Giving young women small, regular cash payments can reduce their dependence on sexual relationships with older men, which also lowers their HIV risk, according to a new study by the World Bank.
Malawi's southeastern Zomba district, where the survey took place, has high rates of poverty and HIV - up to 22 percent, compared to a national prevalence of about 12 percent - but the study found that 18 months of cash transfers, with or without conditions attached, decreased the participants' risk of HIV infection by 60 percent.
"The study has shown that girls who have a modest amount of income ... maybe don't decrease their number of sexual partners, but do choose to have safer sexual partners or those closer to their own age, and maybe based on emotional attachment rather than financial need," the World Bank's newly appointed director of HIV and AIDS programmes, Dr David Wilson, told IRIN/PlusNews.
Nearly 4,000 young women between the ages of 13 and 22 years took part in the “Schooling, Income and HIV Risk” (SIHR) study, some of whom were given up to US$10 in cash each month, while others had their school fees paid.
It was the first large-scale, rigorous study proving that cash transfers can have a significant impact on HIV infection, which had previously only been shown in small, observational studies. "The study really does suggest a case in which cash transfers give women agency," Wilson said.
The study also showed that women who received some kind of cash transfer – whether to themselves, their families, or in the form of school fees – had a 75 percent reduced risk of genital herpes.
Researchers attributed the decline in HIV and genital herpes risk to delayed sexual debut, reduced sexual activity, and the choice of younger male partners, who were less likely to harbour sexually transmitted infections. However, the transfers did not increase the likelihood of condom use.
Show me the money
The study's findings are supported by those of another World Bank study in Tanzania, where over 2,000 young women and men were paid various amounts if they tested negative for a number of sexually transmitted infections (STIs), excluding HIV.
|The study has shown that girls who have a modest amount of income...maybe don't decrease their number of sexual partners, but do choose to have safer sexual partners|
In the course of a year, the rate of STIs among those who were rewarded with $20 for negative test results fell by 25 percent, but stayed the same among those who only received $10 for negative test results.
"We do need to get the incentive right - if it's too small, it may not produce the results we want; if it's too big, it may not be sustainable," Wilson commented.
Critics have argued that even small cash transfers as an HIV prevention strategy would be unaffordable in poor countries. Wilson noted that large-scale, national cash transfer schemes have been successful in Mexico, Brazil and South Africa, but admitted that low-income countries would most likely need international assistance to fund similar programmes.
"The point of cash transfers is that they're not intended for HIV only - they are a way to improve other health outcomes, literacy levels, family planning, reduce inter-generational poverty," he told IRIN/PlusNews.
"One of the things to come out of the [2010 International AIDS] conference is that we need multiple, reinforcing methods to tackle HIV," Wilson said. "This isn't about pitting cash transfers against behaviour change programmes ... we need multiple approaches."
See also: AFRICA: Money no protection from HIV