Protecting Women from Economic shocks to fight HIV in Africa (POWER)
Lead Research Organisation:
UNIVERSITY COLLEGE LONDON
Department Name: Institute for Global Health
Abstract
HIV/AIDS is one of the leading cause of mortality globally and the leading cause among women aged 15-44 years. African women aged 15-24 are twice more likely to be infected with HIV than their male counterparts. In Cameroon, one of the countries with the highest gender disparity in HIV globally, adolescent girls are five times more likely to be infected with HIV than boys of the same age. There is a growing number of studies showing that risks taken during transactional sex and commercial sex -in addition to biological susceptibility- are responsible for gender inequalities in HIV/AIDS. However, there is superficial understanding of the main causes driving risky sexual behaviours of women who engage in those practises in Africa.
Recent studies have shown that women mainly adopt risky sexual behaviours in order to cope with negative income shocks (e.g. agricultural and climatic shocks, illness or death of family members) and suggest that economic shocks are a substantial piece of the HIV puzzle in Africa. If women adopt risky sexual behaviours to cope with negative income shocks, hence providing women formal risk-coping strategies could be a very promising approach to prevent HIV. However, there are still important gaps in knowledge, mainly because no previous study has been designed to specifically answer this research question.
The goal of this research is to fill these gaps in knowledge in order to inform the design of novel public health interventions to tackle sexually transmitted infections (STIs) and HIV. Specifically, the study aims (1) to estimate the effect of economic shocks affecting households on sexual behaviours and STI and HIV acquisition of young women, (2) to identify the channels through which economic shocks affect STIs and HIV, (3) to estimate the effectiveness of an intervention that protects women from economic shocks to prevent STI and HIV and (4) to measure the cost-effectiveness of an intervention that protects women from economic shocks to prevent HIV in the general population.
The proposed study will use data from a new cohort of women in Cameroon. The study has recruited 1,500 unmarried women engaging in transactional sex or commercial sex, including three biobehavioural and socioeconomic surveys. A randomised controlled trial was embedded to the cohort study and has provided women allocated to the treatment group with a formal risk-coping strategy (a family health insurance).
This research is of immediate necessity to address a vital public health challenge of our time and has the strong potential to have a long lasting impact on shaping the research agenda on HIV/AIDS.
Recent studies have shown that women mainly adopt risky sexual behaviours in order to cope with negative income shocks (e.g. agricultural and climatic shocks, illness or death of family members) and suggest that economic shocks are a substantial piece of the HIV puzzle in Africa. If women adopt risky sexual behaviours to cope with negative income shocks, hence providing women formal risk-coping strategies could be a very promising approach to prevent HIV. However, there are still important gaps in knowledge, mainly because no previous study has been designed to specifically answer this research question.
The goal of this research is to fill these gaps in knowledge in order to inform the design of novel public health interventions to tackle sexually transmitted infections (STIs) and HIV. Specifically, the study aims (1) to estimate the effect of economic shocks affecting households on sexual behaviours and STI and HIV acquisition of young women, (2) to identify the channels through which economic shocks affect STIs and HIV, (3) to estimate the effectiveness of an intervention that protects women from economic shocks to prevent STI and HIV and (4) to measure the cost-effectiveness of an intervention that protects women from economic shocks to prevent HIV in the general population.
The proposed study will use data from a new cohort of women in Cameroon. The study has recruited 1,500 unmarried women engaging in transactional sex or commercial sex, including three biobehavioural and socioeconomic surveys. A randomised controlled trial was embedded to the cohort study and has provided women allocated to the treatment group with a formal risk-coping strategy (a family health insurance).
This research is of immediate necessity to address a vital public health challenge of our time and has the strong potential to have a long lasting impact on shaping the research agenda on HIV/AIDS.
People |
ORCID iD |
| Aurelia Lepine (Principal Investigator / Fellow) |
Publications
Lépine A
(2024)
The effect of protecting women against economic shocks to fight HIV in Cameroon, Africa: The POWER randomised controlled trial.
in PLoS medicine
| Description | This research explores how providing free health insurance can help protect vulnerable women in sub-Saharan Africa from HIV. Women in this region, especially young women, are significantly more likely to be affected by HIV than men, often due to a combination of biological and financial factors. Many women engage in risky sexual behaviours, like transactional or commercial sex, to cope with economic challenges such as sudden income losses. This study tested whether access to health insurance could reduce such behaviours and, in turn, lower the risk of HIV infection. Key Findings: What was done: The researchers gave free health insurance to some women involved in transactional or commercial sex and compared their health outcomes with a group that didn't receive insurance right away. What they found: Women involved in transactional sex (exchanging sex for financial or material support) who received health insurance were much less likely to become infected with HIV. This suggests that financial security through health insurance helped them avoid risky behaviours linked to economic pressure. Women involved in commercial sex (where sex work is their main occupation) did not show the same reduction in HIV risk, possibly because their circumstances and the characteristics of the relationship with their male sexual partners are different. Other results: The study did not find any impact on the rates of other sexually transmitted infections (STIs) for either group. Why this matters: This is the first study to show that financial support through health insurance can directly reduce the risk of HIV for women engaged in transactional sex. It highlights the importance of addressing economic vulnerabilities as part of strategies to prevent HIV. By helping women avoid desperate financial decisions, interventions like health insurance can play a vital role in improving their health and reducing the spread of HIV. |
| Exploitation Route | The outcomes of this research can be taken forward and utilised in several impactful ways: Policy Development: Governments and international organisations can use these findings to design and implement health insurance programs targeted at vulnerable populations, particularly women at high risk of HIV. This evidence strengthens the case for structural interventions as part of national HIV prevention strategies. Scaling Structural Interventions: Nonprofits and health agencies can adopt similar health insurance models in other regions with high HIV prevalence. By replicating the approach, they can test its effectiveness in different economic and cultural contexts. Integration with Existing HIV Programs: Health insurance could be integrated with existing HIV prevention efforts, such as PrEP distribution and sexual health education, to offer a comprehensive package that addresses both financial and health-related vulnerabilities. Advancing Research: Researchers can build on these findings by exploring other forms of financial support, like cash transfers or savings programs, to determine their effectiveness in reducing risky behaviours and HIV incidence. Additionally, future studies could focus on refining methods for collecting STI data or exploring why commercial sex workers did not benefit similarly. Community Empowerment: Grassroot organisations could use this evidence to advocate for community-based solutions that address the root causes of risky behaviours, such as poverty and lack of access to healthcare. Economic Shock Preparedness: Beyond HIV prevention, these findings highlight the broader role of health insurance in protecting vulnerable populations during economic crises. This could inspire policies that incorporate health insurance as a key component of social safety nets. By leveraging these findings, stakeholders across sectors can develop more effective, sustainable, and evidence-based interventions to combat HIV and support the health and economic security of at-risk populations. |
| Sectors | Healthcare |