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February 25, 2005

Incentives and AIDS infection

People who are HIV negative already have an incentive to have safe sex, but people who are HIV positive have much less off an incentive--except of course for general altruism.¹ Dan Savage makes an interesting suggestion to modify those incentives:

If people are looking for a truly radical step something that might actually curb unsafe sex I've got a suggestion. But first some context: When extremely promiscuous gay men assess the risks and benefits of unprotected sex, most assume that if they get infected, or if they infect someone, an AIDS organization or state health agency will pay for the AIDS meds they or their sex partners are going to need to keep themselves alive. It seems to me that one surefire way to curb unsafe sex would be to put the cost of AIDS meds into the equation. I'm not suggesting that people who cant afford AIDS meds be denied them God forbid. No, my radical plan to curb unsafe sex among gay men is modeled on a successful program that encourages sexual responsibility among straight men: child-support payments. A straight man knows that if he knocks a woman up, he's on the hook for child-support payments for 18 years. He's free to have as much sex as he likes and as many children as he cares to, but he knows in the back of his mind that his quality of life will suffer if he's irresponsible.

So why not drug-support payments? If the state can go after deadbeat dads and make them pay child support, why cant it go after deadbeat infectors and make them pay drug support? Now that would be radical. Infect someone with HIV out of malice or negligence and the state will come after you for half the cost of the meds the person you infected is going to need. (The man you infected is 50 percent responsible for his own infection.) Once a few dozen men in New York City, San Francisco, Toronto, Los Angeles, Chicago, Miami, and Vancouver are having their wages docked for drug-support payments, other gay men will be a lot more careful about not spreading HIV. Trojan won't be able to make condoms fast enough.

This suggestion certainly would incentivize people to use safe sex. However, there's an obvious problem: it disincentivizes people from revealing their contact information. Since contact tracing and partner notification is a major method of controlling STDs (though as Dan points out not as widely used with HIV as with other STDs) this is bad. If people are going to be liable for the medical costs of people they infect, they're pretty unlikely to list the names of their contacts. Standard post-exposure protocol for HIV involves immediate anti-retroviral therapy, but this can't be administered if people don't know they're infected.

^1. It's of course possible to get infected with another HIV strain or some other STD, but if you already have HIV, the potential marginal loss of utility is a lot less.

Posted by ekr at February 25, 2005 9:48 PM | Filed under:

Comments

Posted by: Maximillian Dornseif at February 27, 2005 12:50 PM