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Supporting adolescent orphan girls to stay in school as HIV risk prevention: Evidence from a randomized controlled trial in Zimbabwe

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  • Hallfors, D.
  • Cho, H.
  • Rusakaniko, S.
  • Iritani, B.
  • Mapfumo, J.
  • Halpern, C.

Abstract

Objectives: Using a randomized controlled trial in rural eastern Zimbabwe, we tested whether comprehensive support to keep orphan adolescent girls in school could reduce HIV risk. Methods: All orphan girls in grade 6 in 25 primary schools were invited to participate in the study in fall 2007 (n=329). Primary schools were randomized to condition. All primary schools received a universal daily feeding program; intervention participants received fees, uniforms, and a school-based helper to monitor attendance and resolve problems. We conducted annual surveys and collected additional information on school dropout, marriage, and pregnancy rates. We analyzed data using generalized estimating equations over 3 time points, controlling for school and age at baseline. Results: The intervention reduced school dropout by 82% and marriage by 63% after 2 years. Compared with control participants, the intervention group reported greater school bonding, better future expectations, more equitable gender attitudes, and more concerns about the consequences of sex. Conclusions: We found promising evidence that comprehensive school support may reduce HIV risk for orphan girls. Further study, including assessment of dose response, cost benefit, and HIV and herpes simplex virus 2 biomarker measurement, is warranted.

Suggested Citation

  • Hallfors, D. & Cho, H. & Rusakaniko, S. & Iritani, B. & Mapfumo, J. & Halpern, C., 2011. "Supporting adolescent orphan girls to stay in school as HIV risk prevention: Evidence from a randomized controlled trial in Zimbabwe," American Journal of Public Health, American Public Health Association, vol. 101(6), pages 1082-1088.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2010.300042_2
    DOI: 10.2105/AJPH.2010.300042
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    Cited by:

    1. Stephanie Psaki & Nicole Haberland & Barbara Mensch & Lauren Woyczynski & Erica Chuang, 2022. "Policies and interventions to remove gender‐related barriers to girls' school participation and learning in low‐ and middle‐income countries: A systematic review of the evidence," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(1), March.
    2. Nia King & Cate Dewey & David Borish, 2015. "Determinants of Primary School Non-Enrollment and Absenteeism: Results from a Retrospective, Convergent Mixed Methods, Cohort Study in Rural Western Kenya," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-17, September.
    3. Helen Elizabeth Denise Burchett & Dylan Kneale & Sally Griffin & Málica de Melo & Joelma Joaquim Picardo & Rebecca S. French, 2022. "Which Structural Interventions for Adolescent Contraceptive Use Have Been Evaluated in Low- and Middle-Income Countries?," IJERPH, MDPI, vol. 19(18), pages 1-31, September.
    4. Megan S Dunbar & Mi-Suk Kang Dufour & Barrot Lambdin & Imelda Mudekunye-Mahaka & Definate Nhamo & Nancy S Padian, 2014. "The SHAZ! Project: Results from a Pilot Randomized Trial of a Structural Intervention to Prevent HIV among Adolescent Women in Zimbabwe," PLOS ONE, Public Library of Science, vol. 9(11), pages 1-1, November.
    5. Sudhanshu Handa & Carolyn Tucker Halpern & Audrey Pettifor & Harsha Thirumurthy, 2014. "The Government of Kenya's Cash Transfer Program Reduces the Risk of Sexual Debut among Young People Age 15-25," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-9, January.
    6. Ismayilova, Leyla & Ssewamala, Fred & Mooers, Elizabeth & Nabunya, Proscovia & Sheshadri, Srividya, 2012. "Imagining the future: Community perceptions of a family-based economic empowerment intervention for AIDS-orphaned adolescents in Uganda," Children and Youth Services Review, Elsevier, vol. 34(10), pages 2042-2051.
    7. Rebecca de Boer & Jeffrey Musgrave & Neil Andersson & Frithjof Lutscher, 2017. "The importance of choice disability and structural intervention in the HIV epidemic in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-14, April.
    8. Jessica E. Taaffe & Andrew F. Longosz & David Wilson, 2017. "Themed Issue: Cash Transfers and Microfinance," Development Policy Review, Overseas Development Institute, vol. 35(5), pages 601-619, September.
    9. Evans, David K. & Gale, Charles & Kosec, Katrina, 2023. "The educational impacts of cash transfers in Tanzania," Economics of Education Review, Elsevier, vol. 92(C).
    10. Ramanath, Ramya, 2014. "Ethical implications of resource-limited evaluations: Lessons from an INGO in the eastern Democratic Republic of Congo," Evaluation and Program Planning, Elsevier, vol. 46(C), pages 25-37.

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