Cash Transfers, Incentives for School Attendance May Decrease Incident HIV Risk in Women, Girls

Government social protection cash transfer programs and programs that incentivize school attendance may help prevent incident HIV infection among young women and adolescent girls, according to findings published in PLOS Medicine.

Researchers searched publication databases through October 2021 for studies on cash transfer programs, interventions to decrease school costs, and matched savings programs aimed at the prevention of HIV or other sexually transmitted infections (STI). A total of 45 publications comprising 27 studies were included in this review.

Most studies included in the review were conducted in Sub-Saharan Africa (n=23), followed by Mexico (n=2), Mongolia (n=1), and the United States (n=1). Of the included studies, 74% were randomized controlled trials, 18% were observational, 4% were case-control, and 4% were quasi-experimental. The interventions were cash transfer (n=12), matched savings programs (n=3), and decreased school costs (n=3). The researchers noted that 12 of the studies are ongoing.

The target populations included adolescents (n=12), orphans and vulnerable children (n=5), adolescent girls (n=3), adolescents and adults (n=2), adults (n=1), men who sell sex (n=1), and women who sell sex (n=1).

The researchers assessed HIV outcomes from 8 studies included in the review. Among young women aged 13 to 22 years, the researchers found that cash transfer programs that incentivize school attendance were associated with a decrease in HIV prevalence (adjusted odds ratio [aOR], 0.36; 95% CI, 0.14-0.91). A lottery program conditional on testing negative for STIs that also combined incentives for school enrollment and attendance was found to decrease the incidence of HIV infection among adolescent girls (OR, 0.77; 95% CI, 0.60-0.98). Similar findings were observed on analysis of a lottery program for adults who tested negative for STIs, as the researchers noted that the risk for incident HIV was decreased by 2.5% (95% CI, 0.0-5.0; P =.046) and HIV prevalence by 3.4% (95% CI, 0.0-5.9; P =.044). Results from the remaining studies were not statistically significant.

The researchers also assessed STI outcomes from 8 studies included in the review. Among adolescent girls and boys, a cash transfer program conditional on various school-related outcomes was found to significantly decrease the incidence of herpes simplex virus type 2 (HSV-2; incidence rate ratio [IRR], 0.70; 95% CI, 0.57-0.86; P =.007). Of note, a cash transfer program conditional on school attendance among young girls was found to decrease the prevalence of HSV-2 (OR, 0.24; 95% CI, 0.09-0.65) but had no effect on the prevalence of syphilis (aOR, 0.91; 95%CI, 0.12-6.8). For adults, a cash transfer program conditional on testing negative for 4 curable STIs found a significant decrease in the incidence of a composite measure that included Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium among adults (risk ratio [RR], 0.73; 95% CI, 0.47-0.99). In addition, a lottery program for adults conditional on testing negative for syphilis and trichomoniasis was found to decrease the prevalence of both infections by 3.2% (95% CI, 1.4-5.0; P <.001).

On analysis of 3 studies that examined the longer-term effects of cash programs, the researchers found that that the beneficial effects were not sustained after cash incentives were removed.

This study was limited by the small number of included studies that examined interventions to decrease school costs and matched savings programs.

According to the researchers, “program and policymakers interested in HIV prevention for young women should consider programs that directly incentivize school enrollment and attendance or are conditional on attendance, which may have the largest impact on HIV risk for girls, especially in contexts where secondary school attendance is low.”

Reference

Stoner MCD, Kilburn K, Godfrey-Faussett P, Ghys P, Pettifor AE. Cash transfers for HIV prevention: A systematic review. PLoS Med. 2021;18(11):e1003866. doi:10.1371/journal.pmed.1003866