• Based on the Introduction section and Discussion section of the journal article, write a one paragraph concise overview – in your own words – of what “cash transfer” means and what the study showed. Insert the text directly in the text toolbar section of the assignment (not comments to professor/instructor section).

Preventing AIDS A drug called money

Cash payments to schoolgirls cut HIV infection rate


HALFWAY between marriage and prostitution lies the sugar daddy. Not quite a husband, not quite a John, he looks after his girl and expects her to be loyal to him—a loyalty that is frequently unreciprocated. But if you are a poor African teenager, having a sugar daddy is not such a bad deal. Eventually, Mr Right may come along and in the meantime life is, as the term suggests, a lot sweeter than it might otherwise be. Except for one thing. In many parts of Africa, relationships between older men and younger women are one of the main transmitters of HIV.

With that in mind, it has often been hypothesised that if teenage girls were given an alternative income—one that might, for instance, allow them to stay on at school—they would be less likely to get infected. It is a plausible hypothesis but one that has not, until now, actually been tested.

That lack has just been remedied by Berk Özler, of the World Bank, and his colleagues. In a paper just published by the Lancet, they describe how they conducted a randomised clinical trial of the idea that money, and money alone, can stop the spread of HIV.

They carried out their experiment in the Zomba district of Malawi, recruiting nearly 1,300 never-married women between the ages of 13 and 22. They divided Zomba into 176 areas, and each participant in a given area was treated in the same way. That area-wide treatment was, however, decided at random by a computer. In some areas, which acted as controls, the women were simply monitored. In some they and their parents were given small amounts of money each month (between $1 and $5 for the women, and between $4 and $10 for the parents), again decided at random by the computer. In a third set of areas money was doled out in a similar way, but only in exchange for a promise by the woman to attend school. If she failed to do so, no money was forthcoming.

When the results were in, the team found that the unpaid women had suffered more than twice the HIV infection rate experienced by the paid women over the course of the 18 months of the experiment, and four times the infection rate of genital herpes. Intriguingly, there was no difference between the infection rate suffered by those required to go to school and those who received the money unconditionally. Whether the actual amount of money mattered was not clear. For that to emerge a larger sample would be needed.

What is abundantly clear, however, was that the money did make women behave differently. They had younger boyfriends than those in the control group, and had sex less frequently. Liberated from the need to find a sugar daddy, they could behave in a safer way.

Those attempting to stop the spread of AIDS have, in the past, tried many ways of getting people to change their behaviour in order to reduce the risk of infection. They have extolled, exhorted and even threatened, all to little avail. They have not, though, previously, resorted to bribery. But it seems to work.

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