Can Social Protection Improve Sustainable Development Goals for Adolescent Health?

Cluver, Lucie; Orkin, F Mark; Meinck, Franziska; Boyes, Mark; Yakubovich, Alexa R.; Sherr, Lorraine

doi:10.1371/journal.pone.0164808

Cited by 49 publications

(54 citation statements)

References 28 publications

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“…Although our findings come from an experimental intervention, cash transfers play a major role in many SSA governments’ social protection schemes . Consequently, these findings illustrate the potential for current social protection programmes in the SSA region to achieve important progress in SDGs, which builds on other recent findings demonstrating how social protection in South Africa is benefiting adolescent across many SDGs . In particular, our results highlight the benefits of combining age and gender‐sensitive targeting with structural interventions to achieve the SDG agenda as it relates to adolescent HIV prevention.…”

Section: Discussionsupporting

confidence: 82%

Conditional cash transfers and the reduction in partner violence for young women: an investigation of causal pathways using evidence from a randomized experiment in South Africa (HPTN 068)

et al. 2018

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IntroductionEvidence has shown that the experience of violence by a partner has important influences on women's risk of HIV acquisition. Using a randomized experiment in northeast South Africa, we found that a conditional cash transfer (CCT) targeted to poor girls in high school reduced the risk of physical intimate partner violence (IPV) in the past 12 months by 34%. The purpose of this analysis is to understand the pathways through which the CCT affects IPV.MethodsHPTN 068 was a phase 3, randomized controlled trial in rural Mpumalanga province, South Africa. Eligible young women (aged 13–20) and their parents or guardians were randomly assigned (1:1) to either receive a monthly cash transfer conditional on monthly high school attendance or no cash transfer. Between 2011 and 2015, participants (N = 2,448) were interviewed at baseline, then at annual follow‐up visits at 12, 24 and 36 months. The total effect of the CCT on IPV was estimated using a GEE log‐binomial regression model. We then estimated controlled direct effects to examine mediation of direct effects through intermediate pathways. Mediators include sexual partnership measures, the sexual relationship power scale, and household consumption measures.ResultsWe found evidence that the CCT works in part through delaying sexual debut or reducing the number of sexual partners. The intervention interacts with these mediators leading to larger reductions in IPV risk compared to the total effect of the CCT on any physical IPV [RR 0.66, CI(95%):0.59–0.74]. The largest reductions are seen when we estimate the controlled direct effect under no sexual debut [RR 0.57, CI(95%):0.48–0.65] or under no sexual partner in the last 12 months [RR 0.53, CI(95%):0.46–0.60].ConclusionsResults indicate that a CCT for high school girls has protective effects on their experience of IPV and that the effect is due in part to girls choosing not to engage in sexual partnerships, thereby reducing the opportunity for IPV. As a lower exposure to IPV and safer sexual behaviours also protect against HIV acquisition, this study adds to the growing body of evidence on how cash transfers may reduce young women's HIV risk.

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Section: Discussionsupporting

confidence: 82%

Conditional cash transfers and the reduction in partner violence for young women: an investigation of causal pathways using evidence from a randomized experiment in South Africa (HPTN 068)

et al. 2018

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“…There is a strong evidence‐base outlining HIV risk factors for young women in southern Africa, including IPV , transactional sex , multiple partners , alcohol and substance use , and poor mental health . Interventions are often designed to reduce these risk factors, for example to reduce transactional sex or risky behaviours, interventions focus on building young women's access to savings or reducing alcohol consumption.…”

Section: Discussionmentioning

confidence: 99%

“…There is a strong evidence-base outlining HIV risk factors for young women in southern Africa, including IPV [13,49], transactional sex [50], multiple partners [51], alcohol and substance use [52], and poor mental health [7,8]. Interventions are often designed to reduce these risk factors, [53] for example to reduce transactional sex or risky behaviours, interventions focus on building young women's access to savings or reducing alcohol consumption. Agency of young women is multifaceted and "distributed" across time, space and social location [38][39][40] An alternate approach has been to focus on "structural drivers" of HIV risk [54].…”

Section: Interventions Are Developed Based On An Analysis Of Risk Fmentioning

confidence: 99%

Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa

et al. 2019

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Introduction Adolescent girls and young women aged 15 to 24 years have some of the highest HIV incidence rates globally, with girls two to four times more likely to be living with HIV than their male peers. High levels of intimate partner violence ( IPV ) experienced by this age group is a significant risk factor for HIV acquisition. While behavioural interventions to prevent IPV and HIV in southern Africa have seen some success in reducing self‐reported experiences of IPV , these interventions have largely failed to achieve similar outcomes for young women. Discussion We identify three main reasons for the failure of IPV / HIV interventions for many young women in southern Africa. First, interventions are usually developed without the meaningful involvement of both young women and young men. Youth input into research design is largely focused on user testing or consultation of targeted groups, involving relatively low levels of participation. Second, interventions are focused on addressing individual risk factors rather than broader social and structural contexts of being a young woman. “Risk factor” interventions, rather than supporting women's agency, can pose a major barrier for supporting changes in behaviour among young women because they often fail to dislodge well‐entrenched gender and age‐related inequalities. Third, current intervention models have not adequately accounted for changes in gender norms and relationships across southern Africa. Individuals are getting married later in life (or not at all), new technologies are transforming romantic interactions and opening new opportunities for violence, and discussions about women's rights are both challenging gender inequalities and reinforcing them. Conclusions In order to move beyond the status quo of current approaches, and to support real innovation, IPV / HIV prevention interventions need to be co‐developed with youth as part of a meaningful participatory process of research, intervention design, youth involvement in development and implementation. This process of co‐development needs to be radical and break with the current focus on adapting existing interventions to meet the needs of young people, which are not well understood and often do not directly reflect their priorities. Broader social contexts and compound lenses are needed to avoid narrow approaches and to accommodate evolving norms.

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“…Poverty can also be a driver of transactional sexthe exchanging of sex for material goods including food, gifts and cashwhich in turn increases the risk of HIV acquisition [9]. Social protection systems, which attempt to reduce social and economic vulnerability of the most marginalized groups, further progress towards target 1.3, and can reduce HIV risk behaviours [10], as well as improve adherence to ART for adolescents [11]. While cash transfers alone may have some impact on HIV risk, combining cash with "care" interventionspsychosocial support, such as from parents or teachersmore effectively reduce HIV risk for male and female adolescents [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Ending AIDS by 2030: the importance of an interlinked approach and meaningful youth leadership

Gleeson

Rodriguez²,

Hatane³

et al. 2018

J Intern AIDS Soc

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IntroductionThis commentary by authors from the Adolescent HIV Treatment Coalition calls for action to improve advocacy and service delivery for young people by leveraging the interlinkages between HIV and the broader development agenda. The 2030 Agenda for Sustainable Development includes target 3.3 on ending the AIDS epidemic by 2030, and along with the 2016 Political Declaration on HIV and AIDS, this has led to a global renewal of political commitment to the HIV response. However, young people are still being left behind, and to provide an equitable and sustainable response to HIV we must ensure that we are meeting the needs of the 3.9 million young people living with HIV, and the millions more at risk.DiscussionWhile HIV has its own target within the 2030 Agenda, efforts to end AIDS are inextricable from other goals and targets, such as on poverty eradication, education, gender equality and peace. To tackle HIV we must work beyond target 3.3 and provide a comprehensive response that addresses the underlying structural inequalities that impact adolescents and young people, ensuring that we enable the meaningful engagement of youth and adolescents as partners and leaders of sustainable development and the HIV response. Finally, it is necessary to collect better disaggregated data and evidence on the HIV epidemic among adolescents, as well as on best practices for supporting them.ConclusionsEnding the AIDS epidemic among adolescents and young people (aged 10 to 24) by 2030 is possible. However, it requires an integrated, multi‐sectoral response to HIV which pays attention to the social determinants that put adolescents at risk and fuel the epidemic. Positioning efforts to end AIDS among young people within the broader 2030 Agenda and building youth leadership will contribute to building a more healthy, equitable and sustainable society for all.

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Can Social Protection Improve Sustainable Development Goals for Adolescent Health?

Cited by 49 publications

References 28 publications

Conditional cash transfers and the reduction in partner violence for young women: an investigation of causal pathways using evidence from a randomized experiment in South Africa (HPTN 068)

Conditional cash transfers and the reduction in partner violence for young women: an investigation of causal pathways using evidence from a randomized experiment in South Africa (HPTN 068)

Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa

Ending AIDS by 2030: the importance of an interlinked approach and meaningful youth leadership

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