Is It Time to Start Paying Men to Stay HIV-Free?
A new study has one very radical suggestion: offering money to men as an incentive for them to stay HIV-free could not only cut HIV rates, but could also cut total medical costs.
Just $288 Dollars a Year to Cut a Person’s Risk of Contracting HIV
Researchers from Brown University, the University of California at Berkeley and Mexico’s national public health institute, surveyed 1,745 men who have sex with men (MSM) and men who have sex with women (MSW) in Mexico City. The researchers recruited participants in gay bars, discos, and from the city’s red-light district.
Using a discrete hand-held computer set-up that looks very much like a cellphone, they asked the men who were all between 18-25 if they would pledge to stay HIV-free, attend a monthly safe-sex talk, and take regular HIV and STI tests to prove they were uninfected, all in return for a monetary incentive.
The 40-minute survey increased or decreased the amount each man was offered by way of incentive until 70 percent of participants had answered yes. The figure arrived at through this process was just $288 a year. Interestingly, the figure was lower for MSW at $156 a year.
Finding the Incentive Sweet-Spot: An Innovation With Real-World Possibilities
While several programs have attempted to find monetary incentives for good health practices among at risk groups, they have often failed to estimate proper long-terms costs weighed against benefits.
However, this study was able to do something most of those programs could not: it determined a figure that at least 70 percent of a high-risk group agreed would be an amount they would be willing to receive in order for them to make changes in their lives.
This has given the researchers a figure from which to extrapolate costs and project outcomes. And, they say, it could potentially save a great deal of money.
Among Mexico City’s gay men and male sex workers, HIV infection is about 20 and 30 percent of the population respectively. The Mexican government’s health care service offers universal access to HIV therapy, which costs between $5,000 to $7,000 a year, and that’s just for medical care for HIV-specific treatments, not to mention associated care or HIV prevention efforts.
The study’s lead author Omar Galarraga, a health economist at Brown, is quoted as saying that men involved in prostitution enter high risk situations simply because they can charge more for things like having sex without a condom, but it is precisely groups like MSM whom the current system fails, saying, “If you’re a man who has sex with men in Mexico City, you’re lucky if you are tested every two years, if at all.”
Galarraga believes an incentive system would mean that MSM and indeed MSW would no longer feel as much pressure to put themselves in high-risk situations. What’s more, this wouldn’t require a radical shake-up of Mexico’s approach to health care.
“The target population seems generally very well-disposed to participate in these types of programs at prices which are consistent with other social programs currently in place in Mexico for preventing other health risks,” Galarraga said.
Could This HIV Prevention Scheme Translate to Countries Like the U.S.?
Put simply, the researchers aren’t sure. The cost/benefits ratio might be viable in the United States because drugs and hospital care are so much more expensive than in Mexico City and therefore the inflated cost of living might be absorbed.
Crucially, however, the study’s authors haven’t yet surveyed U.S. populations — and such research will not be easy. While prostitution is legal in Mexico, it is illegal in the United States. Finding participants for the study could, for this reason, be much more difficult.
The researchers also found another trend in the Mexico figures which may suggest a problem translating the incentive idea.
A small but significant number (9 percent) of the sample refused to participate no matter the incentive offered. That group were all wealthier and better educated than the majority.
Galarraga and his team believe that this attitude could be more prevalent in the U.S., where the average standard of living and education is higher than in Mexico, and for this reason may hamper the success of such a program. However, they remain confident that this is a sound idea that could have a wider impact in the HIV fight.
Galarraga and team are currently running a trial program with around 200 MSM and gay-identifying men to assess whether the promise of this scheme can be seen in real world trials.
The research is published this week in the European Journal of Health and Economics.
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