Study finds economic incentives may encourage better sexual health

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A recent study involving economic incentives as a means of HIV prevention pinpoints the exact monetary amount that would incentivize individuals to stay HIV- and STI-free.

The study, which was published in the European Journal of Health Economics, involved conducting a randomized survey among men who have sex with men — or MSM — and male sex workers — or MSW — in Mexico City and determined that in exchange for payments of $288 to MSM and $156 to MSW, subjects would agree to be tested regularly and enroll in awareness programs, thereby reducing HIV and STI prevalence.

According Sandra McCoy, an assistant adjunct professor in UC Berkeley’s School of Public Health whose work deals with HIV, the study is important because it shows paying a small cash amount could have a big impact on sexual health.

“It’s a reward for using condoms or not sharing needles … so (individuals) are conscious about behaviors,” said co-author Paul Gertler, Li Ka Shing Professor of Economics and a professor of public health.

The study also found that wealthier individuals and those with higher levels of education were less likely to respond to the cash incentive because wealthier people are much more likely to have paid for testing themselves, Gertler explained.

“The incentive needs to be high enough to potentially spur meaningful behavior change, but it cannot be too high as to be considered coercive, dangerous or economically inefficient,” the study said.

In Mexico City and Latin America, the HIV epidemic is largely confined to risk populations of MSM, MSW and intravenous drug users. This study is the first of its kind among MSM and MSW subjects, McCoy said, though studies that used cash rewards as a means of reducing the prevalence of HIV have been conducted in Tanzania and Kenya.

According to the study, the Mexican government currently offers universal HIV therapy.

Regarding implementation of the study’s findings, the first step would be to work with public health clinics that offer testing services and provide a cash payment to people who come in to be tested, giving a higher payment as a reward for staying HIV- or STI-free, Gertler said.

An HIV- and STI-free cash reward program for Mexico is feasible, as Gertler said the country already utilizes cash transfers for human development and poverty reduction, such as a cash pension program for people older than 70.

Contact Christine Tyler at [email protected].