First, there is a vast academic literature which demonstrates the harmful effects of using economic incentives on intrinsic motivation. Intrinsic motivation is the notion that persons do an activity for its own sake and not for any other reward. In this case, that would be observing safe sex practices without being paid to do so. When these economic incentives are removed in the future, what will be the effect if intrinsic motivation has been eroded by the use of incentives? Instead of simply comparing before and after, it is important to see what happens when these economic incentives are removed if this example is to be followed elsewhere.
Second, there are about 22.5M infected with HIV/AIDS in Africa. To run a programme involving a similar number of persons would cost $13.5B over 3 years if you extrapolate from the figures given in the article about the programme's costs. Prevention-through-payment is not an inexpensive option. Overall, this is a well-meaning effort and I wish it well, but there are just two of the things to think about. Those with expertise on the matter of disease prevention and health care in developing countries should have more to say. The age range of the participants is also something that requires further explanation. From the Financial Times:
Thousands of people in
Africawill be paid to avoid unsafe sex, under a groundbreaking World Bank-backed experiment aimed at halting the spread of Aids.
The $1.8m trial – to be launched this year – will counsel 3,000 men and women aged 15-30 in southern rural Tanzania over three years, paying them on condition that periodic laboratory test results prove they have not contracted sexually transmitted infections. The proposed payments of $45 equate to a quarter of annual income for some participants.
The programme, jointly funded by the World Bank, the William and Flora Hewlett Foundation, the Population Reference Bureau and the Spanish Impact Evaluation Fund, marks an important step in the fight to tackle Aids, which claims 2m lives a year. In spite of billions of dollars spent annually on treatment and prevention worldwide, there were about 2.5m new HIV infections in 2007, predominantly in
Carol Medlin from the
Universityof California, , one of the researchers, said: “We hope this ‘reverse prostitution’ will make people think hard about the long-term consequences of their short-term behaviour.” The Tanzanian experiment is a big advance in efforts to test public health ideas more rigorously, with some participants placed in a control arm not offered payment in order to track the effects of the programme precisely. San Francisco
“Conditional cash transfers” have already been used in
Latin Americato motivate poor parents to attend health clinics, and have their children vaccinated and schooled. Michael Bloomberg, the mayor of , last year unveiled a project to boost school attendance. New York
The designers of the Tanzanian programme believe that payments of $45 when combined with careful counselling could play an important role in reducing HIV infection, especially for vulnerable young women. The study will be conducted by the Ifakara Health Research and Development Centre in
Tanzania, in conjunction with researchers from the Universityof California, Berkeley, the Universityof California, and the World Bank. San Francisco
The Tanzanian trial programme, which is still subject to fine-tuning and ethical approval, will not specifically test for HIV, which is costly and already widely conducted in the country. It will use proxies including gonorrhoea, and guarantees any participant found to be infected receives state treatment.