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How lotteries generate excitement, dialogue and social support for HIV tests at the workplace

by Martin Weihs


A heated debate

There is currently a heated debate in South Africa about the use of lotteries as incentive for the participation in HIV testing at the workplace. The lotteries are organized in such a way that anyone who has an HIV test will take part in a draw in which he or she can win attractive prices.

Supporters argue that the organisation of such lotteries contribute to making it “hip” to get tested. However, opponents fear that incentives undermine individuals’ intrinsic motivation to get tested and the moral values associated with this decision, such as the wish not to infect others.

South Africa’s National Strategic Plan has made it a priority that, by 2016, 80% of adults in South Africa should know their HIV status. The countries’ employers could potentially make a significant contribution to the attainment of this goal, however, mid-sized companies’ report relatively poor workplace HIV testing uptake rates. In this situation, lottery incentives appear like an option that should be explored, keeping an eye on the way in which such incentives influence employees’ intrinsic motivation.

Germany’s support to HIV testing at the workplace

Commissioned by the Federal Ministry for Economic Cooperation and Development (BMZ), the private sector component of the South African GIZ Multi-Sectoral HIV and AIDS Prevention Programme (MHIVP) supports the implementation of HIV and AIDS workplace programmes in South African automotive supplier companies. Over the past five years the GIZ-supported companies succeeded in motivating over 4000 employees to get tested which corresponds to participation rates of more than 80%. To achieve these rates, they used lottery incentives – and were challenged by those opposing them, as mentioned above.

A study about the effects of lotteries as incentives for HIV testing

This is why GIZ decided to conduct a rigorous study to better understand how lottery incentives influence employees’ HIV testing behaviour. With the findings, GIZ was hoping to help resolve the continuing debate about the use of lottery incentives for HIV testing.

GIZ’s partner for this project were the Automotive Industry Development Centre Eastern Cape (www.aidcec.co.za), an agency of the Eastern Cape Development Centre mandated to assist automotive companies become more globally competitive and the University of KwaZulu Natal. 

Lotteries facilitate social support

The study revealed that lottery incentives influenced HIV testing behaviour by enhancing the employees’ intrinsic rather than their extrinsic motivation: the employees who took part in the study made it quite clear that they had taken the test because of their personal conviction and not because they wanted to win a price. And yet they also pointed out that they had enjoyed the lottery since it had created a positive spark at their workplace for more discussion of the whole issue of getting tested.

According to study participants, the lotteries increased the relevance of HIV testing at the workplace because they triggered and sustained thinking and self-talking about HIV testing. They provided a social platform for open dialogue about HIV testing in the companies and at home and generated reciprocal social support and collective action.

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On the basis of its findings, the study recommends that lottery prizes, date of prize-giving, and entry conditions need to be communicated to employees well in advance to allow sufficient time for excitement, self-talk , group discussions, and social support to develop. During this period, peer educators, posters and leaflets play an important role in reminding workers about the lottery so as to increase excitement and anticipation.

Workplace counselling and testing should be organised as a short and intensive know-your-status initiative on the company’s premises as it is important that many colleagues are seen to participate at the same time.

Finally, it is not necessary to make HIV testing a condition to be entered in the lottery. The study found that lotteries in which employees just have to participate in any of three health tests of their choice (e.g. body mass index, blood pressure, blood glucose or HCT) to be entered in the lottery influenced employees’ HIV testing motivation in a seemingly similar way. This way, it can be ruled out that employees feel coerced to take an HIV test can be ruled out.

First results of the study were presented at the 6th SA Aids Conference in Durban in June 2013 (link to abstract). Further results will be presented at the 7th SAHARA Conference in Senegal in March 2014 (link to abstract).

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