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Comment on a study published in The Lancet Global Health by Audrey Pettifor and colleagues on cash transfers, school attendance and the reduction of HIV risk behaviours in adolescent girls.
Cash transfers have been proposed as an intervention to reduce HIV-infection risk for young women in sub-Saharan Africa. However, scarce evidence is available about their effect on reducing HIV acquisition. The authors aimed to assess the effect of a conditional cash transfer on HIV incidence among young women in rural South Africa. Based on their research findings, the authors draw the conclusion that cash transfers conditional on school attendance did not reduce HIV incidence in young women. School attendance significantly reduced risk of HIV acquisition, irrespective of study group. …
Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women. The authors assessed the efficacy of a cash transfer programme for schooling to reduce the risk of sexually transmitted infections in young women. Based on their findings the authors conclude that cash transfer programmes can reduce HIV and HSV-2 infections in adolescent schoolgirls in low-income settings. Structural interventions that do not directly target sexual behaviour change can be important components of HIV prevention strategies.
This article investigates how well South Africa’s Child Support Grant (CSG) responds to the material and psychosocial needs of adolescents, and the resultant effects on schooling and risky behaviour. One driver of schooling decisions is shame related to poverty and the ‘social cost’ of school, where a premium must often be paid for fashionable clothes or accessories. The other driver relates to symbolic and consumptive capital gained through engaging in sexual exchange relationships. The anticipated impacts from the CSG are partial because of these non-material drivers of adolescent choices. …
Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can “cash plus care” social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa.
Background: The ‘Cash Transfer to Orphans and Vulnerable Children’ (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people’s health and well-being and other international human rights. …
Objectives: It is not known whether cumulative ‘cash plus care’ interventions can reduce adolescent HIV-infection risks in sub-Saharan Africa. This study investigated whether parental AIDS and other environmental adversities increase adolescent HIVrisk behaviour and whether social protection provision of ‘cash’ or integrated ‘cash plus care’ reduces HIV-risk behaviour. Design: A prospective observational study with random sampling (<2.5% baseline refusal, 1-year follow-up, 96.8% retention). …
The aim of this study is to assess whether the Government of Kenya’s Cash Transfer for Orphans and Vulnerable Children (Kenya CT-OVC) can reduce the risk of HIV among young people by postponing sexual debut. The program provides an unconditional transfer of US$20 per month directly to the main caregiver in the household. An evaluation of the program was implemented in 2007–2009 in seven districts. Fourteen Locations were randomly assigned to receive the program and fourteen were assigned to a control arm. A sample of households was enrolled in the evaluation in 2007. …
Background: Effective and scalable HIV prevention for adolescents in sub-Saharan Africa is needed. Cash transfers can reduce HIV incidence through reducing risk behaviours. However, questions remain about their effectiveness within national poverty-alleviation programmes, and their effects on different behaviours in boys and girls. Methods: In this case-control study, we interviewed South African adolescents (aged 10–18 years) between 2009 and 2012. …
Cash payments to improve health outcomes have been used for many years; however, their use for HIV prevention is new and the impact not yet well understood. We provide a brief background on the rationale behind using cash to improve health outcomes, review current studies completed or underway using cash for prevention of sexual transmission of HIV, and outline some key considerations on the use of cash payments to prevent HIV infections. We searched the literature for studies that implemented cash transfer programs and measured HIV or HIV-related outcomes. …
Between a quarter and a third of young women in sub-Saharan Africa are infected with HIV by the time they reach their early 20s. Structural factors such as poor education, poverty, and gender and power inequalities are important determinants of young women’s vulnerability to HIV infection. In The Lancet, Sarah Baird and colleagues report the results of a randomised controlled trial done with adolescent girls in rural Malawi, examining the effects of a cash transfer programme on risk of HIV infection. …
The relationship between poverty and mental health functioning is well documented. Poverty affects not only families’ ability to physically care for children, but also families’ stability, functioning, and psychosocial well-being. In this article, we examine the impact of a comprehensive microfinance intervention, intended to reduce the risk of poverty, on depression among adolescent youth who have lost either one or both parents to AIDS.A child who has been affected by AIDS is more likely to have increased levels of anxiety, depression, and reduced self-esteem. …
Abstince-only education programs in the United States have been controversial since their inception in 1981 because of their lack of efficacy and because of the sexualities and behaviors that they promulgate. Barack Obama's 2010 budget eliminates federal funding for abstinence-only education programs in the US; however, the outline of his five-year strategy for the President's Emergency Plan for AIDS Relief (PEPFAR) does not indicate whether the US government will continue to mandate abstinence-only education in so-called "focus countries", primarily in sub-Saharan Africa. …
This paper investigates the short-run consumption expenditure dynamics and the interaction of public and private arrangements of ultra-poor and labor-constrained households in Malawi using an original dataset from the Mchinjii social cash transfer pilot project (one of the first experiments of social protection policies based on unconditional cash transfers in Sub-Saharan Africa). …
While it does not cost a great deal to make a difference in the life of a child living in poverty, that does not mean that they are cheap to care for. To avoid confusion there is a need to distinguish between expenditures on care, marginal costs of care and total cost of care. Expenditures on children are the amounts of money spent on their care. The marginal cost of care is the cost of achieving a specific increase in the level of care. The total cost of care is the cost of providing a given level of care. …
