The Impact of Short-term Financial Incentives on Sexual Behavior and HIV Incidence Among Youth: Evidence From a Randomized Controlled Field Trial in Lesotho

Lesotho has the third-highest HIV prevalence in the world at 23.2%. Many HIV prevention initiatives are currently going on in the country. The proposed impact evaluation responds to the urgent need to find innovative approaches to promote safer sexual behaviors among youths in Lesotho. In particular, the project will be implemented through the New Start Voluntary Counseling and Testing (VCT) sites established by PSI in the country.

PSI, the implementing agency, has 5 static New Start VCT sites nationally in 5 out of the 10 districts in Lesotho. They are located in the main camp town of each district. Each of these sites has vehicles and tents that are used for outreach services. Outreach activities aim at targeting more specific groups of the population who are generally at higher risk of HIV infection. For example, rural and peri-urban villages (within 60 km radius from the VCT sites, working places (garment factories, phone companies, etc.)) and schools. The present randomized evaluation aims at targeting youths in rural and peri-urban villages.

PSI Lesotho has an extensive experience of working in the HIV prevention sector and it is currently involved in various HIV prevention activities, including, in particular, provision of VCT services and condom distribution.

3. Research objective and Motivation The result of traditional information campaigns (like ABC-Abstinence, Be Faithful and use Condom) on sexual behavioral changes is not conclusive. Although, anecdotal evidence shows that it has resulted in some changes, for example, interventions focusing on condoms use have resulted in increasing condoms during commercial and sexual encounters, there is no rigorous evidence actually showing a significant reduction in HIV prevalence in most Southern Africa countries.

Perhaps the reason for this resides in some differences in sexual behavior in Africa (e.g. it is much more common to have concurrent partnerships that can overlap for significant time) and so the information campaigns are not focusing on the right messages and thus not affecting behavior where it matters the most. Or maybe, as recent literature suggests people tend to delay activities that are a little bit unpleasant in the present (like protecting themselves) even if they have very large returns in the future. People may not be aware of the long-term benefits of safe sexual behaviors. Alternatively, they give a lot of weight to short-term gains, either because they discount the future heavily or have preferences that might be inconsistent over time, with a strong preference for the present.