Offering lottery tickets as an incentive to practice safer sex reduced the number of HIV infections by 25 percent in a World Bank study in Africa.
In a trial among 3,426 HIV-negative people in Lesotho, about 2,000 were given a lottery ticket every four months if they stayed free of the virus and other sexually transmitted maladies. After two years, there were 25 percent fewer infections among those offered tickets than those who weren’t, according to results presented today at the International AIDS Society’s meeting in Kuala Lumpur.
The finding adds to evidence from earlier World Bank studies that showed financial incentives can reduce infections with HIV and other sexually transmitted infections. A study in Tanzania showed cash payments to people who tested negative for diseases including gonorrhea and chlamydia reduced infections by 27 percent over a year. In Malawi, payments to schoolgirls lowered HIV infections by 60 percent.
“The results indicate that short-term financial incentives to engage in safe sex can lead to a measurable decline in HIV incidence,” the researchers, led by Damien de Walque of the World Bank, wrote in a summary of the study on the conference website. “It would however be advisable to replicate and potentially scale-up such an intervention in other settings.”
Some participants were eligible to receive tickets for a lottery offering prize money of either 1,000 South African rand ($101) or 500 rand if they tested negative for HIV, syphilis and trichomonas vaginalis, an infection that can make women more susceptible to HIV infection. Lotteries were held every four months in the villages in which the participants lived, with two male and two female winners in each village.
All the participants received free testing, counseling and treatment every four months during the trial, including if they tested positive for HIV.
While the overall risk reduction was 25 percent, it was 33 percent for women and 31 percent for those who received the higher-value tickets.
About 23.3 percent of people 15 to 49 years old in Lesotho are infected with HIV, according to the Joint United Nations Programme on HIV/AIDS, or UNAIDS. Only Botswana, with a rate of 23.4 percent, and Swaziland with 26 percent, have higher prevalence rates.