Background: Social protection may be defined as public actions to reduce extreme poverty and vulnerability. Cash transfers (CTs) are an important and growing element of social protection and may be conditional (CCTs) which are contingent on specified actions or behaviors or unconditional (UCTs) which are not contigent.
A review of the literature identified over 50 randomized controlled trials (RCTs) evaluating the effects of RCTs on education, health and income, including sexually transmitted infections (STIs) and HIV.
Three World Bank RCTs with biomarker endpoints show that cash transfers reduce STI and HIV infection. In Tanzania, people offered up to $60 each annually to stay STI-free had 25 percent lower STI prevalence (De Walque et al 2012). In Malawi, girls and parents offered up to $15 monthly to stay in school had 60% lower HIV prevalence – whether they stayed in school or not (Ozler et al, 2012). In Lesotho, adolescents offered a lottery ticket to win up to $50 or $100 every four months if they stayed STI and HIV-free had a 25% lower HIV incidence – 33% lower among girls and 31% in the $100 arm (De Walque et al 2012).
Discussion: These studies are promising, but have methodological challenges. Tanzania and Malawi used STI and HIV prevalence, respectively. Two NIH HPTN studies reporting soon will provide decisive evidence. Questions to be answered include: (i) is the evidence robust enough? (2) Are cash transfers scalable and sustainable? (3) How durable are the effects, after cash transfers end? (4) Are there opportunities to combine cash transfers with other proven interventions, such as PrEP among the highest risk populations, including key populations and young women in hotspots in hyper-endemic countries?