Study finds price for reducing HIV risk

Studies have found that conditional cash transfer programs, in which governments pay citizens if they consistently practice societally beneficial behaviors, have improved pediatric health care and education in Mexico, increased HIV testing in Malawi, and reduced sexually transmitted infections in Tanzania. Public health researchers therefore investigated whether the idea could be applied to HIV risk behaviors among gay men and male sex workers in Mexico City. A new study reports not only that some members of those populations would change behavior for conditional cash payments, but the exact prices they would accept.

“We’re trying to prevent HIV from spreading and we are trying to save money,” said public health economist Omar Galárraga, assistant professor of health services policy and practice and lead author of the study published in the European Journal of Health Economics. “We want to make sure that every dollar spent has the greatest impact.”

In Mexico, like many other Western nations, the HIV epidemic is especially concentrated within certain populations. Among the capital city’s young gay men and male sex workers, the estimated prevalence of HIV infection is about 20 and 30 percent respectively. The Mexican government’s health care policy, meanwhile, offers universal access to HIV therapy, which costs $5,000 to $7,000 a year.

Through detailed questionnaires administered to 1,745 gay men 18-25 years of age, Galárraga and his colleagues in Mexico’s Institute for Public Health (INSP) found that at a rate of $288 a year, more than three-quarters of the men would attend monthly prevention talks, engage in testing for sexually transmitted infections, and pledge to stay free of STI’s with testing to verify that. To obtain a similar level of participation among the 5.1 percent of the sample who were male sex workers, the price was much lower: $156 a year.

The study therefore gives policymakers a specific prediction of how much a program would cost to have high participation, and how much money — and how many lives — it might save.

“The target population seems generally very well-disposed to participate in these types of programs at prices which are consistent with other social programs currently in place in Mexico for preventing other health risks,” Galárraga said.

Men on the street

To gather the large sampling of data, the researchers recruited and trained young members of Mexico City’s gay community in 2008 to present the surveys to their peers in discotheques, metro stations, bars, and streets in the city’s red-light district. The interviewers briefly explained that they were conducting a survey about HIV risk behaviors and ways to reduce infection.

Consenting subjects were then given a handheld computer with software that administered the confidential and anonymous 40-minute survey. The intentionally discreet technique, Galárraga said, allowed the survey process to appear as if each subject was simply using a cell phone.