The effects of the integration of an economic strengthening and HIV prevention education programme on the prevalence of sexually transmitted infections and savings behaviours among adolescents: a full-factorial randomised controlled trial in South Africa
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health, Women’s Economic Empowerment
View SourceKey Social Norms Take-aways
This study underscores that social norms, particularly those related to gender dynamics, communication about sex, and financial decision-making, play an important but complex role in shaping adolescent sexual health outcomes. While the integrated intervention aimed to shift norms around gender and economic autonomy, the study found limited evidence of behavioral change. The findings suggest that longer-term or more intensive approaches may be needed to address entrenched norms that underlie sexual risk-taking among youth.
Objectives
The study aimed to determine whether integrating an economic strengthening intervention with an HIV prevention education program would more effectively reduce sexually transmitted infection prevalence and improve economic and sexual health outcomes among adolescents compared to either intervention alone or no intervention.
Methods
A full-factorial randomized controlled trial was conducted with 1,773 adolescents aged 14–17 in Gauteng Province, South Africa. Participants were randomized into one of four groups: economic strengthening only, HIV prevention only, both interventions combined, or control. Outcomes included STI prevalence (measured via biomarker testing) and self-reported economic and sexual behavior data collected at baseline and two post-intervention assessments.
Intervention Details
The economic strengthening intervention (Impumelelo) provided financial literacy education covering budgeting, savings, and income strategies. The HIV prevention intervention (Vhutshilo 2.0) addressed topics such as healthy relationships, communication, and safer sex practices. Each consisted of 16 sessions, and in the combined group, both curricula were delivered sequentially. Interventions were implemented by a local NGO and delivered in group sessions at community or school settings.
Results
No significant reduction in STI prevalence or sexual risk behaviors was found in any intervention group. The combined intervention group showed a small but significant improvement in HIV knowledge compared to the control and economic-only groups, but not when compared to the HIV-only group. Adolescents in the economic or combined groups were more likely to participate in savings groups and plan to save for education, but these effects did not consistently persist over time. High baseline HIV knowledge and underreporting of sexual activity (with 32% of STI-positive youth denying prior sexual activity) limited the reliability of self-reported outcomes.
Conclusions
The integration of HIV prevention and economic strengthening interventions did not significantly impact STI prevalence or sexual behaviors in this study. These findings highlight the difficulty of achieving short-term shifts in behavior and norms, especially among adolescents. Future programs may need to be more targeted, sustained, and fully integrated to address the underlying normative and structural drivers of HIV risk.
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