Highlights from the IATT HIV-Sensitive Social Protection Care and Support Meeting

In February, the Coalition had the opportunity to participate in the International Meeting on HIV-sensitive Social Protection to end AIDS & TB in Geneva. This convening included high-level participants across a range of sectors and provided a unique opportunity for inter-sectoral dialogue and sharing of evidence. The Coalition welcomes the opportunity to work with this esteemed group and looks forward to further collaboration.

Encouragingly, many different sectors acknowledged that they can and should speak with one voice about common drivers of vulnerability. Similarly acknowledged was the vital role that social protection can play in addressing this vulnerability. Meeting participants welcomed the wealth of evidence showing the impact of social protection on accelerating development across multiple Sustainable Development Goal (SDG) indicators for children and adolescents affected by HIV and AIDS. This is an important way of maintaining a focus on HIV even as we shift to a broader development agenda.

 Other key take aways from the meeting include:

Global AIDS-related deaths are at their lowest in history, but little has changed in HIV infections outside of Southern Africa.

• Key populations represent 47% of new infections. The infection rate is exacerbated by the fact that discriminatory attitudes, despite a slight decline, still remain high for many particularly vulnerable groups.
• Children in Western and Central Africa are being left behind, with far fewer interventions to reach them.
• Combination prevention approaches are making an impact, but too few girls are being reached.

Social protection interventions must be scaled up.

• The benefits of social protection are vast and generate improvements across several of the SDGs. For example, a new study[1] assessing 1,000 HIV-affected adolescents in South Africa showed that cash transfers, education grants, and parenting support were powerful development accelerators, achieving greater impact across multiple SDGs, especially when combined together. Similarly, a study of over 1,000 young children across South Africa, Malawi and Zambia demonstrated how cash and parenting support cut off pathways to HIV infection later on and improved a range of SDG outcomes[2].
• Development programs must be redesigned to accommodate the holistic support needed by people affected by HIV. The Fast Track commitments target 75% of people affected by HIV to benefit from HIV-sensitive social protection. Currently, 55% of people globally do not have access to social protection at all.
• The 2018 UNAIDS National Commitment and Policy Instrument Report highlights the six key elements of an effective HIV-sensitive social protection strategy, yet only 18 countries report having them all in place. The biggest barriers include fear of stigma and discrimination, lack of information, complicated procedures, lack of documentation for eligibility, high out of pocket expenses, and prohibitive laws and policies.
• The criticisms against social protection are not evidenced and can, therefore, be discredited as untrue. For example, the common claim that social protection is unaffordable in countries with high levels of poverty is not in evidence. Indeed, Lesotho, one of the poorest countries in the world, has managed to finance domestically their own social protection
• The existence of a national policy on social protection is not enough. While many countries have strong policies in pace, they are not being implementing. In Eastern and Southern Africa, for example, social protection programs only cover 9% of the population.
• Making a service free at the point of entry is not enough. It does not overcome the many indirect economic burdens faced by people affected by HIV and AIDS.

We must work across development sectors in order to be successful.

• Many different sectors agree on the need for similar interventions, but they are not yet working together enough to advocate or deliver them.
• The mechanism for delivering social protection on the ground must be integrated within other existing systems (e.g. through health workers). To ensure this, we must further explore and document the existing multisectoral referral pathways managed by the social workforce.

 Funding social protection requires collaboration.

• Many countries have social protection strategies and policies, but this is not matched with sufficient funding for implementation.
• In an environment of increasing constraints, we must leverage resources in other sectors to achieve HIV outcomes. Social protection interventions do a lot more than just achieve HIV outcomes – they also improve education, health, livelihoods, and more. By adopting an evaluation approach that understands the complexity of the problem and, therefore, incorporates comprehensive interventions, we will build allies across sectors. Importantly, limited resources will go further.

The drive for Universal Health Coverage (UHC) is both an opportunity and a challenge.

• One size does not fit all. Universal benefits must be layered with targeted interventions for especially vulnerable groups. By showing how social protection can address complex drivers, we will be able to build political alliances that support their scale up.
• Equally, UHC must include some unconditional benefits, including for the middle classes, to ensure that they are politically sustainable. Programs that only target the very poor are politically vulnerable, as evidenced by the recent demise of the Propsera project in Mexico.
• The High Level Political Meeting on Universal Health Coverage in September provides a key moment for advocacy. However, there is concern that there will be insufficient focus on the particular needs of HIV-affected communities. In particular, key populations are at risk of not being well served by a universal approach due to limited resources, stigma and discrimination, and structural exclusion. Further, vital HIV civil society platforms, such as the Global Fund’s Country Coordinating Mechanism, which are essential for advocacy and accountability, risk disappearing under the UHC agenda.

Additional resources shared at the meeting include:

• An International Labour Organization 2018 report titled Care Work and Care Jobs highlighting households affected by HIV and the implications, especially for women.
• UNICEF Tanzania’s video on its Cash Plus program, which targets adolescents affected by HIV, highlights the impacts on adolescent health, livelihood prospects, education of cash transfers combined with a package of broader awareness HIV raising services delivered by youth mentors.
• The World Food Program Malawi’s video “Out of Drought, Hope” tells the story of how parents living with HIV struggle with drought and how it impacted their ability to stay on HIV treatment and care.

[1] Cluver, L. et al (2019 in press) The Lancet Child and Adolescent Health

[2] Sherr, L & Tomlinson, M. et al (2016) A Foot in the Door: A report on the Child Community Care study evaluating the effect of Community Based Organisation support on Child wellbeing in HIV affected communities