Michael Samson Economic Policy Research Institute, South Africa

1. Operationalizing HIV-sensitive social protection: opportunities and challenges Michael Samson Economic Policy Research Institute, South Africa msamson@epri.org.zawww.epri.org.za AIDS 2012 Symposium Social protection: Promoting a more effective response 23 July 2012

2. Social protection for equitable HIV responses • Global Commitments to Universal Accessto HIV prevention, treatment care and support • HIV epidemic has put equity issuesin the spot light (gender, income, social exclusion) • Importance of addressing economic deprivations and social exclusion • Emerging priority area for UN cosponsors and development partners

3. Social cash transfer programmes have emerged in countries all across sub-Saharan Africa over the past 12 years 2000 2012 SOURCE: Garcia and Moore (2012)

4. Government is the main funder of cash transfers in Africa, followed by DFID, the World Bank, and UNICEF SOURCE: Marito Garcia and Charity Moore. 2012. Cash Dividend: The Rise of Cash Transfer Programs in Sub-Saharan Africa. Washington, D.C.: The World Bank.

5. A framework for HIV-sensitive social protection evidence 1 2 Design and Implementation 4 3

6. HIV-sensitive social protection’s transmission mechanisms to impact follow complex pathways

7. National scale programmes are yielding positive impacts on HIV-related outcomes • South Africa’s Child Support Grant… • targets with inclusive approaches that effectively reach HIV-affected households • generates behavioural impacts that strengthen prevention efforts • Kenya’s scaling up of its OVC programme may be yielding similar results • Research in ongoing in Ghana, Lesotho and Malawi—and with other projects around the world

8. Important opportunities exist to ensure greater coverage of HIV-affected populations and strengthen HIV-related impacts • Inclusive versus HIV-specific targeting • Reaching excluded groups • Addressing stigma • Maximising the empowerment effect of social protection • Addressing economic vulnerability • The role of the Investment Framework in maximising impact • An appropriate and efficient mix of instruments • The virtuous circle of effective impact as well as developmental multipliers strengthening political will and leading to increased resources, improving coverage and propelling the virtuous circle

9. HIV-affected households in South Africa are twice as likely to receive the Child Support Grant than are non-affected households SOURCE: EPRI micro-simulation model calibrated with National Income Dynamics Survey 2010

10. EPRI’s impact assessment of South Africa’s Child Support Grant (CSG) demonstrates reductions in risky behavior resulting from both early (within 2 years from birth) and current receipt: Early CSG receipt reduces the likelihood adolescents engage in sexual intercourse, use alcohol or drugs, become pregnant and work outside the home. Household receipt of the CSG in adolescents’ teenage years is important in reducing absences from school as well as engagement in the above risky behaviours. Adolescents in South Africa receiving the Child Support Grant are less likely to engage in a range of risky behaviours SOURCE: EPRI/Government of South Africa/UNICEF CSG impact assessment (2012)

11. Early childhood intervention is a key driver of impact SOURCE: Handa(2007) citing and adapting Heckman & Carneiro (2003)

12. Systemic challenges limit opportunities to scale up HIV-sensitive social protection • Weak systems for cross-sectoral linkages • Resource constraints limiting adequate financing • The interaction of these two challenges is particularly constraining: when resources are limited, support for inter-sectoral linkages erodes

13. Investment Framework (Schwartlander et al., 2011) Reduce Risk Reduce the likelihood of transmission Reduce mortality and morbidity • PMTCT • Condom promotion and distribution • Key populations • Treatment care and support to PLWH • Male Circumcision • Behavior Change Programmes Basic Programme Activities Critical Enablers Synergies With Development Sectors including social protection

19. Identified knowledge gaps limit opportunities for scale-up • Do existing programmesreach and effectively cover households affected by HIV and AIDS? • How can social protection programmes promote behavioural change that strengthens prevention initiatives? • How do social protection programmes reinforce capabilities for treatment adherence? • How can integrated social protection systems better achieve these impacts? • What are the benefits (investment returns) to more integrated and comprehensive approaches to HIV-sensitive social protection?

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30. Conclusions • A rich evidence base on HIV-sensitive social protection is emerging • In many countries key policy-makers are open to using this evidence to design and implement better policies and programmes • Identified gaps exist across the spectrum of areas of policy interest • In particular, policy-makers see robust and credible evidence on cross-sectoral investment returns as essential for scaling up successful programmes • Research partnerships with development partners and key stakeholders can help build the required evidence