Abstract
Background: In sub-Saharan Africa, there is growing interest in the use of cash transfer (CT) programs for HIV
treatment and prevention. However, there is limited evidence of the consequences related to CT provision to
adolescents in low-resourced urban settings. We explored the experiences of adolescents receiving CTs to assess
the acceptability and unintended consequences of CT strategies in urban Johannesburg, South Africa.
Methods: We collected qualitative data during a pilot randomized controlled trial of three CT strategies (monthly
payments unconditional vs. conditional on school attendance vs. a once-off payment conditional on a clinic visit)
involving 120 adolescents aged 16–18 years old in the inner city of Johannesburg. Interviews were conducted in
isiZulu, Sesotho or English with a sub-sample of 49 participants who adhered to study conditions, 6 months after
receiving CT (280 ZAR/ 20 USD) and up to 12 months after the program had ended. Interviews were transcribed
and translated by three fieldworkers. Codes were generated using an inductive approach; transcripts were initially
coded based on emerging issues and subsequently coded deductively using Atlas.ti 7.4.
Results: CTs promoted a sense of independence and an adult social identity amongst recipients. CTs were used to
purchase personal and household items; however, there were gender differences in spending and saving
behaviours. Male participants’ spending reflected their preoccupation with maintaining a public social status
through which they asserted an image of the responsible adult. In contrast, female participants’ expenditure
reflected assumption of domestic responsibilities and independence from older men, with the latter highlighting
CTs’ potential to reduce transactional sexual partnerships. Cash benefits were short-lived, as adolescents reverted to
previous behavior after the program’s cessation.
Conclusion: CT programs offer adolescent males and females in low-income urban settings a sense of agency,
which is vital for their transition to adulthood. However, gender differences in the expenditure of CTs and the
effects of ending CT programs must be noted, as these may present potential unintended risks.