The Impact of Short-term Financial Incentives on Sexual Behavior and HIV Incidence in Lesotho

The HIV/AIDS epidemic is a major concern in many countries. The epidemic is especially acute in Lesotho where roughly one quarter of the population is infected by HIV/AIDS. In Lesotho, and elsewhere, new innovative approaches to induce safer sexual behavior have been desperately called for, particularly in view of the limited impact that existing prevention schemes have had on the trajectory of the HIV/AIDS epidemic. One of the key questions is to understand why individuals get involved in short-term risky sexual behavior when the potential long-term cost of becoming HIV infected is so high? A follow-up question is what replicable and feasible interventions can affect this trade-off between short and long run returns? The primary aim of this study is to evaluate whether the use of short-term financial incentives can affect this trade-off, thereby influencing young individuals' decisions with respect to sexual and reproductive health behavior, and thus in the end reduce HIV incidence rates. The investigators will study this question using a sample of population attending served by New Start Voluntary Counseling and Testing (VCT) sites that a local NGO, Population Service International (PSI), has already implemented in Lesotho. The investigators propose to conduct a randomized controlled trial to test whether adding a financial incentive to remain STI-negative in the form of a lottery can promote safer sexual activity. The lotteries will work as follows: if the individual is tested negative on a set of curable STIs, she will get a lottery ticket with the chance to win a "big" prize. If she is tested positive, she will receive free treatment, but no lottery ticket. If an individual who tested positive is cured, she can come back in the lottery system and get a later chance to win the lottery ticket if she remains STI-negative. The outcome will be to measure the impact of financial incentives on HIV incidence after two years. The results of this research project will