AIDS and Behavior

, Volume 21, Issue 12, pp 3440–3456 | Cite as

Punto Seguro: A Randomized Controlled Pilot Using Conditional Economic Incentives to Reduce Sexually Transmitted Infection Risks in Mexico

  • Omar Galárraga
  • Sandra G. Sosa-Rubí
  • Caroline Kuo
  • Pedro Gozalo
  • Andrea González
  • Biani Saavedra
  • Nathalie Gras-Allain
  • Carlos J. Conde-Glez
  • Maria Olamendi-Portugal
  • Kenneth H. Mayer
  • Don Operario


Randomized controlled pilot evaluated effect of conditional economic incentives (CEIs) on number of sex partners, condom use, and incident sexually transmitted infections (STIs) among male sex workers in Mexico City. Incentives were contingent on testing free of new curable STIs and/or clinic attendance. We assessed outcomes for n = 227 participants at 6 and 12 months (during active phase with incentives), and then at 18 months (with incentives removed). We used intention-to-treat and inverse probability weighting for the analysis. During active phase, CEIs increased clinic visits (10–13 percentage points) and increased condom use (10–15 percentage points) for CEI groups relative to controls. The effect on condom use was not sustained once CEIs were removed. CEIs did not have an effect on number of partners or incident STIs. Conditional incentives for male sex workers can increase linkage to care and retention and reduce some HIV/STI risks such as condomless sex, while incentives are in place.


Conditional economic incentives Conditional cash transfers HIV prevention Sexually transmitted infections prevention Male sex workers Mexico 


Este estudio controlado aleatorizado evaluó el efecto de los incentivos económicos condicionados (IECs) sobre el número de parejas sexuales, el uso del condón y las infecciones de transmisión sexual (ITS) entre los trabajadores sexuales masculinos en la Ciudad de México. En los grupos experimentales, los participantes recibieron IECs por estar libres de nuevas ITS curables y/o por asistencia a la clínica. Se evaluaron resultados para n = 227 participantes a los 6 y 12 meses (durante la fase activa con incentivos) y luego a los 18 meses (sin incentivos). Se utilizó modelos de intención de tratar y ponderación de probabilidad inversa. Durante la fase activa, los IECs aumentaron las visitas clínicas (10–13 puntos porcentuales) y el uso del condón (10–15 puntos porcentuales) en relación al grupo control. El efecto sobre el uso del condón no se mantuvo una vez que se eliminaron los incentivos. Los IECs no tuvieron efecto sobre el número de parejas sexuales o la incidencia de ITS. Los incentivos condicionales para los trabajadores sexuales pueden aumentar el vínculo y la retención en los servicios clínicos y reducir algunos riesgos como el sexo sin preservativo.



We acknowledge useful comments, at different stages of development of these ideas, from Sergio Bautista-Arredondo, Stefano Bertozzi, Damien de Walque, Will Dow, Paul Gertler, Manisha Shah, Kristen Underhill, David M. Williams and Ira Wilson. Preliminary results presented at scientific conferences: International AIDS Society (IAS); HIV in the Americas; HIV Research for Prevention (R4P); Northeastern Universities Development Conference (NEUDC) at Massachusetts Institute of Technology (MIT). As well as seminars at: Brown University; Centro de Investigación y Docencia Económicas, CIDE; Clínica Condesa; Harvard Center for Population and Development Studies; McGill University; National Institute of Public Health. We gratefully acknowledge all staff members; particularly Octavio Parra, and Jehovani Tena; as well as the clinical staff including Arturo Martínez and Florentino Badial. Santa García conducted the PCR diagnosis of chlamydia and gonococcus in urine samples. The Consortium for HIV/AIDS Research (CISIDAT, A.C.) provided project management and administration support. We especially thank the participants for agreeing to become part of Punto Seguro.


U.S. National Institutes of Health (R21HD065525 Economic incentives to reduce HIV/STI risk: A pilot in Mexico, PI: Galárraga O; and R24HD041020 Population Studies and Training Center at Brown University) with additional support provided by the Mexican National Center for HIV/AIDS Control and Prevention (CENSIDA: Proy-2014-0262). The funders had no role in study design; data collection, analysis or interpretation; report writing; or decision to submit article for publication. The findings, interpretations and conclusions expressed in this paper are entirely those of the authors.

Compliance with Ethical Standards

Competing interests

The authors declare that they have no competing interests.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Omar Galárraga
    • 1
  • Sandra G. Sosa-Rubí
    • 2
  • Caroline Kuo
    • 1
  • Pedro Gozalo
    • 1
  • Andrea González
    • 3
  • Biani Saavedra
    • 2
  • Nathalie Gras-Allain
    • 3
  • Carlos J. Conde-Glez
    • 2
  • Maria Olamendi-Portugal
    • 2
  • Kenneth H. Mayer
    • 4
  • Don Operario
    • 1
  1. 1.Brown University School of Public HealthProvidenceUSA
  2. 2.National Institute of Public Health (INSP)CuernavacaMexico
  3. 3.Clínica CondesaMexico CityMexico
  4. 4.Fenway Health, Beth Israel Deaconess Medical CenterHarvard UniversityBostonUSA

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