Abstract
BackgroundSocial protection interventions, including cash grants and care provision have been shown to effectively reduce some negative impacts of the HIV epidemic on adolescents and families. Less is known about the role of social protection on younger HIV affected populations. This study explored the impact of cash grants on children’s cognitive development. Additionally, we examined whether combined cash and care (operationalised as good parenting) was associated with improved cognitive outcomes.MethodsThe sample included 854 children, aged 5 – 15, participating in community-based organisation (CBO) programmes for children affected by HIV in South Africa and Malawi. Data on child cognitive functioning were gathered by a combination of caregiver report and observer administered tests. Primary caregivers also reported on the economic situation of the family, cash receipt into the home, child and household HIV status. Parenting was measured on a 10 item scale with good parenting defined as a score of 8 or above.ResultsAbout half of families received cash (55%, n = 473), only 6% (n = 51) reported good parenting above the cut-off point but no cash, 18% (n = 151) received combined cash support and reported good parenting, and 21% (n = 179) had neither. Findings show that cash receipt was associated with enhanced child cognitive outcomes in a number of domains including verbal working memory, general cognitive functioning, and learning. Furthermore, cash plus good parenting provided an additive effect. Child HIV status had a moderating effect on the association between cash or/plus good parenting and cognitive outcomes. The association between cash and good parenting and child cognitive outcomes remained significant among both HIV positive and negative children, but overall the HIV negative group benefited more.ConclusionsThis study shows the importance of cash transfers and good parenting on cognitive development of young children living in HIV affected environments. Our data clearly indicate that combined provision (cash plus good parenting) have added value.
Highlights
Social protection interventions, including cash grants and care provision have been shown to effectively reduce some negative impacts of the Human immunodeficiency virus (HIV) epidemic on adolescents and families
Primary caregivers reported that 13.5% of children (n = 115) were HIV positive
Grant receipt according to HIV status of the child showed that HIV positive children were less likely to get a cash grant compared to HIV negative children (60.0% versus 75.3%, X2(1) = 11.89, p = 0.01)
Summary
Social protection interventions, including cash grants and care provision have been shown to effectively reduce some negative impacts of the HIV epidemic on adolescents and families. We examined whether combined cash and care (operationalised as good parenting) was associated with improved cognitive outcomes. HIV can affect children directly when they themselves are HIV positive or indirectly when their parent/s are HIV infected. Most child HIV infection occurs at birth. In addition to those born and acquiring HIV, other children are born HIV negative to an HIV positive mother – thereby exposed to both the virus, the. Time and quality of attention may affect younger children where alternative caregivers are brought in, sibling care may be needed, and school attendance may be disrupted. HIV is associated with stigma and this may have a consequential negative effect on the family and the child [7]
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