Effects of a Savings-Led Economic Empowerment Intervention on HIV Preventive Practices Among AIDS-Orphaned Adolescents in Rural Uganda: Results from the Suubi-Maka Project

Significance and Purpose: Improving economic resources of impoverished youth may alter intentions to engage in sexual risk-taking behaviors by motivating more positive future planning to avoid negative consequences, including HIV infection. Yet, few studies have examined the impact of economic strengthening on sexual risk-taking intentions and HIV preventive practices of AIDS-orphaned youth, despite high poverty and high HIV infection in this population. This study assessed the effects of a savings-led economic empowerment intervention, on asset savings and HIV preventive practices among adolescents in rural Uganda.

Methods: This study utilized data from the NIMH funded study, called Suubi-Maka (Hope for Families). Data was collected from a sample of 346 AIDS-orphaned youth, aged 12-16, living in rural Uganda. Participants were randomly assigned to either the control condition (n=167) receiving usual care of services for school-going orphaned youth (scholastic materials and food aid) or the treatment condition (n=179) receiving a savings-led economic empowerment intervention comprising of a youth matched savings account, financial planning and management workshops, and a mentorship program. Interviews were conducted at baseline, 10-month, and 20-month post intervention initiation. Hierarchical longitudinal regressions were conducted to assess the effect of the intervention, on changes over time in asset savings and HIV preventive practices among adolescents.

Findings: Results showed that compared to adolescents in the control condition, intervention adolescents significantly increased their cash savings over time (b=$US12.317, +1.122, p=0.000). At 24-months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control (p<0.05). Intervention youth also placed increasing value on savings for the future with a significant relative increase in mean savings scores (b=0.252 +0.107 p=0.019) from baseline to 24 months post-baseline. The highest proportions of intervention adolescents valued saving money for animal husbandry (100%, n=166), one’s education (99.4%, n=165), and family assistance (97.0%, n=161). As compared to the control group, intervention youth also had an average relative increase over time in scores relating to HIV prevention attitudes (b=+0.189, +0.089, p=0.034), most commonly in regards to perceived risk of HIV (95.8%, n=159), postponement or abstinence from sex (91.6%, n=152), and consistent condom use (93.4%, n=144).

Implications: To minimize HIV risk throughout the adolescent and young adult periods, more effort is needed to develop long-term strategies that link youth-led savings, housing, and business development opportunities with combination prevention programs for high-risk youth, such as those orphaned due to HIV/AIDS.