Study Finds Price for Reducing HIV Risk

This article from Brown University, Providence, Rhode Island, United States, describes a study done in Mexico City on the feasibility of reducing HIV risk behaviours using a conditional cash transfer programme that encourages HIV prevention education and regular testing among young men who have sex with men (YMSM). As stated in the article: "Studies have found that conditional cash transfer programs, in which governments pay citizens if they consistently practice societally beneficial behaviors, have improved pediatric health care and education in Mexico, increased HIV testing in Malawi, and reduced sexually transmitted infections in Tanzania. Public health researchers therefore investigated whether the idea could be applied to HIV risk behaviors among gay men and male sex workers in Mexico City. A new study reports not only that some members of those populations would change behavior for conditional cash payments, but the exact prices they would accept." The study is published in the European Journal of Health Economics, available by subscription.

Public health economist Omar Galárraga, Assistant Professor of Health Services Policy and Practice at Brown, described Mexico's universal access to HIV therapy as costing US$5,000-$7,000 per person for a population in Mexico city of young gay men and male sex workers with an estimated prevalence of HIV infection at about 20 and 30 percent respectively. "Through ...questionnaires administered to 1,745 gay men 18-25 years of age, Galárraga and his colleagues in Mexico’s Institute for Public Health (INSP) found that at a rate of $288 a year, more than three-quarters of the men would attend monthly prevention talks, engage in testing for sexually transmitted infections, and pledge to stay free of STIs [sexually transmitted infections] with testing to verify that. To obtain a similar level of participation among the 5.1 percent of the sample who were male sex workers, the price was much lower: $156 a year."

"To gather the large sampling of data, the researchers recruited and trained young members of Mexico City’s gay community in 2008 to present the surveys to their peers in discotheques, metro stations, bars, and streets in the city’s red-light district. The interviewers briefly explained that they were conducting a survey about HIV risk behaviors and ways to reduce infection. Consenting subjects were then given a handheld computer with software that administered the confidential and anonymous 40-minute survey. The intentionally discreet technique, Galárraga said, allowed the survey process to appear as if each subject was simply using a cell phone."

"The data show that there is an optimal price for a conditional cash transfer program. Just for the monthly prevention talks and tests, for example, the percentage of men who would participate rapidly climbed above 75 percent as offers reached between $7 and $8.75 a month. But participation only inched up a little closer to 80 percent when offers were raised as high as $12.25 a month. Above $12.25 the potential participation rate even started to decline a little."

Other researchers include: Sandra G. Sosa-Rubí and Cesar Infante of El Instituto Nacional de Salud Publica (INSP); Stefano M. Bertozzi of the Bill and Melinda Gates Foundation; and Paul J. Gertler of the University of California–Berkeley. As a result of the research, a small pilot test programme has begun.