7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)


TUPDC0106 - Poster Discussion Abstract

Evaluating the impact of short term financial incentives on HIV and STI incidence among youth in Lesotho: a randomized trial

Presented by Damien de Walque (United States).

M. Björkman-Nyqvist1, L. Corno2, D. de Walque3, J. Svensson4

1Stockholm School of Economics, Stockholm, Sweden, 2University College London, London, United Kingdom, 3The World Bank, Development Research Group, Washington, United States, 4Stockholm University, Institute for International Economic Studies (IIES), Stockholm, Sweden

Background: Conditional cash transfers and other financial incentives are tested as an HIV/STI prevention strategy to incentivize safe sex. This study tests the hypothesis that a system of rapid feedback and positive reinforcement using a lottery scheme as a primary incentive to reduce risky sexual behavior can be used to promote safer sexual activity and reduce HIV incidence among young people in Lesotho, one country with very high HIV prevalence.
Methods: An unblinded, individually randomized and controlled trial with 3426 participants, males and females 18-32 years old drawn from 29 rural and peri-urban villages in 5 districts in Lesotho. The intervention linked the receipt of lottery tickets to negative results for rapid tests for curable STIs: syphilis and Trichomonas vaginalis. The study objective was to test the efficacy of the lottery incentive scheme in reducing HIV incidence. Participants were randomly assigned to either a control arm (n=1347) or one of two intervention arms eligible to receive lottery tickets: high (n=1116) or low (n=963) value lottery (1,000 or 500 Malotis or South African Rands). All arms received STI testing, counseling, and STI treatment every four months during two years. All participants were tested for HIV at baseline and after 16, 20 and 24 months. Village level lotteries were organized every 4 months in which STI negative individuals from the intervention arms were eligible to participate and during which 4 lottery winners (2 males, 2 females) per village were drawn. The primary study outcome is HIV incidence.
Results: After 2 years of intervention, HIV incidence was significantly lower among study participants eligible for the lotteries (OR 0.75, 95% CI 0.58 - 0.97), especially among women (OR 0.67, 95% CI 0.52 - 0.86), and in the group eligible for the high prize lotteries (1000 Rands)(OR 0.69, 95% CI 0.50 - 0.98). No harm reported.
Conclusion: The results indicate that short-term financial incentives to engage in safe sex can lead to a measurable decline in HIV incidence. It would however be advisable to replicated and potentially scale-up such an intervention in other settings.

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