From the Mouths of ‘Non-Incentivisers’

prevention ngos hiv/aids HCT
Thursday, 1 December, 2011 - 11:10

The benefit to oneself and one’s partner should be the main reason behind taking an HIV test and not the incentive. In this opinion piece, the author critiques Western Cape Premier, Helen Zille’s strategy of incentivising HIV testing

In recent days there has been a big stir about the political stint of Helen Zille’s “take an HIV test and win big money.” An article published on 28 November 2011 lamented an opinion where politicians, when it comes to the issue of AIDS, have fallen short. Earning brownie points in the political arena, the article laments, has become more important to politicians than finding a solution to our current trajectory of HIV/AIDS.

While the debate on the political approach of leading parties in our government is an incredibly necessary one, discussing the point of incentivising HIV testing is of more pertinent value of the 16 Days of Activism.

Prizes for testing, in my humble view, are misinformed. While I wouldn’t go as far as naming it a political game, I fully agree that it is not the way forward. There has been, for a very long time, a debate within the HIV sector on the incentivising of HIV testing and knowing one’s status. Having worked in mobile HIV testing in the Western Cape communities over the past year, I can vouch that on a daily basis we are approached by clients wanting an incentive to take an HIV test.  From stationary to t-shirts, food parcels to airtime vouchers, many community members want something in return for taking a test. While there is an understanding that there are individuals who truly are in need of that extra loaf of bread or a small token of airtime, it is difficult to believe that the majority of those who approach and ask our service for an incentive are in dire need of the handout that they will receive in many testing centres. Having an incentive is a draw card – it shouldn’t be a necessary factor in a decision to do an HIV test. However, it is done. Put two HIV testing centres next to each other, one offering incentives and the other not, and let the testing numbers tell the narrative of where individuals will go to test. Questioning why this practice has been done in the first place certainly should be looked into. Taking responsibility for wanting to take an HIV test, and understanding why it is important and its benefit to oneself and one’s partner should be the flame behind the desire. Unfortunately, this is seldom the case.

An individual writing a popular opinion piece in a local Western Cape newspaper wrote: “An insight is what changes behaviour, not money.” Unfortunately, this as a fundamental is untrue. Neither insight, nor money will change a person’s behaviour. While insight is valuable (as is awareness) which affirm the stages of behavioural change in many health-related models and theories of behaviour change, behaviour will change when people make the choice to change. Advocating for safer sex (the use of condoms) every time a person has sex, and having one partner in a committed long term relationship are areas of particularly important focus. And this is affected by many factors including gender relations, poverty levels, culture and customs, other risk taking behaviours, self esteem and fear. Ultimately, it is those who are at the top who should be modelling this behaviour.

The government’s HIV Counselling and Testing (HCT) model initiated over a year ago, aimed at testing 15 million people in 12 months. These targets pushed for fast and effective ways of individuals knowing their HIV status. While pushing for people knowing their status is beneficial, what we knew then and what we continue to know now is that behavioural change and knowing one’s status are not simultaneously correlating. Behaviour change is not an immediate action and needs a strong emphasis on desire to change, the relevant factors supporting behavioural change, and adequate conditions for lasting change. This is not an easy recipe, but it can be achieved. Similarly, HCT protocol is fast and not focused on behaviour change.

In conclusion, having seen how a well-presented HIV protocol by a competent counsellor in a private and confidential HIV counselling and testing situation can facilitate a process of starting to change, I will forever continue to support HIV testing. However, I do not support incentivising HIV testing. There appears to have been wide media coverage and condemnation of Zille’s shortfall in pushing forward incentivised testing in the upcoming weeks. However, all of our leaders should focus on long-term solutions not quick fixes. Let’s not become consumed by the focus on what the political strategy that Zille is putting forward such as the incentivised campaign. Let’s not forget that HIV testing incentivising is not new and that the national HIV strategy has not created behavioural change in HIV testing. We may disagree with it, but it does and will continue to happen and in effect it isn’t changing anyone’s HIV risk behaviour fast.

- Elizabeth Hobbs is VCT coordinator at Life Choices.


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