Are students being coerced into HIV testing? Ethical considerations related to offering incentives for HIV counselling and testing at tertiary institutions in South Africa

A social marketing strategy, including substantial prizes, was used to promote HIV testing at 17 institutions of higher learning in South Africa. Over 20 000 students with a mean age of 19 years were counselled and tested for HIV. The majority were being tested for the first time. Afterwards they signed a public pledge: ‘We, the class of 2010, pledge to know our status, to stop HIV/AIDS stigma and to contribute to the struggle against HIV/AIDS.’ The students’ opinion of the campaign was surveyed and they were found to be overwhelmingly in favour of it. The issue of whether the prizes unduly influenced the students’ participation is investigated and an approach to resolving ethical dilemmas is presented. The potential of incentives to undermine ‘moral sentiments’ is reviewed.