Schooling, Income, and HIV Risk in Malawi

Study Overview
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Brief Summary
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This study is designed to evaluate a two-year randomized intervention in Malawi that provides cash transfers to current schoolgirls (and young women who have recently dropped out of school) to stay in (and return to) school in order to understand the possible effects of such programs on the sexual behavior of the beneficiaries and their subsequent HIV risk.

Detailed Description
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Motivation: Education has been suggested as a social vaccine to prevent the spread of HIV (Jukes, Simmons, and Bundy, 2008), but almost all of the evidence we have on the link between school attendance (or attainment) and the risk of HIV infection comes from cross-sectional studies. Furthermore, the role of income (especially that of women's poverty) has been hypothesized as a significant factor in the spread of HIV in SSA, but again there is no credible evidence showing a causal link between income and HIV risk. A randomized intervention, such as the one proposed here, that provides randomly varied amounts of cash transfers to young individuals and their guardians is the perfect setting to examine the possible existence of such causal relationships. Objectives: The objective of the proposed study here is to provide credible evidence on issues about which we still know very little. Specifically, the main questions the study will try to answer are the following: Are the observed effects of a CCT associated with the transfer or the conditionality imposed on the recipient? Do the outcomes of interest improve with increased benefit levels set by the program? Do CCT programs for schooling have any positive health impacts, including prevention of STIs such as HIV/AIDS among young people?

Official Title
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Does Schooling Protect Young Women From HIV?

Conditions
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HIV, Schooling, Conditional Cash Transfers, Unconditional Cash Transfers

Intervention / Treatment
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* Behavioral: Zomba Cash Transfer Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: female 13-22 years old never married

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 22 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Unconditional cash transfers<br>Monthly cash transfers given to households with school aged girls with no strings attached. Transfer amounts randomized within this arm. | Behavioral: Zomba Cash Transfer Program<br>* Cash transfers were provided monthly to a randomly selected sample of school aged girls. Amounts were also varied in both treatment arms.<br>|
| Experimental: Conditional Cash Transfer<br>Monthly cash transfers given to households with school aged girls conditional on regular school attendance (80%). Transfer amounts randomized within this arm. | Behavioral: Zomba Cash Transfer Program<br>* Cash transfers were provided monthly to a randomly selected sample of school aged girls. Amounts were also varied in both treatment arms.<br>|
| No Intervention: Control Group<br>No cash transfer program implemented in this group. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sexually Transmitted Infections | HIV prevalence HSV-2 prevalence | 18 months | 
| Schooling | school enrollment | 12 months/24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sexually Transmitted Infections | syphilis | 18 months | 
| Marriage and fertility | ever married currently pregnant | 12 months/24 months | 
| sexual behavior | new sexual debut unprotected sexual intercourse weekly sexual intercourse had a sexual partner 25 or older | 12 months/ 24 months | 
| HIV Awareness | ever tested for HIV received health training on HIV HIV knowledge | 12 months/24 months |