Research on HIV prevention led to a Cash plus Care programme that has helped over two million girls in 10 African countries avoid contracting HIV/AIDS since 2014.

Impacts

  • Evidence gathered by Professor Lucie Cluver and a team of researchers has led to the rollout of social welfare and support packages known as 'Cash plus Care' in Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Cash plus Care can cut HIV risks among teenage girls by 60%.
  • Governments, policymakers and international organisations use this research to endorse Cash plus Care programmes. For example, the $385 million USAID and Gates Foundation HIV prevention programme DREAMS, which Professor Cluver advised, funds Cash plus Care; and UNICEF has led Cash plus Care programs in four countries funded by the Netherlands government.
  • The South African government and the research team worked together on a successful application to the Global Fund to fight AIDS, Tuberculosis and Malaria. In 2015, $50 million was awarded to South Africa to implement Cash plus Care programmes. The team also drafted South Africa's National Adolescent and Youth Policy 2017-2021.
  • The team's work has been cited extensively by the United Nations, the World Bank and in USAID briefings to the White House.
  • Researchers established a Teen Advisory Group of 20 young people in South Africa who have presented evidence to the UN, influencing the take-up by UNAIDS and UNDP of Cash plus Care as a key HIV prevention policy.

"The term Cash plus Care was first coined by Professor Cluver in an interagency task team for social protection, care and support, here at UNAIDS in Geneva in 2013. Since then, the concept has become an integral part of UN planning and response to the HIV epidemic." (Mariângela Simão, UNAIDS, Joint United Nations Programme on HIV/AIDS)

About the research

Every year 170,000 adolescents in Southern and Eastern Africa become infected with HIV. Most infections, explains Professor Cluver, are caused by girls from low-income families having unprotected sex with older men.

“Education-based HIV prevention work in Africa over 30 years wasn't having enough success, and governments and UN agencies realised they needed a new approach,” she explains. “In 2014 we were able to show that social welfare grants combined with parenting support and free schooling had the greatest impact on those most at risk of HIV-infection – reducing incidence of risky sex among teenagers from 11% to 2%.”

This approach is effective because it gives girls from very low-income families the freedom not to have a 'sugar daddy', she points out. Findings show that poverty and abuse are the greatest predictors of HIV infection rates among girls. “For poor girls in sub-Saharan Africa sometimes the only way to bring money into the family to pay for food is through an older boyfriend, and the primary route to infection is through these older men,” she says.

Free schooling and welfare grants of $20 a month per family are key to interrupting the pathways from poverty to abuse and school dropout, and onwards to HIV-infection. “Together these initiatives are helping girls to form protected and healthy relationships, and prevent risk behaviours that lead to HIV/AIDS, responsible for 470,000 deaths in Southern and Eastern Africa last year,” she states.