UC Irvine faculty, students, and alumni affiliated with the GHREAT initiative collaborated with an expert HIV researcher in Nigeria to publish a manuscript titled “Using Financial Incentives for HIV Prevention Studies in Diverse Global Contexts- a Review of the Literature”. The article was published in a special issue of the Nigerian Journal of Health Sciences based on a presentation at the 2013 Biomedical HIV Prevention Forum in Abuja (http://www.nigerian-jhs.org/issue.php?v=14&n=1)
Clear and concise guidelines for determining the appropriate amount of payment to research participants are nonexistent and as a result remunerations for participation in research studies vary greatly. Furthermore, decisions regarding when and why to pay research subjects are divergent, raising ethical, moral, and practical questions within the research community. Ethicists and scholars who study the impact of financial incentives have raised several questions regarding the use of financial incentives, whether they are actually exploitative or therapeutic, and whether they introduce bias. The current study examines various financial incentives used in domestic and international HIV prevention studies between 2009 and 2013, and outlines important ethical and moral considerations to using financial incentives in HIV prevention research.
Of the 84 manuscripts reviewed, 49 studies were conducted in the U.S., 13 in Africa, 17 in Asia, three in the Caribbean, one in Europe, and one in South America. Sample sizes ranged from 37 12,590 participants. Of the 49 studies that offered financial incentives, the amount ranged from $2.00 to $60.00 USD. In one U.S.-based study, sites were compensated $5,000 and could determine what incentives to offer study participants. Studies included HIV prevention activities via education (n = 43), counseling and motivational interviewing (n=20), testing (n = 4), treatment (n=2), pre-exposure prophylaxis (n =2), condoms (n = 3), weaning (n = 2), payment to stay negative (n = 2), body empowerment (n = 1), microbicide (n=1), housing (n=1), vocational training (n = 1), and circumcision (n = 2).
There was a significant variety and amount of monetary and non-monetary incentives used in HIV prevention studies, with no standards of regulations to help guide what incentives should be used in each context. Several questions arise considering the ethical standards of using incentives. Incentives may be coercive if they lure participants into harmful research protocols regardless of informed consent. Regulators of research should consider participants’ views when assuming that financial incentives diminish autonomy and capacity for informed decision making.
Manuscript authors include Mr. Omeid Heidari, Ms. Parneet Ghuman, Ms. Melissa Soohoo, Ms. Mariam Davtyan, and Dr. Brandon Brown from the Global Health Research, Education and Translation (GHREAT) Initiative at the UC Irvine Program in Public Health, and Dr. Morenike Folayan from the New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria.