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


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.

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Fig. 1
Fig. 2


  1. 1.

    The CES-D was not included in the baseline survey so we show baseline descriptive data for the 10-item Children’s Depression Index (cite) in Table 1.

  2. 2.

    3.4% of control group also reported the CCT as their main source of money. This data could be due to misreporting, but as there were reports of young women in the treatment group sharing their money with friends and siblings, this may reflect those allocations.

  3. 3.

    Less than half of women report being sexual active during the trial, however, of the women that report having a partner, the majority report that they received money at some point from their partner.

  4. 4.

    Results look the same for the resource index with no paid work.


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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).

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Correspondence to Kelly Kilburn.

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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.



See Figs. 3 and 4 and Tables 6 and 7.

Fig. 3

Cumulative distribution functions (CDFs) for the economic index. CDFs show the cumulative distribution of the economic index separately for treatment and control arms across baseline and follow-up visits. Panel 1 shows the distributions for full sample, while panels 2 and 3 divide the sample by baseline poverty status (panel 2, bottom half; panel 3, top half)

Fig. 4

Marginal effects for the impact of the CCT on young women’s economic participation and resources. Notes Marginal effects for the total treatment effect and by baseline poverty status (top or bottom half). Estimates provided with 95% confidence interval bars (insignificant results cross the vertical line at 0)

Table 6 Baseline comparison between young women from the poorest (bottom half) of households to the top half at baseline
Table 7 Impacts of CCT on Young women’s economic resources and moderation by baseline poverty

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Kilburn, K., Hughes, J.P., MacPhail, C. et al. Cash Transfers, Young Women’s Economic Well-Being, and HIV Risk: Evidence from HPTN 068. AIDS Behav 23, 1178–1194 (2019).

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