20th International AIDS Conference - Melbourne, Australia


MOAC0104 - Oral Abstract

Combination social protection halves HIV-risk behavior incidence amongst female and male South African adolescents

Presented by Lucie Cluver (South Africa).

L. Cluver1, M. Orkin2, M. Boyes3, L. Sherr4

1Oxford University & University of Cape Town, Social Policy and Intervention, Cape Town, South Africa, 2University of the Witwatersrand, School of Public and Development Management, Johannesburg, South Africa, 3Curtin University, School of Psychology and Speech Pathology, Perth, Australia, 4University College London, Royal Free and University College Medical School, London, United Kingdom

Background: Social protection is emerging as a potentially powerful HIV-prevention tool for adolescents. Evidence to date has focused on conditional or unconditional cash transfers, with little known about effects of non-cash economic support (such as food gardens, school feeding), or about combinations of economic and psychosocial support provision.
Methods: 3515 10-18 year-olds (f=56·7%; m=43.3%) were interviewed twice (baseline < 2.5% refusal, one year follow-up 96.8% retention) in South Africa in a random prospective observational study. All homes with a resident adolescent were sampled, within randomly-selected census areas in two urban and two rural districts in two provinces. Socio-demographic predictors of very high-risk behavior (i.e. unprotected sex, transactional sex, multiple partners, sex whilst using substances) were identified. Economic support included unconditional government cash transfers, school feeding and food gardens. Psychosocial support included positive parenting and teacher social support. Analyses used hierarchical regression and log-linear models, controlling for socio-demographics and prior HIV-risk behavior.
Results: Economic support alone predicted reduced incidence of HIV-risk behaviour for adolescent girls (OR .588, CI .394-.876, p=.009), but not for boys, in prospective multivariate logistic regression. Combined economic and psychosocial support predicted halved incidence of HIV-risk behavior for girls (OR .484 CI.303-.773, p=.002) and also for boys (OR .495 CI.300-.816, p=.006), compared to no support. Females experiencing parental AIDS-mortality or morbidity (AIDS-affected) had increased overall risk behavior. For these, combined economic and psychosocial support showed amplified impact, with HIV-risk behavior reduced from 51.2% to 19.8%.

Effects of combination social protection
[Effects of combination social protection]

Conclusions: Combined, unconditional economic and psychosocial protection provision reduces HIV-risk behavior for female and male adolescents in Southern Africa. Adolescence is a period of heightened risk, but also of rapid cognitive and social development. By targeting adolescent needs both for alleviation of severe poverty, and for adult psychosocial support, social protection has potential for maximized HIV-prevention effects.

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