A recent study published by The Lancet, indicates that an effective way of reducing the prevalence of HIV and HSV-2 infections among young women, is through providing financial aid to them and their families. The study was led by Dr Berk-zler, The World Bank; Prof Richard Garfein and Dr Craig McIntosh, University of California at San Diego; and Dr Sarah Baird, George Washington University, USA.
Some of the principal risk factors for HIV infection among women are lack of education and economic dependence on men; these gender inequalities are suggested to be a main cause of their sexual decision-making. This study analyzed the effectiveness of a crash transfer program in reducing HIV infection rates among a population of never-married women aged 13-22 years, in the Zomba district of Malawi.
A total of 1289 schoolgirls from 176 enumeration areas in the Zomba disctrict were included. The areas were randomly divided into three different groups based on the terms of the financial aid given; one intervention area offered unconditional cash payments, another offered conditional cash payments (school attendance required), and the control area did not give any financial support whatsoever. Those receiving cash transfers (conditional or unconditional), were randomly assigned to be given any amount from US$1 to $5 each month, with their families receiving an additional range of $4-10 each month as well. The researchers conducted behavioral risk assessments of the participants at baseline and 12 months later, and a serology test after 18 months. They measured and compared the prevalence of HIV and herpes simplex virus 2 in the groups.
A total of 88 areas received the financial aid intervention – conditional or not – with the other 88 as controls. The rate of HIV in the intervention groups was far lower than the control group, with only 1·2% (seven of 490 participants) developing the infection compared to 3·0% (17 of 799 participants). In terms of HSV-2 prevalence, the intervention groups also had a far lower rate, of only 0·7% (5 of 488 participants) compared to 3·0% (27 of 796 participants). They found that there was hardly – if any- notable difference of HIV and HSV-2 prevalence between the conditional versus unconditional intervention groups.
The authors say:
“Poor education, poverty, and gender inequalities are postulated to be important determinants of young women’s vulnerability to HIV infection. However, to date, no randomised controlled trial of a structural intervention has shown a significant effect on HIV incidence. The Zomba cash transfer programme reduced the prevalence of HIV and HSV-2 infection at 18 month follow-up in school-age girls who were enrolled in school at baseline. These effects are supported by changes in self-reported sexual behaviour. The findings suggest that financially empowering school-age girls and their families can have substantial effects on their sexual and reproductive health.”
Dr Nancy Padian, School of Public Health, University of California, Berkeley, CA, USA and colleagues comment:
“These results add to the increasing evidence suggesting that economic development and anti-poverty programmes can alter the context of sexual decision making and, thus, HIV infection risk. These findings also warrant more collaboration with economists and those who work in development to more completely test the effects of social protection…livelihood-based and economic development programmes, on the sexual and reproductive health of young people.”
Written by Joseph Nordqvist