Abstract

BackgroundHIV is an inherently gendered disease in eastern and southern Africa, not only because more women than men are infected, but also because socially constructed gender norms work to increase women’s HIV-infection risk. The provision of cash transfers to young women alone in such a context adds another dimension to already existing complex social relations where patriarchal values are entrenched, gender inequality is the norm, and violence against women and girls is pervasive. It raises concerns about complicating young women’s relationships with their male partners or possibly even setting them up for more violence. In our attempt to understand how cash transfers influence social relations in the context of a trial among young women in South Africa, we used qualitative data collected during the trial to explore men’s perceptions of the impact of cash transfers on male-female relationships, both intimate and platonic, peer relationships.MethodBetween April 2012 and August 2015, we conducted focus group discussions (n = 12) and interviews (n = 20) with the male peers and intimate partners of young women aged 13–20 years, who were participating in a phase III randomised controlled trial of CTs for HIV prevention in Mpumalanga, South Africa. A thematic content analysis approach was used to analyse the data. The codebook was developed on the basis of the topic guides, with additional codes added inductively as they emerged from the data.ResultsIntimate partners were older (range 20–32 years) and more likely to be working than the male peers. Both intimate partners and male peers were supportive of the CT trial targeting young women; younger peers however expressed some concerns that the money might diminish their power and status in relationships. HIV testing requirements associated with the trial appeared to have improved communication about sex and HIV in intimate relationships, with some women even encouraging their partners to go for an HIV test.ConclusionCTs provide AGYW with a measure of autonomy and power to contribute in their gendered relationships, albeit in limited ways. However, there is potential for CTs to have a negative impact on male-female relationships if the cash received by AGYW is equal to or greater than the income earned by their male counterparts or sexual partners.

Highlights

  • High incidence of HIV among adolescent girls and young women (AGYW) in eastern and southern Africa remains a critical public health issue, with Adolescent Girls and Young Women (AGYW) representing two out of three new infections in 2016 [1]

  • Both intimate partners and male peers were supportive of the Cash Transfer (CT) trial targeting young women; younger peers expressed some concerns that the money might diminish their power and status in relationships

  • CTs provide AGYW with a measure of autonomy and power to contribute in their gendered relationships, albeit in limited ways

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Summary

Introduction

High incidence of HIV among adolescent girls and young women (AGYW) in eastern and southern Africa remains a critical public health issue, with AGYW representing two out of three new infections in 2016 [1]. Of three randomised controlled trials with HIV endpoints reviewed, one in Malawi (n = 1289) found that unconditional and conditional CTs reduced pregnancy and early marriage among AGYW [8] Another trial (HPTN 068) in South Africa found that AGYW receiving CTs with school attendance as a condition were less likely to report intimate partner violence (IPV) and risky sexual behaviour, compared to their counterparts in the control arm; the CT did not reduce HIV incidence [9]. The provision of cash transfers to young women alone in such a context adds another dimension to already existing complex social relations where patriarchal values are entrenched, gender inequality is the norm, and violence against women and girls is pervasive It raises concerns about complicating young women’s relationships with their male partners or possibly even setting them up for more violence. In our attempt to understand how cash transfers influence social relations in the context of a trial among young women in South Africa, we used qualitative data collected during the trial to explore men’s perceptions of the impact of cash transfers on male-female relationships, both intimate and platonic, peer relationships

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