14 September 2012

Do Cash Transfers Reduce AIDS Risk?

A study in Kenya presented at the International AIDS Conference shows promise that a cash transfer program can help to prevent vulnerable children from engaging in risky sexual behavior.
Participating households were provided a $25 unconditional cash transfer every month. The program saw a 30% increase in the number of children who were more likely to delay having sex, but it showed little progress on the issue of condom use.

African currency
"Our study is based on the government of Kenya's Cash Transfer for OVC [orphans and vulnerable children]," Sudhanshu Handa, a professor at the University of North Carolina and one of the study's researchers, told IRIN/PlusNews. "We find that those aged 11 to 16 at baseline were seven percentage points less likely to engage in sexual activity four years later. Other studies have also shown a link between sexual activity and HIV-related behavioural risk and receipt of cash transfers, but those have been from small-scale experiments. Ours is the first study from an actual, scaled-up national programme."

Another study carried out by the World Bank in Malawi returned equally promising results. Girls who received the cash transfers were significantly less likely to contract HIV and Herpes as compared to girls that did not.

"The findings here suggest that cash transfer programs that focus on adolescent girls can empower them to steer away from risky sexual behavior and thus reduce their risk of HIV infection. They also indicate that while ABC campaigns might no doubt be effective in fighting the disease, empowering girls financially can also lead to reduced risk – not just by reducing their sexual activity or having safer sex, but also by enabling them to choose partners who are less likely to be infected with HIV," concluded the study.

However, the evidence is by no means conclusive. A longitudinal study in rural Malawi tested whether conditional cash transfers would provide the necessary incentives for both men and women to maintain their HIV status. The researchers found no evidence that the incentives had an effect on behaviors. In fact, they found that men were more likely to engage in risky sexual behavior after receiving the cast transfer.

"Our analyses therefore question the “unconditional effectiveness” of CCT program for HIV prevention: CCT Programs that aim to motivate safe sexual behavior in Africa should take into account that money given in the present may have much stronger effects than rewards offered in the future, and any effect of these programs may be fairly sensitive to the specific design of the program, the local and/or cultural context, and the degree of agency an individual has with respect to sexual behaviors," wrote Hans-Peter Kohler and Rebecca Thorton in the paper.

The findings from the first two studies are exciting, but the second shows that design is absolutely important and adds some question marks to how effective cash transfer programs are in terms of reducing risky behaviors. 

I would love to hear from some more knowledgeable people on the subject. Any other studies out there to consider? Do you have any concerns about the three studies listed here?

Thanks to Matt for pointing out the third study.