Conditional economic incentives for reducing HIV risk behaviors: Integration of psychology and behavioral economics.

Abstract

Objective This paper reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. Methods We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories end behavioral economics can be combined into new approaches for HIV prevention. Results Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and STI prevalence, HIV testing, HIV medication adherence, and drug use. Conclusion CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success.

Financial incentives to improve progression through the HIV treatment cascade

“…Behavioral economics integrates psychological and economic principles to understand individual decision making [8]. In contrast to traditional microeconomic theory, behavioral economics recognizes that decisions are not consistently rational, and are strongly influenced by contextual factors, beliefs, competing demands, emotion and other social-cognitive factors [8].…”

“…In contrast to traditional microeconomic theory, behavioral economics recognizes that decisions are not consistently rational, and are strongly influenced by contextual factors, beliefs, competing demands, emotion and other social-cognitive factors [8]. Specifically, individuals often make a ‘rational’ choice to pursue unhealthy behaviors over healthy behaviors, which are often associated with a delay and uncertainty in anticipated health gains (i.e.…”

“…These payments may be unconditional, such as payments to households with children which earn less than a means-tested benchmark in South Africa [30] or conditional on certain behaviors such as school or preventive care attendance for impoverished households in the Oportunidades program in Mexico [31]. In addition to improving socioeconomic status, these cash payments are believed to reduce sexual risk taking in several ways, including improving individuals’ outlook for the future and increasing preferences for healthier behaviors and activities with delayed returns such as schooling [6, 8]. Cash may also address the causal path linking poverty to HIV infection by mitigating the need for transactional sex and sex with older partners and allow individuals to give more weight to long-term consequences of risk behaviors [32].…”

Behavioral Economic Decision Making and Alcohol-related Sexual Risk Behavior

“…There has been growing interest in the extent to which the field of behavioral economics may be used to understand HIV risk [e.g, 8]. Behavioral economics integrates concepts and methods from psychology and microeconomics to systematically characterize individuals’ decision making preferences.…”

The challenges and opportunities of ‘nudging’

“…The application of nudging in health-related research has been proposed in disparate areas ranging from weight loss, adherence,10 11 managing chronic diseases,12 improving maternal and child health,13 preventing mother-to-child transmission,14 promoting Long-Acting Reversible Contraceptive (LARC) methods,15 devising new approaches to HIV prevention,16 and many others.…”