Advertisement

Cash Transfers, Young Women’s Economic Well-Being, and HIV Risk: Evidence from HPTN 068

  • Kelly Kilburn
  • James P. Hughes
  • Catherine MacPhail
  • Ryan G. Wagner
  • F. Xavier Gómez-Olivé
  • Kathleen Kahn
  • Audrey Pettifor
Original Paper

Abstract

Despite the large interest in economic interventions to reduce HIV risk, little research has been done to show whether there are economic gains of these interventions for younger women and what intermediary role economic resources play in changing participants’ sexual behavior. This paper contributes to this gap by examining the impacts of a conditional cash transfer (CCT) for young women in South Africa on young women’s economic resources and the extent to which they play a role in young women’s health and behavior. We used data from HIV Prevention Trials Network 068 study, which provided transfers to young women (in addition to their parents) conditional on the young woman attending at least 80% of school days in the previous month. We found that the CCT increased young women’s economic wellbeing in terms of having savings, spending money, being unindebted, and food secure. We also investigated heterogeneous effects of the program by household economic status at baseline because the program was not specifically poverty targeted and found that the results were driven by young women from the poorest families. From these results, we examined heterogeneity by baseline poverty for other outcomes related to HIV risk including sexual behavior and psychosocial well-being. We found psychosocial well-being benefits in young women from the poorest families and that economic wellbeing gains explained much these impacts.

Keywords

Adolescent girls and young women South Africa Economic empowerment Cash transfers Psychosocial well-being 

Notes

Funding

Funding support for the HPTN was provided by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH; Award Numbers UM1AI068619 [HPTN Leadership and Operations Center], UM1AI068617 [HPTN Statistical and Data Management Center], and UM1AI068613 [HPTN Laboratory Center]. The study was also funded under R01MH110186, R01MH087118, and R24 HD050924 to the Carolina Population Center. Research reported in this publication was also supported by the NIAID of the NIH [Award Number T32AI007001]. Additional funding was provided by the Division of Intramural Research, NIAID, and NIH. The Agincourt Health and Socio-Demographic Surveillance System is supported by the University of the Witwatersrand, the Medical Research Council, South Africa and the Wellcome Trust, UK (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; and 085477/B/08/Z).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Levine R, Lloyd B, Greene ME, Grown C. Girls count: a global investment & action agenda. https://www.icrw.org/wp-content/uploads/2016/10/Girls-Count-A-global-Investment-and-Action-Agenda.pdf (2009).
  2. 2.
    Jones N, Harper C, Watson C, Espey J, Wadugodapitiya D, Page E et al. Stemming girls’ chronic poverty: catalysing development change by building just social institutions (SSRN scholarly paper no. ID 1719613). Rochester: Social Science Research Network. https://papers.ssrn.com/abstract=1719613 (2010).
  3. 3.
    UNICEF. The state of the World’s children 2011: adolescence—an age of opportunity. New York: UNICEF; 2011.Google Scholar
  4. 4.
    Wojcicki JM. Socioeconomic status as a risk factor for HIV infection in women in east, central and southern Africa: a systematic review. J Biosoc Sci. 2005;37(1):1–36.  https://doi.org/10.1017/S0021932004006534.CrossRefPubMedGoogle Scholar
  5. 5.
    Kim J, Pronyk P, Barnett T, Watts C. Exploring the role of economic empowerment in HIV prevention. AIDS. 2008;22:S57.  https://doi.org/10.1097/01.aids.0000341777.78876.40.CrossRefPubMedGoogle Scholar
  6. 6.
    Gillespie S, Kadiyala S, Greener R. Is poverty or wealth driving HIV transmission? AIDS. 2007;21:S5.  https://doi.org/10.1097/01.aids.0000300531.74730.72.CrossRefPubMedGoogle Scholar
  7. 7.
    Harrison A, Colvin CJ, Kuo C, Swartz A, Lurie M. Sustained high HIV incidence in young women in Southern Africa: social, behavioral, and structural factors and emerging intervention approaches. Curr HIV/AIDS Rep. 2015;12(2):207–15.  https://doi.org/10.1007/s11904-015-0261-0.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N, Labadarios D, Onoya D, et al. South African national HIV prevalence, incidence and behaviour survey, 2012. Cape Town: HSRC Press; 2014.Google Scholar
  9. 9.
  10. 10.
    Luke N. Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plan. 2003;34(2):67–86.CrossRefGoogle Scholar
  11. 11.
    Karim QA, Sibeko S, Baxter C. Preventing HIV infection in women: a global health imperative. Clin Infect Dis. 2010;50(Supplement_3):S122–9.  https://doi.org/10.1086/651483.CrossRefGoogle Scholar
  12. 12.
    MacPhail C, Campbell C. “I think condoms are good but, aai, I hate those things”: condom use among adolescents and young people in a Southern African township. Soc Sci Med (1982). 2001;52(11):1613–27.CrossRefGoogle Scholar
  13. 13.
    Kaufman CE, Stavrou SE. ‘Bus fare please’: the economics of sex and gifts among young people in urban South Africa. Cult Health Sex. 2004;6(5):377–91.  https://doi.org/10.1080/13691050410001680492.CrossRefGoogle Scholar
  14. 14.
    Jennings L, Mathai M, Linnemayr S, Trujillo A, Mak’anyengo M, Montgomery BEE, Kerrigan DL. Economic context and HIV vulnerability in adolescents and young adults living in urban slums in kenya: a qualitative analysis based on scarcity theory. AIDS Behav. 2017;21(9):2784–98.  https://doi.org/10.1007/s10461-017-1676-y.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Leclerc-Madlala S. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability. AIDS. 2008;22:S17.  https://doi.org/10.1097/01.aids.0000341774.86500.53.CrossRefPubMedGoogle Scholar
  16. 16.
    Harrison A, Cleland J, Frohlich J. Young people’s sexual partnerships in KwaZulu-Natal, South Africa: patterns, contextual influences, and HIV risk. Stud Fam Plann. 2008;39(4):295–308.  https://doi.org/10.1111/j.1728-4465.2008.00176.x.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Luke N. Confronting the “sugar daddy” stereotype: age and economic asymmetries and risky sexual behavior in Urban Kenya. Int Fam Plan Perspect. 2005;31(1):6–14.CrossRefGoogle Scholar
  18. 18.
    Biello KB, Sipsma HL, Ickovics JR, Kershaw T. Economic dependence and unprotected sex: the role of sexual assertiveness among young urban mothers. J Urban Health. 2010;87(3):416–25.  https://doi.org/10.1007/s11524-010-9449-1.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Dunkle RKJ, Brown HC, Gray GE, McIntryre JA, Harlow SD. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med. 2004;59(8):1581–92.  https://doi.org/10.1016/j.socscimed.2004.02.003.CrossRefPubMedGoogle Scholar
  20. 20.
    Jewkes R, Dunkle K, Nduna M, Shai NJ. Transactional sex and HIV incidence in a cohort of young women in the stepping stones trial. J AIDS Clin Res. 2012.  https://doi.org/10.4172/2155-61131000158.CrossRefGoogle Scholar
  21. 21.
    Krishnan S, Dunbar MS, Minnis AM, Medlin CA, Gerdts CE, Padian NS. Poverty, gender inequities, and women’s risk of human immunodeficiency virus/AIDS. Ann N Y Acad Sci. 2008;1136:101–10.  https://doi.org/10.1196/annals.1425.013.CrossRefPubMedGoogle Scholar
  22. 22.
    Ashburn K, Warner A. Can economic empowerment reduce vulnerability of girls and young women to HIV? https://www.icrw.org/publications/can-economic-empowerment-reduce-vulnerability-of-girls-and-young-women-to-hiv/ (2010).
  23. 23.
    Heise L, Lutz B, Ranganathan M, Watts C. Cash transfers for HIV prevention: considering their potential. J Int AIDS Soc. 2013;16:18615.  https://doi.org/10.7448/ias.16.1.18615.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Pettifor A, MacPhail C, Nguyen N, Rosenberg M. Can money prevent the spread of HIV? A review of cash payments for HIV prevention. AIDS Behav. 2012;16(7):1729–38.  https://doi.org/10.1007/s10461-012-0240-z.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Reed E, West BS, Salazar M, Monroy RV. Economic empowerment to improve sexual and reproductive health among women and girls. In: Global perspectives on women’s sexual and reproductive health across the lifecourse. Cham: Springer; 2018. p. 297–315.  https://doi.org/10.1007/978-3-319-60417-6_17.Google Scholar
  26. 26.
    Tenkorang EY, Maticka-Tyndale E, Rajulton F. A multi-level analysis of risk perception, poverty and sexual risk-taking among young people in Cape Town, South Africa. Health Place. 2011;17(2):525–35.CrossRefGoogle Scholar
  27. 27.
    Thornton R. or 2010)? Sexual networks and social capital: multiple and concurrent sexual partnerships as a rational response to unstable social networks. Afr J AIDS Res. 2009;8(4):413–21.  https://doi.org/10.2989/AJAR.2009.8.4.5.1042.CrossRefPubMedGoogle Scholar
  28. 28.
    Loevinsohn M, Gillespie SR. HIV/AIDS, food security and rural livelihoods: understanding and responding. Washington, DC: IFPRI. https://core.ac.uk/download/pdf/6289494.pdf (2003).
  29. 29.
    Nyanzi B, Nyanzi S, Wolff B, Whitworth J. Money, men and markets: economic and sexual empowerment of market women in southwestern Uganda. Cult Health Sex. 2005;7(1):13–26.  https://doi.org/10.1080/13691050410001731099.CrossRefPubMedGoogle Scholar
  30. 30.
    Mumah JN, Jackson-Smith D. Why are the benefits of increased resources not impacting the risk of HIV infection for high SES women in Cameroon? PLoS ONE. 2014;9(6):e100507.  https://doi.org/10.1371/journal.pone.0100507.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Jennings L, Pettifor A, Hamilton E, Ritchwood TD, Gómez-Olivé FX, MacPhail C, et al. Economic resources and HIV preventive behaviors among school-enrolled young women in rural South Africa (HPTN 068). AIDS Behav. 2017;21(3):665–77.  https://doi.org/10.1007/s10461-016-1435-5.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, et al. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet. 2006;368(9551):1973–83.  https://doi.org/10.1016/S0140-6736(06)69744-4.CrossRefPubMedGoogle Scholar
  33. 33.
    Ssewamala FM, Han C-K, Neilands TB, Ismayilova L, Sperber E. Effect of economic assets on sexual risk-taking intentions among orphaned adolescents in Uganda. Am J Public Health. 2010;100(3):483–8.  https://doi.org/10.2105/AJPH.2008.158840.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Ssewamala FM, Ismayilova L, McKay M, Sperber E, Bannon W, Alicea S. Gender and the effects of an economic empowerment program on attitudes toward sexual risk-taking among AIDS-orphaned adolescent youth in Uganda. J Adolesc Health. 2010;46(4):372–8.  https://doi.org/10.1016/j.jadohealth.2009.08.010.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Taaffe J, Cheikh N, Wilson D. The use of cash transfers for HIV prevention—are we there yet? Afr J AIDS Res. 2016;15(1):17–25.  https://doi.org/10.2989/16085906.2015.1135296.CrossRefPubMedGoogle Scholar
  36. 36.
    Dunbar MS, Dufour M-SK, Lambdin B, Mudekunye-Mahaka I, Nhamo D, Padian NS. The SHAZ! project: results from a pilot randomized trial of a structural intervention to prevent HIV among adolescent women in Zimbabwe. PLoS ONE. 2014;9(11):e113621.  https://doi.org/10.1371/journal.pone.0113621.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Baird S, Chirwa E, McIntosh C, Özler B. The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women. Health Econ. 2010;19(S1):55–68.CrossRefGoogle Scholar
  38. 38.
    Baird SJ, Garfein RS, McIntosh CT, Özler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet. 2012;379(9823):1320–9.CrossRefGoogle Scholar
  39. 39.
    Pettifor A, MacPhail C, Hughes JP, Selin A, Wang J, Gómez-Olivé FX, et al. The effect of a conditional cash transfer on HIV incidence in young women in rural South Africa (HPTN 068): a phase 3, randomised controlled trial. Lancet Glob Health. 2016;4(12):e978–88.CrossRefGoogle Scholar
  40. 40.
    MacPhail C, Khoza N, Selin A, Julien A, Twine R, Wagner RG, et al. Cash transfers for HIV prevention: what do young women spend it on? Mixed methods findings from HPTN 068. BMC Public Health. 2017;18:10.  https://doi.org/10.1186/s12889-017-4513-3.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Kahn K, Collinson MA, Gómez-Olivé FX, Mokoena O, Twine R, Mee P, et al. Profile: agincourt health and socio-demographic surveillance system. Int J Epidemiol. 2012;41(4):988–1001.  https://doi.org/10.1093/ije/dys115.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Gómez-Olivé FX, Angotti N, Houle B, Klipstein-Grobusch K, Kabudula C, Menken J, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care. 2013;25(9):1122–8.  https://doi.org/10.1080/09540121.2012.750710.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Baird S, de Hoop J, Özler B. Income shocks and adolescent mental health. J Hum Resour. 2013;48(2):370–403.  https://doi.org/10.3368/jhr.48.2.370.CrossRefGoogle Scholar
  44. 44.
    Ssewamala FM, Neilands TB, Waldfogel J, Ismayilova L. The impact of a comprehensive microfinance intervention on depression levels of AIDS-orphaned children in Uganda. J Adolesc Health. 2012;50(4):346–52.  https://doi.org/10.1016/j.jadohealth.2011.08.008.CrossRefPubMedGoogle Scholar
  45. 45.
    Ssewamala FM, Han CK, Neilands TB. Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: findings from a randomized clinical trial in rural Uganda. Soc Sci Med. 2009;69(2):191–8.CrossRefGoogle Scholar
  46. 46.
    Pulerwitz J, Gortmaker SL, DeJong W. Measuring sexual relationship power in HIV/STD research. Sex Roles. 2000;42(7–8):637–60.  https://doi.org/10.1023/A:1007051506972.CrossRefGoogle Scholar
  47. 47.
    Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21.CrossRefGoogle Scholar
  48. 48.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.  https://doi.org/10.1177/014662167700100306.CrossRefGoogle Scholar
  49. 49.
    Abler L, Hill L, Maman S, DeVellis R, Twine R, Kahn K, et al. Hope matters: developing and validating a measure of future expectations among young women in a high HIV prevalence setting in rural South Africa (HPTN 068). AIDS Behav. 2017;21(7):2156–66.  https://doi.org/10.1007/s10461-016-1523-6.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Bedoya, G., Bittarello, L., Davis, J., & Mittag, N. (2017). Distributional impact analysis. World Bank policy research working paper 8139.Google Scholar
  51. 51.
    Keele L, Tingley D, Yamamoto T. Identifying mechanisms behind policy interventions via causal mediation analysis. J Policy Anal Manag. 2015;34(4):937–63.CrossRefGoogle Scholar
  52. 52.
    Inson MA, White MJ, Ginsburg C, Gómez-Olivé FX, Kahn K, Tollman S. Youth migration, livelihood prospects and demographic dividend: a comparison of the Census 2011 and Agincourt Health and Demographic Surveillance System in the rural northeast of South Africa. Afr Popul Stud. 2016;30(2 Suppl):2629–39.Google Scholar
  53. 53.
    Stats SA. Poverty trends in South Africa: an examination of absolute poverty between 2006 and 2011. Pretoria: Stat South Africa; 2014.Google Scholar
  54. 54.
    Dunbar MS, Maternowska C, Kang M-SJ, Laver SM, Mudekunye I, Padian NS. Findings from SHAZ!: a feasibility study of a microcredit and life-skills HIV prevention intervention to reduce risk among adolescent female orphans in Zimbabwe. J Prev Interv Commun. 2010;38(2):147–61.  https://doi.org/10.1080/10852351003640849.CrossRefGoogle Scholar
  55. 55.
    Baird S, McIntosh C, Özler B. Cash or condition? Evidence from a cash transfer experiment. Q J Econ. 2011;126(4):1709–53.CrossRefGoogle Scholar
  56. 56.
    Bastagli F, Hagen-Zanker J, Harman L, Barca V, Sturge G, Schmidt T, Pellerano L. Cash transfers: what does the evidence say. A rigorous review of programme impact and the role of design and implementation features. London: ODI; 2016.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Carolina Population CenterUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Global Health, School of Public HealthGeorge Washington UniversityWashingtonUSA
  3. 3.Department of Biostatistics, School of Public HealthUniversity of WashingtonSeattleUSA
  4. 4.Statistical Center for HIV/AIDS Research and Prevention (SCHARP)SeattleUSA
  5. 5.School of Health and SocietyUniversity of WollongongWollongongAustralia
  6. 6.Wits Reproductive Health and HIV InstituteUniversity of the WitwatersrandJohannesburgSouth Africa
  7. 7.MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
  8. 8.Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
  9. 9.INDEPTH NetworkAccraGhana
  10. 10.Department of EpidemiologyUniversity of North CarolinaChapel HillUSA

Personalised recommendations