Background: Young women in South Africa face elevated risk of HIV infection compared with male peers. This is exacerbated by structural factors, including poverty, that shape HIV risk behaviours. Conditional cash transfers (CCT) may provide economic strengthening to young women and mitigate their risk for HIV; however, there is limited understanding of the pathways through which this occurs. Hope, which is related to environmental stressors like poverty, motivates future-oriented behaviour and is therefore critical in HIV prevention. This analysis explored hope as a potential pathway through which CCT influences young women''s behaviours and HIV risk.
Methods: A qualitative study was embedded in a randomized CCT trial in rural South Africa (HPTN 068). The study enrolled young women aged 13-20 and cash was conditional on school attendance. In-depth interviews were conducted with women every six months. We analysed 53 interview transcripts from participants (n=12) who received CCT and were interviewed three or more times. We used longitudinal qualitative analysis methods to understand how women in the study conceptualized hope over time and how CCT influenced their hope.
Results: This analysis found that CCT instilled in young women a belief that a better life, defined as being educated, independent, and supportive to family, was attainable. Women from financially and emotionally supportive baseline contexts expressed this especially strongly. In addition, CCT influenced women''s hope in the present by alleviating daily financial stressors and promoting “good behaviour,” including HIV testing, condom use, partner reduction, and, through trial requirements, school attendance. They expressed that, as their hope for a better life increased, their desire to behave well in preparation for that life also increased.
Conclusions: CCT influences hope among young women in rural South Africa by alleviating routine stressors, promoting plans for higher education, and increasing confidence. By increasing women''s hope for a better life, CCT also reduces their desire to engage in HIV risk behaviours. However, these influences are highly reliant on baseline family and financial contexts. This analysis supports the need for additional mixed methods research to better understand hope as a possible mechanism by which CCT influences young women in this and other contexts.