CASH TRANSFERS AND HEALTH 117


ising approach. A study by Bakari et al. (2000) in Zambia looked at appro- priate formats and venues for VTC using a community survey of attitudes toward VTC (comparing those seeking and declining HIV testing), pre- and post- counseling surveys of HIV knowledge, and a pilot study of same-day VTC in urban antenatal care clinics. The results indicate that 98 percent of partici- pants supported the promotion of VTC in the community. The majority thought that community workers were most effective in promoting this, and 83.8 percent preferred same-day testing. Counseling accompanying VTC was found to improve knowledge by reducing incorrect understanding of transmission by at least one-half. Even with strong community support for VTC, however, there are often important logistical constraints to testing, such as the costs faced by potential beneficiaries (for example, transportation costs, testing fees, and the opportunity cost of time), hours of operation (for example, convenient times available for both men and women), availability of child- care on site, and the regularity of couples testing (giving couples an opportu- nity to consult beforehand) (Bakari et al. 2000). Several studies look at the relationship between cash incentives and HIV


testing and provide examples of how experimental cash transfer programs (conditional or unconditional) have been adapted to respond to health pri- orities. A study in Malawi provided monetary incentives to people to pick up their HIV test results, taking into account distance to results centers, and found that even a small incentive doubled the percentage of participants who learned their results. In addition, sexually active individuals who learned their results and tested positive were three times more likely to purchase condoms two months later, though only two additional condoms. There was no impact on condom purchase among those who tested negative (Thornton 2008). In Tanzania, cash transfers are provided to young adults conditional on periodic negative tests for curable STDs. Their purpose is to evaluate the impact of combining a CCT with counseling on STD incidence and economic impacts. Treatment is offered, and participants may rejoin the program after being cured. Significantly, there is no conditioning on HIV and HSV-2 because these are not curable. In Lesotho, another pilot program uses a similar design but provides lottery tickets for larger prizes instead of a cash transfer (Özler and de Walque 2009).


Antiretroviral Therapy The use of ARVs can be an effective way to inhibit viral replication and reduce viral load, and it can also improve individuals’ nutritional status. Highly active antiretroviral therapy has been shown to positively affect child growth among children with advanced disease and poor nutritional status prior to


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