Conditional Cash Transfers to Encourage Safer Sex: A Qualitative Study

University Of California Berkeley, Berkeley CA

Investigators

Abstract

DESCRIPTION (provided by investigator): Conditional cash transfers (CCTs) work in part by providing short-run financial incentives for people to act in their own or society's long-term interest, rather than respond to real or perceived short-term incentives that could be detrimental to their health or well-being. CCTs have proven remarkably effective at inducing and reinforcing positive change in many diverse areas of social and health policy, and in circumstances in which behaviors are deeply ingrained and highly resistant to change. For these reasons, CCTs in conjunction with counseling and training may be especially appropriate for encouraging safer sexual behavior. The proposed research aims to collect qualitative data to supplement a randomized, controlled trial of a cash transfer conditional on negative tests for curable sexually transmitted infections (STIs) in rural Tanzania. Coupled with the quantitative data already planned for collection as part of the parent trial, these new qualitative data would enhance understanding of incentive-based decision-making and its influence on behavior change and STI incidence. The broad, long-term objectives of this study are to inform future interventions and to guide policymaking related to the use of conditional cash transfers as an incentive to avoid risky sexual behaviors and to prevent sexually transmitted infections and HIV infection. The specific aims of the proposed research are: (1) To understand how men and women in rural Tanzania understand a cash transfer conditional on negative tests for STIs;(2) To explore how the cash incentive fits in with life decisions and life plans of men and women in rural Tanzania;(3) To explore what strategies men and women in rural Tanzania believe will be effective in avoiding infection with STIs or HIV;(4) To explore how repeated testing and feedback about their STI status in the four waves of the study affects participants'assessment of risk;(5) To explore the responses to the incentive among HIV-positive participants, and to understand how having HIV might result in differential interpretations and responses to the cash incentive;(6) To investigate how those in the treatment arm testing positive for STIs respond to not receiving the incentive, and how not receiving the incentive influences their behavior for the remainder of study;(7) To understand how members of the community are responding to the study and the incentive. To accomplish this, we propose to collect and analyze qualitative data over 12 months from 92 participants in the CCT trial, and to use a conversational journal method to collect data on the community response to the CCT trial. In line with the CDC's vision of healthy people in a healthy world through prevention, and its mission to work with global partners to conduct research to enhance prevention and to implement prevention strategies the results of this study will qualitatively evaluate a potentially new and innovative STI and HIV prevention strategy, and provide direction and recommendations for the most effective and culturally appropriate way to implement such an intervention, should it prove effective. PUBLIC HEALTH RELEVANCE: Public Health Relevance Statement The proposed research is relevant to public health because it addresses several issues that are of primary importance to not only the health of the local communities being studied in Tanzania, but also the health of the global community. The proposed research aims to evaluate a new and innovative HIV prevention strategy that addresses both social and cultural, but especially economic risk factors for HIV infection. Gaining a more comprehensive understanding of these issues will help to improve the lives of those living in Tanzania, and will helptosuportCDC'spublichealthresearchgoalofimprovingglobalpublichealth.