Posted: Jul 19, 2017
Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents
Introduction: 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.
Methods: This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection.
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CLUVER, L. D., ORKIN, F. M., MEINCK, F., BOYES, M. E. & SHERR, L. 2016. Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents. Journal of the International AIDS Society, 19.
Posted: Jul 19, 2017
Can Social Protection Improve Sustainable Development Goals for Adolescent Health?
The first policy action outlined in the Sustainable Development Goals (SDGs) is the imple-mentation of national social protection systems. This study assesses whether social protection provision can impact 17 indicators of five key health-related SDG goals amongst adolescents in South Africa.
We conducted a longitudinal survey of adolescents (10–18 years) between 2009 and 2012. Census areas were randomly selected in two urban and two rural health districts in two South African provinces, including all homes with a resident adolescent. Household receipt of social protection in the form of ‘cash’ (economic provision) and ‘care’ (psychosocial sup-port) social protection, and health-related indicators within five SDG goals were assessed. Gender-disaggregated analyses included multivariate logistic regression, testing for inter-actions between social protection and socio-demographic covariates, and marginal effects models.
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Social protection was associated with significant adolescent risk reductions in 12 of 17 gender-disaggregated SDG indicators, spanning SDG 2 (hunger); SDG 3 (AIDS, tuberculosis, mental health and substance abuse); SDG 4 (educational access); SDG 5 (sexual exploitation, sexual and reproductive health); and SDG 16 (violence perpetration). For six of 17 indicators, combined cash plus care showed enhanced risk reduction effects. Two interactions showed that effects of care varied by poverty level for boys’ hunger and girls’ school dropout. For tuberculosis, and for boys’ sexual exploitation and girls’ mental health and violence perpetration, no effects were found and more targeted or creative means will be needed to reach adolescents on these challenging burdens.
CLUVER, L. D., ORKIN, F. M., MEINCK, F., BOYES, M. E., YAKUBOVICH, A. R. & SHERR, L. 2016. Can social protection improve sustainable development goals for adolescent health? PLoS One, 11, e0164808.
Posted: Jan 16, 2017
School, Supervision and Adolescent-Sensitive Clinic Care: Combination Social Protection and Reduced Unprotected Sex Among HIV-Positive Adolescents in South Africa
Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence among HIV-positive adolescents is limited. This study quantitatively tests whether social protection is associated with reduced unprotected sex among 1060 ART-eligible adolescents from 53 government facilities in South Africa. Potential social protection included nine ‘cash/cash-in-kind’ and ‘care’ provisions. Analyses tested interactive/additive effects using logistic regressions and marginal effects models, controlling for covariates. 18 % of all HIV-positive adolescents and 28 % of girls reported unprotected sex. Lower rates of unprotected sex were associated with access to school (OR 0.52 95 % CI 0.33–0.82 p = 0.005), parental supervision (OR 0.54 95 % CI 0.33–0.90 p = 0.019), and adolescent-sensitive clinic care (OR 0.43 95 % CI 0.25–0.73 p = 0.002). Gender moderated the effect of adolescent-sensitive clinic care. Combination social protection had additive effects amongst girls: without any provisions 49 %reported unprotected sex; with 1–2 provisions 13–38 %; and with all provisions 9 %. Combination social protection has the potential to promote safer sex among HIV-positive adolescents, particularly girls.
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BAIRD, S. J., GARFEIN, R. S., MCINTOSH, C. T. & ÖZLER, B. 2012. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. The Lancet, 379, 1320-1329
Posted: Jan 16, 2017
Promoting healthy behaviours and improving health outcomes in low and middle income countries: A review of the impact of conditional cash transfer programmes
Objective: To provide an overview of Conditional Cash Transfer (CCT) programmes in low and middle in-come countries and present the evidence to date on their contribution to improvements in health and the encouragement of healthy behaviours.
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Methods: Several bibliographic databases and websites were used to identify relevant studies. To be included, a study had to provide evidence of effects of a ﬁnancial incentive conditional upon speciﬁc health-related behaviours. Only experimental or quasi-experimental study designs were accepted.
Results: We identiﬁed 13 CCT programmes, whose effects had been evaluated, mostly in Latin-American countries. Their results suggest that CCTs have been effective in increasing the use of preventive services, improving immunisation coverage, certain health outcomes and in encouraging healthy behaviours.
Conclusion: CCTs can be valuable tools to address some of the obstacles faced by populations in poorer countries to access health care services, or maybe to modify risky sexual behaviours. However, CCTs need to be combined with supply-side interventions to maximise effects. Finally, some questions remain regarding their sustainability and cost-effectiveness.
RANGANATHAN, M. & LAGARDE, M. 2012. Promoting healthy behaviours and improving health outcomes in low and middle income countries: a review of the impact of conditional cash transfer programmes. Preventive medicine, 55, S95-S105.
Posted: Jan 16, 2017
Can money prevent the spread of HIV? A review of cash payments for HIV prevention
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. We identified 16 studies meeting our criteria; 10 are completed. The majority of studies have been conducted with adolescents in developing countries and payments are focused on addressing structural risk factors such as poverty. Most have seen reductions in sexual behavior and one large trial has documented a difference in HIV prevalence between young women getting cash transfers and those not. Cash transfer programs focused on changing risky sexual behaviors to reduce HIV risk suggest promise. The context in which programs are situated, the purpose of the cash transfer, and the population will all affect the impact of such programs; ongoing RCTs with HIV incidence endpoints will shed more light on the efficacy of cash payments as strategy for HIV prevention.
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PETTIFOR, A., MACPHAIL, C., NGUYEN, N. & ROSENBERG, M. 2012. Can money prevent the spread of HIV? A review of cash payments for HIV prevention. AIDS and Behavior, 16, 1729-1738.