The Lancet doi: 10.1016/S0140-6736(11)61709-1 (02.15.12) -
"Lack of education and an economic dependence on men are often
suggested as important risk factors for HIV infection in
women," wrote the authors, whose current study assessed the
efficacy of a cash transfer program to reduce the risk of STIs
in young women.
The cluster randomized trial recruited never-married women
ages 13-22 from 176 enumeration areas in Malawi's Zomba
district. The women were randomly assigned with computer-
generated random numbers by enumeration area (1:1) to receive
cash payments (the intervention group) or nothing (the control
group). In addition, the intervention enumeration areas were
randomly assigned with computer-generated random numbers to
conditional (school attendance was required to receive
payment) and unconditional (nothing was required to receive
In both intervention groups, participants were assigned by
lottery to receive monthly payments ranging from US $1-$5.
Their parents were independently assigned with computer-
generated random numbers to receive $4-$10. At baseline and at
12 months, behavioral risk assessments were performed.
Serology was tested at 18 months. Although the participants
were not masked to treatment status, the counselors who
performed the serologic testing were. The study's primary
outcomes were prevalence of HIV and herpes simplex virus 2
(HSV-2) at 18 months; these were assessed by intention-to-
Eighty-eight enumeration areas were assigned to the
intervention, and 88 to the control condition. Among the 1,289
individuals enrolled in school at baseline with complete
interview and biomarker data, weighted HIV prevalence at 18
months was 1.2 percent (seven of 490 participants) in the
combined intervention group, compared to 3.0 percent (17 of
799 participants) in the control group (adjusted odds ratio
0.36, 95 percent CI: 0.14-0.91); weighted HSV-2 prevalence was
0.7 percent (five of 488 participants), versus 3.0 percent (27
of 796 participants) (AOR 0.24, 0.09-0.65).
The authors noted no difference between the conditional and
unconditional intervention groups for weighted HIV prevalence
(3/235 [1 percent] vs. 4/255 [2 percent]) or weighted HSV-2
prevalence (4/233 [1 percent] vs. 1/255 [<1 percent]). Among
individuals who had already dropped out of school at baseline,
no significant difference was noted between intervention and
control groups for weighted HIV prevalence (23/210 [10
percent] vs. 17/207 [8 percent]) or weighted HSV-2 prevalence
(17/211 [8 percent] vs. 17/208 [8 percent]).
"Cash transfer programs can reduce HIV and HSV-2 infections in
adolescent schoolgirls in low-income settings," the authors
concluded. "Structural interventions that do not directly
target sexual behavior change can be important components of
HIV prevention strategies."