Emerging Issues in Today's HIV Response Debate Series

Debate Five: The Ethics of Material Incentives for HIV Prevention

Keywords: incentives

The fifth debate in the USAID and World Bank-sponsored Emerging Issues in Today’s HIV Response Debate Series was based on the following proposition: “Providing material incentives is an ethical and effective tool for HIV prevention and should be implemented.”

The debate was prompted by a long-standing, often-cited challenge to HIV prevention: a lack of economic power and agency, particularly among women. Qualitative research has suggested that women in high burden HIV countries have limited ability to access goods they need (e.g. basic food stuffs, education) and want (e.g. mobile phone, cars). Material incentives – whether supply-driven incentives for the service providers to increase service coverage and quality, or demand-driven incentives such as for example cash, school fees assistance or consumer goods to increase service uptake and thereby increase the effectiveness of the service at a population level – could be part of the solution. However, for a number of reasons (including operational, technical and ethical), these types of programs have had a long and controversial history in public health, education, and economic disciplines. In the past five years, a number of studies have examined the possibility of using such incentives to prevent HIV infection, with mixed results.

The debate was moderated by Amie Batson, Deputy Assistant Administrator for the Global Health Bureau at USAID. Two panelists spoke against the proposition: Dr. Peter Lamptey, President of Public Health Programs at FHI, and Dr. Daniel Wikler, Mary B. Saltonstall Professor of Population Ethics and Professor of Ethics and Population Health, Department of Global Health and Population at the Harvard School of Public Health. The two panelists who spoke in favor of the proposition were Dr. Julia Kim, Cluster Leader: Millennium Development Goals & Universal Access, United Nations Development Programme, HIV/AIDS Practice, Bureau for Development Policy; and Dr. Mead Over, Senior Fellow at the Center for Global Development.

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