Why conditional cash transfers can prevent HIV

Conditional Cash Transfers, in which poor families receive regular payments from governments or aid donors on condition they keep their kids in school, or get them vaccinated, are all the rage at the moment. They are seen as effective ways to reduce poverty, cushion poor families against shocks and get kids into school, but it seems their benefits extend even further. New research from the World Bank even suggests they reduce the risk of HIV infection. ‘The Short-Term Impacts of a Schooling Conditional Cash Transfer Program on the Sexual Behavior of Young Women’ summarizes the results of a randomized control trial in Malawi, involving nearly 4,000 young women, comparing those who received a $10 a month CCT for a year, with a control group in the same community who did not.

Main finding: ‘After one year, the program led to large increases in self reported school enrollment, as well as declines in early marriage, teenage pregnancy, sexual activity, and risky sexual behavior. The evidence presented here suggests that as girls and young women returned to (or stayed in) school, they significantly delayed the onset (and, for those already sexually active, reduced the frequency) of their sexual activity. The program also delayed marriage – which is the main alternative for schooling for young women in Malawi – and reduced the likelihood of becoming pregnant.’

This matters because young women in sub-Saharan Africa are nearly three times more likely to be HIV positive than young men. It’s received wisdom that girls’ education is a ‘social vaccine’, but according to the paper, the evidence for this comes from snapshots in time and comparisons between countries. By tracking a single community over a year, the Malawi study builds a much firmer case not just for the health benefits of girls’ education but also of CCTs. All this in addition to the intrinsic benefits of education, of course.

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3 Responses to “Why conditional cash transfers can prevent HIV”
  1. It makes sense that reduced sexual activity and the empowerment from education should reduce the chance of contracting HIV, but it’s still worth noting this study doesn’t actually show a reduction in the incidence of HIV, just the behaviours associated with it. T

    The authors say as much:

    “One should not assume that the changes in self-reported sexual behavior will
    result in a decline in HIV incidence among this cohort of program beneficiaries.”

  2. Interestingly, the same study also demonstrated conclusively that the conditionality associated with the transfer made absolutely no difference to its effectiveness. Part of the experiment was to give some girls the same level of transfer without the condition of school attendance – and the beneficial impact on them (in terms of school enrolment, literacy, early marriage, and pregnancy) was exactly the same as on those girls for whom the transfer was conditional. It would therefore be more correct for the title of your blog to read “Why Cash Transfers can prevent HIV?”. But this of course is not what the World Bank, a great proponent of Conditional Cash Transfers, would have wanted, so they mysteriously removed all reference to the unconditional sample from the report that you cite! See http://www.wahenga.net/node/1508 for a more detailed analysis of this by Sissy Teese!

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