Coming soon to a health clinic near you: a subsidized sex-life

I found this in my inbox this morning courtesy of Cynthia. I am not entirely sure what to make of this article, except to say that the saying 'the road to hell is paved with good intentions' was coined for these kinds of incidents. Ms Medlin's line, in particular, is priceless. Do we assume that people who are living in poverty aren't rational enough to consider long-term consequences of their behavior unless someone provides a $45 incentive? Why does this make me feel mildly nauseous?

By Andrew Jack in London

Published: April 25 2008 22:25

Thousands of people in Africa will be paid to avoid unsafe sex, under a groundbreaking World Bank-backed experiment aimed at halting the spread of Aids.

The $1.8m trial – to be launched this year – will counsel 3,000 men and women aged 15-30 in southern rural Tanzania over three years, paying them on condition that periodic laboratory test results prove they have not contracted sexually transmitted infections.

The proposed payments of $45 equate to a quarter of annual income for some participants.

The programme, jointly funded by the World Bank, the William and Flora Hewlett Foundation, the Population Reference Bureau and the Spanish Impact Evaluation Fund, marks an important step in the fight to tackle Aids, which claims 2m lives a year.

In spite of billions of dollars spent annually on treatment and prevention worldwide, there were about 2.5m new HIV infections in 2007, predominantly in Africa.

Carol Medlin from the University of California, San Francisco, one of the researchers, said: "We hope this 'reverse prostitution' will make people think hard about the long-term consequences of their short-term behaviour."

The Tanzanian experiment is a big advance in efforts to test public health ideas more rigorously, with some participants placed in a control arm not offered payment in order to track the effects of the programme precisely.

"Conditional cash transfers" have already been used in Latin America to motivate poor parents to attend health clinics, and have their children vaccinated and schooled. Michael Bloomberg, the mayor of New York, last year unveiled a project to boost school attendance.

The designers of the Tanzanian programme believe that payments of $45 when combined with careful counselling could play an important role in reducing HIV infection, especially for vulnerable young women.

The study will be conducted by the Ifakara Health Research and Development Centre in Tanzania, in conjunction with researchers from the University of California, Berkeley, the University of California, San Francisco and the World Bank.

The Tanzanian trial programme, which is still subject to fine-tuning and ethical approval, will not specifically test for HIV, which is costly and already widely conducted in the country. It will use proxies including gonorrhoea, and guarantees any participant found to be infected receives state treatment.

Copyright The Financial Times Limited 2008