Willice Onyango is an enterprising university student in western Kenya who is traveling the country with an unusual offer for women living with HIV. It goes like this: you join a cohort of ten to fifteen other HIV-positive women, together you come up with a viable plan for a small business, and you get an intrauterine device (IUD) to serve as long-term birth control. In return, you will be paid $40.
This is Onyango’s strategy for zeroing-out the number of children infected with HIV in Kenya. “We provide financial incentives to participating women to help with their socioeconomic empowerment, get their attention, and as a reward for choosing not to transmit the virus to an innocent child,” he said. To put his offer in context, the average household income in Kenya is less than $400.
Onyango didn’t come up with the idea himself. He was inspired by hearing Barbara Harris interviewed on the BBC. Harris founded a nonprofit called Children Requiring a Caring Kommunity, or CRACK, in California in 1997; the organization made headlines for offering to pay women addicted to drugs $300 if they agreed to be sterilized, or ongoing payments as long as addicted women used long-term contraception. Harris, who herself adopted four children born to an addicted mother, is committed to using financial incentives as a tactic to reduce the number of infants born to addicted and alcoholic parents.
While CRACK has been the subject of critical media coverage and policy reports, and has changed its name to something more unassuming—today it’s known as Project Prevention—the program is still active, and is now moving beyond the US borders. Both its domestic and international efforts are funded almost entirely by donations, including Harris’s personal funds. Project Prevention’s most recent records, from 2009, indicate that it received $286,591 in contributions, gifts and grants, with $311,479 in end-of-year net assets. Its public support doesn’t go far beyond the benefits it gets as a 501(c)(3) nonprofit, but its private-sector fundraising is strong; it accepted more than $1.3 million in contributions between 2005 and 2009. The project reported that it “paid nearly 400 new clients in 2009 including hundreds of ongoing participants…. On average, we have paid 44 new clients per month making 2009 our most successful year ever for new program participants.” That pace is accelerating: in the first nine months of 2010, Project Prevention paid 465 new participants in the United States. And last year, a $20,000 individual donation from a London resident brought the program to Britain—though the British Medical Association’s pushback compelled Project Prevention to drop its sterilization efforts and focus on long-term contraception.
After hearing Harris on the radio, Onyango began e-mailing her about bringing the program to East Africa. He was studying international diplomacy and disaster management at Masinde Muliro University and had spent two months in 2008 working as a research assistant for the AIDS, Population and Health Integrated Assistance Program (APHIA), sponsored by USAID. While Onyango didn’t have substantial professional experience in the prevention of mother-to-child transmission (PMTCT) of HIV, he thought Harris’s incentives strategy was “based on profound logic and sound common sense.” Onyango figured incentives would work best in Kenya with women who have HIV, interrupting the disturbing prevalence of infants contracting the virus. In Kenya, 50,000 to 60,000 children each year are either born with HIV or are infected during breastfeeding.