Paying for Safe Sex in Tanzania

An innovative research proposal by the Center for Global Development to the Tanzanian government proposes to offer payments to women who repeatedly test negative for curable sexually transmitted infections, such as gonorrhea and syphilis.

They hope that reductions in unsafe sexual contacts will protect the women not only from the curable STIs but also from contracting or spreading HIV, and the research project will measure whether this happens.

To help them achieve these objectives and also to contribute to the womens’ success in other dimensions of their lives, the intervention will include substantial gender and life-skills counseling.

They offer the following arguments in support of the proposal:

  • First, so-called “conditional cash transfers” have previously been shown to be successful in changing health-related behaviors and improving health. For example, in Mexico’s Progresa program cash grants conditional on a poor family’s preventive health visits are reportedly associated with improved health of the family, adults and children alike.
  • Second, transfers which are conditional on remaining free of the curable STIs reward safe behavior among those who are already HIV-positive as as well as those who are not. This is in contrast to conventional HIV testing and counseling programs, which urge safe sex by appealing to the self-interest of those who test negative, but can only appeal to the altruism of those who are already infected.

The obvious concern about the program is that that it would effectively punished people who would need support, that is people who test positive. Another risk is that this program will encourage social exclusion of those who test positive. Further the program assumes that women have control over their sexual behaviour and does not seem to take sufficient account of the effects of gender inequality.

What do you think? Could this program work? How would it work in your country?

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