Editorial: Paying to prevent HIV infection in young women?
AUTHORS: Pettifor A, McCoy SI, Padian N
http://www.thelancet.com/
Fellow Advocate;
Between a quarter and a third of young women in sub-Saharan Africa are
infected with HIV by the time they reach their early 20s. Structural
factors such as poor education, poverty, and gender and power inequalities
are important determinants of young women's vulnerability to HIV infection.
However, until now, no rigorously assessed intervention targeting this
group has significantly reduced HIV infection and no intervention that
targets structural factors has directly affected HIV infection.
In *The Lancet*, Sarah Baird and colleagues report the results of a
randomised controlled trial done with adolescent girls in rural Malawi,
examining the effects of a cash transfer programme on risk of HIV
infection. The investigators report that school girls who received monthly
cash payments of varying amounts were significantly less likely than girls
who did not receive payments to be infected with HIV... and HSV-2..., to
have an older male partner, and to have sexu al intercourse once per week
at follow-up (18 months for biological outcomes and 12 months for
behavioural outcomes)...
To plan the next step, it would be helpful to understand the precise
mechanism by which the intervention worked... However, the study was not
powered to detect heterogeneous effects on biological outcomes between the
CCT and the UCT interventions, and the reduced rates of pregnancy in the
UCT group and small but significant effect of the CCT on school attendance
suggest that some potential differences exist in the causal pathways
between the two treatment groups.
Although these findings are exciting, they are attenuated by the key
weakness of this study: the investigators did not measure HIV incidence,
the gold standard in HIV prevention trials. However, the balance of
covariates between study groups at baseline and the consistency of effects
across outcomes suggest that the intervention was probably effective in
reducing HIV and HSV-2 infections. Additionally, few HIV infections were
detected (n=24) and the programme had little effect on intermediate
outcomes when absolut e (rather than relative) measures of effect were
used...
Even so, Baird and colleagues' study provides a proof of concept that
alteration of the structural environment with cash payments can affect HIV
risk in young women... Although the results of this study are intriguing,
advocating the halt of HIV prevention campaigns focused on strategies that
include sexual and reproductive health information, education, and
behaviour change is premature. More experiments and mixed-methods research
should be done to better understand the mechanism of action through which
CCT and UCT programmes work to reduce risk--this mechanism will probably
differ, depending on the target population and context...
Click on the link above to read full story. Thanks for reading through.
--
Many Thanks
Yours' in Prevention Science