Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
School of Health and Society, University of Wollongong, Wollongong, NSW, Australia.
BMC Public Health. 2018 Jan 10;18(1):120. doi: 10.1186/s12889-018-5027-3.
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.
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.
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.
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.
在撒哈拉以南非洲，人们对使用现金转移（CT）计划来治疗和预防艾滋病毒越来越感兴趣。然而，在资源匮乏的城市环境中，向青少年提供 CT 的相关后果的证据有限。我们探讨了接受 CT 的青少年的经验，以评估在南非约翰内斯堡城市地区提供 CT 的可接受性和意外后果。
我们在一项针对三种 CT 策略（无条件每月付款、有条件取决于上学出勤率、有条件一次性付款取决于诊所就诊）的试点随机对照试验中收集了定性数据，涉及约翰内斯堡市中心的 120 名 16-18 岁青少年。使用 isiZulu、Sesotho 或英语对遵守研究条件的 49 名参与者（280 南非兰特/20 美元）进行了访谈，在接受 CT（280 南非兰特/20 美元）后 6 个月和项目结束后长达 12 个月时进行了访谈。访谈由三名实地工作者进行转录和翻译。使用归纳法生成代码；根据出现的问题对转录本进行初步编码，然后使用 Atlas.ti 7.4 进行演绎编码。
CT 促进了接受者的独立感和成人社会认同。CT 被用于购买个人和家庭用品；然而，在消费和储蓄行为方面存在性别差异。男性参与者的支出反映了他们通过维持公共社会地位来关注，通过这种地位，他们表现出负责任的成年人的形象。相比之下，女性参与者的支出反映了对家庭责任的承担和对老年男性的独立，后者强调了 CT 减少交易性性伙伴关系的潜力。现金福利是短暂的，因为青少年在项目结束后恢复了以前的行为。
现金转移计划为低收入城市环境中的青少年男女提供了一种代理感，这对于他们向成年期过渡至关重要。然而，必须注意 CT 支出方面的性别差异以及结束 CT 计划的影响，因为这可能会带来潜在的意外风险。
