Do Cash Transfers to Young Women Help Prevent HIV/AIDS?

By Harold Pollack, the Helen Ross Professor at the School of Social Service Administration and faculty chair of the Center for Health Administration Studies at the University of Chicago.

When you think about how to protect young women from HIV around the world, improved sex education and condoms are the first things that come to mind. Both of these things are valuable. Neither is enough, because neither addresses the sexual risks facing millions of impoverished women who are vulnerable participants in the sexual economy.

I don’t mean outright commercial sex work, here, although this is an important concern, too. Rather, I mean the much more widespread, generally implicit ways in which adult men use cash or gifts as inducements to partner with younger women or adolescent girls. Such “transactional sex” is common in many societies, including ours. In many low-income settings, young women must support themselves and help others in their families. They have powerful reasons to partner with older, relatively prosperous men. This is a major public health threat, because these older men are likely to have had previous partners, and are thus especially likely to spread HIV and other sexually-transmitted infections.

A new study tests one strategy to address this problem: Putting a little money in young women’s pockets so they are less vulnerable to economic blandishments. A World Bank research team implemented a 2008-09 randomized trial, in which adolescent girls and young women age 13-22 in Zomba, Malawi received monthly cash payments. Their families received payments, too. Not much cash was involved by western standards. On average, households were offered $10-15 per month, in a society whose per-capita GDP is about $288. The program also paid girls’ secondary school fees. (In return for the money, some girls were required to regularly attend school. Others simply received the cash. This didn’t seem to matter for HIV prevention.)

The program was not designed as an HIV prevention intervention, but it was an effective one. After 18 months, 1.2% of girls who received the cash had been infected with HIV, compared with 3% of girls in the control group. The program provided a larger reduction in genital herpes (0.7% vs. 3.0%). Girls who received payments had less sex, and a higher proportion of the sex they engaged in was with younger male partners estimated to have about half the rate of HIV infection. Girls receiving cash transfers were less likely to have early marriages or to have teen pregnancies. They were more likely to attend school.

It’s fashionable to criticize development assistance as ineffective or even self-defeating. This cynical stance provides comfort to wealthy nations, who provide well below one percent of GDP in assistance to the poorest countries in the world. The growing track record of well-designed cash transfer programs refutes such cynicism. Excellent studies such as this one reflect the fruitful partnership between development economics and the public health community. The two fields have never been more rigorous or more effective.

The need could hardly be greater. The world’s women cannot protect themselves unless they command some degree of financial independence from men who would prey upon them. A little money in their pockets is a lifesaver.