Stimulating Demand for Aids Prevention: Lessons from the Respect Trial

40 Pages Posted: 20 Apr 2016

See all articles by Damien de Walque

Damien de Walque

World Bank - Development Research Group (DECRG); World Bank

William Dow

University of California, Berkeley - School of Public Health

Carol Medlin

University of California, San Francisco (UCSF) - School of Medicine

Rose Nathan

Ifakara Health Research and Development Centre

Multiple version iconThere are 2 versions of this paper

Date Written: February 1, 2012

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 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.

Keywords: Health Monitoring & Evaluation, Population Policies, Disease Control & Prevention, HIV AIDS, Adolescent Health

Suggested Citation

de Walque, Damien and Dow, William and Medlin, Carol and Nathan, Rose, Stimulating Demand for Aids Prevention: Lessons from the Respect Trial (February 1, 2012). World Bank Policy Research Working Paper No. 5973, Available at SSRN: https://ssrn.com/abstract=2009228

Damien De Walque (Contact Author)

World Bank - Development Research Group (DECRG)

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William Dow

University of California, Berkeley - School of Public Health ( email )

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Berkeley, CA 94720-7360
United States

Carol Medlin

University of California, San Francisco (UCSF) - School of Medicine ( email )

513 Parnassus Ave
San Francisco, CA 94143
United States

Rose Nathan

Ifakara Health Research and Development Centre ( email )

Ifakara
United States

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