Nber Working Paper Series Stimulating Demand for Aids Prevention: Lessons from the Respect Trial


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. Damien de Walque The World Bank Development Research Group 1818 H Street, NW Washington, DC 20433 ddewalque@worldbank.org William H. Dow University of California, Berkeley School of Public Health 239 University Hall, #7360 Berkeley, CA 94720-7360 and NBER wdow@berkeley.edu Carol Medlin Bill & Melinda Gates Foundation Seattle, WA 98102 Carol.Medlin@gatesfoundation.org Rose Nathan Ifakara Health Institute Dar es Salaam Tanzania rnathan@ihi.or.tz

7 Figures and Tables

Cite this paper

@inproceedings{Walque2012NberWP, title={Nber Working Paper Series Stimulating Demand for Aids Prevention: Lessons from the Respect Trial}, author={Damien de Walque and William H . Dow and Carol A Medlin and Rose Nathan}, year={2012} }