Cash transfers decreased HIV, HSV-2 risk of school-aged Malawian females

Baird SJ.Lancet. 2012;doi:10.1016/S0140-6736(11)61709-1.

Issue: March 2012

A program that provided cash transfers to unmarried school-aged females and their parents in Malawi decreased the risk for HIV and herpes simplex virus type 2 infections.

Schooling has been considered a “social vaccine” for the prevention and spread of HIV in low-income settings such as Malawi, according to background information in the study published in The Lancet. Furthermore, cash transfer programs have shown to increase household income and school enrollment in this population.

For this reason, Berk Özler, PhD, of The World Bank in Washington, D.C., and colleagues assessed the efficacy of a cash transfer program (Zomba cash transfer program) to reduce the risk for sexually transmitted infections among unmarried females aged 13 to 22 years across 176 areas in Malawi.

From January 2008 to December 2009, young women were randomly assigned to receive cash transfers 10 times per year (intervention group) or no cash transfers (controls). Intervention group participants received monthly payments ranging from $1 to $5; their parents were independently assigned $4 to $10.

Among those who received cash transfers, the researchers further grouped the young women into a conditional group, in which they received cash transfers only if they attended school for at least 80% of school days, or to an unconditional group, in which they received cash transfers if they simply attended the monthly cash transfer meetings.

The researchers assessed behavioral risk at baseline and 1 year; serology tests performed at 18 months determined the prevalence of HIV and herpes simplex virus 2 (HSV-2) infections.

Compared with 3% of controls with HIV, 1.2% of those in the intervention group had HIV (OR=0.36; 95% CI, 0.14-0.91). In addition, 3% of controls and only 0.7% of those in the intervention group had HSV-2 (OR=0.24; 95% CI, 0.09-0.65).

No differences were observed between the conditional vs. unconditional intervention groups for weighted HIV or HSV-2 prevalence, according to the researchers. “Structural interventions that do not directly target sexual behavior change can be important components of HIV prevention strategies,” the researchers wrote.

Disclosure: This research was funded by the Global Development Network, Bill & Melinda Gates Foundation, National Bureau of Economic Research Africa Project, World Bank’s Research Support Budget, and several World Bank trust funds (Gender Action Plan, Knowledge for Change Program, and Spanish Impact Evaluation fund).

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