Impact of a School Conditional Cash Transfer on HIV Risk: a 3-year RCT
This multi-level HIV prevention intervention jointly addresses both structural and social factors that contribute to young women’s increased vulnerability to HIV. Cash transfers will be provided to families of young women conditional on the young women attending school with the goal of reducing the young women’s HIV risk and acquisition by keeping her in school and improving her family’s economic resources (structural factors). The structural level intervention will be complemented by a community level mobilization intervention focused on young men. The goal of the mobilization activities is to engage young men around the issues of gender norms and HIV risk and to encourage them to take action to protect young women and reduce HIV risk in their communities.
Primary Objective
To determine whether young women who are randomized to receive Conditional Cash Transfers (CCTs) conditional on school attendance have a lower incidence of HIV infection over time compared to young women who are not randomized to receive cash transfers.
Secondary Objectives
1) To determine whether young women who are randomized to receive CCTs conditional on school attendance have a lower incidence of Herpes Simplex Virus type 2 (HSV-2) infections over time compared to young women who are not randomized to receive cash transfers.
2) To determine whether young women who receive the CCTs report less unprotected sex, fewer number of sexual partners, younger male partners, an older age of coital debut, a lower incidence of self-reported pregnancy, and greater school attendance compared to young women who do not receive the cash transfers.
3) To determine whether young people ages 18-35 living in villages that are randomized to a mobilization intervention focused on young men demonstrate positive changes in gender norms compared to young people living in villages that are not randomized to mobilization.
4) To determine whether young women who are randomized to receive CCTs and who live in villages that are receiving the mobilization intervention targeting young men to change gender norms have a lower incidence of HIV and HSV-2 over time compared to young women who receive the cash transfer alone.
Study Design
This study is a multi-level intervention that involves individually randomizing 2,660 HIV-negative young women and their household to receive a monthly cash transfer, conditional on the young woman attending school. In addition, half of the villages (n≈12) in which the young women reside are also randomized to receive a community mobilization intervention with a particular focus on changing gender norms in young men.
Study Site
This study is situated in the Agincourt area of the rural Bushbuckridge Sub-district of the Mpumalanga Province in South Africa. The MRC/Wits Agincourt Unit runs an Agincourt Health and Demographic Surveillance System (AHDSS) in this area.
Study Population
Young women enrolled in grades 8, 9, 10 or 11 in 2011 and between the ages of 13 and 20 years.
Households are identified for recruitment into the study using the AHDSS as the sampling frame and also using school enrollment rosters. Households are recruited and eligible households and young women who provide consent/assent are enrolled and randomized to receive the cash transfer intervention. Young women will be recruited at the beginning of grades 8,9,10, and 11 and will be provided a monthly cash transfer conditional on school attendance for 3 years (or 2 years if in 11th grade at enrollment). The study will randomize approximately 2660 HIV negative young women to receive the intervention or not. To examine the effect of the CCTs, young women and parent/legal guardians will be interviewed at baseline (prior to randomization) and then every 12 months (or 2 years if in 11th grade at enrollment) until the end of the intervention (3 years post baseline) using Audio-Computer Self-Interviews (ACASI). We will test for HIV and HSV-2 at each study visit. Young women and their parent/legal guardians in the intervention arm will receive the CCT (100 Rand and 200 Rand, respectively) if the young woman attends 80% school in a given month.
After households are identified for the CCT intervention, villages will be randomized to receive the community mobilization (CM) intervention. Mobilization activities in the intervention villages will include: one-on-one contact, workshops and community events such as street theater to promote awareness around the role of negative gender norms and HIV risk and to encourage young men and community members to take action to change norms and behaviors that place young women at risk of HIV infection. To assess the effect of the CM intervention on changes in gender norms and sexual behavior, we will select a sample of young people (n=1200) (age 18-35) from the ≈24 villages in whom we will conduct a survey at baseline and 3 years post baseline.
We will also assess the combined effect of the CCT intervention and CM intervention in young women.
This research is funded by a grant from the U.S. National Institute of Health to UNC and is being undertaken in collaboration with the Agincourt Health and Population Unit and the Reproductive Health and HIV Research Unit, University of Witwatersrand, South Africa. The PIs are Audrey Pettifor (UNC), Catherine MacPhail (RHRU) and Kathleen Kahn (AHPU). For further details contact Audrey Pettifor at apettif@email.unc.edu.
Baseline survey instruments
Presentations
