Newark, New Jersey — Stephen Smith had just seen three HIV-positive patients in a row. None of them had been taking their medication.
Another doctor turned to Smith and asked “Why are we doing this?”
Smith didn’t have an answer.
“I didn’t know what to say, we weren’t treating the patients if they’re not taking their medicine,” said Smith, a former medical director at Peter Ho Memorial Clinic at Saint Michael’s Medical Center in Newark, New Jersey. “So it was an act of desperation, rather than inspiration when I started the incentive program.”
Smith now offers his patients, predominantly poor and African-American, a $25 grocery coupon if tests show they’ve been taking their medicine regularly. He admits patients not taking medicine is a strange problem to have, but that it’s a reality for many living in high-poverty urban areas throughout the country.
“If a patient is struggling ‘today,’ to meet the rent, to find a place to sleep—you think you care about living an extra 10 years?” Smith asks. “Many patients’ focus are entirely on the moment.”
Dolores Harrison, who was diagnosed with HIV in 2000, said Smith’s program is about commitment.
“You can’t pay a person to do their health care,” Harrison said. “But you can inspire them. You can give them hope. [The coupons] make us feel like [Dr. Smith] is with us for the long run.”
Smith, who opened a new HIV/Aids clinic in East Orange, New Jersey last month, considers his program a cost-efficient way to save lives.
“If I could pay every HIV-positive patient in America $100 a year to get out treatment successfully, the savings would be astronomical,” said Smith, whose clinic relies on federal monies and private donations. “The [coupons] matter to these patients.”
Others aren’t as convinced.
Dr. Sally Hodder is the director of HIV programs at New Jersey Medical School. She said Smith’s program is well-intentioned, but not proven.
“Are you going to incentivize folks their whole life?,” Hodder asks.”The business model for this is still relatively new. We all want to save lives, but there needs to be comprehensive studies done on this method.”
The CDC estimates more than 56,000 Americans are infected with HIV each year, roughly half of them African-American.
“I don’t want to wait to study this,” said Smith, who first tried his program in Newark before opening a clinic in East Orange. “I know it works. [In Newark,] we went from less than 30 patients to hundreds on their medication consistently. We can’t wait.”