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Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial

In: African Successes, Volume II: Human Capital

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  • 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.
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Suggested Citation

  • 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.
  • Handle: RePEc:nbr:nberch:13375
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    References listed on IDEAS

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    Cited by:

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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).
    6. 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.
    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.

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    More about this item

    JEL classification:

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

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