The Impact of School Subsidies on HIV-Related Outcomes Among Adolescent Female Orphans

Abstract

Objectives We examine effects of school support as a structural HIV prevention intervention for adolescent female orphans in Zimbabwe after 5 years. Methods 328 orphan adolescent girls were followed in a clustered randomized control trial from 2007 to 2010. The experimental group received school fees, uniforms, and school supplies and were assigned a school-based “helper.” In 2011-12, the control group received delayed partial treatment of school fees only. At the final data point in 2012, survey, HIV, and HSV-2 biomarker data were collected from approximately 88% of the sample. Bivariate and multivariate analyses were conducted on endpoint outcomes, controlling for age, religious affiliation, and baseline SES. Results The two groups did not differ on HIV or HSV-2 biomarkers. The comprehensive five-year intervention continued to reduce the likelihood of marriage, improve school retention, improve SES (food security), and marginally maintain gains in quality of life, even after providing school fees to the control group. Conclusions Paying school fees and expenses resulted in significant improvements in life outcomes for orphan adolescent girls. Biological evidence of HIV infection prevention, however, was not observed. Our study adds to the growing body of research on school support as HIV prevention for girls in sub-Saharan Africa, but as yet, no clear picture of effectiveness has emerged.

Educational Outcomes for Orphan Girls in Rural Zimbabwe: Effects of a School Support Intervention

“…Cultural norms to marry by a certain age may override a girl taking advantage of the opportunity to stay in school. From our study experience, we found that rural girls, particularly those who do not have school fees, are increasingly likely to drop out and marry as they get older (Hallfors et al, 2015). From other analyses, we found that Apostolic religious affiliation was strongly associated with greater likelihood of early marriage and school dropout among rural orphan girls (Hallfors et al, 2013).…”

“…In 2012, the conditional dropout rate increased further to 17.3% in the control/delayed partial intervention group, and to 12.8% in the intervention. Participants were then, on average, almost 17 years old and marriage rates were rising particularly among the control/delayed partial intervention group (Hallfors et al, 2015). …”

“…Wave 5 participation was 88%; sensitivity testing indicated that participants who responded to the last survey were equivalent by condition on most baseline measures (Hallfors et al, 2015). Other sources of data were notes and records maintained by field staff.…”

“…Our purpose here is to examine the effect of a school support intervention on orphan girls’ educational outcomes. Previous publications include the intervention’s impact on health outcomes more directly (e.g., Hallfors et al, 2015) but the current paper addresses the question: can school support improve the educational achievement of adolescent Zimbabwean female orphans?…”

“…Girls who stay in school are less likely to engage in sexual activity and marry as teenagers (Hallfors et al, 2015), and are more likely to have a better economic future and better health (Miller, Hallfors, Cho, Luseno, & Waehrer, 2013), including protection from HIV and other sexually transmitted infections (STIs) (Jukes, Simmons, & Bundy, 2008) and intimate partner violence (McCloskey, Williams, & Larsen, 2005). Positive effects of education may occur through many paths, including changing attitudes about gender (Macintyre et al, 2013) and facilitating learning of HIV/AIDS information (Jesmin, Chaudhuri, & Abdullah, 2013).…”