Article Text
Abstract
With the expansion of antiretroviral treatment programmes, many children and adolescents with HIV in sub-Saharan Africa could expect to live healthy lives. Yet adolescents have the highest levels of poor antiretroviral adherence and of loss to follow-up compared with other age groups. This can lead to increased morbidity and mortality, to the development of drug-resistant strains, and to high societal costs. While financial incentives have been extensively used to promote medication adherence among adults, their use among adolescents remains rare. And while there is a large body of ethical literature exploring financial incentives among adults, little philosophical thought has gone into their use among adolescents. This paper explores three oft-mentioned ethical worries about financial incentives for health behaviours and it asks whether these concerns are more serious in the context of incentives for improving adolescent adherence. The three worries are that such incentives would unduly coerce adolescents' decision-making, would compromise distributive justice and would crowd out intrinsic motivations and non-monetary values. Our tentative conclusion is that more empirical investigation of these concerns is necessary, and that at this point they are not compelling enough to rule out trials in which adolescents are incentivised for antiretroviral adherence.
- Coercion
- HIV Infection and AIDS
- Public Health Ethics
- Behavioural Research
Statistics from Altmetric.com
Request Permissions
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Copyright information:
Linked Articles
- The concise argument
Read the full text or download the PDF:
Other content recommended for you
- Point - of - care viral load testing among adolescents and youth living with HIV in Haiti: a protocol for a randomised trial to evaluate implementation and effect
- Ethically incentivising healthy behaviours: views of parents and adolescents with type 1 diabetes
- Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting: an observational cohort study
- Evaluating adherence to medication in children and adolescents with HIV
- Community engagement with HIV drug adherence in rural South Africa: a transdisciplinary approach
- Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996 - 2017)
- The role of HIV viral load in mathematical models of HIV transmission and treatment: a review
- How IRBs view and make decisions about coercion and undue influence
- Putting a price on empathy: against incentivising moral enhancement
- WYZ: a pilot study protocol for designing and developing a mobile health application for engagement in HIV care and medication adherence in youth and young adults living with HIV