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Money, Sex, and Power: An Analysis of Relationship Power in the Context of Conditional Cash Transfer Interventions to Reduce Risky Sex in Tanzania


The success of Conditional Cash Transfer (CCTs) program in several health and social domains has led to recent experiments testing CCTs for sexual and reproductive health. However, this approach has yielded mixed results and has been understudied. My dissertation explores whether sexual relationship power - the power women have to decide if and when to have sex, with whom, and with or without a condom - influences the effectiveness of CCTs to reduce STIs, and additionally, if these CCTs influence relationship power. If we can answer these questions, researchers will be better able to design CCT interventions to reduce the spread of STIs and HIV.

My overall hypotheses are: (1) CCTs given to women with high baseline relationship power are more effective at reducing STIs than CCTs given to women with low baseline relationship power (Chapter 1); and (2) that the CCT itself changes the relationship power of those enrolled in the intervention (Chapter 2). A relevant example of women’s power to negotiate safer sex is female sex workers’ interactions with their clients. Therefore, in chapter 3, I draw on theoretical models and previous literature related to the determinants of safer sex among commercial sex workers to analyze qualitatively how Female Sex Workers (FSWs) respond to a novel pilot study using CCTs to incentivize safe sex (Chapter 3).

To test these hypotheses, I conducted three studies: The first explores the effect modification of baseline relationship power on the impact of CCTs to reduce STIs; the second is an intent-to-treat analysis of the effect of the CCT on relationship power; and the third is a qualitative analysis of how female sex workers respond to a pilot CCT intervention to incentivize safe sex. Chapters 1 and 2 draw on data from the RESPECT study in Tanzania and Chapter 3 draws on data from the RESPECT II Pilot study to reduce STIs and HIV among female sex workers in Tanzania.

My analysis reveals that women’s relationship power significantly modifies the effect of the CCT on STIs. In addition, I show that a CCT improved women’s relationship power, but whether or not women were eligible to receive a high, low, or no cash transfer had little relative impact on changes in their relationship power. Finally, I identify the salient domains of power for female sex workers that are necessary to meet the conditions of a CCT intervention.

Taken together, acknowledging and addressing both the degrees of relationship power and domains of relationship power that women experience when enrolled in a CCT will improve the outcomes of these interventions in the context of STIs and HIV.

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