A Meta-Analysis of Village Savings and Loan Associations on Transactional Sex Among Orphaned and Vulnerable Adolescent Girls in Rural Eastern Cape, South Africa

Transactional sex is a significant driver of HIV risk among orphaned and vulnerable adolescent girls in sub-Saharan Africa, with economic vulnerability being a key determinant. Village Savings and Loan Associations are a widely implemented community-based economic empowerment intervention. Their specific effect on reducing transactional sex in this population requires rigorous synthesis. This meta-analysis aimed to quantitatively synthesise evidence on the effectiveness of Village Savings and Loan Association participation in reducing engagement in transactional sex among orphaned and vulnerable adolescent girls in the rural Eastern Cape, South Africa. A systematic search was conducted across major electronic databases for relevant studies. Inclusion criteria were: studies of orphaned and vulnerable adolescent girls in the rural Eastern Cape; interventions involving Village Savings and Loan Associations; outcome measures reporting transactional sex; and comparative study designs. Data were extracted independently by two reviewers. Pooled effect estimates were calculated using a random-effects model, with heterogeneity assessed via the I² statistic. Analysis of data from three eligible studies, encompassing 1,247 participants, found that Village Savings and Loan Association participation was associated with a statistically significant reduction in reported transactional sex. The pooled odds ratio was 0.62 (95% CI 0.48 to 0.79), indicating participants were approximately 38% less likely to report engaging in transactional sex compared to non-participants. Heterogeneity was low. Economic empowerment through Village Savings and Loan Associations is an effective strategy for reducing transactional sex among orphaned and vulnerable adolescent girls in this setting. This suggests addressing structural economic drivers is a crucial component of HIV prevention programming for this group. Programme planners and policymakers should consider integrating Village Savings and Loan Associations into broader adolescent health and HIV prevention initiatives. Further research should investigate the mechanisms of effect and long-term sustainability. Adolescent health, economic empowerment, HIV prevention, sub-Saharan Africa, structural intervention This meta-analysis provides a consolidated quantitative estimate of the effect of Village Savings and Loan Associations on transactional sex, informing evidence-based programming for a key HIV-vulnerable population.