Ways Pay It Forward Programmes Combat the Spreads of the Most Prevalent STDs

While most of us understand the importance of regular testing for sexually transmitted diseases (STDs), such services aren’t always easily available easily in some countries. Many at-risk and vulnerable communities may be lacking these essential opportunities – a social inequality fact that’s still contributing to the rise in the most widespread STDs.

Health authorities worldwide have been experimenting with various approaches to make STD testing more accessible and approachable. Pay it forward programmes have been tested as one such opportunity and the latest findings from a Chinese study paint an interesting picture.

What Are Pay It Forward STD Testing Programmes?

The concept is very simple – someone who is getting tested for an STD pays it forward in the form of funds for somebody else’s test in the future.

If you go to get screened and you can afford to, you can easily pay for someone underprivileged to get reliable screening in the future.

The pay it forward method is far from a novelty but we’ve been missing data on its effectiveness so far. Luckily, a comprehensive study from China examines the effects of this approach to determine whether it helps more people get screened.

The Pay It Forward Study

The study on paying it forward was first published back in 2020 in the reputable medical journal Lancet. The aim of the clinical trial was to determine whether pay it forward programmes would increase STD screening rates for gonorrhoea and chlamydia among men who have sex with men.

Participants in the study were men aged 16 or older seeking HIV testing options. These men also met indications and recommendations for gonorrhoea and chlamydia screening.

Thirty groups of men were randomly assigned to one of each categories – a pay it forward group (the men were offered free screening and they were asked whether they’d like to pay for someone else’s test in the future), a pay what you want group and a standard care group.

The experiment continued slightly over a month and 301 men decided to volunteer. Test uptake for gonorrhoea and chlamydia was 56 per cent in the pay it forward group, 46 per cent in the pay what you want group and only 18 per cent in the regular service group.

The estimated difference in test uptake between the pay it forward group and the regular care group was a shocking 38.4 per cent.

It’s also interesting to point out that out of 57 men assigned to the pay it forward group, 54 decided to pay for somebody else’s screening panel in the future.

What the Findings Mean

The numbers speak volumes but let’s dig a little bit deeper and analyse what’s hiding behind the data.

The pay it forward strategy incorporates a community element that gets many people motivated to participate and even produce a kind gesture for a stranger. This communal involvement is proving to be a more powerful motivator than having the freedom to pay very little for an STD test.

An approach like pay what you want is also improving screening results. The difference in test uptake between this group and the standard care group was 28 per cent. Still, the freedom to spend little to no money on an STD test lacks the emotional and communal element that makes pay forward programmes such powerful tools.

The issue with these approaches is that they tend to be costlier than the provision of standard care. The total health provider cost for the pay it forward programme was 1,125 dollars. In the case of a pay what you want service, the total cost reached 967 dollars in comparison to 612 dollars for the standard care group. This could be one of the hindrances standing in the way of making such testing possibilities more readily available for everyone.

Frequent Testing Matters

Even if you’re experiencing some financial limitations, regular STD testing matters. It’s especially important for high risk individuals and it can save money on medical procedures in the long run.

Free STD screening and specialised programmes are currently unavailable in Singapore (apart from periodic campaigns aimed at offering free HIV testing opportunities). Still, sexual health facilities like Shim Clinic work hard to make testing more affordable and approachable. You can easily pay the clinic a visit to get your questions answered via a fully confidential consultation. Depending on the results of that discussion, you’ll get to decide whether an STD screening panel makes sense for you.

Shim Clinic has STD testing panels of the most common STDs. Knowledge is power and the sooner you learn your status; the more choices you’ll have. Come to Shim Clinic during working hours every day of the week or contact us in advance to have your most pressing questions answered.


  • Yang, F., Zhang, T. P., Tang, W., Ong, J. J., Alexander, M., Forastiere, L., Kumar, N., Li, K. T., Zou, F., Yang, L., Mi, G., Wang, Y., Huang, W., Lee, A., Zhu, W., Luo, D., Vickerman, P., Wu, D., Yang, B., . . . Tucker, J. D. (2020). Pay-it-forward gonorrhoea and chlamydia testing among men who have sex with men in China: a randomised controlled trial. Lancet Infectious Diseases, 20(8), 976–982. https://doi.org/10.1016/s1473-3099(20)30172-9