Publication: Stimulating Demand for AIDS Prevention : Lessons from the RESPECT Trial
Loading...
Published
2012-02-01
ISSN
Date
2012-03-19
Author(s)
Editor(s)
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 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.
Link to Data Set
Citation
“Dow, William H.; de Walque, Damien; Medlin, Carol; Nathan, Rose. 2012. Stimulating Demand for AIDS Prevention : Lessons from the RESPECT Trial. Paper is funded by the Knowledge for Change
Program (KCP),Policy Research working paper ; no. WPS 5973. © World Bank. http://hdl.handle.net/10986/3259 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication South Africa’s Fragmented Cities: The Unequal Burden of Labor Market Frictions(Washington, DC: World Bank, 2026-01-08)Using high-resolution administrative, census, and satellite data, this paper shows that South African cities are characterized by spatial mismatches between where people live and where jobs are located, relative to 20 global peers. Areas within 5 kilometers of commercial centers have 9,300 fewer residents per square kilometer than expected, which is 60 percent below the global median. Poor, dense neighborhoods are most affected. In Johannesburg, a 10-percentile increase in distance from the nearest business hub corresponds to a 3.7-percentile drop in asset wealth (a proxy of household wellbeing) and 4.9-percentile drop in employment. In Cape Town, the declines are 4.0 and 3.7 percentiles, respectively. Employment is 87 percent lower in the poorest decile than the richest in Johannesburg and 61 percent lower in Cape Town. These findings suggest that South Africa’s spatial organization of people and economic activity constrains agglomeration and reinforces inequality. This methodology provides a scalable and standardized data-driven framework to analyze spatial accessibility and agglomeration frictions in complex, data-constrained urban systems.Publication The Evolution of Local Participatory Democracy in Nepal(Washington, DC: World Bank, 2025-11-05)Nepal is, according to its constitution, among the world’s most decentralized countries, with a long and complex tradition of local-level public participation. This paper traces the evolution of Nepal’s modern participatory institutions, examining the extent to which they are “induced” by external interventions versus being “organically” rooted in indigenous practices. The paper identifies three broad phases: an initial focus on participation in project implementation; a subsequent phase that expanded citizen engagement; and a third phase of citizen empowerment, culminating in the 2015 federal constitution, which granted unprecedented local autonomy. The analysis yields five key findings. First, over the past 50 years, successive reforms have progressively expanded opportunities for citizens to influence local decision-making. Second, these reforms have integrated traditional participatory mechanisms into formal institutions of local government. Third, although central-level initiatives exist, most participatory platforms continue to operate at the local level. Fourth, the federal constitution has created a new landscape of local democracy, embedding autonomy and accountability. Fifth, although they are still valued in many ethnic and territorial communities, traditional participatory practices are gradually disappearing. The paper concludes by offering policy recommendations to help donor agencies and governments strengthen Nepal’s democratic trajectory. It argues that effective interventions should build on Nepal’s deep participatory traditions while recognizing the constitutional reality of far-reaching local autonomy.Publication Institutional Capacity for Policy Implementation: An Analytical Framework(Washington, DC: World Bank, 2026-01-07)State capacity is an important prerequisite for policy implementation, yet at the country level it is difficult to measure, assess, and reform. This paper proposes a focus on institutional capacity: the ability of public institutions to implement the specific policy mandates for which they are responsible. Based on a review of existing literature, the paper defines the different dimensions that compose institutional capacity and groups them into two cross-cutting categories: organizational dimensions (personnel, financial resources, information systems, and management practices) and governance dimensions (transparency, independence, and accountability). The paper proposes measures for organizational and governance dimensions using existing data, shows intra-institutional variation of these measures within countries, and discusses how new data could be collected for better measurement of these concepts. Finally, the paper illustrates how the framework can be used to diagnose the sources of common problems related to weak policy implementation.Publication Closing the Gender Gap in Entrepreneurship: Overcoming Challenges in Law and Practice for Female Entrepreneurs(Washington, DC: World Bank, 2026-01-07)Despite significant strides toward gender equality, women around the world continue to encounter systemic obstacles that hinder their entrepreneurial success. This paper systematically reviews the literature on the barriers female entrepreneurs face and the solutions proposed to overcome these challenges. It discusses institutional factors, financial factors, human capital factors, and social and cultural factors. The literature overview is complemented by a series of stylized facts that illustrate how overcoming some of these existing barriers is correlated with improved women’s entrepreneurship and female labor force participation, drawing on the World Bank’s Women, Business and the Law database as well as the World Bank’s Enterprise Surveys. The findings underscore the need for creating an enabling environment where women can thrive as entrepreneurs.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Potential Applications of Conditional Cash Transfers for Prevention of Sexually Transmitted Infections and HIV in Sub-Saharan Africa(World Bank, Washington, DC, 2008-07)A growing number of developing countries have introduced conditional cash transfer programs that provide money to poor families with certain contingencies attached - such as requiring school attendance or regular immunization and health check-ups. As the popularity of conditional cash transfer programs has grown, experimentation with potential applications in other areas of health, such as sexual and reproductive health, and HIV prevention, in particular, has also increased. Evaluations of conditional cash transfer programs have focused almost exclusively on uptake of health and educational services, which make relatively low demands of participants compared with more complex interventions, which require the cessation of risky behaviors, such as smoking, obesity, and substance abuse. The literature on contingency management - based on the principle that behavioral change occurs when appropriate behaviors are reinforced and rewarded - provides a richer picture of the complexity of the use of conditionality to encourage healthy behavioral change. This paper examines developing countries' experiences with conditional cash transfer programs and the results of trials in clinical settings on the efficacy of contingency management, and addresses their relevance for designing conditional cash transfer programs to address risky sexual behavior and promote the prevention of sexually transmitted infections and HIV in Sub-Saharan Africa.Publication Harm Reduction Policies and Interventions for Injection Drug Users in Thailand(World Bank, Washington, DC, 2011-08)The World Bank initiated a review of HIV prevention among injection drug users in Thailand, with the objective of providing technical assistance to strengthen national capacity to develop state-of-the-art injecting drug use harm reduction interventions. Thailand has received international recognition for its successful interventions to reduce the transmission of HIV among female sex workers and military recruits. It is looked upon as a role model for HIV education and awareness campaigns that include the extensive promotion and wide acceptance of condoms as an HIV prevention strategy. Thailand has the most progressive and comprehensive antiretroviral program in the region with a reported coverage of over 80 percent of eligible individuals. In 2001, it embarked on a progressive universal health care program that provides free access to a wide array of health care diagnostics and therapeutics for the people of Thailand. With these impressive achievements, it is remarkable how poorly Thailand has responded to the HIV epidemic among injection drug users (IDUs). From available data, it appears that the HIV prevalence rates among IDUs have remained high and stagnant over the last decade. Failure to provide effective interventions to reduce HIV transmission among drug users has resulted in unnecessary suffering, and for many, HIV-related death. Continued inaction threatens to undermine successful HIV prevention efforts in the country through ongoing HIV transmission among injection drug users and their sexual partners. The current focus on enforcement and punishment, along with the reliance on compulsory drug treatment centers, has done little to control drug use in Thailand. The unintended consequence of this approach has been to push drug users into precarious and dangerous environments that have directly led to risky drug using patterns and persistently high rates of HIV transmission. Adopting a harm reduction approach to deal with injection drug use could have a major impact on reducing HIV transmission as well as engaging drug users into better health care and effective drug treatment. This will require strong leadership in key government Ministries and related agencies so that the central stakeholders can roll out harm reduction programs. Thailand has the potential to greatly reduce the transmission of HIV among injection drug users and become a regional leader in harm reduction.Publication The Changing HIV/AIDS Landscape : Selected Papers for the World Bank's Agenda for Action in Africa, 2007-2011(World Bank, 2009)The HIV/AIDS pandemic in Sub-Saharan Africa remains a long-term development challenge for the region. Nearly 12 million African children have been orphaned as a result of the disease, and 22.5 million people in Africa 61 percent of them women live with HIV. The hyperepidemics in Southern Africa have diluted poverty reduction efforts and in several countries substantially reduced life expectancy. The critical need to address this development problem is reflected in the sixth Millennium Development Goal (MDG), which seeks to halt and begin to reverse the spread of HIV/AIDS by 2015 and to make access to treatment for HIV/AIDS universal for all those who need it by 2010. With Sub-Saharan Africa representing nearly two-thirds of those living with HIV globally, and the fact that human development indicators of several countries in the region lag far behind the rest of the world, prospects for Sub-Saharan Africa reaching any of the MDG goals will require a sustained response to HIV/AIDS. Reversing the spread of HIV/AIDS is closely linked to combating other major diseases referenced in sixth MDG, promoting gender equality (MDG 3), reducing child mortality (MDG 4) and improving maternal health (MDG 5).Publication HIV and AIDS in South Asia : An Economic Development Risk(World Bank, 2009)This book offers an original perspective on HIV and AIDS as a development issue in South Asia, a region with a heterogeneous epidemic and estimated national HIV prevalence rates of up to 0.5 percent. The analysis challenges the common perception of HIV and AIDS, which has been shaped to a large extent by analysis of HIV and AIDS in regions with much higher prevalence rates. The chapters, most of which were commissioned specifically for this volume, can be grouped in three broad themes - the epidemiology of HIV and prevention strategies (chapters one and two), economic and development impacts of HIV and AIDS (chapters three and four), and the implications of HIV and AIDS for the health sector (chapters five and six). Within each theme, one chapter provides a more general discussion of the respective issues in the region (chapters one, three, and five), and one chapter highlights aspects of the respective issue in one particular country (with chapter two dealing with HIV in Afghanistan, and chapters four and six discus sing aspects of the impact of or the response to HIV and AIDS in India). Regarding the broad development themes identified by this book, chapters one and two highlight the epidemiological risks. Chapter three surveys the intersection of HIV and AIDS and key development objectives, and is complemented by chapters four and five. The forward-looking discussion of the challenges of scaling up (chapter five) is complemented by an analysis of the costs of antiretroviral treatment (ART) in India (chapter six) and a cross-country analysis of access to treatment (in chapter three).Publication Revitalizing the HIV Response in Pakistan(World Bank, Washington, DC, 2012-11)Pakistan has made strides over the last decade in its Acquired Immunodeficiency Syndrome (AIDS) response, with active surveillance, considerable research, both governmental and non?governmental prevention and care activities, and treatment since 2005 to 2006. However, the Human Immunodeficiency Virus (HIV) prevalence among People Who Inject Drugs (PWID) has not declined, coverage of current prevention and treatment programs remains limited and the gains made to date are threatened by internal and external factors. This report attempts to review and synthesize available data on HIV in Pakistan and to use these data to suggest strategic priorities for the next phase of the HIV response in an effort to improve the allocative efficiency of resources and effective and efficient implementation of the response. This report presents an integrated model for HIV services delivery that depicts a continuum of care from prevention outreach to treatment with a focus on evidence based interventions and strong linkages. It describes three potential models for Volunteer Counseling and Testing (VCT) services for most at risk populations that increase outreach and engagement with PWID, hijra communities, and Male Sex Workers (MSWs), and their clients. It also places heavy emphasis on evidence based approaches to prevention including expanding treatment for High Risk Groups (HRGs) and improving the linkages for HIV positive and HIV negative PWID for drug treatment services, such as Methadone Maintenance Therapy (MMT), and outlines the steps for an evidenced based, effective and efficient policy response at a time of shrinking resources for HIV in overall low prevalence settings. This report is organized as follows: chapter one gives introduction; chapter two presents epidemiology methods; chapter three gives country context; chapter four presents status of HIV epidemic; chapter five gives summary of key findings; chapter six deals with systems response to HIV and AIDS in Pakistan; chapter seven gives key policy recommendations; and chapter eight gives conclusion.
Users also downloaded
Showing related downloaded files
Publication South Asia Development Update, October 2024: Women, Jobs, and Growth(Washington, DC: World Bank, 2024-10-10)South Asia’s growth is on track to exceed earlier expectations, in a broad-based upturn. The region is expected to remain the fastest-growing among emerging market and developing economies (EMDEs). Several risks could upend this generally promising outlook, including extreme weather events, social unrest, and policy missteps, such as reform delays. But South Asian countries also have considerable untapped potential that could help them further boost productivity growth and employment and adapt to climate change. In particular, with about two-thirds of the region’s working-age women out of the labor force, raising female employment rates to those of men could increase per capita income by as much as one-half. Measures to accelerate job creation, remove obstacles to women working, and equalize gender rights would be more effective if combined with a shift toward social norms that looked more favorably on working women. Also, most South Asian countries rank among the EMDEs least open to global trade and investment. Greater openness could boost women’s employment, spur the growth of firms, and allow the region to take better advantage of the reshaping of global supply chains and trade. Reducing the cost of conducting business could help the region better harness large-scale remittance inflows.Publication Social Gains in the Balance : A Fiscal Policy Challenge for Latin America and the Caribbean(Washington, DC, 2014-02-24)In 2012, the Latin America and the Caribbean (LAC) region continued its successful drive to reduce poverty and build the middle class. The proportion of the region's 600 million people living in extreme poverty, defined in the region as life on less than $2.50 a day, was cut in half between 2003 and 2012 to 12.3 percent. Reflecting the upward mobility out of poverty, households vulnerable to falling back into poverty became the largest group in LAC in 2005, and represent almost 38 percent of the population. However, in the last two years, the share of vulnerable households has started to decline. The middle class, currently 34.3 percent of the population, is growing rapidly and is projected to replace the vulnerable as the largest economic group in LAC by 2016. The Southern Cone region (including Brazil) continued to be the most dynamic region and the main driver of poverty reduction in LAC, while poverty in Central America and Mexico proved more stubborn. About 68 percent of poverty reduction between 2003 and 2012 was driven by economic growth, with the remaining 32 percent arising from decline in inequality. Overall, equality of access to basic childhood goods and services has improved in recent years. Yet access can be further improved, and serious issues remain concerning the quality of those goods and services, particularly in education and housing infrastructure. Moreover, access increases with parental education and income or assets, reflecting low intergenerational mobility in many countries in the region. As with poverty reduction, most of the progress in equality of access since 2000 has come in the Southern Cone and the Andean regions, while many of Central America's countries managed only small improvements. There are also severe differences at the subnational level and between urban and rural areas, highlighting the need to strengthen the capacity of local governments to deliver high quality basic services to all their citizens.Publication World Bank East Asia and the Pacific Economic Update, October 2024: Jobs and Technology(Washington, DC: World Bank, 2024-10-07)East Asia and the Pacific, seen in the context of the world economy, stands out as a paragon of development. Despite the recent ravages of the pandemic and the persistent tensions of geopolitics, the region is growing at stably high rates and the benefits are widely shared. But compared to its own past and potential, the region’s economic performance is less impressive. Growth is still below pre-pandemic rates, except in Indonesia, and output has not yet recovered to pre-pandemic levels in several countries, especially in the Pacific. This Economic Update highlights three key developments: shifting regional growth dynamics as China’s growth slows, changing trade patterns due to global tensions, and the impact of technologies such as robots, artificial intelligence, and digital platforms on jobs. The report calls for productivity-enhancing structural reforms to strengthen domestic growth drivers through; deeper international trade agreements to foster more open and stable trade regimes; deeper technical, digital, and soft skills while addressing impediments to labor mobility, factor price distortions and expanding social protection for workers in the digital informal economy to boost productivity and employment.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Remarks to the G20 Finance Ministers and Central Bank Governors Meeting(World Bank, Washington, DC, 2020-11-20)World Bank Group President David Malpass said that while some countries are recovering, the pandemic is still taking a terrible toll, with poverty levels rising sharply. He highlighted on the health emergency response programs in one hundred twelve countries using a fast-track mechanism that is now able to access a further window of twelve billion in funding for vaccine purchases and delivery. He also mentioned that the World Bank is already at work in cooperation with WHO, UNICEF, the Global Fund and GAVI on rapid vaccine deployment readiness assessments for one hundred countries. He spoke about IFC working in coordination with CEPI to invest a further four billion in manufacturing and distribution of vaccines and products that support vaccination programs. He recognized that fragile conflict and violence (FCV) states are most in need, and World Bank's engagement with them. Under his Presidency, the World Bank Group has invested more in climate finance than at any time in its history. He mentioned that IDA is frontloading its financing to make more resources available for the poorest countries. He highlighted on an important step that the G20 call on DSSI beneficiary countries to commit to disclose all public sector financial commitments. The Development Committee that asked the Bank and the IMF to propose more actions to address the unsustainable debt burdens of low- and middle-income countries. He concluded that the fuller transparency is the only way to balance the interests of the people with the interests of those signing the debt and investment contracts.