Financial Incentives, Testing, and HIV Prevention

Abstract

I present results from two randomized controlled studies to evaluate the effectiveness of HIV testing and conditional cash transfers. In the first experiment, individuals in rural Malawi were randomly assigned monetary incentives to learn their HIV results after being tested. Distance to the HIV results centers was also randomly assigned. Without any incentive, 34 percent of the participants learned their HIV results. However, even the smallest incentive doubled that share. Using the randomly assigned incentives and distance from results centers as instruments for the knowledge of HIV status, sexually active HIV-positive individuals who learned their results are three times more likely to purchase condoms two months later than sexually active HIV-positive individuals who did not learn their results; however, HIV-positive individuals who learned their results purchase only two additional condoms than those who did not. There is no significant effect of learning HIV-negative status on the purchase of condoms. The second experiment is a conditional cash transfer program in rural Malawi which offered financial incentives to men and women to maintain their HIV status for approximately one year. The amounts of the reward ranged from zero to approximately 4 months wage. We find no effect of the offered incentives on HIV status or on reported sexual behavior. However, shortly after receiving the reward, men who received the cash transfer were 8.5 percentage points more likely and women were 7.5 percentage points less likely to engage in risky sex. Programs that aim to motivate safe sexual behavior in Africa should take into account that money given in the present may have much stronger effects than rewards in the future.