Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
J Int AIDS Soc. 2024 Oct;27(10):e26369. doi: 10.1002/jia2.26369.
Without effective, scalable interventions, we will fail to achieve the Global AIDS Targets of zero AIDS-related deaths, zero HIV transmission and zero discrimination. This study examines associations of social protection and food security among adolescents living with HIV (ALHIV), with three Global AIDS Targets aligned outcomes: antiretroviral treatment (ART) adherence and viral suppression, HIV transmission risk behaviour and enacted stigma.
We conducted three study visits over 2014-2018 with 1046 ALHIV in South Africa's Eastern Cape province. Standardized surveys provided information on receipt of government-provided cash transfers and past-week food security, alongside self-reported ART adherence, sexual debut and condom use, and enacted HIV-related stigma. Viral load (VL) data was obtained through data extraction from patient files and linkage with National Health Laboratory Service test results (2014-2020). We used a multivariable random-effects regression model to estimate associations between receiving government cash transfers and food security and three outcomes: ART adherence and viral suppression, delayed sexual debut or consistent condom use and no enacted stigma. We tested moderation by sex and age and fitted disaggregated models for each outcome.
Among the 933 ALHIV completing all three study visits, 55% were female, and the mean age was 13.6 years at baseline. Household receipt of a government cash transfer was associated with improvements on all outcomes: ART adherence and viral suppression (aOR 2.03, 95% CI 1.29-3.19), delayed sexual debut or consistent condom use (aOR 1.62, 95% CI 1.16-2.27) and no enacted stigma (aOR 2.33, 95% CI 1.39-3.89). Food security was associated with improvements on all outcomes: ART adherence and viral suppression (aOR 1.73, 95% CI 1.30-2.30), delayed sexual debut or consistent condom use (aOR 1.30, 95% CI 1.03-1.64) and no enacted stigma (aOR 1.91, 95% CI 1.32-2.76). Receiving both cash transfers and food security increased the probability of ART adherence and VL suppression from 36% to 60%; delayed sexual debut or consistent condom use from 67% to 81%; and no enacted stigma from 84% to 96%.
Government-provided cash transfers and food security, individually and in combination, are associated with improved outcomes for ALHIV aligned with Global AIDS Targets. They may be important, and underutilized, accelerators for achieving these targets.
如果没有有效且可扩展的干预措施，我们将无法实现零艾滋病相关死亡、零艾滋病毒传播和零歧视的全球艾滋病目标。本研究考察了社会保护和食物安全与青少年艾滋病病毒感染者（ALHIV）与三个全球艾滋病目标相一致的结果之间的关联：抗逆转录病毒治疗（ART）的依从性和病毒抑制、艾滋病毒传播风险行为和实施的耻辱感。
我们在 2014 年至 2018 年期间对南非东开普省的 1046 名 ALHIV 进行了三次研究访问。标准化调查提供了关于政府提供的现金转移和过去一周的粮食安全情况的信息，以及自我报告的 ART 依从性、性初潮和避孕套使用情况，以及实施的与 HIV 相关的耻辱感。病毒载量（VL）数据是通过从患者档案中提取数据并与国家卫生实验室服务测试结果（2014-2020 年）进行链接获得的。我们使用多变量随机效应回归模型来估计接受政府现金转移和粮食安全与三个结果之间的关系：ART 依从性和病毒抑制、延迟性初潮或持续使用避孕套和无实施的耻辱感。我们测试了性别和年龄的调节作用，并为每个结果拟合了分类模型。
在完成所有三次研究访问的 933 名 ALHIV 中，55%为女性，基线时的平均年龄为 13.6 岁。家庭收到政府现金转移与所有结果的改善有关：ART 依从性和病毒抑制（调整后的比值比 [aOR] 2.03，95%置信区间 [CI] 1.29-3.19）、延迟性初潮或持续使用避孕套（aOR 1.62，95% CI 1.16-2.27）和无实施的耻辱感（aOR 2.33，95% CI 1.39-3.89）。粮食安全与所有结果的改善有关：ART 依从性和病毒抑制（aOR 1.73，95% CI 1.30-2.30）、延迟性初潮或持续使用避孕套（aOR 1.30，95% CI 1.03-1.64）和无实施的耻辱感（aOR 1.91，95% CI 1.32-2.76）。同时获得现金转移和粮食安全将 ART 依从性和病毒抑制的概率从 36%提高到 60%；将延迟性初潮或持续使用避孕套的概率从 67%提高到 81%；将无实施耻辱感的概率从 84%提高到 96%。
政府提供的现金转移和粮食安全，单独和组合使用，与符合全球艾滋病目标的 ALHIV 结果的改善有关。它们可能是实现这些目标的重要但未充分利用的加速器。
