81458 enGender Impact: The World Bank’s Gender Impact Evaluation Database Sexual Behavior Change Intentions and Actions in the Context of a Randomized Trial of a Conditional Cash Transfer for HIV Prevention in Tanzania Author(s) Laura Packel, William Dow, Damien de Walque, Zachary Isdah, Albert Majura Contact ddewalque@worldbank.org Country Tanzania Organizing Theme Health, Voice and Agency Status Completed Intervention Category Reproductive Health Sector Health, Nutrition & Population Information, education, communication and interventions based on behavioral-change communication have had success in increasing the awareness of HIV. But these strategies alone have been less successful in changing risky sexual behavior. This paper addresses this issue by exploring the link between action and the intention to change behaviors. In Africa, uncertainty in the lives of those at risk for HIV may affect how intentions are formed. Characterize this uncertainty by understanding the reasons for discrepancies between Abstract intentions and actions may help improve the design of HIV-prevention interventions. Based on an incentives-based HIV prevention trial in Tanzania, the longitudinal dataset in this paper allows the exploration of intended strategies for changing sexual behaviors and their results. The authors find that gender, intervention groups and new positive diagnoses of sexually transmitted infections can significantly predict the link between intent and action. The paper examines potential mediators of these relationships. Gender Connection Gender Focused Intervention Gender Outcomes Reproductive health, STDs/STIs, decision making over family formation IE Design Randomized Control Trial The intervention arm was divided into two sub-arms. The first is a low value cash award arm eligible for up to $30 over the course of the study, or a high-value CCT eligible for up Intervention to $60. All participants were tested for STIs at the baseline and then every 4 months for one year. Individuals were not eligible for cash if they tested positive for STDs. Anyone who tested positive for an STI was offered free counseling and treatment. Intervention Period February 2009- July 2009 The study was comprised of females aged 18-30 residing in one of 10 study locations in South-West Tanzania. There were 3 exclusion criteria: pregnancy, intention to permanently Sample population migrate, unwillingness to participate. There were 2,399 enrollees with an average age 26.5 years. Comparison conditions The control group was tested for STDs but did not receive any cash. Unit of analysis Individual level Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database Evaluation Period 1 year starting in early 2009 Change in sexual behaviors was motivated by the baseline level of risk behaviors and corresponding perceived level of risk. Perceived need for change predicts levels of intended and reported change. Groups that reported less risky behavior were less likely to change. There is only weak evidence that suggests that women report less change than men because of external constraints. There were no interactive effects of measures of agency and marital Results status with reported change. Participants who reported more power in their relationships were more likely to report intending to change their behavior. There is some evidence that a positive HIV test had more effect for women than men. Individuals from the high-cash treatment were more likely to report unanticipated change. But there is little support to suggest that the cash incentive provides additional leverage for women. Social desirability bias may have made it less likely for respondents to report that they did Primary study limitations not change their behavior. World Bank Research Committee, Spanish Impact Evaluation Fund, Knowledge for Funding Source Change Program, the William and Flora Hewlett Foundation, the Berkeley Population Center, and the CDC dissertation grant Packel, L., Dow, W., De Walque, D., Isdahl, Z., & Majura, A. (2012). Sexual behavior Reference(s) change intentions and actions in the context of a randomized trial of a conditional cash transfer for HIV prevention in Tanzania. World Bank Policy Research Working Paper Link to Studies https://openknowledge.worldbank.org/handle/10986/3285 Microdata Last updated: 14 August 2013 2