The use of financial incentives for improving social outcomes, for example, giving girls monetary support to stay in school or mothers cash rewards to get their children vaccinated or young people money to maintain an HIV negative status…is an unconventional yet favourable strategy in certain contexts.
It was certainly an effective approach for HIV prevention in Lesotho for young women, but not for men.
A study presented at the just finished International Aids Society Conference in Malaysia found an HIV prevention intervention in which young people who had tested negative for sexually transmitted infections were given lottery tickets and had the possibility of winning a cash prize reduced the number of HIV infections by 39 percent in young women, but not in men.
This World Bank study adds to other financial incentives studies; in Tanzania cash rewards reduced infections by 20 percent and here in Malawi cash incentives for school girls reduced infection by 60 percent.
A study conducted in Canada presented at the conference found improved HIV testing in drug users when cash benefits were offered. Drug users could receive $10 to get tested and $15 to come back for their results.
Lesotho has a high prevalence of HIV, especially among young people. The investigators wanted to find out whether using a lottery to provide positive reinforcement and timely feedback would reduce risky sexual behaviour, encourage safe sex and prevent new HIV infections.
The study involved over 3 000 women and men from 29 villages. Participants were randomly allocated to either receive a high value lottery ticket ($100), low value lottery tcket ($50) or no lottery.
The study was conducted over two years with participants tested at the beginning, at 16, 20 and 24 months.
Each of the 29 villages had a lottery every four months where four people could win, two males and two females. With roughly about 50-70 lottery ticket holders from each village, there was reasonably good chance that a person could win. However a person could only win if they were free of sexual transmitted infections.
At the end of the two years, it was found out that the intervention had no impact on the men. i.e. the men who received lottery tickets (high value and low value) were just as likely to test positive for HIV compared to the men who did not receive any lottery tickets.
But what would a financial incentive and HIV prevention and testing programme in Malawi look like? What monetary value would encourage you to maintain an HIV negative status? And is a cash incentive likely to increase your willingness to get tested and get your results?