Social protection contributes to HIV prevention
February 12, 2015
Poverty alone is not necessarily a driver of HIV risk. It interacts with other structural factors - including mobility, social and economic inequalities, and a lack of education and social capital - that increase HIV vulnerability, especially among groups such as young women. In turn, HIV can push people into poverty, placing adolescent girls and women in risky situations and compounding overall vulnerability. Social protection, especially cash transfers, can play a powerful role in addressing these structural drivers of HIV infection risk. UNICEF and EPRI have written a policy brief, that explains the recent evidence and gives policy recommendations. The summary of the brief can hopefully help you to further understand the importance of social protection in preventing HIV.
Social protection to reduce risky sexual behaviour and economic insecurity
Evidence from South Africa’s Child Support Grant e.g. shows that female adolescents living in households receiving cash transfers were less likely to have sex in exchange for food, shelter, school fees, transport or money. Households receiving transfers generally increase their spending on and consumption of food. By reducing food insecurity, and other poverty and inequality-related drivers of risky sexual behaviour, social protection thus contributes to HIV prevention.
Social protection to increase education
Social protection furthermore strengthens prevention gains through education. Education is considered a ‘social vaccine’ for HIV due to a direct link between educational attainment and reduced HIV vulnerability. A strong body of evidence demonstrates that cash and in-kind transfers (such as food and uniforms) can increase school enrolment and attendance. A study in Zimbabwe showed a reduction in school dropout rates by 82% 2 years after cash and in-kind transfers were introduced.
Social protection to promote gender equality
Social protection promotes gender equality. Empowerment of women and girls can increase their social status and strengthen their ability to negotiate sexual relationships. An example from Zimbabwe shows that adolescent girls were reported to have more equitable gender attitudes and were able to demand condom use or refuse sex.
Social Protection to improve access to healthcare
Social protection has the potential to address both direct and indirect barriers to accessing healthcare. A cash transfer, for example, may free up financial resources to make transportation costs toclinics affordable. Evidence from an Indian programme where women were given cash to deliver in a health facility showed an increase in number of antenatal care visits and an increase of health facility based deliveries. Social protection programmes thus hold the potential to increase the uptake of critical prevention health services, such as HIV treatment, counselling and testing, andPMTCT services.
- Promote relevant social protection programmes as critical mechanisms for HIV prevention – it has a proven impact on school enrolment and attendance and on increasing food security, witch consequent HIV-prevention gains, and reduces risky sexual behaviour. Leveraging existing social protection programmes can maximize impacts on HIV prevention.
- Carefully consider the target populations and potential for unintended consequences – when it comes to HIV vulnerable populations there is no conclusive evidence that conditional cash transfer programmes are more effective than unconditional transfers.
- Cash incentives for remaining HIV negative are not an alternative to inclusive social protection – inclusive social protection strategies that do not target on the basis of HIV-status have been shown to achieve broad developmental impacts that reach HIV-vulnerable households.
- Encourage and promote further research to address current evidence gaps.
This article is based on the HIV-Sensitive Social Protection Policy Brief entitled Social Protection Programmes Contribute to HIV Prevention, January 2015 by UNICEF and EPRI.
Discussion Paper: Cash Transfers and HIV Prevention, UNDP, 2014.
HIV and Social Protection, UNAIDS 2014 Guidance