Presentation on theme: "Cash, care, prevention and adherence for adolescents: Latest evidence from southern africa L Cluver, M Orkin, M Boyes, L Sherr, F Meinck Arusha, December."— Presentation transcript:
Cash, care, prevention and adherence for adolescents: Latest evidence from southern africa L Cluver, M Orkin, M Boyes, L Sherr, F Meinck Arusha, December 2014
Child- focused research Universities: Oxford, UCT, Wits, Curtin, UKZN Collaborative research: science to assist policy
National longitudinal study of adolescents 6850 adolescents, 2500 adult caregivers, 2008-2012 Longitudinal national survey Main study: N=6000 (age: 10-18) 3 provinces South Africa; 6 sites >30% prevalence Stratified random sampling of census EAs Every household with a child aged 10-17 Urban/rural, 1 year follow-up in 2 provinces n=3401, 97% follow-up Measures Standardised scales, national surveys Ethics Approved by Universities of Cape Town, Oxford, KwaZulu-Natal, 6 Provincial Health & Education Departments Social & health service referrals Controlling for prior HIV risk
South Africa: Child grant reduces incidence & prevalence of transactional sex and age-disparate sex for girls No cash transfer Child cash transfer Cluver, Boyes, Orkin, Pantelic, Molwena, Sherr (2013). The Lancet Global Health.
Kenya: Summary Impacts of OVC cash transfer on adolescents (Odds Ratios) Handa, Halpern, Pettifor, Thirmurthy (2014) PLOS One.
Can CASH + CARE reduce HIV risk behavior? CASH CARE Incidence rates: Transactional sex Age-disparate sex Sex using substances Multiple partners Unprotected sex Teen pregnancy Incidence rates: Transactional sex Age-disparate sex Sex using substances Multiple partners Unprotected sex Teen pregnancy
Child-focused grant Regular food parcels Free school meals School counsellor Food garden Positive parenting Teacher support
% girls with incidence of 1+ HIV risk behavior: Cash plus care = halved risk Cash alone: OR.63 Cash plus care: OR.55 Controlling for: family HIV/AIDS, informal/formal housing, age of child, poverty levels, number of moves of home, baseline HIV risk behaviour Cluver, Orkin, Boyes, Sherr (2014). AIDS. Cash alone: no effect Cash plus care: OR.50
HIV+ adolescents: ART adherence, cash and care Indicative percentages only, n=250 Random sampling 32 state clinics, South Africa
Hunger Community violence Parental HIV/AIDS Informal settlement 2011 Structural deprivation 2012 HIV-risk behavior incidence Poverty & family AIDS predict adolescent HIV-risks: how? Transactional sex Age-disparate sex Sex using substances Multiple partners Unprotected sex Pregnancy Transactional sex Age-disparate sex Sex using substances Multiple partners Unprotected sex Pregnancy controlling for: baseline HIV-risk, age, gender all p<.001 Cluver, Orkin, Boyes, Sherr (2014). AIDS.
High vulnerability Starving Sex Psychosocial risks Girls: ‘starving sex’ incidence (longitudinal, 60% of HIV-risk behavior explained) CARE CASH CLASSROOM controlling for: age, baseline HIV-risk
What kinds of cash and care work best? (preliminary analyses)
Combinations for HIV-prevention Males Females CarelessEconomicCarelessEconomic Pregnancy Cash Child Grants Medical care Class- room School feeding Free school & books Care Monitoring Teacher support
Aims: Reduce child abuse, improve parenting and supervision Local NGO staff, no materials needed Free: Creative Commons WHO and UNICEF: scale-up to other countries Thula Sana (pregnancy – 6 months) Book sharing (toddlers) Sinovuyo Kids (ages 2-9) Sinovuyo Teen (ages 10-17) Group work, collaborative problem-solving Home practice, role-playing Evidence-based core principles Building a Rondavel of Support Parenting for Lifelong Health: Sinovuyo SA
Unconditional, government cash transfers reduce adolescent HIV risks Cash plus care gives greater effects Effective in real-world sub-Saharan Africa Cash and care mitigate structural risk Cumulative impacts of 2+ interventions
‘I would like to advice the government to issue grants to those countries that are suffering socially and see the difference. And see how the impact it could create in the life many of youngsters. How it can better their decision and destiny.Take it from me I am the living difference.’ Noxolo, 19 yrs.