AIDS and Behavior

, Volume 17, Issue 7, pp 2301–2312 | Cite as

Acceptability and Feasibility of Cash Transfers for HIV Prevention Among Adolescent South African Women

  • Catherine MacPhailEmail author
  • Michelle Adato
  • Kathleen Kahn
  • Amanda Selin
  • Rhian Twine
  • Samson Khoza
  • Molly Rosenberg
  • Nadia Nguyen
  • Elizabeth Becker
  • Audrey Pettifor
Original Paper


Women are at increased risk of HIV infection in much of sub-Saharan Africa. Longitudinal and cross-sectional studies have found an association between school attendance and reduced HIV risk. We report feasibility and acceptability results from a pilot of a cash transfer intervention conditional on school attendance paid to young women and their families in rural Mpumalanga, South Africa for the prevention of HIV infection. Twenty-nine young women were randomised to intervention or control and a cash payment based on school attendance made over a 2-month period. Quantitative (survey) and qualitative (focus group and interview) data collection was undertaken with young women, parents, teachers and young men in the same school. Qualitative analysis was conducted in Atlas.ti using a framework approach and basic descriptive analysis in Excel was conducted on the quantitative data. Results indicate it was both feasible and acceptable to introduce such an intervention among this population in rural South Africa. There was good understanding of the process of randomisation and the aims of the study, although some rumours developed in the study community. We address some of the changes necessary to ensure acceptability and feasibility of the main trial.


HIV prevention South Africa Women Cash transfers School Social relationships 



The authors would like to acknowledge the young women and their parents who participated in this study and the field team who collected the data. Financial support for the research and authorship of this article was obtained from HPTN 068, a Grant (1RO1MH087118-01) from the National Institutes of Mental Health and funding from the Regional Network on AIDS, Livelihoods and Food Security (RENEWAL).


  1. 1.
    Pettifor A, Rees H, Kleinschmidt I, Steffenson A, MacPhail C, Hlongwa-Madikizela L, et al. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviours from a nationally representative household survey. AIDS. 2005;19:1525–34.PubMedCrossRefGoogle Scholar
  2. 2.
    UNAIDS. Report on the global AIDS epidemic. Geneva: UNAIDS, 2006.Google Scholar
  3. 3.
    Pettifor A, Levandowski B, MacPhail C, Padian N, Cohen M, Rees H. Keep them in school: the importance of education as a protective factor against HIV infection among young South African women. Int J Epidemiol. 2008;37(6):1266–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Bärnighausen T, Hoosegood V, Timaeus I, Newell M. The socioeconomic determinants of HIV incidence: evidence from a longitudinal, population-based study in rural South Africa. AIDS. 2007;21(suppl 7):s29–38.PubMedCrossRefGoogle Scholar
  5. 5.
    Hargreaves J, Morrison L, Kim J, Bonell C, Porter J, Watts C, et al. The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa. J Epidemiol Community Health. 2008;62:113–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Jukes M, Simmons S, Bundy D. Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa. AIDS. 2008;22(suppl 4):s41–56.PubMedCrossRefGoogle Scholar
  7. 7.
    Michelo C, Sandøy I, Fylkesnes K. Marked HIV prevalence declines in higher educated young women: evidence from population-based surveys (1995–2003) in Zambia. AIDS. 2006;20(7):1031–8.PubMedCrossRefGoogle Scholar
  8. 8.
    de Walque D, Nakiyingi-Miiro J, Busingye J, Whitworth J. Changing association between schooling levels and HIV-1 infection over 11 years in a rural population cohort in south-west Uganda. Tropical Med Int Health. 2005;10(10):993–1001.CrossRefGoogle Scholar
  9. 9.
    Department of Education. Monitoring and evaluation report on the impact and outcomes of the education system on South Africa’s population: evidence from household surveys. Pretoria: Department of Education; 2006.Google Scholar
  10. 10.
    Barham T, Maluccio J. Eradicating diseases: the effect of conditional cash transfers on vaccination coverage in rural Nicaragua. J Health Econ. 2009;28(3):611–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Baird S, McIntosh C, Özler B. Designing cost-effective cash transfer programs to boost schooling among young women in sub-Saharan Africa. Washington, DC: The World Bank; 2009.Google Scholar
  12. 12.
    Hallfors D, Cho H, Rusakaniko S, Iritani B, Mapfumo J, Halpern C. Supporting adolescent orphan girls to stay in school as HIV risk prevention: evidence from a randomized controlled trial in Zimbabwe. Am J Public Health. 2011;101(6):1082–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Cho H, Hallfors DM II, Itindi J, Malimo B, Halpern C, Iritani B. Keeping adolescent orphans in school to prevent human immunodeficiency virus infection: evidence from a randomized controlled trial in Kenya. J Adolesc Health. 2011;48(5):523–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Hankins C, de Zalduondo B. Combination prevention: a deeper understanding of effective HIV prevention. AIDS. 2010;24(suppl 4):s70–80.PubMedCrossRefGoogle Scholar
  15. 15.
    Collinson M. Striving against diversity: the dynamics of migration, health and poverty in rural South Africa. Glob Health Action. 2010;. doi: 10.3402/gha.v3i0.5080.Google Scholar
  16. 16.
    Kahn K, Tollman S, Collinson MA, Clark S, Twine R, Clark B, et al. Research into health, population and social transitions in rural South Africa: data and methods of the Agincourt Health and Demographic Surveillance System. Scand J Public Health. 2007;35(suppl 69):8–20.CrossRefGoogle Scholar
  17. 17.
    De Lannoy A, Hall K. Children Count. 2012 Accessed 30 January 2013
  18. 18.
    Kahn K, Tollman S, Collinson M, Clark S, Twine R, Clark B, et al. Research into health, population and social transitions in rural South Africa: data and methods of the Agincourt Health and Demographic Surveillance System 1. Scand J Public Health. 2007;35(suppl 69):8–20.CrossRefGoogle Scholar
  19. 19.
    Tollman S, Kahn K. Health, population and social transitions in rural South Africa. Scand J Public Health. 2007;35(suppl 69):4–7.CrossRefGoogle Scholar
  20. 20.
    Pope S, Ziebland S, Mays N. Qualitative research in health care: analysis of qualitative data. Br Med J. 2000;320:114–6.CrossRefGoogle Scholar
  21. 21.
    Tollman S, Herbst K, Garenne M, Gear JS, Kahn K. The Agincourt Demographic and Health Study: site description, baseline findings and implications. S Afr Med J. 1999;89:858–64.PubMedGoogle Scholar
  22. 22.
    Adato M, Roopnaraine T, Smith N, Altinok E, Çelebioğlu N, Cemal S. An evaluation of the conditional cash transfer program in Turkey: Second qualitative and anthropological study. Washington, DC: International Food Policy Research Institute; 2007.Google Scholar
  23. 23.
    Baird S, de Hoop J, Ozler B. Income shocks and adolescent mental health. Washington DC: The World Bank; 2011.Google Scholar
  24. 24.
    Geissler P, Pool R. Popular concerns about medical research projects in sub-Saharan Africa—a critical voice in debates about medical research ethics. Trop Med Int Health. 2006;11(7):975–82.PubMedCrossRefGoogle Scholar
  25. 25.
    Stadler J, Saethre E. Rumours about blood and reimbursements in a microbicide gel trial. Afr JAIDS Res. 2010;9(4):345–53.CrossRefGoogle Scholar
  26. 26.
    Adato M, Roopnaraine T. Conditional cash transfer programs, participation and power. In: Adato M, Hoddinott J, editors. Conditional cash transfers in Latin America. Baltimore: Johns Hopkins University Press; 2010.Google Scholar
  27. 27.
    Bourguignon F, Ferreira F, Leite P. Conditional cash transfers, schooling, and child labor: micro-stimulating Brazil’s Bolsa Escola Program. World Bank Econ Rev. 2003;17(2):229–54.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Catherine MacPhail
    • 1
    • 2
    Email author
  • Michelle Adato
    • 3
  • Kathleen Kahn
    • 4
  • Amanda Selin
    • 5
  • Rhian Twine
    • 4
  • Samson Khoza
    • 4
  • Molly Rosenberg
    • 5
  • Nadia Nguyen
    • 5
  • Elizabeth Becker
    • 3
  • Audrey Pettifor
    • 5
  1. 1.Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the WitwatersrandJohannesburgSouth Africa
  2. 2.Collaborative Research Network (CRN) for Mental Health and Well-being of Rural and Regional Communities, University of New EnglandArmidaleAustralia
  3. 3.Regional Network on AIDS, Livelihoods, and Food Security (RENEWAL), International Food Policy Research Institute (IFPRI)Washington DCUSA
  4. 4.Wits/MRC Rural Public Health and Health Transitions Research Unit (Agincourt), University of the WitwatersrandJohannesburgSouth Africa
  5. 5.Gillings School of Public Health, University of North CarolinaChapel HillUSA

Personalised recommendations