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Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents.

Cluver LD, Orkin FM, Meinck F, Boyes ME, Sherr L - J Int AIDS Soc (2016)

Bottom Line: Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations.Adolescents with the greatest structural deprivation are at higher risk of HIV, but social protection has the greatest prevention effects for the most vulnerable.Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Social Policy and Intervention, Oxford University, Oxford, UK.

ABSTRACT

Introduction: Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can "cash plus care" social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa.

Methods: This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection.

Results: Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=-0.08, p<0.002 between structural deprivation and psychosocial problems, and B=-0.07, p<0.001 between psychosocial problems and HIV risk behaviour).

Conclusions: Adolescents with the greatest structural deprivation are at higher risk of HIV, but social protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination package of HIV-prevention approaches.

No MeSH data available.


Related in: MedlinePlus

Main and moderating effects of cash/cash-in-kind and care social protection on mediated pathways to HIV risk behaviour among adolescents.
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Figure 0002: Main and moderating effects of cash/cash-in-kind and care social protection on mediated pathways to HIV risk behaviour among adolescents.

Mentions: Fifth, only those psychosocial factors that showed significant mediation were factor-analyzed together and the first factor score (variance explained: 43% girls and 41% boys), was used as a composite mediator scale for each gender. This simplified mediation model was then tested for adolescent boys and girls, in order to provide a base for testing the potential effects of social protection. Sixth, in order to test the potential effects of social protection, gender-disaggregated PROCESS models simultaneously tested the main and moderating effects of cash/cash-in-kind and care on the significant HIV risk pathways, controlling for the confounders mentioned. This process used Hayes’ Model 76 to allow testing of potentially dual moderation of each linkage within the mediation model [40]. For the final values of coefficients that are reported (Figure 2), the moderated mediation models were re-run using only significant covariates, namely baseline HIV risk behaviours, province and adolescent age.


Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents.

Cluver LD, Orkin FM, Meinck F, Boyes ME, Sherr L - J Int AIDS Soc (2016)

Main and moderating effects of cash/cash-in-kind and care social protection on mediated pathways to HIV risk behaviour among adolescents.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834365&req=5

Figure 0002: Main and moderating effects of cash/cash-in-kind and care social protection on mediated pathways to HIV risk behaviour among adolescents.
Mentions: Fifth, only those psychosocial factors that showed significant mediation were factor-analyzed together and the first factor score (variance explained: 43% girls and 41% boys), was used as a composite mediator scale for each gender. This simplified mediation model was then tested for adolescent boys and girls, in order to provide a base for testing the potential effects of social protection. Sixth, in order to test the potential effects of social protection, gender-disaggregated PROCESS models simultaneously tested the main and moderating effects of cash/cash-in-kind and care on the significant HIV risk pathways, controlling for the confounders mentioned. This process used Hayes’ Model 76 to allow testing of potentially dual moderation of each linkage within the mediation model [40]. For the final values of coefficients that are reported (Figure 2), the moderated mediation models were re-run using only significant covariates, namely baseline HIV risk behaviours, province and adolescent age.

Bottom Line: Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations.Adolescents with the greatest structural deprivation are at higher risk of HIV, but social protection has the greatest prevention effects for the most vulnerable.Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Social Policy and Intervention, Oxford University, Oxford, UK.

ABSTRACT

Introduction: Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can "cash plus care" social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa.

Methods: This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection.

Results: Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=-0.08, p<0.002 between structural deprivation and psychosocial problems, and B=-0.07, p<0.001 between psychosocial problems and HIV risk behaviour).

Conclusions: Adolescents with the greatest structural deprivation are at higher risk of HIV, but social protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination package of HIV-prevention approaches.

No MeSH data available.


Related in: MedlinePlus