Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa
MetadataShow full item record
Objectives: It is not known whether cumulative ‘cash plus care’ interventions can reduce adolescent HIV-infection risks in sub-Saharan Africa. This study investigated whether parental AIDS and other environmental adversities increase adolescent HIV risk behaviour and whether social protection provision of ‘cash’ or integrated ‘cash plus care’ reduces HIV-risk behaviour. Design: A prospective observational study with random sampling (<2.5% baseline refusal, 1-year follow-up, 96.8% retention).Methods: Three thousand five hundred and fifteen 10–18 year-olds (56.7% girls) were interviewed in South Africa between 2009–2010 and 2011–2012. All homes with a resident adolescent were sampled, within randomly selected census areas in two urban and two rural districts in two provinces. Measures included potential environmental risks (e.g. parental HIV/AIDS, poverty), social protection: receipt of cash/food support (e.g. child grants, school feeding), care (e.g. positive parenting) and HIV-risk behaviours (e.g. unprotected sex). Analyses used logistic regression.Results: Cash alone was associated with reduced HIV risk for girls [odds ratio (OR) 0.63; 95% confidence interval (95% CI) 0.44–0.91, P = 0.02] but not for boys. Integrated cash plus care was associated with halved HIV-risk behaviour incidence for both sexes (girls OR 0.55; 95% CI 0.35–0.85, P = 0.007; boys OR 0.50; 95% CI 0.31–0.82, P = 0.005), compared with no support and controlling for confounders. Follow-up HIV-risk behaviour was reduced from 41 to 15% for girls and from 42 to 17% for boys. Girls in AIDS-affected families and informal-dwelling boys had higher HIV-risk behaviour, but were less likely to access integrated social protection. Conclusion: Integrated cash plus care reduces male and female adolescent HIV-risk behaviours. Increasing adolescent access to social protection may be an effective HIV prevention strategy in Sub-Saharan Africa.
This article is published under the Open Access publishing model and distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by-nc-nd/3.0/. Please refer to the licence to obtain terms for any further reuse or distribution of this work.
Showing items related by title, author, creator and subject.
Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescentsCluver, L.; Orkin, F.; Meinck, F.; Boyes, Mark; Sherr, L. (2016)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 ...
Cluver, L.; Orkin, F.; Meinck, F.; Boyes, Mark; Yakubovich, A.; Sherr, L. (2016)BACKGROUND: The first policy action outlined in the Sustainable Development Goals (SDGs) is the implementation of national social protection systems. This study assesses whether social protection provision can impact 17 ...
School, Supervision and Adolescent-Sensitive Clinic Care: Combination Social Protection and Reduced Unprotected Sex Among HIV-Positive Adolescents in South AfricaToska, E.; Cluver, L.; Boyes, Mark; Isaacsohn, M.; Hodes, R.; Sherr, L. (2016)© 2016 The Author(s). 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 ...