Stimulating Demand for AIDS Prevention : Lessons from the RESPECT Trial

de Walque, Damien ; Dow, William H. ; Medlin, Carol ; Nathan, Rose

关键词: ABSTINENCE;    ADDICTION;    ADDICTIVE BEHAVIORS;    ADOLESCENT;    ADOLESCENT GIRL;   

DOI  :  10.1596/1813-9450-5973
RP-ID  :  WPS5973

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

HIV-prevention strategies have yieldedonly limited success so far in slowing down the AIDSepidemic. This paper examines novel intervention strategiesthat use incentives to discourage risky sexual behaviors.Widely-adopted conditional cash transfer programs that offerpayments conditioning on easily monitored behaviors, such aswell-child health care visits, have shown positive impact onhealth outcomes. Similarly, contingency managementapproaches have successfully used outcome-based rewards toencourage behaviors that are not easily monitored, such asstopping drug abuse. These strategies have not been used inthe sexual domain, so this paper assesses how incentives canbe used to reduce risky sexual behavior. After discussingtheoretical pathways, it discusses the use ofsexual-behavior incentives in the Tanzanian RESPECT trial.There, participants who tested negative for sexuallytransmitted infections are eligible for outcome-based cashrewards. The trial was well-received in the communities,with high enrollment rates and more than 90 percent ofparticipants viewing the incentives favorably. After oneyear, 57 percent of enrollees in the "low-value"reward arm stated that the cash rewards "verymuch" motivated sexual behavioral change, rising to 79percent in the "high-value" reward arm. Despiteits controversial nature, the authors argue for furthertesting of such incentive-based approaches to encouragingreductions in risky sexual behavior.