Will paying people to avoid unsafe sex stop the spread of AIDS in Africa?
The World Bank thinks it’s worth a try: It will cofund a three-year experiment, whose start date has yet to be disclosed, wherein some 3,000 Tanzanian men and women 15 to 30 years old will be periodically tested for sexually transmitted diseases (STDs). Participants won’t be tested for HIV, however. Such tests are costly, and researchers can reasonably assume that if participants avoid contracting STDs during the experiment, they will also avoid contracting HIV if they engage in the same modifi ed behavior. An unpaid control group, meanwhile, will also be asked to avoid unsafe sex.
Test subjects who test negative will receive $45 each month; most earn an annual salary of about $180.
Joining the World Bank to fund the $1.8 million study are the William and Flora Hewlett Foundation, the Population Reference Bureau, and the Spanish Trust Fund for Impact Evaluation. Eric Brown, communications director for the Hewlett Foundation, says that this is just another case of Hewlett “funding a novel approach because the traditional approach hasn’t yielded results.” Indeed, the Joint United Nations Programme on HIV/ AIDS estimated that last year 2.5 million adults and children acquired HIV, and that most of them lived in sub-Saharan Africa.
The Ifakara Health Institute (IHI) in Tanzania, the World Bank, and researchers from the University of California, Berkeley, and the University of California, San Francisco (UCSF), will conduct the experiment. IHI will also counsel participants about safe sex and treat anyone who tests positive for a particular STD.
Carol Medlin, a member of the UCSF research team, reports that the university researchers as well as IHI researchers are “currently engaged in a very thorough process of ethical review,” and that other issues about the experiment will also be addressed before it begins. Although Medlin won’t elaborate, one topic of debate will likely be whether paying people to behave a certain way—“conditional cash transfers”—will work, even if the consequence of not behaving in a desired way could mean death. Psychological research by Stanford University psychology professor Mark Lepper and many other studies suggest that monetary incentives actually undermine people’s intrinsic motivation. And a recent “pay-for-performance” program in New York City, wherein students at 31 high schools could earn $1,000 simply by passing an Advanced Placement exam, produced mixed results: Students took 345 more of the tests this year than last, but the number who passed declined slightly.
IHI sounds hopeful, however. “The ‘conditional cash transfer’ is a big advance in efforts to test public health ideas more rigorously,” reads a statement on its Web site.
Read more stories by Jennifer Roberts.