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Rewarding safer sex : conditional cash transfers for HIV/STI prevention

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  • de Walque, Damien
  • Dow, William H.
  • Nathan, Rose

Abstract

Incentive-based policies have been shown to be powerful in many areas of behavior, but have rarely been tested in the sexual domain. The Rewarding Sexually Transmitted Infection Prevention and Control in Tanzania (RESPECT) study is a randomized controlled trial testing the hypothesis that a system of rapid feedback and positive reinforcement that uses cash as the primary incentive can be used to reduce risky sexual activity among young people, male and female, who are at high risk of HIV infection. The study enrolled 2,399 participants in 10 villages in rural southwest Tanzania. The intervention arm received conditional cash transfers that depended on negative results of periodic screenings for sexually transmitted infections, an objectively measured marker for risky sexual behavior. The intervention arm was further divided into two subgroups, one receiving a high value payment of up to $60 over the course of the study ($20 payments every four months) and the other receiving a lower value payment of up to $30 ($10 payments every four months). At the end of the one year of intervention, the results showed a significant reduction in sexually transmitted infections in the group that was eligible for the $20 payments every four months, but no such reduction was found for the group receiving the $10 payments. The effects were stronger among the lower socioeconomic and higher risks groups. The results of a post-intervention follow-up survey conducted one year after discontinuing the intervention indicate a sustained effect among males, but not among females.

Suggested Citation

  • 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.
  • Handle: RePEc:wbk:wbrwps:7099
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    References listed on IDEAS

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    1. Kahneman, Daniel & Tversky, Amos, 1979. "Prospect Theory: An Analysis of Decision under Risk," Econometrica, Econometric Society, vol. 47(2), pages 263-291, March.
    2. 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.
    3. 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, Volume II: Human Capital, pages 85-112, National Bureau of Economic Research, Inc.
    4. 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.
    5. 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.
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    Cited by:

    1. 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.
    2. 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.
    3. Jessica E. Taaffe & Andrew F. Longosz & David Wilson, 2017. "Themed Issue: Cash Transfers and Microfinance," Development Policy Review, Overseas Development Institute, vol. 35(5), pages 601-619, September.
    4. de Walque, Damien, 2020. "The use of financial incentives to prevent unhealthy behaviors: A review," Social Science & Medicine, Elsevier, vol. 261(C).

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    Keywords

    Disease Control&Prevention; Health Monitoring&Evaluation; Population Policies; Adolescent Health; Gender and Health;
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