Working Paper: NBER ID: w17865
Authors: 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.
Keywords: HIV prevention; economic incentives; behavioral change; conditional cash transfers
JEL Codes: I12; I15
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| linking rewards to STI status (J33) | increases implicit cost of risky sex (J17) |
| cash rewards (J33) | alleviate immediate economic pressures (E64) |
| systematic cognitive errors (D91) | influence behavior (C92) |
| high discounting (D15) | influence behavior (C92) |
| economic incentives (M52) | reduce risky sexual behaviors (I12) |
| cash rewards (J33) | motivate individuals to engage in safer sexual practices (C91) |
| high-value reward arm (C71) | significant motivation for behavior change (D91) |