Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Cash transfer interventions for sexual health: meanings and experiences of adolescent males and females in inner-city Johannesburg

TitleCash transfer interventions for sexual health: meanings and experiences of adolescent males and females in inner-city Johannesburg
Publication TypeJournal Article
Year of Publication2018
AuthorsKhoza, N, Stadler, J, MacPhail, C, Chikandiwa, A, Brahmbhatt, H, Delany-Moretlwe, S
JournalBMC Public Health
Date PublishedJan 10
ISBN Number1471-2458
Accession Number29316885
Keywords*Adolescents, *Boys, *Cash transfers, *Financial Support, *Girls, *Sexual Health, *South Africa, Adolescent, Cities, Female, Health Promotion/*methods, Humans, Male, Pilot Projects, Poverty Areas, Program Evaluation, Qualitative Research, SOUTH Africa

BACKGROUND: In sub-Saharan Africa, there is growing interest in the use of cash transfer (CT) programs for HIV treatment and prevention. However, there is limited evidence of the consequences related to CT provision to adolescents in low-resourced urban settings. We explored the experiences of adolescents receiving CTs to assess the acceptability and unintended consequences of CT strategies in urban Johannesburg, South Africa. METHODS: We collected qualitative data during a pilot randomized controlled trial of three CT strategies (monthly payments unconditional vs. conditional on school attendance vs. a once-off payment conditional on a clinic visit) involving 120 adolescents aged 16-18 years old in the inner city of Johannesburg. Interviews were conducted in isiZulu, Sesotho or English with a sub-sample of 49 participants who adhered to study conditions, 6 months after receiving CT (280 ZAR/ 20 USD) and up to 12 months after the program had ended. Interviews were transcribed and translated by three fieldworkers. Codes were generated using an inductive approach; transcripts were initially coded based on emerging issues and subsequently coded deductively using Atlas.ti 7.4. RESULTS: CTs promoted a sense of independence and an adult social identity amongst recipients. CTs were used to purchase personal and household items; however, there were gender differences in spending and saving behaviours. Male participants' spending reflected their preoccupation with maintaining a public social status through which they asserted an image of the responsible adult. In contrast, female participants' expenditure reflected assumption of domestic responsibilities and independence from older men, with the latter highlighting CTs' potential to reduce transactional sexual partnerships. Cash benefits were short-lived, as adolescents reverted to previous behavior after the program's cessation. CONCLUSION: CT programs offer adolescent males and females in low-income urban settings a sense of agency, which is vital for their transition to adulthood. However, gender differences in the expenditure of CTs and the effects of ending CT programs must be noted, as these may present potential unintended risks.