effective combination prevention: cash, care and hiv -risk for adolescents in south africa
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Effective combination prevention: Cash, care and HIV -risk for adolescents in South Africa. L Cluver, M Orkin , M Boyes , L Sherr IAS, July 2014. Collaborative research: science to assist policy. National longitudinal study of adolescents - PowerPoint PPT PresentationTRANSCRIPT
Effective combination prevention:
Cash, care and HIV-risk for adolescents in South Africa.
L Cluver, M Orkin, M Boyes, L SherrIAS, July 2014
Child-focused research
Universities: Oxford, UCT, Wits, Curtin,
UKZN
Collaborative research: science to assist policy
National longitudinal study of adolescents6850 adolescents, 2500 adult caregivers, 2008-2012
Longitudinal national survey• Main study: N=6000 (age: 10-18) • 3 provinces South Africa; 6 sites >30% prevalence• Stratified random sampling of census EAs• Every household with a child aged 10-17• Urban/rural, 1 year follow-up in 2 provinces • n=3401, 97% follow-up
Measures• Standardised scales, national surveys
Ethics• Approved by Universities of Cape Town, • Oxford, KwaZulu-Natal,• 6 Provincial Health & Education Departments• Social & health service referralsControlling for prior HIV risk
Effects of abuse, poverty & parental AIDS on female adolescent risk of transactional sex
Cluver, Orkin, Boyes, Meinck, Makhasi (2011). JAIDS
Healthy family AIDS-sick parent Abused & hungry AIDS-sick parent, abused, hungry
1%
7%
13%
57%
Proof of concept: cash incentives
Unconditional cash transfers
12-14 years 15-17 years0
1
2
3
4
5
6
7
8 % Incidence of transactional
sex (OR .49 CI .26-.93*)
South Africa: Child grant reduces incidence & prevalence of transactional sex and age-disparate sex for girls
No cash transfer
Child cash transfer
Cluver, Boyes, Orkin, Pantelic, Molwena, Sherr (2013). The Lancet Global Health.
12-14 years 15-17 years
% Incidence of age-disparate sex (OR .29 CI .13-.67**)
Cash plus care?
Can CASH + CARE reduce HIV risk behavior?
CASH
CARE
Incidence rates:Transactional sex
Age-disparate sex
Sex using substances
Multiple partners
Unprotected sex
Teen pregnancy
Child-focused grant
Regular food parcels
Free school meals
Free school transport
School counsellor
Food garden
Home-based carer
Positive parenting
Free school uniform
Teacher supportSoup kitchen
Child-focused grant
Free school meals
Food garden
Positive parenting
Teacher support
n=3515, longitudinal
% girls with incidence of 1+ HIV risk behavior: Cash plus care = halved risk
Cash alone: OR .63Cash plus care: OR .55
no support cash cash plus care0
10
20
30
40
50
60
41%
25%
15% Controlling for: family HIV/AIDS, informal/formal housing, age of child, poverty levels, number of moves of home, baseline HIV risk behaviour
Cluver, Orkin, Boyes, Sherr (2014). AIDS.
% boys with incidence of 1+ HIV risk behavior:Cash plus care = halved risk
Cash alone: no significant effectCash plus care: OR .50
no support cash cash plus care0
10
20
30
40
50
60
42%
28%
17% Controlling for: family HIV/AIDS, informal/formal housing, age of child, poverty levels, number of moves of home, baseline HIV risk behaviour
Cluver, Orkin, Boyes, Sherr (2014). AIDS.
Structural drivers and mechanisms
Hunger
Community violence
Parental HIV/AIDS
Informal settlement
2011Structural deprivation
2012HIV-risk behavior
incidence
Poverty & family AIDS predict adolescent HIV-risks: how?
Transactional sex
Age-disparate sex
Sex using substances
Multiple partners
Unprotected sex
Pregnancy
controlling for: baseline HIV-risk, age, gender
all p<.001
HIV-risk behaviorincidence
Structural deprivation
school dropout
child abuse
conduct problems
drug/alcohol use
psychological distress
p<.0
01p<
.001
p<.00
1
p<.001
p<.001
p<.001p<.001
p<.002
p<.05
p<.001
controlling for: baseline HIV-risk, age, gender
Psychosocial problemsp<.004
ReducedHIV-risk behaviorincidence
Structural deprivation
Reduced psycho-social
problems
controlling for: baseline HIV-risk, age, gender
CASH
CARE
Cash and care: greatest effects for highest-risk adolescents
P<.001P<.001P<.001
P<.001
P<.001
P<.001 P<.001
P<.001
P<.001
0
5
10
15
20% adolescents with multiple
past-year sexual partners
Cumulative HIV-prevention impact
Unconditional, government cash transfers reduce adolescent HIV risks
Cash plus care gives greater effects
Effective in real-world sub-Saharan Africa
Cash and care mitigate structural risk
Cumulative impacts of 2+ interventions
Funders: thank you.