We propose to determine the effect of an innovative, multi-level HIV prevention intervention that will jointly address both structural and social factors that contribute to young women's increased vulnerability to HIV. We propose providing cash transfers to the families of young women conditional on the young women attending school with the goal of reducing the young women's HIV risk by keeping her in school by improving her family's economic resources (structural factors). The structural level intervention will be complemented by a community level mobilization intervention focused on engaging young men around the issues of gender norms and HIV risk and encouraging them to take action to protect young women and reduce HIV risk in their communities. This study will be situated in the Agincourt sub-district of Bushbuckridge of rural Mpumalanga Province in South Africa. Approximately 84,000 individuals live in Agincourt in 25 villages, and the area is a Households Demographic Surveillance Site (Agincourt HDSS). We will use the AHDSS as the platform from which we will identify eligible households and young women for the cash transfer intervention (Aim 1). Young women will be recruited at the end of grade 9 and randomly allocated to the intervention (n=200/arm), a cash transfer to the household conditional on school attendance. The cash transfer will be provided for 3 years (until the expected completion of high school, grade 12). To examine the effect of the conditional cash transfers, young women will be interviewed at baseline and then every 12 months until the end of the intervention (3 years post baseline). After households are identified for the cash transfer intervention, villages will be randomized to receive the community mobilization intervention (Aim 2). We will select community mobilizers (n=15) who will conduct mobilization activities in the intervention villages (n=12), including one-on-one contact, workshops and community events to promote awareness around the role of negative gender norms and HIV risk and to encourage young men and community members to take action to reduce young women's HIV risk. To assess the effect of the community mobilization intervention on changes in gender norms and sexual behavior, we will select a sample of young people (age 18-35) from the 25 villages in whom we will conduct a survey at baseline and 3 years post baseline. We will also assess the combined effect of the cash transfer intervention and community mobilization intervention in young women (Aim 3).

Public Health Relevance

In South Africa, young women are infected at 3-4 times the rate of young men and by the time a woman reaches age 21, she has a 1 in 3 chance of being infected. We propose providing cash transfers to the families of young women conditional on the young women attending school with the goal of reducing the young women's HIV risk by keeping her in school by improving her family's economic resources (structural factors). The structural level intervention will be complemented by a community level mobilization intervention focused on engaging young men around the issues of gender norms and HIV risk and encouraging them to take action to protect young women and reduce HIV risk in their communities.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH087118-01
Application #
7666008
Study Section
Special Emphasis Panel (ZHD1-DSR-W (17))
Program Officer
Kamath, Susannah M Allison
Project Start
2009-07-01
Project End
2014-04-30
Budget Start
2009-07-01
Budget End
2010-04-30
Support Year
1
Fiscal Year
2009
Total Cost
$593,291
Indirect Cost
Name
University of North Carolina Chapel Hill
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Pettifor, Audrey; Lippman, Sheri A; Gottert, Ann et al. (2018) Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa. J Int AIDS Soc 21:e25134
Leddy, Anna M; Lippman, Sheri A; Neilands, Torsten B et al. (2018) Community collective efficacy is associated with reduced physical intimate partner violence (IPV) incidence in the rural province of Mpumalanga, South Africa: findings from HPTN 068. J Epidemiol Community Health :
Zhang, Yinfeng; Sivay, Mariya V; Hudelson, Sarah E et al. (2018) Antiretroviral Drug Use and HIV Drug Resistance Among Young Women in Rural South Africa: HPTN 068. J Acquir Immune Defic Syndr 79:315-322
Gottert, Ann; Barrington, Clare; McNaughton-Reyes, Heath Luz et al. (2018) Gender Norms, Gender Role Conflict/Stress and HIV Risk Behaviors Among Men in Mpumalanga, South Africa. AIDS Behav 22:1858-1869
Hill, Lauren M; Abler, Laurie; Maman, Suzanne et al. (2018) Hope, the Household Environment, and Sexual Risk Behaviors Among Young Women in Rural South Africa (HPTN 068). AIDS Behav 22:1908-1918
Rosenberg, Molly; Pettifor, Audrey; Twine, Rhian et al. (2018) Evidence for sample selection effect and Hawthorne effect in behavioural HIV prevention trial among young women in a rural South African community. BMJ Open 8:e019167
Lippman, Sheri A; Leslie, Hannah H; Neilands, Torsten B et al. (2018) Context matters: Community social cohesion and health behaviors in two South African areas. Health Place 50:98-104
Ranganathan, Meghna; Heise, Lori; MacPhail, Catherine et al. (2018) 'It's because I like things… it's a status and he buys me airtime': exploring the role of transactional sex in young women's consumption patterns in rural South Africa (secondary findings from HPTN 068). Reprod Health 15:102
Stoner, Marie C D; Edwards, Jessie K; Miller, William C et al. (2018) Does Partner Selection Mediate the Relationship Between School Attendance and HIV/Herpes Simplex Virus-2 Among Adolescent Girls and Young Women in South Africa: An Analysis of HIV Prevention Trials Network 068 Data. J Acquir Immune Defic Syndr 79:20-27
Sivay, Mariya V; Hudelson, Sarah E; Wang, Jing et al. (2018) HIV-1 diversity among young women in rural South Africa: HPTN 068. PLoS One 13:e0198999

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