Linkages between cash incentives and behaviour change with regards to HIV counselling and testing uptake in adolescents: An assessment of the Rhiva programme in the Khomas region, Namibia

Abstract

Adolescents must deal with a range of biological, social, emotional, and psychological transitions in order to successfully enter the adult world. Yet, they lack the basic knowledge, skills and structural support to prevent themselves from becoming infected with HIV. Vulnerable children typically grow into vulnerable youth and vulnerable adults, who in turn have vulnerable children of their own. This reinforces a cycle of poverty and vulnerability for most families in Namibia. A clear understanding of the situation of young people and their needs is required to design and successfully implement interventions such as the Reduce HIV/AIDS in adolescents (RHIVA) programme. The aim of the research was to assess the efficacy of the RHIVA programme’s cash incentive based theory of change model, focusing on HCT uptake and HIV prevention in Namibia. Consequently, the study sought to understand the impact of structural factors on incentives and behaviour model proposed by the RHIVA theory of change model. The study used secondary data from a pre-post quasi-experimental design collected from 529 baseline survey and 458 end line survey data of learners from the RHIVA pilot programme in Khomas region. The study used a combination of confirmatory factor analysis (CFA) and structural equation modelling (SEM) to answer the research questions. The study found a significant cash incentives relationships, notably with HCT uptake (r=0.487) and the use of drugs and alcohol among peers (r =0.121). Moreover, the findings suggest that RHIVA intervention schools (IG2) received more cash incentives than RHIVA control schools (IG1) and Pure Control schools (CG). The study concludes that strengthened school support structures and conditional cash transfers are important in increasing HCT uptake of the learners. While teacher support, age and cash management also plays a key role in increasing HCT uptake. The study recommends the active engagement of young people and strengthening the school support system by training both the teachers and the learners on sexual reproductive health. Teachers and parents are structural agents encouraging learners towards positive sexual behaviours.