2014. 9 p.
AIDS 2014, 28 (Suppl 3):S389–S397
Objectives: It is not known whether cumulative ‘cash plus care’ interventions can reduce adolescent HIV-infection risks in sub-Saharan Africa. This study investigated whether parental AIDS and other environmental adversities increase adolescent HIVrisk behaviour and whether social protection provision of ‘cash’ or integrated ‘cash plus care’ reduces HIV-risk behaviour. Design: A prospective observational study with random sampling (<2.5% baseline refusal, 1-year follow-up, 96.8% retention). Methods: Three thousand five hundred and fifteen 10–18 year-olds (56.7% girls) were interviewed in South Africa between 2009–2010 and 2011–2012. All homes with a resident adolescent were sampled, within randomly selected census areas in two urban and two rural districts in two provinces. Measures included potential environmental risks (e.g. parental HIV/AIDS, poverty), social protection: receipt of cash/food support (e.g. child grants, school feeding), care (e.g. positive parenting) and HIV-risk behaviours (e.g. unprotected sex). Analyses used logistic regression. Results: Cash alone was associated with reduced HIV risk for girls [odds ratio (OR) 0.63; 95% confidence interval (95% CI) 0.44–0.91, P¼0.02] but not for boys. Integrated cash plus care was associated with halved HIV-risk behaviour incidence for both sexes (girls OR 0.55; 95% CI 0.35–0.85, P¼0.007; boys OR 0.50; 95% CI 0.31–0.82, P¼0.005), compared with no support and controlling for confounders. Follow-up HIV-risk behaviour was reduced from 41 to 15% for girls and from 42 to 17% for boys. Girls in AIDS-affected families and informal-dwelling boys had higher HIV-risk behaviour, but were less likely to access integrated social protection. Conclusion: Integrated cash plus care reduces male and female adolescent HIV-risk behaviours. Increasing adolescent access to social protection may be an effective HIV prevention strategy in Sub-Saharan Africa.
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