1. HIV-Sensitive Social Protection Anurita Bains UNICEF HIV/AIDS Regional Advisor East and Southern Africa ICASA – 2015

2. Conceptual Framework: HIV Risk Factors and Pathways

3. Social protection addresses structural factors that increase vulnerability to HIV  Cash transfers  Financial incentives for supply and demand of HIV prevention services Zero new infections  Free HIV treatment  Transport refunds  Decent employment  Food and nutrition  Housing, etc Zero AIDS-related deaths  Social transformation  Community empowerment  Legal and policy reforms to reduce HIV-related discrimination Zero discrimination Starting Point: Social Protection and Ending AIDS

4. HIV/AIDS: Improved and equitable use of proven HIV prevention and treatment interventions by children, pregnant women and adolescents Social Inclusion: Improved policy environment and systems for disadvantaged and excluded children UNICEF Strategic Plan 2014-17 PLHIV and households affected by HIV are addressed in all national social protection strategies and have access to essential care and support UNAIDS Goal AIDS-free generation starts with children Two Workstreams Infants, young children and mothers Adolescen ts HIV prevention treatment care & support Social Protection, Nutrition, Health, WASH, Education, Child Protection, Emergencies UNICEF’s Framework for Social Protection

5. Heterogeneous landscape but some common elements: “Home-grown” models  Unconditional cash payments targeted to poor and vulnerable families  OVC, labor-constrained, high dependency  Mitigation for HIV/AIDS affected families  In Malawi, 80 percent of recipients considered ‘AIDS affected’  AIDS sensitive but not AIDS exclusive  From OVC to vulnerable children  Community-based targeting Regional Landscape and Trends

6. 2000 9 countries, 25 programs 2012 41 countries, 245 programs Increasing mobilization around social protection, including HIV-sensitive social protection. Economic safety nets for children affected by HIV have expanded and catalyzed broader social protection responses SOURCE: Garcia and Moore (2012) Social Protection Scale Up

7. Vulnerable children Live in a household ranked in the bottom two wealth quintiles, and  Are not living with either parent, or  Have lost one or both parents, or  Have caregivers with no education Finding a Vulnerable Child

8. Kenya: Cash transfers for OVC led to 31% reduction in the odds of sexual debut among 15-25 year olds and 6pp reduction in pregnancy among 15-21 year olds Malawi: Cash transfers reduced HIV infections by 64% and HSV-2 prevalence by 76%. South Africa: 51% reduction in odds of transactional sex and 71% reduction in age-disparate sex among girls 10-18 Zambia: No measurable impact on HIV related risk behaviours among 13-17 year olds (after 2 years). Similar research ongoing in Malawi and Zimbabwe UNICEF, FAO, National Universities, etc. Transfer Project supporting rigorous impact evaluation of CT programmes Cash Transfers Reducing Adolescent HIV Risk – Evaluation Results

9. Cash + Care: Combining Social Protection with Care and Support Interventions

10. Social Protection and HIV Outcomes  Care and support: Mitigation of negative effects of HIV/AIDS  Prevention: Social protection can potentially impact on factors that contribute to HIV risk including inequality, education levels, poverty and exclusion/ Impacts on increase uptake of preventive measures such as such as PMTC treatment and counseling.  Access to treatment: Removal of financial and social barriers to access treatment (direct and indirect costs)

11. HIV-sensitive social protection can reach HIV-vulnerable households through broadly inclusive targeting approaches. Key Lesson 2 – National Programmes Social protection, appropriately designed, can be instrumental in supporting HIV outcomes, sometimes through complex pathways Impacting structural drivers (economic and gender inequalities; education) Increasing uptake of critical prevention services Impacting proxies for risk of infection Key Lesson 1 – Social Protection and HIV Outcomes HIV-sensitive social protection should be embedded within a comprehensive and integrated developmental policy framework. Key Lesson 3 – Developmental Framework Conclusion and Recommendations

12. @unicef_aids #AIDSFreeGen