Effects of Cash Transfer and Community Mobilization in Young South African Women

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DESCRIPTION (provided by applicant): We propose to determine the effect of an innovative, multi-level HIV prevention intervention that will jointly address both structural and social factors that contribute to young women's increased vulnerability to HIV. We propose providing cash transfers to the families of young women conditional on the young women attending school with the goal of reducing the young women's HIV risk by keeping her in school by improving her family's economic resources (structural factors). The structural level intervention will be complemented by a community level mobilization intervention focused on engaging young men around the issues of gender norms and HIV risk and encouraging them to take action to protect young women and reduce HIV risk in their communities. This study will be situated in the Agincourt sub-district of Bushbuckridge of rural Mpumalanga Province in South Africa. Approximately 84,000 individuals live in Agincourt in 25 villages, and the area is a Households Demographic Surveillance Site (Agincourt HDSS). We will use the AHDSS as the platform from which we will identify eligible households and young women for the cash transfer intervention (Aim 1). Young women will be recruited at the end of grade 9 and randomly allocated to the intervention (n=200/arm), a cash transfer to the household conditional on school attendance. The cash transfer will be provided for 3 years (until the expected completion of high school, grade 12). To examine the effect of the conditional cash transfers, young women will be interviewed at baseline and then every 12 months until the end of the intervention (3 years post baseline). After households are identified for the cash transfer intervention, villages will be randomized to receive the community mobilization intervention (Aim 2). We will select community mobilizers (n=15) who will conduct mobilization activities in the intervention villages (n=12), including one-on-one contact, workshops and community events to promote awareness around the role of negative gender norms and HIV risk and to encourage young men and community members to take action to reduce young women's HIV risk. To assess the effect of the community mobilization intervention on changes in gender norms and sexual behavior, we will select a sample of young people (age 18-35) from the 25 villages in whom we will conduct a survey at baseline and 3 years post baseline. We will also assess the combined effect of the cash transfer intervention and community mobilization intervention in young women (Aim 3). PUBLIC HEALTH RELEVANCE: In South Africa, young women are infected at 3-4 times the rate of young men and by the time a woman reaches age 21, she has a 1 in 3 chance of being infected. We propose providing cash transfers to the families of young women conditional on the young women attending school with the goal of reducing the young women's HIV risk by keeping her in school by improving her family's economic resources (structural factors). The structural level intervention will be complemented by a community level mobilization intervention focused on engaging young men around the issues of gender norms and HIV risk and encouraging them to take action to protect young women and reduce HIV risk in their communities.