Coin Operated World: Getting Paid to Say No

Coin Operated World is a blog series covering innovative and unusual ways to achieve results through the use of incentives.

 
If you’re fascinated (like me) by any attempt to modify behavior through the use of incentives, you’ll enjoy this read. In a recent issue of BusinessWeek they chronicle a proposed behavior modification initiative in Zimbabwe.
http://www.businessweek.com/magazine/content/11_15/b4223018788385.htm

In summary, they have an AIDS epidemic going on in sub-Saharan Africa. That’s not breaking news. What might be is this story that health officials have determined that the virus is being spread in a disproportionately large percentage by relatively well-off middle aged men. These men attract young women with gifts, take them as girlfriends and subsequently pass on their HIV. In a targeted effort to squash this specific social behavior, the World Bank has proposed paying young girls to be in their program. The rationale is that if the girls have some money coming in, they will be less likely to seek out “Sugar Daddy’s” in order to fulfill their financial needs.

In one study in Malawi in 2008 the infection rate amongst the participants was 60% less than the control group. The plan appears to be effective and the $10 a month seems relatively cheap when compared to the cost of treating patients with AIDS. That being said, the obvious downside to this initiative is the expense. I would imagine that most African countries can’t afford to pay every young woman. Also, if this were a wide scale initiative you would probably have some unintended consequences. For example, in this proposal there are no actual mandates on the behavior of each girl. If she wants to take the money and still date older men there are no financial consequences. Human nature is to maximize earnings and over time the risk of contracting AIDS gets marginalized to the point that the extra money seems more imported. Eventually $10 wouldn’t be enough and the price would go up causing the debate to restart. Or worse, the government could end up with this huge expense but no real reduction in AIDS cases.

I wonder if it might be better to specifically target the result and not the behavior. What if they paid young girls who don’t have AIDS? Educate them on the behaviors that put them at risk and then pay them to NOT be infected. That seems like a simpler way to incent and it should be easier to justify because the outcome will be clear. Of course, with any incentive there will be some unexpected outcome but hopefully some lives are saved in the process.