Abstract
ABSTRACTThis systematic review assessed outcome evidence of financial education and plural interventions aimed at reducing HIV vulnerability for youth, orphans and vulnerable children in low and middle-income countries. Relevant evidence reviews found both positive and mixed evidence that HIV prevention may be addressed through economic strengthening activities such as financial education for youth. There was some evidence related to the potential for plural interventions that include sexual and reproductive health education but limited quality evidence that focused on HIV vulnerable youth in low-and-middle income countries. To address this gap, the team systematically reviewed the scope and strength of impact evidence of financial education and plural interventions for HIV-vulnerable youth and OVC in LMIC, with a focus on outcome analysis. Of 5,216 records, 16 moderate to higher quality studies representing 10 interventions were identified, mostly focusing on HIV-vulnerable girls in Sub-Saharan Africa. More than half of the interventions were plural and included access to finance and counseling or social supports. Most used an experimental design. The strongest odds ratio effects were found to be on HIV-related outcomes by plural interventions. Observed improvements included increased HIV related knowledge, attitudes, reduced sexual risk-taking behavior and improved self-efficacy. While positive effects were also observed related to increased savings and improved attitudes toward saving, generally interventions showed mixed effects on financial and economic outcomes. This review supports emerging evidence that plural interventions are associated with positive health and economic outcomes for vulnerable youth and children in LMIC. Even so, as a body of evidence, it is not clear which components are effective at producing favorable outcomes. Quality evidence is needed in more settings separating out economic, health and self-efficacy components to better understand pathways and effects on outcomes. Segmentation will enhance our understanding of asset, capability and self-efficacy theories for greater impact.
Highlights
Global commitments to reverse the HIV epidemic will only be achieved if strategies focus on children and youth (United Nations).1 HIV is the leading cause of youth mortality in Africa, and the second cause of death among young people worldwide (UNAIDS, 2015; WHO, 2014)
Two reviewers screened the titles and abstracts for relevant studies focused on financial education for vulnerable youth or OVC in lowand middle-income countries (LMIC) with or without financial services
A number of lessons can be learned from the selected studies on the mix of financial and plural education and supports that led to positive health and economic outcomes for vulnerable youth and children
Summary
Global commitments to reverse the HIV epidemic will only be achieved if strategies focus on children and youth (United Nations). HIV is the leading cause of youth mortality in Africa, and the second cause of death among young people worldwide (UNAIDS, 2015; WHO, 2014). Global commitments to reverse the HIV epidemic will only be achieved if strategies focus on children and youth (United Nations).. HIV is the leading cause of youth mortality in Africa, and the second cause of death among young people worldwide (UNAIDS, 2015; WHO, 2014). Young girls are vulnerable (Fleischman & Peck, 2015), accounting for 20% of the new HIV infections globally in 2015, despite accounting for just 11% of the adult population Pronyk et al (2008) found the combination of financial education and microfinance effective at reducing HIV risk behavior in young women in rural South Africa. Cui, Lee, Thirumurthy, Muessig, and Tucker (2013) found potential utility in microenterprise development to reduce HIV risk, for sex workers with limited effects for non-sex workers. Asset theory holds that economic and financial supports reduce economic vulnerability and increase overall resources which may lead to other positive personal and social outcomes (Kennedy, Fonner, O’Reilly, & Sweat, 2014; Witte et al, 2015)
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