MEDIA RELEASE FROM WITS UNIVERSITY
DATE: WEDNESDAY, 22 JULY 2015
CASH TRANSFERS CONDITIONAL ON SCHOOLING DOES NOT PREVENT HIV INFECTION AMONG YOUNG SOUTH AFRICAN WOMEN
A new study has found that giving cash transfers to high school girls to attend school in rural Mpumalanga did not reduce their risk of contracting HIV, according to investigators from the HIV Prevention Trials Network (HPTN). The study – a collaboration between the MRC/Wits Rural Public Health and Health Transitions Unit (Agincourt) and the University of North Carolina, USA – was undertaken at the Agincourt Health and Socio-Demographic Surveillance System study site based in rural Mpumalanga, an area characterised by high HIV prevalence, poverty, and migration for work. Professor Kathleen Kahn, site lead investigator, said addressing the problem of high HIV acquisition in adolescent women is an urgent priority. “This is the first study large enough to look at new infections, or HIV incidence, and as such makes in important contribution to the field looking at the use of economic incentives to change behaviour.”
The findings were reported at the 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada.During the trial, young women and their parent/guardian were divided into one of two study arms. The first group was given a monthly cash transfer of R300 per month conditional on 80 percent school attendance. The second group was not given a cash transfer. The provision of cash conditional on school attendance has been proposed as an intervention to prevent HIV infection in young women. It was envisaged that paying females to stay in school reduces HIV risk. Cash transfers have also been hypothesised to reduce young women’s HIV risk by decreasing their dependence on older male partners and transactional sex.
“Cash transfers play a key role in social protection in many settings, including South Africa, but in this study setting they were not protective for acquiring HIV,” said Audrey Pettifor, Associate Professor in the Department of Epidemiology at the University of North Carolina at Chapel Hill and chair of the study.
“School attendance was very high for young women in both arms of the study and staying in school reduced the risk of HIV acquisition. Overall HIV risk was low in the study population, much lower than anticipated, which may have affected the findings from this trial.”
The study found that there was no difference in HIV acquisition between the young women who received the cash transfer and those that did not. There were 59 incident HIV infections in the intervention arm and 48 in the control arm. Overall HIV incidence was 1.8% during the study, lower than the study team expected. Surprisingly, school attendance was high during the study as 95% of the girls in both arms attended school, and there was no difference in school attendance between study arms. In line with the original hypothesis of the trial, young women who stayed in school and attended school more of the time across both arms of the study had a two-thirds reduced risk of acquiring HIV.
A total of 2 533 young women were enrolled on the trial between March 2011 and December 2012. 2448 of the young women were HIV negative at the time of enrollment. Participants enrolled in the study were aged 13-20 years, in high school, not married or pregnant, and resident in the Medical Research Council (MRC)/Wits University Agincourt Health and Socio-Demographic Surveillance System (AHDSS) study site. This region is a rural area of Mpumalanga Province in South Africa that is characterized by high HIV prevalence, poverty, and migration for work.
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