The next Economics Seminar of Paris-Saclay will be held on Thursday, April 4th, from 12h15 to 13h15, in room Gaudemet.

Aurélia Lépine (University College London) will present “Are economic shocks a missing piece to the HIV puzzle? Evidence from the POWER trial in Cameroon”, co-authored with Sandie Szawlowski, Emile Nitcheu, Henry Cust, Eric Defo Tamgno, Julienne Noo, Fanny Procureur,  Illiasou Mfochive, Serge Billong and Ubald Tamoufe.

Background: Women in sub-Saharan Africa are disproportionately affected by the HIV epidemic. Young women are twice as likely to be living with HIV as men of the same age and account for 64% of new HIV infections among young people. Many studies suggest that financial needs, in addition to biological susceptibility, are the main drivers of the gender gap in HIV acquisition. While the literature shows a limited understanding of the link between poverty and HIV, there is some new robust evidence that women engage in risky sexual behaviour to cope with economic shocks.

Methods: We recruited 1,506 adolescent girls and women involved in transactional or commercial sex in Yaounde, Cameroon, using snowball sampling. Half of the study participants were randomly assigned to receive free health insurance for themselves and their economic dependents for 12 months. We collected data on socioeconomics, health and sexual behaviour, sexually transmitted infections and HIV biomarkers at baseline, 6 months after randomisation (midline) and 12 months after randomisation (endline).

Results: We found an 88% reduction in HIV infection in the treatment group at 12 months (p-value<0.05) among women involved in transactional sex. This was probably due to 1) the intervention enabling women to leave transactional sex and 2) the intervention increasing condom use and reducing sex acts among participants who remained in transactional sex. There was no evidence of a change in risky sexual behaviour or a reduction in HIV incidence among sex workers.

Conclusion: The study provides the first evidence of the effectiveness of a formal shock strategy for HIV prevention among women who engage in transactional sex in Africa. The effectiveness of the intervention is mediated by the reduction of health shocks, as the increase in health care use following the intervention was small. We estimated that the cost of each HIV infection averted in the cohort of women engaging in transactional sex in our trial was £4,667.

Link to the seminar web page: