Original Paper

The European Journal of Health Economics

, Volume 15, Issue 1, pp 41-55

Willingness-to-accept reductions in HIV risks: conditional economic incentives in Mexico

  • Omar GalárragaAffiliated withDepartment of Health Services, Policy and Practice, Brown UniversityCenter for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (INSP)
  • , Sandra G. Sosa-RubíAffiliated withCenter for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (INSP) Email author 
  • , César InfanteAffiliated withCenter for Health Systems Research, National Institute of Public Health (INSP)
  • , Paul J. GertlerAffiliated withHaas School of Business, School of Public Health, University of California
  • , Stefano M. BertozziAffiliated withCenter for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (INSP)Bill and Melinda Gates FoundationDepartment of Global Health, University of Washington

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Abstract

The objective of this study was to measure willingness-to-accept (WTA) reductions in risks for HIV and other sexually transmitted infections (STI) using conditional economic incentives (CEI) among men who have sex with men (MSM), including male sex workers (MSW) in Mexico City. A survey experiment was conducted with 1,745 MSM and MSW (18–25 years of age) who received incentive offers to decide first whether to accept monthly prevention talks and STI testing; and then a second set of offers to accept to stay free of STIs (verified by quarterly biological testing). The survey used random-starting-point and iterative offers. WTA was estimated with a maximum likelihood double-bounded dichotomous choice model. The average acceptance probabilities were: 73.9 % for the monthly model, and 80.4 % for the quarterly model. The incentive-elasticity of participation in the monthly model was 0.222, and 0.515 in the quarterly model. For a combination program with monthly prevention talks, and staying free of curable STI, the implied WTA was USD$ 288 per person per year, but it was lower for MSW: USD$ 156 per person per year. Thus, some of the populations at highest risk of HIV infection (MSM and MSW) seem well disposed to participate in a CEI program for HIV and STI prevention in Mexico. The average WTA estimate is within the range of feasible allocations for prevention in the local context. Given the potential impact, Mexico, a leader in conditional cash transfers for human development and poverty reduction, could extend that successful model to targeted HIV/STI prevention.

Keywords

Willingness-to-accept Conditional economic incentive HIV/AIDS and STI prevention Contingency management/conditional cash transfer Mexico

JEL Classification

I18 O15 C93 C33 C35