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Study investigates monetary incentives to reduce STIs

High-risk populations in Mexico have expressed willingness to participate in the program

A team of researchers including Omar Galarraga, assistant professor of health services policy and practice, is testing a program in which the Mexican government would pay high-risk citizens to take steps to prevent contracting HIV.

In Mexico City, 20 percent of young gay men and 30 percent of male sex workers have HIV, according to a recent University press release. The incidence of HIV is often highest in specific populations.

In a study published online in the European Journal of Health Economics earlier this month, Galarraga and his colleagues worked to identify “that magic number” for the approximate sum of money required to engage participants in a program aimed at reducing sexually transmitted infections, Galarraga said.

Using these conditional economic incentives could ultimately save money for the Mexican government, which offers universal access to HIV treatments with costs averaging between $5,000 and $7,000 per person annually, Galarraga said.

To conduct the study, Galarraga’s team surveyed 1,745 male sex workers and men who have sex with men from ages 18 to 25. Interviewers were selected from the community and trained by the researchers before administering surveys through hand-held computers. This enabled the surveys to be administered discreetly in such places as “bars, discotheques, metro stations and specific streets in the red district,” the researchers wrote in the paper.

Galarraga said he was pleasantly surprised by how willing people were to participate and how quickly he could gather the data.

Galarraga explored two aspects to the incentives program: the amount of money  individuals would be willing to accept in exchange for attending monthly prevention talks and testing and the sum required for individuals to opt to stay free of sexually transmitted infections. Through the bargaining setup, the price was raised or lowered to determine the minimum amount individuals would accept to engage in such a combination program.

“Once we started getting the data and analyzing it, once we started seeing the patterns, that was pretty exciting,” Galarraga said. The team ultimately discovered the willingness to  accept sum was $288 per person per year, though for male sex workers it was a lower sum of $156. These monetary amounts would result in an approximately 75 percent participation rate.

The study shows that there is an “optimal incentive level” to encourage participation among the greatest number of individuals, the authors wrote in the paper.

The results also illustrate that economic incentives can facilitate the implementation of novel approaches and technologies, especially in concentrated, high-risk populations, according to the paper.

Damien de Walque, senior economist at the World Bank who worked on a similar study in Tanzania, said Galarraga’s focus on a comparatively more specific population was a strength of the study. He commended Galarraga’s work for its effort in gaining the trust and participation of a hard-to-reach population.

Caroline Kuo, assistant professor at the Center for Alcohol and Addiction Studies who was previously involved in the study, said the HIV/AIDS problem “is not easy to solve or resolve.” It is important that we do not “stagnate our approaches,” she said, adding that Galarraga’s study offers a unique interdisciplinary approach by blending economic and psychological approaches for prevention.

The concept of the broad reach of the issue was echoed by Don Operario, associate professor of behavioral and social sciences, who said the problem “is not purely biomedical but social and economic” as well. He said the study holds significant potential, especially for illustrating the value of dollars invested in prevention on costs later down the line.



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