A "Plus" Model for Safe Transitions to Adulthood: Impacts of an Integrated Intervention Layered onto A National Social Protection Program on Sexual Behavior and Health Seeking among Tanzania's Youth.

Poverty is a structural driver of risky sexual behaviors. While cash transfers can mitigate some of this risk, complementary interventions have been posited as a way to further reduce multidimensional vulnerability. We examine the impacts of a multicomponent intervention targeted to Tanzanian adolescents on their sexual behaviors and reproductive health. The intervention comprised livelihood and life skills training, mentoring, and health facilities' strengthening. Data come from a cluster randomized controlled trial, where one study arm received the intervention and the other was randomized to control, but both arms participated in a government cash transfer program. Among 1,933 adolescents interviewed over three rounds, we found increases in contraceptive and HIV knowledge. The program also increased health seeking and HIV testing among boys, but slightly reduced age at sexual debut among girls. There were no impacts on contraceptive use, number of sexual partners, or pregnancy. Findings support the value of an adolescent intervention, and the fact that it was delivered within a social protection platform suggests a potential for scalability. Additional efforts are required to delay sexual debut and reduce the number of sexual partners and pregnancy, possibly through addressing supply-side barriers and social norms, or through additional linkages to economic opportunities.

Uptake of HIV testing among adolescents and associated adolescent-friendly services.

BACKGROUND: HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact. METHODS: The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents' uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services. RESULTS: Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents. CONCLUSIONS: We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.

Migration and the Multi-Dimensional Well-Being of Elderly Persons in Georgia.

High rates of migration coupled with low formal social protection provisions may place many members of the elderly Georgian population in precarious living conditions that promote vulnerability and limit well-being achievement. This potential connection has been poorly explored in past literature, however, suggesting a need to better assess how the migration of an adult child may influence the multidimensional well-being of the elderly in Georgia. Using a novel dataset comprising 2202 elderly individuals across all regions of Georgia (excepting the territories of Abkhazia and South Ossetia), this paper proposes a multidimensional well-being index that has been specifically designed to encompass the unique resources and constraints faced by elderly individuals in different age cohorts. Following the construction of a multidimensional well-being index-comprised of domains including physical health and independence, housing well-being, social well-being, and emotional well-being-the outcomes of elderly individuals are compared by age and the presence/absence of adult children due to migration. Findings suggest that the migration status of an elderly person's adult children is related to the attainment of well-being. Elderly individuals with a migrant child are more likely to attain well-being in physical health as well as in the overall multidimensional well-being index.

Unpacking the Relationship between Parental Migration and Child well-Being: Evidence from Moldova and Georgia.

Using household survey data collected between September 2011 and December 2012 from Moldova and Georgia, this paper measures and compares the multidimensional well-being of children with and without parents abroad. While a growing body of literature has addressed the effects of migration for children 'left behind', relatively few studies have empirically analysed if and to what extent migration implies different well-being outcomes for children, and fewer still have conducted comparisons across countries. To compare the outcomes of children in current- and non-migrant households, this paper defines a multidimensional well-being index comprised of six dimensions of wellness: education, physical health, housing conditions, protection, communication access, and emotional health. This paper challenges conventional wisdom that parental migration is harmful for child well-being: while in Moldova migration does not appear to correspond to any positive or negative well-being outcomes, in Georgia migration was linked to higher probabilities of children attaining well-being in the domains of communication access, housing, and combined well-being index. The different relationship between migration and child well-being in Moldova and Georgia likely reflects different migration trajectories, mobility patterns, and levels of maturity of each migration stream.

Adult Child Migration and Elderly Multidimensional Well-Being: Comparative Analysis Between Moldova and Georgia.

Despite growing concern over the potential consequences of migration for the "left behind," few systematic attempts have been made to document the relationship between the migration of an adult child and the well-being of his or her elderly parent(s) remaining in the country of origin. This article proposes a multidimensional elderly well-being index that enables the identification and comparison of outcomes between elderly individuals with and without adult migrant children in Moldova and Georgia, two former Soviet states that are both experiencing demographic and mobility transitions. The outcomes of elderly individuals with and without children living abroad are compared to illustrate in what domains child absence through migration corresponds to differing well-being outcomes. The findings suggest that the migration of an adult child is not as significant a factor in shaping well-being outcomes as would be expected based on past literature; other factors may play much stronger roles in shaping of well-being.