Association for Public Policy Analysis & Management

Evidence has shown that the experience of violence by a partner has important influences on women’s risk of HIV acquisition. Conditional cash transfers (CCTs) targeted to young women in sub-Saharan Africa have been advocated as an intervention to reduce the risk of HIV-infection, but the success of such interventions may be conditional upon changes in gendered power inequalities. Using a randomized experiment in northeast South Africa, we find that a CCT targeted to poor girls in high school reduced the risk of intimate partner violence (IPV) by 34%. The purpose of this study is to understand the pathways through which the CCT affects IPV.Our study is a phase 3, randomized controlled trial (HPTN 068) in a rural area in Mpumalanga province, South Africa. Eligible young women (aged 13-20) and their parents or guardians were randomly assigned (1:1) to receive a monthly cash transfer conditional on school attendance versus no cash transfer. Participants (N=2,448) were interviewed at baseline, then at annual follow-up visits at 12, 24, and 36 months. We estimate the primary outcome, physical IPV in the past 12 months, using a GEE log-binomial regression model. We examined mediation of direct effects through intermediate pathways using methods designed for nonlinear models under the counterfactual framework. Mediators include sexual behaviors, empowerment, and economic well-being measures.We find evidence that the CCT works through delaying sexual debut or reducing the likelihood of having a sexual partner. The intervention interacts with these mediators leading to a larger reduction in IPV risk. Compared to the direct effect of the CCT on any physical IPV [RR 0.66, CI(95%):0.59-0.74], the risk of IPV is further reduced when we set the controlled direct effect to either no sexual debut [RR 0.59, CI(95%):0.51-0.68] or to no sexual partners [RR 0.54, CI(95%):0.47-0.61]. Results indicate that a CCT for adolescent school girls has protective effects on girls’ experience of violence in part because the intervention reduces the likelihood of debut or having a sexual partner, thereby reducing the opportunity for IPV. Since these behaviors also protect against HIV acquisition, this evidence strengthens the case for CCTs for HIV prevention.