Economic Opportunity for Zimbabwean Adolescent Orphans

Investigator: Philip Darney, MD, MS
Sponsor: NIH National Institute of Child Health and Human Development

Location(s): Zimbabwe


The overall aim of this project is to determine, using a randomized controlled design, whether an innovative economic and life-skills intervention designed to increase control over sexual interactions prevents the adverse consequences of unprotected sex among out-of-school female orphans aged 16-19 in Zimbabwe. The intervention, which builds on our recently completed study that assessed the feasibility of such a program, will be evaluated for its effect on the acquisition of sexually transmitted infections, including HIV, as well as unintended pregnancy. The intervention consists of an integrated micro-credit program, including entrepreneurial training, loan provision, practical business education, mentorship, and peer support groups. This will be combined with a previously-tested fife-skills education curriculum that delivers HIV/reproductive health education through the use of role plays, drawing exercises, and other techniques, to help participants negotiate the terms of their sexual relationships. In order to assess the effects of this combined intervention over and above life-skills alone, the control group will receive the fife-skills education curriculum, a "placebo" health and nutrition training, and on-going peer support groups. Although there is great potential for such combined economic and life-skills programs to improve the reproductive health of female adolescent orphans, no research to date has assessed the effect of such interventions on sexual risk behaviors, STI/HIV or pregnancy outcomes in this or any other at-risk group. Our intervention is guided by a causal model in which the provision of economic alternatives and opportunities (through the micro-credit intervention) and sexual negotiation skills (through the life-skills intervention) are the driving forces in increasing control over sexual interactions, and thus reducing high-risk behaviors and adverse biological outcomes. The specific aims of this project are: 1) To assess the effectiveness of a combined micro-credit and life-skills education intervention in reducing the incidence of our primary outcomes: Herpes simplex virus type 2 (HSV2) and unintended pregnancy; 2) To assess the effectiveness of a combined micro-credit and life-skills education intervention in reducing our secondary outcomes: high-risk risk behaviors (e.g., unprotected sex, number of partners, transactional sex, early sexual debut, sexual coercion and violence); 3) To examine the intermediary effects of increased economic opportunity and improved sexual negotiation skills in enhancing participants' control over sexual interactions, and 4) To evaluate whether characteristics related to participation, i.e., factors related to participant adherence, satisfaction, and understanding of the intervention mediate observed effects.