The use of cash transfers for HIV prevention — are we there yet?

Abstract

Poverty and social inequality are significant drivers of the HIV epidemic and are risk factors for acquiring HIV. As such, many individuals worldwide are at risk for new HIV infection, especially young women in East and Southern Africa. By addressing these drivers, social protection programmes may mitigate the impact of poverty and social inequality on HIV risk. There is reason to believe that social protection can be used successfully for HIV prevention; social protection programmes, including cash transfers, have led to positive health outcomes and behaviour in other contexts, and they have been used successfully to promote education and increased income and employment opportunities. Furthermore, cash transfers have influenced sexual behaviour of young women and girls, thereby decreasing sexual risk factors for HIV infection. When HIV outcomes have been measured, several randomised controlled trials have shown that indirectly, cash transfers have led to reduced HIV prevalence and incidence. In these studies, school attendance and safer sexual health were directly incentivised through the cash transfer, yet there was a positive effect on HIV outcomes. In this review, we discuss the growth of social protection programmes, their benefits and impact on health, education and economic potential, and how these outcomes may affect HIV risk. We also review the studies that have shown that cash transfers can lead to reduced HIV infection, including study limitations and what questions still remain with regard to using cash transfers for HIV prevention.

Perspectives of beneficiaries, health service providers, and community members on a maternal and child health conditional cash transfer pilot programme in Nigeria

“…Being consistent with previous studies, which identified incentives as an innovative approach to reduce financial barriers to obstetric care in low‐income countries, this paper provides evidence that CCT can stimulate demand for MNCH services and just as CCT was found to be successful in HIV prevention efforts . Beyond stimulating positive behaviour change towards the use of health services, the CCT served as a form of financial empowerment for the beneficiaries and their communities as well as empowerment for beneficiaries to confidently access facility‐based services without being deterred by other structural factors .…”

Effectiveness of a girls’ empowerment programme on early childbearing, marriage and school dropout among adolescent girls in rural Zambia: study protocol for a cluster randomized trial

“…Evaluations of cash transfer programmes have previously indicated that the effects of the cash transfers may continue for a few years after the intervention has come to an end, and in some cases, long-term impact has been found [22]. However, long-term effects may depend on changes in norms taking place [27].…”

“…Once a girl is married, she is expected to start childbearing. Moreover, where access to cash is severely limited, many unmarried adolescent girls engage in sexual relationships, even if not socially acceptable, to receive gifts and cash [20–22]. …”

“…More recently, two RCTs on the effects of conditional cash transfer programmes on HIV have been conducted in South Africa [35]. They found no effect on HIV incidence [22]. Thus effects of cash transfers appear to be context dependent [24], and there is a need for further evaluations of such programmes in new settings, alone and in combination with other interventions [22].…”

The dual burden of gender-based violence and HIV in adolescent girls and young women in South Africa

“…[10,42] Novel social protection interventions that provide cash transfers/incentives have been shown in some settings to improve school attendance, decrease risky sexual behaviour and activity and improve income and social opportunities for women. [43] Given that IPV and HIV are so intimately intertwined, efforts to eliminate GBV/IPV have the potential also to improve sexual and reproductive health outcomes and HIV prevention among adolescent girls. Primary healthcare/antenatal care clinics provide the opportunity to assess GBV among clients and offer post-exposure prophylaxis for those who have experienced GBV, as well as preexposure prophylaxis for young girls and women who experience IPV.…”