition: An evidence review:," IFPRI discussion papers 1294, International Food Policy Research Institute (IFPRI).
    8. Wilson, Nicholas, 2016. "Antiretroviral therapy and demand for HIV testing: Evidence from Zambia," Economics & Human Biology, Elsevier, vol. 21(C), pages 221-240.
    9. Aaron Richterman & Harsha Thirumurthy, 2022. "The effects of cash transfer programmes on HIV-related outcomes in 42 countries from 1996 to 2019," Nature Human Behaviour, Nature, vol. 6(10), pages 1362-1371, October.
    10. Sudhanshu Handa & Carolyn Tucker Halpern & Audrey Pettifor & Harsha Thirumurthy, 2014. "The Government of Kenya's Cash Transfer Program Reduces the Risk of Sexual Debut among Young People Age 15-25," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-9, January.
    11. Owusu-Addo, Ebenezer & Renzaho, Andre M.N. & Smith, Ben J., 2018. "Evaluation of cash transfer programs in sub-Saharan Africa: A methodological review," Evaluation and Program Planning, Elsevier, vol. 68(C), pages 47-56.
    12. Cassidy, Rachel & Groot Bruinderink, Marije & Janssens, Wendy & Morsink, Karlijn, 2021. "The power to protect: Household bargaining and female condom use," Journal of Development Economics, Elsevier, vol. 153(C).
    13. Nyqvist,Martina Björkman & Corno,Lucia & De Walque,Damien B. C. M. & Svensson,Jakob, 2015. "Using lotteries to incentivize safer sexual behavior : evidence from a randomized controlled trial on HIV prevention," Policy Research Working Paper Series 7215, The World Bank.
    14. Adato, Michelle & Hoddinott, John (ed.), 2010. "Conditional Cash Transfers in Latin America," IFPRI books, International Food Policy Research Institute (IFPRI), number 978-0-8018-9498-5.
    15. Mark E. McGovern & Kobus Herbst & Frank Tanser & Tinofa Mutevedzi & David Canning & Dickman Gareta & Deenan Pillay & Till Bärnighausen, 2016. "Do Gifts Increase Consent to Home-based HIV Testing? A Difference-in-Differences Study in Rural KwaZulu-Natal, South Africa," CHaRMS Working Papers 16-05, Centre for HeAlth Research at the Management School (CHaRMS).
    16. Richard Groot & Tia Palermo & Sudhanshu Handa & Luigi Peter Ragno & Amber Peterman, 2017. "Themed Issue: Cash Transfers and Microfinance," Development Policy Review, Overseas Development Institute, vol. 35(5), pages 621-643, September.
    17. Hans-Peter Kohler & Rebecca L. Thornton, 2012. "Conditional Cash Transfers and HIV/AIDS Prevention: Unconditionally Promising?," The World Bank Economic Review, World Bank Group, vol. 26(2), pages 165-190.
    18. Friedman, Willa & Wilson, Nicholas, 2022. "Can nudging overcome procrastinating on preventive health investments?," Economics & Human Biology, Elsevier, vol. 45(C).
    19. Cooper, Jan E. & Dow, William H. & de Walque, Damien & Keller, Ann C. & McCoy, Sandra I. & Fernald, Lia C.H. & Balampama, Marianna P. & Kalolella, Admirabilis & Packel, Laura J. & Wechsberg, Wendee M., 2017. "Female sex workers use power over their day-to-day lives to meet the condition of a conditional cash transfer intervention to incentivize safe sex," Social Science & Medicine, Elsevier, vol. 181(C), pages 148-157.
    20. Brent Robert J., 2013. "A cost-benefit framework for evaluating conditional cash-transfer programs," Journal of Benefit-Cost Analysis, De Gruyter, vol. 4(2), pages 159-180, August.

    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:17865. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.