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    Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa

    200093_130273_Cluver_et_al_-_Cash_plus_care.pdf (340.4Kb)
    Access Status
    Open access
    Authors
    Cluver, L.
    Orkin, M.
    Boyes, Mark
    Sherr, L.
    Date
    2014
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Cluver, L. and Orkin, M. and Boyes, M. and Sherr, L. 2014. Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa. AIDS. 28 (3): pp. S389-S397.
    Source Title
    AIDS
    DOI
    10.1097/QAD.0000000000000340
    Additional URLs
    http://journals.lww.com/aidsonline/Fulltext/2014/07001/Cash_plus_care__social_protection_cumulatively.19.aspx
    ISSN
    0269-9370
    School
    School of Psychology
    Remarks

    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.

    URI
    http://hdl.handle.net/20.500.11937/35539
    Collection
    • Curtin Research Publications
    Abstract

    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.

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