Financially empowering young women in poor countries may help protect them against sexually transmitted diseases. A new study shows that addressing poverty can help prevent risky behavior.
Poverty, a lack of education and gender inequality make girls and young women more vulnerable. It happens when they turn to older men for financial help for themselves or their families. Men who may be infected with HIV or herpes.
The findings are based on a study of 13 to 22 year old women in the Zomba district of Malawi. At the start of the study none had ever been married.
"We knew that Malawi was a poor country with a high HIV problem particularly among adolescent girls and young women, especially in the south where we ended up doing our study. So we said, why don't we start this little pilot experiment to see as a proof of concept whether small amounts of cash transfers can reduce the risk of getting infected?" said Dr. Berk Ozler, a senior economist at the World Bank, who took part in the research.
Education, he said, has been described as a "social vaccine" against HIV and other diseases. But many girls in the study were dropouts.
"A lot of times young girls will drop out of school very early, like age 14, 15, 16. And soon after that, their fertility, their child bearing starts and then they get married. And the earlier you're getting married the older your husband or your sexual partners tend to be. That's essentially the link toward unprotected – not necessarily risk per se – but unprotected sexual behavior in an environment where older men have a significant chance of being HIV positive," said Ozler.
Sugar Daddies?
Sometimes, older men who are with much younger women are called sugar daddies. But the World Bank economist said that was not necessarily the case in the Malawi study.
"In the media, this kind of sugar daddy phenomena gets sensationalized a little bit. What we find is much more subtle. It's that if you're an 18, 19 year old girl and you need somebody to support you and your family, your age mates aren't really able to do that because your age mates are as poor as you. But it's the older guys who have a bit of money. So, when we're talking about this kind of sugar daddy phenomenon, it's really not that. It's that you're essentially dating out of your age cohort because of economic reasons," he said.
If the young women had sex with men their own age, he said, they would have a very low risk of contracting HIV. Surveys in Malawi show the HIV prevalence rate among teenage boys is close to zero.
Little money, big difference
The study offered the girls and young women cash payments, perhaps 10 dollars a month. Some were just given the money with no conditions attached, while others were required to regularly attend school. There was some behavior change in those who received the money.
Ozler said, "Girls who were sexually active kept being sexually active. But they chose different partners. They dated their age mates, who are much less likely to be HIV positive. But on top of that they actually had much less sexual activity with them. Right, so it wasn't like they're abstaining, but they were having less sex. And we know both of those things are protective factors."
The study showed these young women generally had extremely low HIV or herpes infection rates.
Ozler said more research is needed to determine if such a program would work in most poor countries. But he says it could be considered as part of a comprehensive strategy to prevent HIV infection.
Ozler was joined in the research by Dr. Sarah Baird of George Washington University; Professor Richard Garfein; and Dr. Craig McIntosh of the University of California at San Diego. The Study was published by the Lancet medical journal.