March 31, 2011
Young women in sub-Saharan Africa have HIV infection rates up to three times higher than their male peers, largely because of relationships with older "sugar daddies" who give them money in exchange for sex. The phenomenon contributes significantly to HIV's spread, said Ester Etkin of loveLife, South Africa's largest anti-AIDS group.
A World Bank study in Malawi examined cash incentives among approximately 3,800 females ages 13-22. One group received roughly $10 a month and payment for school fees if they regularly attended class, while the control received no incentives. HIV infection rates at 18-month follow-up were 60 percent lower among girls who were given cash: 1.2 percent, compared with 3 percent. The study also showed a delay in the start of sexual activity among beneficiaries and a decline in the number of partners among those who were sexually active.
Though the study's results are being assessed by a peer-reviewed journal, plans are underway to repeat the experiment elsewhere in Africa, said Mayra Buvinic, director of gender and development at the World Bank. "The potential could be huge to reduce HIV rates in teenage girls," she said.
But some experts question whether cash payouts are an appropriate strategy. "We could end up creating an environment of dependency that cannot be sustained," warned Peter Lamptey, a Family Health International physician practicing in Ghana. "Paying people to influence their sexual behavior won't solve the wider problems of abuse, esteem, neglect and inequality that cause them to get HIV," said Sophie Harman, a senior lecturer at London's City University who has studied World Bank AIDS policies.