Description:
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 are not easily monitored, such as
stopping drug abuse. These strategies have not been used in
the sexual domain, so this paper assesses how incentives can
be used to reduce risky sexual behavior. After discussing
theoretical pathways, it discusses 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 more than 90 percent of
participants viewing the incentives favorably. After one
year, 57 percent of enrollees in the "low-value"
reward arm stated that the cash rewards "very
much" motivated sexual behavioral change, rising to 79
percent in the "high-value" reward arm. Despite
its controversial nature, the authors argue for further
testing of such incentive-based approaches to encouraging
reductions in risky sexual behavior.