6014.0: Thursday, November 16, 2000: 8:30 AM-10:00 AM

Use of monetary incentives with disenfranchized populations: Are they practical? Are they ethical?

Monetary incentives are a tool to encourage participation among marginalized populations in public health research and health promotion activities. Some argue that incentives "level the playing field," facilitating the participation of individuals who struggle with poverty and competing life demands, such as drug addiction. In research settings, they can be seen as the fair payment of individuals for their time and contributions. Incentives are also seen as a way of encouraging people to engage in healthy behaviors, such as STD education, HIV testing or TB treatment. Others argue that monetary incentives are unduly coercive and undermine the self-determination of the individuals being targeted. If an incentive is the motivator rather than a desire to improve health, will lasting health behavior change result? Controversy also exists regarding what type of incentives are appropriate, such as cash versus food vouchers, and what their monetary value should be. It is also believed that community-based health organizations which do not offer incentives are sometimes undermined by better-funded intervention research programs which do. This session seeks to examine and foster dialogue on these issues. Presentations will include a review of existing literature regarding the effectiveness and limitations of incentives, a discussion of the use of cash incentives in a clinic for the HIV-positive urban poor, the use of incentives in research involving invasive medical procedures, and a discussion regarding ethical issues related to incentives, power and individual agency
See individual abstracts for presenting author's disclosure statement.
Learning Objectives: Refer to the individual abstracts for learning objectives
Moderator(s):Jennifer Lorvick, BA
8:30 AMEffectiveness of incentives in health interventions: what do we know from the literature?
Jennifer Lorvick, BA, Brian R. Edlin, MD
8:50 AMA content analysis of the rationale for the use of incentives in public health: clarification of assumptions about provider responsibility and client autonomy
Lisa Dorothy Moore, DrPH, Brian R. Edlin, MD
9:10 AMIncentives for research involving liver biopsy in HCV-infected injection drug users: ethical and practical considerations
Karen H. Seal, MD, MPH, Jennifer Lorvick, BA, Jeffry Moore, Robert Thawley, Jon Paul Hammond, BA, Donald Gann, BA, Brian R. Edlin, MD
9:30 AMUse of cash incentives to improve adherence to antiretroviral (ARV) medication among the HIV+ urban poor
Joshua D. Bamberger, MD, MPH, George J. Unick, MA, Wolfgang Stuwe, MA, Joan E. Myles, JD, MA
Sponsor:Forum on Bioethics

The 128th Annual Meeting of APHA