ObjectiveThe authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex.DesignAn unblinded, individually randomised and controlled trial.Setting10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania.ParticipantsThe authors enrolled 2399 participants, aged 18–30 years, including adult spouses.InterventionsParticipants were randomly assigned to either a control arm (n=1124) or one of two intervention arms: low-value conditional cash transfer (eligible for $10 per testing round, n=660) and high-value conditional cash transfer (eligible for $20 per testing round, n=615). The authors tested participants every 4 months over a 12-month period for the presence of common sexually transmitted infections. In the intervention arms, conditional cash transfer payments were tied to negative sexually transmitted infection test results. Anyone testing positive for a sexually transmitted infection was offered free treatment, and all received counselling.Main outcome measuresThe primary study end point was combined prevalence of the four sexually transmitted infections, which were tested and reported to subjects every 4 months: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. The authors also tested for HIV, herpes simplex virus 2 and syphilis at baseline and month 12.ResultsAt the end of the 12-month period, for the combined prevalence of any of the four sexually transmitted infections, which were tested and reported every 4 months (C trachomatis, N gonorrhoeae, T vaginalis and M genitalium), unadjusted RR for the high-value conditional cash transfer arm compared to controls was 0.80 (95% CI 0.54 to 1.06) and the adjusted RR was 0.73 (95% CI 0.47 to 0.99). Unadjusted RR for the high-value conditional cash transfer arm compared to the low-value conditional cash transfer arm was 0.76 (95% CI 0.49 to 1.03) and the adjusted RR was 0.69 (95% CI 0.45 to 0.92). No harm was reported.ConclusionsConditional cash transfers used to incentivise safer sexual practices are a potentially promising new tool in HIV and sexually transmitted infections prevention. Additional larger study would be useful to clarify the effect size, to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively.Trial registration numberNCT00922038 ClinicalTrials.gov.

Disease spread is in part a function of individual behavior. We examine the factors predicting individual behavior during the Covid-19 pandemic in the United States using novel data collected by Belot et al. (2020). Among other factors, we show that people with lower income, less flexible work arrangements (e.g., an inability to tele-work) and lack of outside space at home are less likely to engage in behaviors, such as social distancing, that limit the spread of disease. We also find evidence that region, gender and beliefs predict behavior. Broadly, our findings align with typical relationships between health and socioeconomic status. Moreover, they suggest that the burden of measures designed to stem the pandemic are unevenly distributed across sociodemographic groups in ways that affect behavior and thus potentially the spread of illness. Policies that assume otherwise are unlikely to be effective or sustainable.

Intimate partner violence is widespread and represents an obstacle to human freedom and a significant public health concern. Poverty alleviation programs and efforts to economically "empower" women have become popular policy options, but theory and empirical evidence are mixed on the relationship between women's empowerment and the experience of violence. We study the effects of a successful poverty alleviation program on women's empowerment and intimate partner relations and violence from 2009 to 2011. In the first experiment, a cluster-randomized superiority trial, 15 marginalized people (86% women) were identified in each of 120 villages (n = 1800) in Gulu and Kitgum districts in Uganda. Half of villages were randomly assigned via public lottery to immediate treatment: five days of business training, $150, and supervision and advising. We examine intent-to-treat estimates of program impact and heterogeneity in treatment effects by initial quality of partner relations. 16 months after the initial grants, the program doubled business ownership and incomes (p < 0.01); we show that the effect on monthly income, however, is moderated by initial quality of intimate partner relations. We also find small increases in marital control (p < 0.05), self-reported autonomy (p < 0.10), and quality of partner relations (p < 0.01), but essentially no change in intimate partner violence. In a second experiment, we study the impact of a low-cost attempt to include household partners (often husbands) in the process. Participants from the 60 waitlist villages (n = 904) were randomly assigned to participate in the program as individuals or with a household partner. We observe small, non-significant decreases in abuse and marital control and large increases in the quality of relationships (p < 0.05), but no effects on women's attitudes toward gender norms and a non-significant reduction in autonomy. Involving men and changing framing to promote more inclusive programming can improve relationships, but may not change gender attitudes or increase business success. Increasing women's earnings has no effect on intimate partner violence.

Given the role of human behavior in the spread of disease, it is vital to understand what drives people to engage in or refrain from health-related behaviors during a pandemic. This paper examines factors associated with the adoption of self-protective health behaviors, such as social distancing and mask wearing, at the start of the Covid-19 pandemic in the USA. These behaviors not only reduce an individual’s own risk of infection but also limit the spread of disease to others. Despite these dual benefits, universal adoption of these behaviors is not assured. We focus on the role of socioeconomic differences in explaining behavior, relying on data collected in April 2020 during the early stages of the Covid-19 pandemic. The data include information on income, gender and race along with unique variables relevant to the current pandemic, such as work arrangements and housing quality. We find that higher income is associated with larger changes in self-protective behaviors. These gradients are partially explained by the fact that people with less income are more likely to report circumstances that make adopting self-protective behaviors more difficult, such as an inability to tele-work. Both in the USA and elsewhere, policies that assume universal compliance with self-protective measures—or that otherwise do not account for socioeconomic differences in the costs of doing so—are unlikely to be effective or sustainable.

In many countries, poor young men exhibit high rates of violence, crime, and other antisocial behaviors. In addition to their direct costs, crime and instability hinder economic growth by reducing investment or diverting productive resources to security. In fragile states, such men are also targets for mobilization into election intimidation, rioting, and rebellion.

We show that extremely poor, war-affected women in northern Uganda have high returns to a package of $150 cash, five days of business skills training, and ongoing supervision. Sixteen months after grants, participants doubled their microenterprise ownership and incomes, mainly from petty trading. We also show these ultrapoor have too little social capital, but that group bonds, informal insurance, and cooperative activities could be induced and had positive returns. When the control group received cash and training 20 months later, we varied supervision, which represented half of the program costs. A year later, supervision increased business survival but not consumption. (JEL I38, J16, J23, J24, L26, O15, Z13)

Covid-19 and the measures taken to contain it have led to unprecedented constraints on work and leisure activities, across the world. This paper uses nationally representative surveys to document how people of different ages and incomes have been affected in the early phase of the pandemic. The data was collected in six countries (China, South Korea, Japan, Italy, UK, and US) in the third week of April 2020. First, we document changes in job circumstances and social activities. Second, we document self-reported negative and positive consequences of the crisis on well-being. We find that young people have experienced more drastic changes to their life and have been most affected economically and psychologically. There is less of a systematic pattern across income groups. While lower income groups have been more affected economically, higher income groups have experienced more changes in their social life and spending. A large fraction of people of low and high income groups report negative effects on well-being.

We evaluate the impact of a health information intervention implemented through mobile phones, using a clustered randomized control trial augmented by qualitative interviews. The intervention aimed to improve sexual health knowledge and shift individuals towards safer sexual behavior by providing reliable information about sexual health. The novel technology designed by Google and Grameen Technology Center provided automated searches of an advice database on topics requested by users via SMS. It was offered by MTN Uganda at no cost to users. Quantitative survey results allow us to reject the hypothesis that improving access to information would increase knowledge and shift behavior to less risky sexual activities. In fact, we find that the service led to an increase in promiscuity, and no shift in perception of norms. Qualitative focus groups discussions support the findings of the quantitative survey results. We conclude by discussing a potential mechanism explaining the counterintuitive findings.