By the time young women in South Africa reach the age of 24, almost one in 10 is living with HIV, according to the latest HIV household report published by the Human Sciences Research Council (HSRC).
New programmes aim to use a surprisingly simple recipe to give rise to a new generation of young, HIV-negative women – cash and caring.
HIV-infection rates among young women between the ages of 15 and 24 are more than four times that of their male peers, according to the study. At the heart of young women's increased risk of HIV infection are a range of complex factors, including biology and economics. The latter can force young women to turn to older men for financial support.
Research has shown that even nominal amounts of money, like South Africa's child support grant, injected into young women's households can reduce their risk of contracting HIV. A 2013 study published in the The Lancet Global Health journal found that young women whose families received a child grant were about two times less likely to engage in transactional sex than their peers who did not receive the grant and about three times less likely to have much older sexual partners.
In a study presented in July at the International Aids Conference, researchers from the Centre for the Aids Programme of Research in South Africa found that about 63% of HIV infections among women aged 15 to 24 in the rural community of Vulindlela were linked to older men.
Why does money help to reduce young women's HIV risk? Because it gives women the power to choose.
"If there is a bit of money in the house, young women don't need a boyfriend who is bringing home groceries and young women will choose to date boys in their class and have much safer sexual relationships," says Lucie Culver, a professor of child and family social work at Oxford University.
But recent research shows that cash alone may not always be enough. A study published this year, also by The Lancet Global Health, tracked the effect of grants among about 2 500 young women in Mpumalanga. As part of the research, about half the girls received R100 a month if they attended school at least 80% of the time.
The study found that the money did not affect the girls' HIV risk. Researchers posit this is because, by making the grants conditional on school attendance, they may have excluded women most at risk of contracting HIV: those who were older, or those who had dropped out of school, including teen mothers.
But the research also found that girls enrolled in the research were more likely to finish school than other girls in the area, regardless of whether they received money or not as part of the study. School attendance – not the cash – was associated with lower HIV risk in the women.
"What distinguished these girls from their peers? This was a rigorous study, led by highly ethical researchers with data collection over several years. All participants knew that their school attendance was being monitored. They were asked about their sexual relationships," Culver wrote in a related commentary.
She was part of a panel of experts who helped to design a new programme aimed at reducing HIV infections in young women in 10 African countries, including South Africa. The US government's Dreams project will target girls and women between the ages of 10 and 24 as well as their male sexual partners with HIV-prevention programmes. These will include money, education subsidies and programmes for parents.
Culver told Bhekisisa: "It's not enough to just give cash. Young women also need someone – an important adult – to care about them and their outcomes. Anyone who has a teenage girl wouldn't be surprised by that."
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