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Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial

In: African Successes: Human Capital, Volume 2

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

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 are not easily monitored, such as stopping drug abuse. These strategies have not been used in the sexual domain, so this paper assesses how incentives can be used to reduce risky sexual behavior. After discussing theoretical pathways, it discusses 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 more than 90 percent of participants viewing the incentives favorably. After one year, 57 percent of enrollees in the"low-value"reward arm stated that the cash rewards"very much"motivated sexual behavioral change, rising to 79 percent in the"high-value"reward arm. Despite its controversial nature, the authors argue for further testing of such incentive-based approaches to encouraging reductions in risky sexual behavior.

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This item is provided by National Bureau of Economic Research, Inc in its series NBER Chapters with number 13375.
Handle: RePEc:nbr:nberch:13375
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  1. 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.
  2. 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.
  3. 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.
  4. Robinson, Jonathan & Yeh, Ethan, 2009. "Transactional sex as a response to risk in western Kenya," Policy Research Working Paper Series 4857, The World Bank.
  5. 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.
  6. 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.
  7. Kahneman, Daniel & Tversky, Amos, 1979. "Prospect Theory: An Analysis of Decision under Risk," Econometrica, Econometric Society, vol. 47(2), pages 263-91, March.
  8. 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.
  9. 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.
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