Article

Preventing HIV infection: turning the tide for young women

Institute of Business and Economic Research, University of California, Berkeley, CA 94720, USA.
The Lancet (Impact Factor: 39.21). 10/2010; 376(9749):1281-2. DOI: 10.1016/S0140-6736(10)61309-8
Source: PubMed
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    ABSTRACT: The aim of this study is to assess whether the Government of Kenya's Cash Transfer for Orphans and Vulnerable Children (Kenya CT-OVC) can reduce the risk of HIV among young people by postponing sexual debut. The program provides an unconditional transfer of US$20 per month directly to the main caregiver in the household. An evaluation of the program was implemented in 2007-2009 in seven districts. Fourteen Locations were randomly assigned to receive the program and fourteen were assigned to a control arm. A sample of households was enrolled in the evaluation in 2007. We revisited these households in 2011 and collected information on sexual activity among individuals between 15-25 years of age. We used logistic regression, adjusted for the respondent's age, sex and relationship to caregiver, the age, sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline, to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program. Our results, adjusted for these covariates, show that the program reduced the odds of sexual debut by 31 percent. There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use, number of partners and transactional sex. Since the CT-OVC provides cash to the caregiver and not to the child, and there are no explicit conditions associated with receipt, these impacts are indirect, and may have been achieved by keeping young people in school. Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa.
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    ABSTRACT: Background: We reviewed and examined various financial incentives used in HIV prevention studies, and outlines important ethical considerations to using financial incentives in HIV prevention research. Methods: We searched PubMed using the terms “HIV”, “prevention”, and “incentive” for articles published between January 2009 and January 2013. Manuscripts were excluded if they were not written in English, not involving humans, and were not clinical trials. Results: Of the 84 manuscripts selected for review, 49 studies were conducted in the US, 13 were conducted in Africa, 17 in Asia, 3 in the Caribbean, 1 in Europe, and 1 in South America. Sample sizes ranged from 37 to 12,590. Of the 49 studies that offered financial incentives, the amount given ranged from $2.00 to $60.00 USD. We found a significant variety of monetary and non-monetary incentives used in HIV prevention studies. Several questions arose considering the ethical standards of using incentives. Conclusion: Incentives can be viewed as coercion of participants into harmful research protocols regardless of researchers obtaining informed consent due to the excessive nature of the incentive. Regulators of research should consider participants’ views when assuming that financial incentives diminish autonomy and capacity for informed decision making.