Child-focused state cash transfers and adolescent risk of HIV infection in South Africa

A propensity-score-matched case-control study

Dados Bibliográficos

ID23323410
AutoresLucie D Cluver (0000-0002-0418-835X, University of Cape Town), Lucie Cluver, Mark E Boyes (0000-0001-5420-8606, Oxford Policy Management), Mark Boyes, Mark Orkin (0000-0001-9951-6733, University of the Witwatersrand), Marija Pantelic (0000-0002-7239-645X, Oxford Policy Management), Thembela Molwena (City of Cape Town), Lorraine Sherr (0000-0002-5902-8011, The Royal Free Hospital)
Ano2013
Volume1
Fascículo6
Páginase362-e370
Data de publicação2013-12-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoThe Lancet Global Health (JOURNAL)
Identificadores do periódicoISSN: 2214-109X • E-ISSN: 2572-116X
EditoraElsevier BV (PUBLISHER)
DOI10.1016/s2214-109x(13)70115-3
PMID25104601
OpenAlexW2150753291
IdiomaEN
Citações recebidas76
Referências citadas25

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. We randomly selected census areas in two urban and two rural districts in two provinces in South Africa, including all homes with a resident adolescent. We assessed household receipt of state-provided child-focused cash transfers, incidence in the past year and prevalence of transactional sex, age-disparate sex, unprotected sex, multiple partners, and sex while drunk or after taking drugs. We used logistic regression after propensity score matching to assess the effect of cash transfers on these risky sexual behaviours. FINDINGS: We interviewed 3515 participants (one per household) at baseline, and interviewed 3401 at follow-up. For adolescent girls (n=1926), receipt of a cash transfer was associated with reduced incidence of transactional sex (odds ratio [OR] 0·49, 95% CI 0·26-0·93; p=0·028), and age-disparate sex (OR 0·29, 95% CI 0·13-0·67; p=0·004), with similar associations for prevalence (for transactional sex, OR 0·47, 95% CI 0·26-0·86; p=0·015; for age-disparate sex, OR 0·37, 95% CI 0·18-0·77; p=0·003). No significant effects were shown for other risk behaviours. For boys (n=1475), no consistent effects were shown for any of the behaviours. INTERPRETATION: National, child-focused cash transfers to alleviate poverty for households in sub-Saharan Africa can substantially reduce unsafe partner selection by adolescent girls. Child-focused cash transfers are of potential importance for effective combination strategies for prevention of HIV. FUNDING: UK Economic and Social Research Council, South African National Research Foundation, Health Economics and AIDS Research Division at University of KwaZulu-Natal, South African National Department of Social Development, Claude Leon Foundation, John Fell Fund, Nuffield Foundation, and Regional Interagency Task Team for Children affected by AIDS-Eastern and Southern Africa.

Cash transfers · Environmental health · Incidence (geometry) · Logistic regression · Odds · Odds ratio · Population · Poverty · Propensity score matching · Receipt · Transactional sex · Adolescent Sexual and Reproductive Health · Demography · HIV/AIDS Impact and Responses · Medicine · Poverty, Education, and Child Welfare · Surgery