Schooling, Income, and HIV Risk in Malawi (SIHR)

Does Schooling Protect Young Women From HIV?

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.

Study Overview

• Status: Active, not recruiting
• Conditions: HIV; Schooling; Conditional Cash Transfers; Unconditional Cash Transfers
• Intervention / Treatment: Behavioral: Zomba Cash Transfer Program

Detailed Description

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:

1. Are the observed effects of a CCT associated with the transfer or the conditionality imposed on the recipient?
2. Do the outcomes of interest improve with increased benefit levels set by the program?
3. Do CCT programs for schooling have any positive health impacts, including prevention of STIs such as HIV/AIDS among young people?

• Study Type: Interventional
• Enrollment (Actual): 3796
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Malawi
  • Zomba, Malawi
    • Zomba District, Malawi

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 13 years to 22 years (Child, Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• female
• 13-22 years old
• never married

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Unconditional cash transfers; 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; Cash transfers were provided monthly to a randomly selected sample of school aged girls. Amounts were also varied in both treatment arms.
Experimental: Conditional Cash Transfer; 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; Cash transfers were provided monthly to a randomly selected sample of school aged girls. Amounts were also varied in both treatment arms.
No Intervention: Control Group; No cash transfer program implemented in this group.

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: George Washington University
• Collaborators: University of California, San Diego; World Bank; University of Malawi
• Investigators: Principal Investigator: Craig T McIntosh, PhD, University of California, San Diego; Principal Investigator: Sarah J Baird, PhD, George Washington University; Principal Investigator: Ephraim Chirwa, PhD, University of Malawi; Principal Investigator: Richard S Garfein, PhD, University of California, San Diego; Principal Investigator: Berk Ozler, PhD, World Bank

Publications and helpful links

General Publications

• Baird S, Chirwa E, McIntosh C, Ozler B. The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women. Health Econ. 2010 Sep;19 Suppl:55-68. doi: 10.1002/hec.1569.
• Baird SJ, Garfein RS, McIntosh CT, Ozler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet. 2012 Apr 7;379(9823):1320-9. doi: 10.1016/S0140-6736(11)61709-1. Epub 2012 Feb 15.

Study record dates

Study Major Dates

• Study Start: September 1, 2007
• Primary Completion (Actual): September 1, 2012
• Study Completion (Estimated): May 1, 2025

Study Registration Dates

• First Submitted: April 11, 2011
• First Submitted That Met QC Criteria: April 11, 2011
• First Posted (Estimated): April 12, 2011

Study Record Updates

• Last Update Posted (Actual): August 15, 2023
• Last Update Submitted That Met QC Criteria: August 13, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Other Study ID Numbers: KCP: RF-P109215-RESE-TF090932; RSB: RF-P109215-RESE-BBRSB (Other Grant/Funding Number: World Bank)