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Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial

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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.

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
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    References listed on IDEAS

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    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. 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.
    4. 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.
    5. 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.
    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. Kahneman, Daniel & Tversky, Amos, 1979. "Prospect Theory: An Analysis of Decision under Risk," Econometrica, Econometric Society, vol. 47(2), pages 263-291, March.
    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.
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    Cited by:

    1. 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.
    2. 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.
    3. Corrina Moucheraud & Rifat Hasan, 2016. "Beginning a Family and Adopting a Healthy Lifestyle," World Bank Other Operational Studies 24573, The World Bank.
    4. Corrina Moucheraud & Rifat Hasan, 2015. "Beginning a Family and Adopting a Healthy Lifestyle," World Bank Other Operational Studies 23870, The World Bank.
    5. 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.

    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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