{"id":1053,"date":"2014-12-17T15:00:09","date_gmt":"2014-12-17T15:00:09","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1053"},"modified":"2014-12-13T12:30:09","modified_gmt":"2014-12-13T12:30:09","slug":"living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2014\/12\/17\/living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium\/","title":{"rendered":"Living dangerously in the Dominican Republic and Mexico City: can cash transfer payments be used to counteract the \u201crisk premium\u201d?"},"content":{"rendered":"<p>The Caribbean has the highest levels of HIV outside sub-Saharan Africa &#8211; and the Dominican Republic (DR), which together with Haiti accounts for 70% of all people living with HIV in the Caribbean region, is a hotspot.\u00a0 While there has been a 73% reduction in the rate of new infections in the DR between 2001 and 2011, prevalence of HIV remains high among key populations of MSM (6%) and female sex-workers (3%).\u00a0 A recent qualitative study has sought to investigate the relations between the drug trade, sex tourism, and risk taking which may hold the secret of the obstinately high-levels of HIV in these key populations (<a href=\"http:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/17441692.2014.966250?queryID=%24%7BresultBean.queryID%7D#.VIN6LDGZiuI\">Guillamo-Ramos &amp; Robles<\/a>).\u00a0 In-depth interviews, along with drug screening, were conducted with 30 local drug users in Sosua, known for its tourist sex industry.<\/p>\n<p>Three major themes emerge.\u00a0 First, drugs are freely available as a result of diversion from the major drug routes running from N to S America through the DR.\u00a0 Second, they have become integral to the local tourist industry &#8211; specifically as a vital component of sex work.\u00a0 Third, the engagement of locals, along with tourists, in commercial sex fuelled by drug use gives rise to the kind high-risk behaviours that sustain the spread of HIV in the local population.<\/p>\n<p>What, from the public health angle, seems particularly challenging in this situation is that the element of risk-taking isn\u2019t merely an incidental effect of the sexual activity; it is precisely the element that makes that activity attractive, and &#8211; from the locals\u2019 point of view &#8211; lucrative.\u00a0 Participants associate sex work and drug use with improved livelihood, and describe how risk behaviours are part of the economic negotiating process.<\/p>\n<p>This is the same general kind of problem described in the reported base-line study of a pilot trial of an intervention among male sex workers in Mexico City (<a href=\"http:\/\/www.jiasociety.org\/index.php\/jias\/article\/view\/19218?search=Galarraga%20and%20Sosa-Rubi\">STI\/Galarraga &amp; Sosa-Rubi<\/a>). \u00a0These male sex-workers are at particular risk of infection because they receive market-based inducements from clients to engage in condomless sex. \u00a0It is not simply that MSW are neglecting to take precautions; the average price for a sex transaction is 35% higher for condomless sex &#8211; and, given MSW may be unemployed (16%), or dependent for their income on sex work (37%), the economic pressures to engage in unsafe practices are considerable.<\/p>\n<p>The <em>Punto Seguro<\/em> pilot trial, based at the <em>Clinica Condesa<\/em>, an HIV centre in Mexico City, is considering as a potential solution the idea of a conditional cash transfer (CCT) whereby MSW are rewarded for keeping themselves free of curable STIs over a six-month period. \u00a0Within Mexico CCT has been employed, since the 1990s to provide incentives for poor people to keep their children in school, and to attend preventative check-ups, though not apparently in the sphere of HIV.\u00a0 In the US, however, it has been used to prevent persistent STIs and pregnancy amongst the Latino population (<a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_1\/A49.3.abstract?sid=8223d516-cb93-4588-9206-01c447d67e2b\">STI\/Minnis &amp; Padian<\/a>), in Pakistan to encourage infected men to disclose to their wives, and have them tested (<a href=\"http:\/\/sti.bmj.com\/content\/87\/Suppl_1\/A57.2.abstract?sid=8223d516-cb93-4588-9206-01c447d67e2b\">STI\/Khan &amp; Khan<\/a>).<\/p>\n<p>The paper sets out the procedures and the baseline data for investigating the effectiveness of a form of this kind of intervention.\u00a0 The 267 participants have been randomized to four groups: control; medium conditional incentive ($50); high conditional incentive ($75); unconditional incentive ($50). Previous formative work established the incentive levels necessary for behaviour change ($156 per year).\u00a0 It is also hoped that CCT interventions may benefit participants by helping to link them into care &#8211; since of the participants in the trial who knew they were infected with HIV, only 40% were on treated, and of these, only 61% had achieved viral suppression.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Caribbean has the highest levels of HIV outside sub-Saharan Africa &#8211; and the Dominican Republic (DR), which together with Haiti accounts for 70% of all people living with HIV in the Caribbean region, is a hotspot.\u00a0 While there has been a 73% reduction in the rate of new infections in the DR between 2001 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2014\/12\/17\/living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2043,4364,151,4363],"tags":[],"class_list":["post-1053","post","type-post","status-publish","format-standard","hentry","category-behaviour","category-conditional-cash-transfers","category-epidemiology","category-hiv-and-drugs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Living dangerously in the Dominican Republic and Mexico City: can cash transfer payments be used to counteract the \u201crisk premium\u201d? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2014\/12\/17\/living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Living dangerously in the Dominican Republic and Mexico City: can cash transfer payments be used to counteract the \u201crisk premium\u201d? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"The Caribbean has the highest levels of HIV outside sub-Saharan Africa &#8211; and the Dominican Republic (DR), which together with Haiti accounts for 70% of all people living with HIV in the Caribbean region, is a hotspot.\u00a0 While there has been a 73% reduction in the rate of new infections in the DR between 2001 [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2014\/12\/17\/living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2014-12-17T15:00:09+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/12\\\/17\\\/living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/12\\\/17\\\/living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Living dangerously in the Dominican Republic and Mexico City: can cash transfer payments be used to counteract the \u201crisk premium\u201d?\",\"datePublished\":\"2014-12-17T15:00:09+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/12\\\/17\\\/living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium\\\/\"},\"wordCount\":609,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"Behaviour\",\"Conditional Cash Transfers\",\"Epidemiology\",\"HIV and drugs\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/12\\\/17\\\/living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/12\\\/17\\\/living-dangerously-in-the-dominican-republic-and-mexico-city-can-cash-transfer-payments-be-used-to-counteract-the-risk-premium\\\/\",\"name\":\"Living dangerously in the Dominican Republic and Mexico City: can cash transfer payments be used to counteract the \u201crisk premium\u201d? 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