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
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Effective combination prevention:
Cash, care and HIV-risk for adolescents in South Africa.
L Cluver, M Orkin, M Boyes, L SherrIAS, July 2014
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Child-focused research
Universities: Oxford, UCT, Wits, Curtin,
UKZN
Collaborative research: science to assist policy
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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
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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%
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Proof of concept: cash incentives
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Unconditional cash transfers
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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**)
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Cash plus care?
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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
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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
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Child-focused grant
Free school meals
Food garden
Positive parenting
Teacher support
n=3515, longitudinal
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% 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.
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% 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.
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Structural drivers and mechanisms
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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
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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
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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
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0
5
10
15
20% adolescents with multiple
past-year sexual partners
Cumulative HIV-prevention impact
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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
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Funders: thank you.