incentive, inducement, lottery, HIV, social media, HIV, PrEP, MSM
The global incidence of HIV is escalating in certain populations, such as men who have sex with men (MSM). In a certain Southeast Asian country, sexual behavior between men is highly stigmatized, and HIV incidence associated with MSM has risen sharply, from 10% in 2008 to 54% in 2016. Concurrent use of drugs is a major contributor towards the rising HIV epidemic in MSM, which is also linked to unprotected sexual intercourse and to sexually transmitted infections.
An international, multidisciplinary HIV research team submitted a proposal to the research ethics committee (REC) at a research hospital in the country. The primary aim of the research was to determine the attitudes of MSM about preexposure prophylaxis (PrEP)1 as well as to identify successful dissemination strategies for PrEP, which helps to protect HIV-negative individuals from HIV infection.
Participants were recruited via a social media campaign targeted to MSM. People who clicked on a pop-up banner advertisement were screened for study eligibility before taking an online research questionnaire through a secured survey system. The researchers did not collect any personally identifiable information from study participants.
To maximize the response rate for the survey, the research team provided lottery incentives for items such as laptops and mobile phones. They justified the use of lottery incentives based on prior use of this method in other scientific research worldwide. The researchers also reported increasing acceptance and use of lottery incentives, citing evidence that some RECs do not believe incentives compromise participants’ understanding or alter their decision about participating in research. Thus, they reasoned that lottery incentives could be used as incentive for research and that their proposed incentive should be ethically acceptable.
However, the REC reviewing the proposal did not agree, explaining the potential undue influence of lottery incentives on participants as well as the potential conflict of “lotteries” with cultural and religious norms in the country.
Questions
Do you think the research ethics committee handled this issue appropriately? Why or why not?
What should research ethics committees consider when evaluating the appropriateness of a monetary or nonmonetary “good” that will be provided to research participants?
If the researchers were motivated by the goal of increasing their response rate, what else could they have perhaps done to improve the rate?
In this scenario, local researchers may encounter pressure from international collaborators. What would you suggest to the researchers in handling such situations?
