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African Successes, Volume IIHuman Capital$
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Sebastian Edwards, Simon Johnson, and David N. Weil

Print publication date: 2016

Print ISBN-13: 9780226316055

Published to Chicago Scholarship Online: May 2017

DOI: 10.7208/chicago/9780226316192.001.0001

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PRINTED FROM CHICAGO SCHOLARSHIP ONLINE (www.chicago.universitypressscholarship.com). (c) Copyright University of Chicago Press, 2019. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in CHSO for personal use.date: 20 October 2019

Stimulating Demand for AIDS Prevention

Stimulating Demand for AIDS Prevention

Lessons from the RESPECT Trial

Chapter:
(p.85) 3 Stimulating Demand for AIDS Prevention
Source:
African Successes, Volume II
Author(s):

Damien de Walque

William H. Dow

Carol Medlin

Rose Nathan

Publisher:
University of Chicago Press
DOI:10.7208/chicago/9780226316192.003.0003

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.

Keywords:   HIV prevention, AIDS, cash transfer programs, RESPECT, incentive-based approaches, Tanzania

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