A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours

Figures & data

Figure 1. Flow chart of search.

Table 1. Cash transfer interventions to prevent HIV or IPV (1 January 2000–1 January 2015).

Reference	Intervention	Country	Population	Study design	HIV outcome	IPV outcome
Social protection cash transfers – child-focused outcomes
Cluver et al. [30]	Child Support Grant (CSG) – paid to caregiver; conditional on low income; value ZAR 250/month in 2010 and ZAR 280/month in 2012; roughly equivalent to US.$ 35	South Africa	Adolescents 10–18	3515 participants; prospective study; 1-year follow-up; propensity score matching	For adolescent girls receipt of cash transfer associated with: * Reduced incidence of transactional sex (odds ratio [OR] 0.49, 95% CI 0.26–0.93; p = 0.028) * Reduced incidence of age-disparate sex (OR 0.29, 95% CI 0.13–0.67; p = 0.004) * No significant effects for boys
Cluver et al. [31]	CSG; child-focused care (naturally occurring)	South Africa	Adolescents 10–18	3515 participants; prospective study; 1-year follow-up	* Combined cash plus care reduced HIV risk behaviour for girls (OR 0.55; 95% CI 0.35–0.85; p = 0.007) and boys (OR 0.50; 95% CI 0.31–0.82; p = 0.005)
UNICEF [32]	CSG – paid to caregiver; conditional on low income; value ZAR 250/month in 2010 and ZAR 280/month in 2012; roughly equivalent to US.$ 35	South Africa	Children (10 years old) and adolescents (15–17)	716 children; 1726 adolescents; matched participants on early or late entry to CSG; cross-sectional	* Reduced sexual activity and fewer number of partners (signif) * Reduced pregnancy (signif) * Reduced alcohol and drug use (signif)
Handa et al. [33]	Cash Transfer for Orphans and Vulnerable Children (Kenya CT-OVC): Unconditional transfer US.$ 20/month	Kenya	Young people 15–25	1540 intervention and 754 control households; 28 areas randomly allocated to intervention/control arms; 2-year follow-up	* Reduced sexual debut by 31% (adjusted odds ratio [AOR] 0.69; 95% CI 0.53–0.89) * No statistically significant effects on condom use, number of partners and transactional sex
Rosenberg et al. [34]	Kenya CT-OVC: Unconditional transfer US.$ 20/month	Kenya	Young people 15–25	1540 intervention and 754 control households; 28 areas randomly allocated to intervention/control arms; 2-year follow-up	* No significant impact on relative partner age, partner school status or transactional sex for young women or men Point estimates on transactional sex were on opposite sides of the null for men and women though not significant: * Men in intervention reported higher rates of transactional sex than control (a.OR = 1.57; 95% CI 0.60–4.07; v2 = 0.85; p = 0.36) * Women reported less transactional sex than women in the control arm (a.OR = 0.79; 95% CI 0.40–1.58; v2 = 0.55; p = 0.51), with greater effects for younger women (a.OR: 0.65; 95% CI 0.30–1.42; v2 = 1.18; p = 0.28) and those currently enrolled in school (a.OR: 0.38; 95% CI 0.13–1.11; v2 = 3.15; p = 0.08)
Social protection cash transfers – adult-focused outcomes
Hidrobo [35]	Bono de Desarrollo Humano (BDH); means tested; unconditional; US.$ 15/month	Ecuador	Poor families identified through means test	118 parishes randomly assigned, 79 to intervention and 39 to control; 2354 interviews; 24-month follow-up		* Intervention had no effect on emotional and physical violence * Intervention had negative impact on controlling behaviours (p < 0.05)
Hidrobo [36]	6-monthly transfer of cash, vouchers or food of U.S.$ 40/month (total U.S.$ 240)	Ecuador	Women	2357 randomised into intervention and control arms; 6-month follow-up		*Intervention reduces controlling behaviors, moderate physical, and any physical/sexual violence by 6 to 7 percentage points (p < 0.05)
Bobonis [37]	Oportunidades: conditional grants; food grant; school scholarship; range of values, max 625 pesos/month	Mexico	Poor women	54,000 households; national household survey		* Intervention reduces physical violence by 40% (p < 0.01) * Intervention increases by 3–5% points emotional violence (not significant)
Bobonis [38]	Oportunidades: conditional grants; food grant; school scholarship; range of values, max 625 pesos/month	Mexico	Poor women	54,000 households; national household survey		* 5–9 years later no differences on physical and emotional violence * Potential that women left violent relationships
Haushofer [39]	Unconditional cash transfer; either to husband or wife; either lump sum or nine monthly sums; values varied (either US $300 or US $1100)	Kenya	General population	990 households; randomised 3 arms (and more internally); 18-month follow-up		* 30–50% reduction in various forms of physical violence * 50% reduction in rape (p < 0.1) and 60% reduction in other forms of sexual violence (p < 0.05)
Conditional cash transfers for HIV prevention
de Walque [40]	Conditional cash transfer (low: US.$ 10/test, high: US.$ 20/test) every 4 months for 12 months	Tanzania	Young women and men	2399 randomised into control, low or high incentive; 12-month follow-up	* Adjusted analyses found high value incentive led to significant reduction in STIs (adjusted risk ratio [a.RR] was 0.73) * No significant changes in low-value incentives
Kohler and Thornton [41]	Malawi Incentives Project: conditional cash transfer on maintaining HIV-status for one year; reward ranged from zero to approximately 4 months’ wages	Malawi	Male and female adults	1307 randomised into value of incentives; 12-month follow-up	* Incentives had no impact on HIV-status or reported sexual behaviour Shortly after transfer find: * Men were 13% points more likely to engage in any vaginal sex (p < 0.01) * Men had 0.6 additional days of sex (p < 0.05) * Men reported using a condom more often during sex (6.9% points more likely; p < 0.05) * Women were less likely to report having any vaginal sex (9% reduction; p < 0.05) * Women had no change in reported condom use
Minnis et al. [42]	Yo Puedo – conditional cash transfers for completion of educational and reproductive health wellness goal; life skills	USA	Youth 16–21 years of age and same-aged members of their social network	72 networks, 162 youth; randomised into intervention and control; 6-month follow-up	*Lower odds of having sex (OR 0.50; p = .04)

Table 2. Economic strengthening interventions to prevent HIV or IPV (1 January 2000–1 January 2015).

Reference	Intervention	Country	Population	Study design	HIV outcome	IPV outcome
Microfinance
Ahmed [43]	Microfinance	Bangladesh	BRAC households, women	422 women in BRAC households, 1622 in non-BRAC households; cross-sectional; 60 BRAC-ICDDR villages		* Higher experience of IPV in BRAC households (p = 0.05) * Logistic regression suggests initially violence increases then subsides
Bajracharya [44]	Microfinance	Bangladesh	Women, Demographic Health Surveillance (DHS)data	4195; cross-sectional DHS; propensity score matching		* No difference in IPV experienced between microfinance and non-microfinance participants
Chin [45]	Microcredit	Bangladesh	Women DHS data	1843; cross-sectional DHS		* IPV reduces over time through participation
Dalal et al. [46]	Microfinance	Bangladesh	Women	4465 women; cross-sectional; nationally representative		* For women with secondary or higher education, and women at the two wealthiest levels of the wealth index, microfinance programme membership increased the exposure to IPV two and three times, respectively * The least educated and poorest groups showed no change in exposure to IPV associated with microfinance programmes
Murshid et al. [47]	Microfinance	Bangladesh	Women	4163 ever-married women, DHS		* Significant increase in IPV for women involved in microfinance who were better off (p = 0.008)
Koenig et al. [48]	Microcredit	Bangladesh	Women	10,368 currently married women; cross-sectional; 2 districts		Impact of involvement in microfinance on IPV context specific: * In conservative areas involvement increased vulnerability * In more liberal areas it had no impact
Naved and Persson [49]	Microfinance	Bangladesh	Women	2702 women; population-based survey; cross-sectional		* Increase in IPV in urban areas for belonging to credit group (OR 1.83; p < 0.01)
Schuler et al. [50]	Microfinance	Bangladesh	Women	1305; cross-sectional		* Membership of microfinance institutions showed significant reduction in IPV (p < 0.05)
Hadi [51]	Microfinance	Bangladesh	Women, under 50	500 women, cross-sectional		* Involvement in microcredit institution for more than 5 years reduces sexual violence (p < 0.1), similar to those not eligible
Bates et al. [52]	Microcredit	Bangladesh	Women	1212; cross-sectional		* Involvement in microcredit institution reduced IPV by 25% (p < 0.05)
Kim et al. [53]	Microfinance	South Africa	Women	1489 in intervention; 1647 in control; cross-sectional	* No impact on HIV risk behaviours	* No impact on IPV outcomes

Table 3. Economic strengthening and gender transformative interventions to prevent HIV or IPV (1 January 2000–1 January 2015).

Reference	Intervention	Country	Population		Study design	HIV outcome	IPV outcome
Microfinance/VSLA and gendertransformative
Pronyk et al. [54]	Intervention for Microfinance for AIDS and Gender Equity (I.M.A.G.E) Project. Microfinance; Sisters for Life 10 sessions around gender and life skills	South Africa	Poorest women in communities, identified via participatory wealth ranking; av. age 41	8 clusters randomly allocated into intervention or control; main group-matched control of women 860		* Young women [14–34,37] less likely to have unprotected sex with non-spousal partner (a.R.R. 0.76)	* Reduction of IPV by 55% (a.R.R 0.45 [signif] amongst those directly involved)
Gupta et al. [55]	VSLA for women; 8 couples dialogue sessions	Ivory Coast	Women; av. age 37.7	934 women; 24 intervention clusters, 23 control clusters, randomly allocated; 12–18-month follow-up			* Reduced sexual and physical IPV (not signif) * Reduced economic abuse (O.R = 0.39, p < 0.0001) * Reduced acceptability of wife-beating (p = 0.006)
Spielberg et al. [56]	Existing self-help groups; 10 sessions around gender and life skills	India	Women participating in self-help groups; adolescents identified by women	Cluster randomised trial; 55 villages assigned to intervention (n = 32) or control (n = 23); 6- and 12-month follow-up		Women saw: * No impact on condom use
IRC [57]	VSLA for women; 8 couples dialogue sessions	Burundi	Women members of VSLA	483 women; randomised into intervention and control; 15-month follow-up			* Women in the high or moderate risk category at baseline reported a 22% significant reduction in the incidence of violence in the last two weeks and a 46% reduction in physical harm (no significance reported)
Rosenberg et al. [58]	Microfinance; max 5 training sessions; health book	Haiti	Women; age: mean 36.1; range 18–49	192 participants; cross-sectional		* Improved condom use in last year: O.R 0.63 (95% C.I 0.26–1.54) * Improved condom use among those with an unfaithful partner: O.R 3.95 (95% C.I 0.93–16.85)
Dunbar et al. [59]	SHAZ! 10 life skills modules; 5-day business training; microcredit loans	Zimbabwe	Adolescent female orphans out of school; 16–19; av. age 17.5	49 women; pre-test, post-test; 6-month follow-up; no randomisation		* Use condom with primary partner: post 38% vs pre 67% (p = 0.35) *Currently sexually active: post 22% vs pre 18% (p = 0.79) * Power in sexual relationship: post 50% vs pre 11% (p = 0.79) * Power in non-sexual relationship: post 38% vs pre 5% (p = 0.04)
Bandiera et al. [60]	Life skills training; vocational training; microfinance	Uganda	Adolescent girls; av. age 16	4800 adolescent girls; 100 communities randomly assigned to intervention or control; 2-year follow-up		* Improved condom use (p < 0.05)	* 76% reduction in unwilling sex (p < 0.01)
Erulkar and Chong [61]	Modified microfinance; mentoring; life skills	Kenya	Girls out-of-school 16–22	326 matched pairs; interviews as exited programme – mixed follow-up time		* Condom use at last sex: at endline TRY = 52.1% vs control = 44.3% (N.S) * Able to refuse sex to spouse/partner: at endline TRY = 80.3% vs control = 71.6% (p < 0.05)
Souverein et al. [62]	Comprehensive sex worker community mobilisation, including STI prevention and treatment, crisis support and microfinance	India	Female sex workers	17,092; using entry and exit from systems, 2005–2010; descriptive study		* Significant reduction in STIs (p < 0.001) *Increase in condom use (p < 0.001)
Odek et al. [63]	Existing peer education intervention on HIV; microfinance	Kenya	Female sex workers; av. age: 41.09	227 women; 2-year follow-up; pre-test, post-test; no randomisation		* Reduction in number of sexual partners in past week (p < 0.001) * Reduction in number of casual partners (p = 0.098) * Reduction in number of regular partners (p < 0.001) * No impact on condom use with casual partners (p = 0.727) * Increase in condom use with regular partners (p = 0.031)
Witte et al. [64]	34-session HIV sexual risk reduction intervention; microfinance; vocational training	Mongolia	Female sex workers; av. age 36	107 women randomised into intervention or control; clusters 3- and 6-month follow-up		* Reduction in number of paying sexual partners (p < 0.001) * 3.72 times more likely to report no unprotected vaginal sex acts at 6 months (p < 0.05)
Savings and gender transformative
Austrian and Muthengi [65]	Safe spaces; reproductive health training; financial education; savings accounts	Uganda	Girls 10–23; majority under 19		1159 of which 451 received full intervention; 300 savings only; 311 control; 12-month follow-up; delivery error led to natural randomisation		* No impact on indecent touching in full intervention, but in economic-only arm significant increase (p < 0.01)
Austrian and Muthengi [66]	Safe spaces; reproductive health training; financial education; savings accounts	Kenya; Uganda	Girls 10–19		1473 in Kenya; 1564 in Uganda; 18-month follow-up; comparison groups		* In Kenya no impact on indecently touched in past 6 months * Significant decrease in being indecently touched in past 6 months in Uganda
Vocational strengthening and gender transformative interventions
Dunbar et al. [67]	SHAZ! reproductive health services; life skills-based HIV education; vocational training and microgrants; integrated social support	Zimbabwe	Adolescent female orphans (having lostat least one parent) aged 16 to 19		315 randomly assigned to intervention or control; 24-month follow-up	* No difference in sexual debut *Reduction in transactional sex (Intervention Odds Ratio [I.O.R] = 0.64; 95% C.I 0.50–0.83) * Increased likelihood of using condom (I.O.R = 1.79; 95% C.I 1.23–2.62)	* Reduction in violence (I.O.R = 0.10 vs Control Odds Ratio [C.O.R] = 0.63; p = 0.06)
Jewkes et al. [68]	Stepping Stones and Creating Futures; reproductive health and gender training; livelihood training	South Africa	Young men and women [18–29,31];av. age 22		232 participants; shortened interrupted time series design, 12-month follow-up	*Increase in men reporting last person they hadsex with was main partner (signif) *No impact on condom use at last sex *No impact on transactional sex	*Reduction in sexual violence experience by women (p = 0.033) *No impact on sexual or physical violence perpetrated by men
Rotheram-Borus et al. [69]	Street Smart: 10 sessions HIV prevention; vocational training of apprenticeships	Uganda	Age 13–23 years		100 participants; pre-test, post-test with random assignment to immediate intervention or delayed vocational training; 24-month follow-up	*No impact on mean number of partners *No impact on abstinence/100% condom use
Sherman et al. [70]	JEWEL: HIV education; microfinance; vocational training	USA	Drug-using women who were involved in sex work; aged 18–45		54 women; baseline and 3-month follow-up	*Reduction in receiving drugs or money for sex (100% vs 71.0%; p < 0.0005) *Reduction in median number of sex trade partners per month (9 vs 3; p < 0.02)
Sherman et al. [71]	Pi Bags: HIV education; vocational training	India	Female sex workers; age (median): 35		100 participants; randomised into intervention and control; 6-month follow-up	*Reduction in number of sex partners (p < 0.001) *Reduction in number of sex exchange partners (p < 0.001) *No impact on condom use at last sex exchange (p = 0.32)
Lee et al. [72]	SiRCHESI Hotel Apprenticeship Program (HAP) participants; literacy; health education; life skills; vocational training; apprenticeships	Cambodia	Beer girls/sex workers; av. age: 24.93; range: 19–31		14 participants with baseline and 8-month and 24-month follow-ups	*Increase in condom use at last sex (p = 0.050)
Raj et al. [73]	M.E.N (Making Employment Needs) Count HIV intervention; HIV, gender equity; employment and housing	USA	Men aged 18–54		50 participants; pre-test, post-test; 60–90 follow-up	*Unprotected sex decreased (p = 0.04) *No impact on multiple partners	*Too small at baseline to report trends
Hallman and Roca [74]	Siyakha Nentsha Programme: financial training, life skills and reproductive health training	South Africa	School-age boys and girls (14–16)		18-month follow-up; unclear sample or allocation	*Intervention boys significantly more likely to remain abstinent (no p-values reported)

The search string used for the review was as follows.

Intervention	cash transfer*; cash incentive*; cash reward*; monetary reward*; economic asset*; contingency management; micro-credit; micro credit; microcredit; job training; income generation; income generating; job skills; employment; economic empowerment; cooperatives; microfinance; micro finance; microfinance; micro-enterprise; micro enterprise; microenterprise; small business; small loans; microloans; vocational training; business training; livelihood*
HIV	HIV; acquired immunodeficiency syndrome; acquired AND immunodeficiency AND syndrome;
IPV	domestic violence; family violence; sex offences; sexual violence; battered women; spouse abuse; IPV; intimate partner violence; VAW; violence against women; economic violence; emotional violence; physical violence; anti-violence; anti violence; antiviolence; gender-based violence; gender based violence; GBV; domestic violence; abused women

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