Can we, and should we, pay people to change their behaviour to stop the spread of the HIV virus which causes AIDS? When it comes to HIV prevention, there is nowadays no limit to the “we need more options” motto and that’s what two World Bank studies conducted in Malawi and Tanzania showed.

In an experiment conducted in Malawi, girls aged 13 to 22 and their parents received as much as $15 each month if the girls attended school regularly, HIV Prevalence was 60% lower among girls receiving cash payments.Though this was not the purpose of the programme,“18 months after the program began in January 2008, biomarker data show that HIV infection rates among girls who received cash was 1.2% versus the control group’s 3%.”

• In a randomized controlled trial in Tanzania that only gave payments to those testing negative for common sexually-transmitted disease, prevalence was 25% lower among adults eligible for a $60 reward.

The World Bank researchers concluded that “Studies Suggest Cash Transfers Should be Explored on larger Scale for HIV/STI Prevention.”

The reader is left to decide of the morality and ethical nature of the practice (or of the baseness of human nature) but the idea of putting incentive in the prevention equation will definitively pleases some economists.

Here are some more ideas based on the same principle that could be easily tested and may well become “new options for HIV prevention”.

For a handful of dollars:

• Subsidise sex workers for offering cheaper rate for safe sex. Self evident and easy to assess through HIV incidence in a group of sex workers offering a reduced rate to customers who agree to use condoms compared to “Standard of Service” (Clinical trialists will get the pun). Sex workers only need to keep a record of clients using condoms and reverse the lost of income to PEPFAR or the GFATM (ever noticed the ATM part in GFATM?)

• Pay drug dealers to provide clean needles with heroin and other injectable drugs. Again, easy to assess and come with the added bonus of combining needle exchange programme with drug distribution. This option may also contribute to the rehabilitation of drug dealers.

With a fat envelop:

• Buy a homophobe! Choices are many here, from street yobs to Pastor Martin Ssempa most famous for burning condoms than giving them away and calling for the death penalty for gay people. But everybody has a price and in the case of religious fundamentalists it is just about finding how much they currently make (or receive from foreign supporters) and offer them more to turn them to the prevention cause.

Take the briefcase out:

• Buy a minister or a politician. How much would it have cost to convince the late Manto Tshabalala-Msimang to support condoms instead of promoting potato and lemon juice? This would definitively help with the problem of politicians ignoring scientific evidences in favour of popular support.

With a Swiss bank account:

• How big would the incentive would have to be to convince a Mugabe? What about a Pope? A born-again Christian US president?

Is it all a question of money? Is all of mankind “corruptible”? There is another way of looking at it; indeed the other face of incentive is called conditionality: When Uganda decided that a bill would be needed to root out homosexuality from Uganda, many’s first reactions was to say “Cut the funding”

But what about giving all those who, willingly or not, contribute to the HIV epidemic a financial reward for behaviour change instead of punishing them? The NHS is already doing it to convince some smocker to quit.

This takes us back to why these two World Bank studies worked and resulted in lower rates of HIV: “The program immediately boosted income for many poor girls and their families”.

It’s the economy stupid! Or what I call “having a stake in the fight”.

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