The global record on HIV prevention is bleak. The $8 billion spent each recent year on international AIDS assistance has been split about evenly between AIDS treatment and prevention. But while treatment spending has resulted in a dramatic drop in AIDS deaths since 2003, there is no correspondingly visible benefit from the billions spent on prevention. Can foreign assistance reduce the number of new infections? Can HIV prevention actually work?
In this CGD essay, Mead Over argues that the answer is a resounding “yes” – provided that bilateral and multilateral aid organizations get serious about creating incentives for success. He then explores how Performance Based Incentives or PBIs, a recent innovation in the delivery of social services, could be applied to HIV prevention to strengthen both the measurement of achievements (a major challenge in prevention) and the achievements themselves. He considers six of the most promising prevention interventions (such as adult male circumcision and HIV testing for couples) and shows how each could be improved by adding a PBI reward structure.
The essay concludes with an exploration of how Cash on Delivery (COD), a new approach to foreign assistance that strengthens incentives for improved outcomes, could be applied to HIV/AIDS prevention. Over argues that COD aid for HIV/AIDS could give prevention champions in developing countries the levers they sorely need to recruit allies within their own governments and societies in order to ensure that HIV prevention finally becomes effective in reducing the number of new infections.
This is the second essay in a series of three on a proposed “global AIDS transition.”
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