Incentivising Safe Sex: A Randomised Trial of Conditional Cash Transfers for HIV and STI Prevention in Rural Tanzania

Introduction

Innovative solutions for AIDS prevention are urgently needed, as the Joint United Nations Programme on HIV/AIDS reported that for every two people placed on treatment, five are newly infected. Traditional behavior change interventions have been less effective than hoped. Conditional cash transfer (CCT) programs, which make payments contingent on certain behaviors, have shown promise in other areas and were tested for incentivizing safer sexual practices.

Methods

This unblinded, individually randomized controlled trial in rural Tanzania involved participants aged 18-30, divided into a control group and two intervention groups receiving low-value ($10) and high-value ($20) CCTs per testing round. Participants were tested for STIs every four months for a year, with cash rewards for negative results.

Results

After 12 months, the high-value CCT group showed a significant reduction in STI prevalence compared to the control group. The low-value CCT group did not show a significant reduction. The study suggests that financial incentives can effectively reduce risky sexual behaviors, with higher incentives having a more pronounced effect.

Discussion

The results indicate that CCTs based on negative STI test results can be a useful tool for STI and possibly HIV prevention. The study highlights the potential of financial incentives in public health strategies but calls for further research to assess the sustainability and scalability of such interventions.

Limitations

The study's main outcome measure was the combined prevalence of four STIs, which cannot distinguish between changes in treatment-seeking behavior and safer sexual practices. The study also did not address the long-term sustainability of behavior changes after the cessation of financial incentives.

Conclusion

While the study demonstrates the potential of CCTs in reducing STI prevalence, it underscores the need for further research to explore the broader applicability and long-term impacts of such interventions in HIV and STI prevention strategies.