Combination Social Protection for Reducing HIV-Risk Behavior amongst Adolescents in South Africa
BACKGROUND:
Social
protection (i.e. cash transfers, free schools, parental support) has potential
for adolescent HIV-prevention. We aimed to identify which social protection
interventions are most effective and whether combined social protection has
greater effects in South Africa.
METHODS:
In this
prospective longitudinal study, we interviewed 3516 adolescents aged 10-18
between 2009 and 2012. We sampled all homes with a resident adolescent in
randomly-selected census areas in four urban and rural sites in two South
African provinces. We measured household receipt of fourteen social protection
interventions and incidence of HIV-risk behaviors. Using gender-disaggregated
multivariate logistic regression and marginal-effects analyses, we assessed
respective contributions of interventions and potential combination effects.
RESULTS:
Child-focused
grants, free schooling, school feeding, teacher support, and parental
monitoring were independently associated with reduced HIV-risk behavior
incidence (OR 0.10-0.69). Strong effects of combination social protection were
shown, with cumulative reductions in HIV-risk behaviors. For example, girls'
predicted past-year incidence of economically-driven sex dropped from 11% with
no interventions, to 2% amongst those with a child grant, free school and good
parental monitoring. Similarly, girls' incidence of unprotected/casual sex or
multiple-partners dropped from 15% with no interventions to 10% with either
parental monitoring or school feeding, and to 7% with both interventions.
CONCLUSION:
In
real-world, high-epidemic conditions, 'combination social protection' shows
strong HIV-prevention effects for adolescents and may maximize prevention
efforts.This is an open access article distributed under the terms of the
Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC
BY-NC-ND), which permits downloading and sharing the work provided it is
properly cited. The work cannot be changed in any way or used commercially.
- 1Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK 2Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa 3DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa 4University College London, London, UK.
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