Cargando…

Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents

INTRODUCTION: Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can “cash plus care” social protection reduce risks for ado...

Descripción completa

Detalles Bibliográficos
Autores principales: Cluver, Lucie Dale, Orkin, Frederick Mark, Meinck, Franziska, Boyes, Mark Edward, Sherr, Lorraine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International AIDS Society 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834365/
https://www.ncbi.nlm.nih.gov/pubmed/27086838
http://dx.doi.org/10.7448/IAS.19.1.20646
_version_ 1782427473590353920
author Cluver, Lucie Dale
Orkin, Frederick Mark
Meinck, Franziska
Boyes, Mark Edward
Sherr, Lorraine
author_facet Cluver, Lucie Dale
Orkin, Frederick Mark
Meinck, Franziska
Boyes, Mark Edward
Sherr, Lorraine
author_sort Cluver, Lucie Dale
collection PubMed
description INTRODUCTION: Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can “cash plus care” social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. METHODS: This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. RESULTS: Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=−0.08, p<0.002 between structural deprivation and psychosocial problems, and B=−0.07, p<0.001 between psychosocial problems and HIV risk behaviour). CONCLUSIONS: Adolescents with the greatest structural deprivation are at higher risk of HIV, but social protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination package of HIV-prevention approaches.
format Online
Article
Text
id pubmed-4834365
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher International AIDS Society
record_format MEDLINE/PubMed
spelling pubmed-48343652016-04-19 Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents Cluver, Lucie Dale Orkin, Frederick Mark Meinck, Franziska Boyes, Mark Edward Sherr, Lorraine J Int AIDS Soc Research Article INTRODUCTION: Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can “cash plus care” social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. METHODS: This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. RESULTS: Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=−0.08, p<0.002 between structural deprivation and psychosocial problems, and B=−0.07, p<0.001 between psychosocial problems and HIV risk behaviour). CONCLUSIONS: Adolescents with the greatest structural deprivation are at higher risk of HIV, but social protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination package of HIV-prevention approaches. International AIDS Society 2016-04-15 /pmc/articles/PMC4834365/ /pubmed/27086838 http://dx.doi.org/10.7448/IAS.19.1.20646 Text en © 2016 Cluver LD et al; licensee International AIDS Society http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Cluver, Lucie Dale
Orkin, Frederick Mark
Meinck, Franziska
Boyes, Mark Edward
Sherr, Lorraine
Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents
title Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents
title_full Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents
title_fullStr Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents
title_full_unstemmed Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents
title_short Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents
title_sort structural drivers and social protection: mechanisms of hiv risk and hiv prevention for south african adolescents
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834365/
https://www.ncbi.nlm.nih.gov/pubmed/27086838
http://dx.doi.org/10.7448/IAS.19.1.20646
work_keys_str_mv AT cluverluciedale structuraldriversandsocialprotectionmechanismsofhivriskandhivpreventionforsouthafricanadolescents
AT orkinfrederickmark structuraldriversandsocialprotectionmechanismsofhivriskandhivpreventionforsouthafricanadolescents
AT meinckfranziska structuraldriversandsocialprotectionmechanismsofhivriskandhivpreventionforsouthafricanadolescents
AT boyesmarkedward structuraldriversandsocialprotectionmechanismsofhivriskandhivpreventionforsouthafricanadolescents
AT sherrlorraine structuraldriversandsocialprotectionmechanismsofhivriskandhivpreventionforsouthafricanadolescents