South African HIV/AIDS Assistance Programs Might Cause Some People to Sacrifice Health for Benefits, Aid Workers Say

South African aid workers are concerned that some HIV/AIDS assistance programs might have the "unexpected downside" of "perverse incentives," in which people might sacrifice their health in order to qualify for job programs, food and other benefits, "The World" -- a production of BBC World Service, PRI and WGBH Boston -- reported on Tuesday. People who are "desperately poor" might go to extremes to qualify for job or food aid programs and might make "bad or even unsafe decisions" regarding their health, according to "The World." Government-sponsored programs that help HIV-positive people are important, especially in a country where there are few state-sponsored benefits and no welfare system for unemployed people, "The World" reports. One example is the "highly sought after prize" of government disability grants for HIV-positive individuals in South Africa, according to "The World." In some cases, HIV-positive people who receive the disability grant increase their families' income by an average of 50%, according to research by Nicoli Nattrass, an economics professor and director of the AIDS and Society Research Unit at the University of Cape Town. However, antiretroviral drugs that improve the health of HIV/AIDS patients might make them ineligible for the grants. As a result, HIV-positive individuals face a difficult choice. Nattrass said some HIV-positive people ask, "Should I stay sick and keep the disability grant or should I get better and lose it?" Nattrass added, "This, I think, is a real problem because it's putting people in a bad situation." In addition, some aid workers report having heard about a "black market" of HIV-positive blood that people use in order to falsely produce positive HIV tests and qualify for the program, "The World" reports. Some HIV-negative individuals might even "sacrifice long-term health for short-term money" and attempt to contract HIV in order to qualify for benefits, according to "The World."

Limited Funding
The perverse incentives exist because there is only a limited amount of money to help people in the "real world" of international aid, Mitchell Besser, an OB/GYN and founder of the Mothers to Mothers to Be program, said. Other aid workers are reluctant to discuss the negative incentives caused by HIV/AIDS assistance programs because they are concerned that the public will think that HIV-positive people are receiving "too many benefits," according to "The World." However, they say that is "far from" the truth because only a "small fraction" of South Africa's more than five million HIV-positive people receive aid, "The World" reports. According to Besser, the "way to eliminate perverse incentives is not to reduce benefits for those who are sick, but to also provide more aid to those who are well" (Costello, "The World," PRI, 4/5).

The complete segment is available online in Windows Media.

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