Understanding External and Cascading Benefits for HIV/AIDS Control in a Subsistence Marketplace: Insights from Indonesia

The objectives of this study are (1) to examine user perceptions and preferences toward various HIV/AIDS prevention control products and services and (2) to explore how both perceived likelihood of infection and beliefs about external benefits might distinctively affect intentions to use various HIV/AIDS-prevention goods and services in poor communities. The study compares a sample drawn from a subsistence marketplace (a red-light district in a major city) with one drawn from a relatively non–subsistence marketplace (a university area in the same city) in Indonesia. In spite of significant differences in education, income, and sexual activity, the two samples show a surprising degree of similarity in generic positioning maps for the six HIV/AIDS-prevention goods and services. Quite concerning, though, is the finding that in the higher-risk, subsistence setting, individuals actually infected with HIV are less likely to use HIV/AIDS-prevention goods and services than are those who are not infected. The authors review these empirical results in light of (1) theories of external, cascading benefits, and generalized exchange and (2) a theory of subsistence marketplaces in developing economies.