Test and Win: Using lottery incentives to motivate workers to test for HIV

There is a controversial debate in South Africa about the use of lotteries as an incentive for people to participate in HIV testing. Could lotteries be a real solution to increasing uptake of HIV testing and counselling, or is this a spurious way of motivating people without real benefits for the individual? Martin Weihs examines this question.

Lotteries are organised in such a way that anyone who tests for HIV is entered into a draw in which he or she can win attractive prizes.
Supporters argue that such lotteries considerably increase HIV testing uptake because people find them attractive. However, opponents argue that people should HIV test because they care about their health and not to win prizes. Lotteries are claimed to be ‘coercive’ as they put undue pressure on people to participate in HIV testing, especially those in desperate need of extra income.

South Africa’s workplaces could significantly contribute to testing more South Africans; however, workplaces seldom have HIV testing uptake rates higher than 45% due to fear of stigma and discrimination and denial.
In South Africa, an estimated 6.4 million people lived with HIV in 2012 and only 44.8% were aware of their HIV status: thus, many are not yet seeking treatment. South Africa’s workplaces could significantly contribute to testing more South Africans; however, they seldom have HIV testing uptake rates higher than 45%, due to fear of stigma and discrimination, and denial.

Lotteries seem to be an option worthy of exploration, taking cognisance of the way in which lotteries influence employees’ HIV testing behaviour.

Germany’s support to HIV testing at the workplace
The Multi-Sectoral HIV and AIDS Prevention Programme of the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), in collaboration with the Automotive Industry Development Centre Eastern Cape (AIDC EC), have supported the implementation of HIV and AIDS workplace programmes in South African automotive supplier companies over the past nine years. The programme succeeded in motivating many thousands of employees to be tested, which corresponds to participation rates of more than 80%. Lottery incentives were offered as incentives for HIV testing – and were challenged by those opposing them, as shown above.

A study about how lotteries influence employee’s HIV testing behaviour
It is for this reason that GIZ and the AIDC EC decided to conduct a rigorous study to better understand how lottery incentives influence employees’ HIV testing behaviour. With these findings, the partners aimed to better understand, predict and support employees’ HIV testing behaviour at the workplace and to help resolve the continuing debate about the use of lottery incentives for HIV testing.

A post-test only quasi-experimental, explanatory mixed method approach was used. Quantitative data for the experimental studies were first collected at four automotive companies (514 participants) followed by 33 in-depth interviews two weeks after the HIV testing events. The study was supported by the University of KwaZulu-Natal and the Human Sciences Research Council.

Lotteries facilitate social support
The study revealed that lottery incentives significantly influenced HIV testing behaviour through anticipation of stronger social support and encouragement for participating in HIV testing from partners, friends, colleagues and the company rather than by tempting them to HIV test just to win a prize.

Furthermore, incentives provided an opportunity to openly discuss HIV testing without being discriminated against or stigmatised and allowed HIV testing to become socially accepted and seen as part of a collective effort.

Test and win
On the basis of these findings, the study recommended that, in the design and implementation of lottery incentives, there should also be a focus on social/cultural contexts and on family rather than only on individual behaviours.

Furthermore, lottery prizes, date of prize-giving, and entry conditions need to be communicated to employees well in advance to allow sufficient time for excitement, self-talk, group discussions, and social support to develop. During this period, peer educators, posters and leaflets play an important role in reminding workers about the lottery so as to increase excitement and anticipation.

HIV testing should be organised as a short and intensive know-your-status initiative on the company’s premises as it is important that many colleagues are seen to participate at the same time.

Finally, it is important that all workers benefit from HIV and AIDS workplace programmes and that all are informed about all possible implications of a positive test result, their rights, as well as how to access treatment and care.

Author: Dr. Martin Weihs, senior researcher, Social Aspects of HIV/AIDS Research Alliance (SAHARA), HIV/AIDS, Sexually Transmitted Infections and TB (HAST) research programme, HSRC.