TY - JOUR AU - de Walque, Damien AU - Dow, William H AU - Medlin, Carol AU - Nathan, Rose TI - Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial JF - National Bureau of Economic Research Working Paper Series VL - No. 17865 PY - 2012 Y2 - February 2012 DO - 10.3386/w17865 UR - http://www.nber.org/papers/w17865 L1 - http://www.nber.org/papers/w17865.pdf N1 - Author contact info: Damien de Walque The World Bank Development Research Group 1818 H Street, NW Washington, DC 20433 Tel: (202) 473-2517 E-Mail: ddewalque@worldbank.org William H. Dow University of California, Berkeley School of Public Health 2121 Berkeley Way #5324 Berkeley, CA 94720-7360 Tel: 510/643-5439 Fax: 510/643-6981 E-Mail: wdow@berkeley.edu Carol Medlin Children's Investment Fund Foundation 7 Clifford Street London W1S 2FT England E-Mail: cmedlin@worldbank.org Rose Nathan Ifakara Health Institute Box 78373, Dar es Salaam Tanzania Tanzania E-Mail: rnathan@ihi.or.tz M1 - published as Damien de Walque, William H. Dow, Carol Medlin, Rose Nathan. "Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial," in Sebastian Edwards, Simon Johnson, and David N. Weil, editors, "African Successes, Volume II: Human Capital" University of Chicago Press (2016) M3 - presented at "African Development Successes", August 3-5, 2011 AB - 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. ER -