World Bank backs anti-Aids experiment
By Andrew Jack in London
Published: April 25 2008 22:25 | Last updated: 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.
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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.
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