Impact of the Kenya Cash Transfer for Orphans and Vulnerable Children Program on HIV Risk Behavior

"Study Question: Can a poverty targeted social cash transfer influence HIV risk behavior?"

This study examined the Kenya cash transfer programme for orphans and vulnerable children (CT-OVC). It studied results in the population of economically "ultra-poor" 0-17-year-olds receiving a flat monthly transfer of US$20, a programme covering 125,000 households and 350,000 OVC. Presented at the 2012 International AIDS Conference (IAC) in Washington, DC, United States (US), the study is from the University of North Carolina at Chapel Hill, US, in collaboration with the Ministry of Gender, Children and Social Development Government of Kenya.

The study was a cluster randomised longitudinal design study including a baseline in 2007, a follow-up in 2009 (both United Nations Children's Fund (UNICEF) funding), and a follow-up in 2011 (National Institute of Mental Health (NIMH) funding). The 2011 follow-up included interviews with 2 individuals per household for 1,810 households.

The presentation charts the household demographics in terms of household size, gender of head of the household, and age of the household head. It charts the poverty level in various terms including: mud or dung floor; no toilet; unprotected water source; and walls of grass, mud, or dung. It maps the locations of populations interviewed. It characterises the sample as made up of 15- to 20-year-olds (11-16 years of age at baseline) and explains the inclusion of taking account of the relationship to the interviewer, the age/sex of the head of household interviewed, the head's characteristics, and the understanding of possible mediators of programme effects on sexual début - e.g., depressive symptoms, no sexually experienced friends, currently in school, etc.

In addition, the presentation charts the age of sexual début, use of a condom, and age difference of partner (if +10 years older) and then analyses the data in a number of ways including by gender, by whether the individual had experienced sexual début prior to the baseline or had not, by the programme impact on other sexual outcomes (e.g., condom use, gifts received, and partner age), etc.

The conclusions include the following;

• "First evidence of whether a large scale national poverty program can reduce HIV-related risky behavior among young people
  • 30% lower chance of sexual début; less chance of 3+ unprotected sex acts in last 3 months; among females, fewer partners in last year
• Among those who débuted, no difference in other risk-related behaviors (condom use)
  • Program affecting the least risky? Or only postpones début but not other behaviors?
• Causal pathway still unclear
  • Schooling protective, but not a mediator
  • Perception of friends’ behavior protective, but also not a mediator
  • Psycho-social status not protective
• Similar large scale national 'unconditional' or 'social' transfer programs exist in Zambia, Zimbabwe, Malawi, South Africa, Mozambique
  • Results from Kenya indicate poverty targeted transfer programs may help reduce HIV risk"