AIDS Technical Brief No. 1

Social Protection to Mitigate Impacts of HIV and AIDS Project Summary

AIDS Technical Brief No. 1

Background

Promotion of universal access to HIV and AIDS and social protection mechanisms for

vulnerable groups can play a key role in reducing infections, improving treatment and adherence as well as enhancing care and support. This also reduces the likelihood that HIV will have a damaging effect on individuals, households and communities, reduces poverty and promotes sustainable development. This has effectively contributed towards mitigating the negative impacts of HIV and AIDS in Sub-Saharan Africa. With this goal, Sweden/Norad funded the “Strengthening Social Protection to Prevent and Mitigate the Impact of HIV and AIDS and Poverty in Sub-Saharan

Africa Project (2011 - 2015). The project was implemented by HelpAge International in Ethiopia, Mozambique, Uganda,Tanzania and Zambia and it sought to reduce the negative social and economic impacts of HIV and AIDS thereby contributing to poverty reduction, improved well being of both the infected and affected as well as promote sustainable development in the 5 countries.

This technical brief summarises the findings of a baseline survey commissioned by HelpAge International in 2012 and highlights the key policy gaps and recommendations pertaining to the level of access to HIV and AIDS services and social protection mechanisms in Sub-Saharan Africa.

1,333 households with older persons surveyed

20 Focus Group Discussions & 40 Key Informant Interviews

Baseline survey covered 5 Countries

ContentsBackground 1

Background Information 2

Access to HIV and AIDS Information 2

HIV and AIDS and Household Health Security 2

Access to HIV and AIDS Care and Support Services 3

Access to Social Protection Mechanisms 3

Access to basic Services 3

Recommendations for Policy and further Research 4

Recommendations for further policy research 4

References 4

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Background InformationThe baseline survey revealed that in the 5 project countries, 48% of households headed by older people had orphans and that 24% of the households had at least one person living with disability. All the 5 countries were observed to have policies providing for free medical services but lacked adequate resource allocation to enhance access. This was identified as a major factor limiting access to medical/health and other essential services more so for older people. The survey also noted an apparent lack or shortage of legal services in most of the project locations which was seen to compromise the protection of rights for the older persons. RIATT-ESA (2011) considers legal advice and associated services such as formulation of personal wills as an integral component of any development intervention that is working with older people in developing countries. RIATT-ESA suggests that this could be achieved by working with or involving grassroots community structures to create awareness towards reducing violations of the rights of older persons in various spheres of their lives.

The survey further revealed high incidences of food insecurity among households headed by older people. This was attributed to the main livelihood sources for older people which were identified as small-scale subsistence agriculture and retail trade and casual labour. A related study by RIATT-ESA in 2012 confirmed that the capacities of older people in agricultural production are severely compromised due to several factors which include declining physical strength and large amounts of time committed to caring for children and adults living with HIV

and AIDS. Other studies have indicated that this could be the driving force behind increased advocacy for cash transfer interventions for older persons to provide support for food purchases and universal old age pension (Nolan and Adato, 2009; Bassett, 2012, Osberg and Mbogho, 2011).

This baseline report showcased a successful initiative in Iganga District of Uganda the “Reach One Touch One Ministries (ROTOM)” that addresses poverty and household food insecurity for older people through provision of essential farming inputs such as oxen ploughs, seeds and fertilizers.

Access to HIV and AIDS Information

From the baseline, health facility personnel were identified as the main sources of information on HIV and AIDS. The survey also observed many glaring misconceptions about HIV and AIDS among older people which included among others, the cross-cutting belief that older people considered themselves and others within their age bracket as “low-risk” with regard to HIV infection and the protective value of male circumcision.

Only 30% of older people had accurate information on the modes of transmission of HIV. This was attributed to limited access to medical/health services and lack of other credible sources of information. Lack of accurate HIV and AIDS information was seen to pose significant danger against efforts to control HIV infection among the older people.

HIV and AIDS and Household Health Security

WHO acknowledges the heavy burden of care shouldered by the older people due to HIV and AIDS World Health Organization (2013) further observes that older people are increasingly being infected by HIV, although available data does not often include how the pandemic is affecting the older people. (also see UNAIDS, 2013). To address these challenges the survey identified an imminent need for data dissagregation and to involve PLHIV, older people and community based groups in the design and implementation HIV interventions.

Involvement of the aforementioned groups and subsequent empowerment with accurate knowledge and information is essential. This would facilitate the participatory formulation of effective interventions that take into consideration the challenges experienced at household level and address the household health security burden. This could be achieved by including innovative facilities such as universal pension and cash transfer schemes.

Kapua rights committee meeting.

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Access to HIV and AIDS Care and Support Services

Access to HIV and AIDS care and services was found to be relatively low with only 37% of respondents attesting to being aware and having adequate access to free medical services. All project countries were found to have free medical facilities and services for HIV and AIDS but access was severely compromised owing to various factors which included among others; (i), lack of adequate identification documents by large populations of older people; (ii), poor infrastructure and long distances to health facilities; (iii), lack of or limited awareness about availability of such services; (iv), misinformed perceptions that older people were at lower risk of HIV infection and (v) low levels of trust where older people fear that their health reports may not be kept in confidence. As such, the free medical services policies of the Governments in the project countries have not been actualized. This situation underscores the need to facilitate robust awareness campaigns that promote positive behaviour as well as deliver accurate information on HIV prevention and care by the older people.

Access to Social Protection MechanismsAcross the 5 SSA Countries, the capacities of older people have not been enhanced to equip them with adequate information on social protection mechanisms such as universal pension and cash transfer schemes. Emerging trends in HIV infections indicate that older people account for a steadily growing population of PLHIV. However, this is against their declining capacities to provide for themselves as well as those under their care and limited access or low levels of participation in available economic opportunities. This emphasizes the dire need for well-established social protection mechanisms such as cash transfer schemes and universal pensions for older people in Sub-Saharan Africa (UNAIDS, 2013). Such schemes would ensure that older persons are better placed to economically support themselves as well as those under their care i.e. PLHIV, people with disability and OVCs. This would further reduce the risk and instances of abuse such as forced child labour and other forms of abuse.

Access to basic ServicesMajority of the households headed by older people in the project Countries either lack or have limited access to basic economic services such as savings and credit facilities. Out of the 5, only Mozambique was singled out to have a universal non-contributory pension scheme for older people. In addition to this, the rights of Orphans and Vulnerable Children (OVCs) were also seen to be significantly compromised and not effectively addressed. In the project countries, OCVs were found to regularly face instances of discrimination and segregation and this was compounded by the fact that there were no clear structures and mechanisms to protect the rights of vulnerable people in society.

The survey identified the use of local structures such as WOREDAs in Ethiopia to create awareness on the rights of older persons and the need for greater social support as a possible solution to the current state of affairs. Creation efforts using local structures such as Woreda5 in thiopia for

only 30% of older persons had accurate information on the modes of transmission for HIV

Health personnel identified as the sole providers of accurate HIV and AIDS information

Strengthening Social Protection to Prevent and Mitigate the Impact of HIV and AIDS and Poverty in Sub-Saharan Africa

FINDINGS

48%

24%

37%

Households headed by older people had orphans

Are aware of the presence of services available to PLHIV

24% of households headed by older persons had at least 1 person living with disability

High incidences of food insecurity among the households headed by the older people.

Countries of Survey:

Ethiopia | Tanzania | Uganda | Mozambique | Zambia

30%

All 5 countries have free medical services policy but the inadequate allocation of resources to support this inhibits access to the services and facilities by older persons

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enhanced rights awareness and strengthened. However, even within clan systems, the rights of vulnerable persons are still compromised due to low levels of knowledge and corruption which influences decision-making amongst clan members. Such a scenario underscores the need for community sensitization, training of paralegals who can help to reduce cases of abuse of rights at the grassroots level (RIATT-ESA, 2011).

Recommendations for Policy and further Research

Policies to promote Multi-sectoral approach to social protection: There is a need to develop policies and interventions that will strengthen the national action plans for aging and provide guidelines a multi-sectoral approach that involves both state and non state entities in HIV and AIDS programs. This ought to be followed by a systemic approach to continually monitor the progress of the interventions and ensure that the salient issues about older people are not compromised. Such policies should promote engagement and free communication between government structures on the one side and communities and non-state actors on the other. The suggested national plans of action should guide the establishment of minimum service standards of care for older people and other vulnerable community members such as PLWHA, OVCs and PWD. Such minimum standards of service may include information sharing mechanisms to disseminate critical information as well as report instances of abuse such as stigma and discrimination.

Policies and interventions that enhance agricultural output for households headed by older people: Increasing agricultural production for households headed by older persons would enhance the resilience of such households to the negative effects of HIV and AIDS by improving food security and increasing access to other economic facilities such a savings and credit. Such interventions and policies should seek to increase levels of knowledge on agricultural production, markets and marketing as well as link older persons to financial services. Policy research may be directed towards providing subsidized credit for older persons which may facilitate diversification of livelihood activities thereby making these households resilient against many shocks.

Policies on Advocacy: Policies on advocacy should be developed in the program countries to guide advocacy on such issues as social protection as a right but not a privilege, effectiveness and accessibility of free health care policies in the program countries, reinforcement of the inheritance rights of the older people particularly the elderly women among other issues through training of paralegals and community sensitization, need for a universal pension for all older people that is aligned to changing inflation rates in sub-Saharan Africa.

Recommendations for further policy research

There is a need to commission policy research in the program countries to document and enhance best practices in strengthening social protection to prevent and mitigate the impact of HIV&AIDS and poverty in sub-Saharan Africa such as the woreda structure in Ethiopia and Reach One Touch One (ROTOM) in Uganda for purposes of developing Ministries appropriate policies for scaling up such practices.

References1) Adato, M., and Bassett, L. (2012) Social Protection and

Cash Transfers to Strengthen Families Affected by HIV and AIDS. Research Monograph. Washington D.C: International Food Policy Research Institute.

2) HelpAge International, (2002) Ageways: HIV and AIDS and Older People. London: HelpAge International.

3) RIATT-ESA and HelpAge International (2011) Intergenerational issues between older caregivers and children in the context of AIDS in Eastern and Southern Africa. Regional Inter Agency Task Team on Children and AIDS –Eastern and Southern Africa.http://www.riatt-esa.org/sites/default/files/RIATT%20IGS%20report%20lowres.pdf.

4) RIATT-ESA (2012) Children and Older Carers affected by HIV and AIDS: Regional Brief. Regional Inter Agency Task Team on Children and AIDS –Eastern and Southern Africa.

5) University Research Company/USaid (2013) Findings of a situational analysis of Psycho Social Support for Vulnerable Children in Kenya. Nairobi: A consultancy Report.

6) Nolan, A. and Aid Irish., (2009) Social Protection in the Context of HIV and AIDS. www.oecd.org/dac/povertyreduction/43280854.pdf

7) World Health Organization (2013) Ageing and Life Course: Impact of HIV and AIDS on older people in Africa. www.who.int/ageing/project/hiv

HelpAge International helps older people claim their rights, challenge discrimination and overcome poverty, so that they can lead dignified, secure, active and healthy lives.HelpAge International Africa Regional Office East, West and Central Africa Regional Development Centre, Off Lower Kabete Road, Off Shanzu Road, P.O. Box 14888-00800, Westlands, Nairobi, Kenya

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Author: Prof. Erick Otieno Nyambedha, PhD. Published by CODIT Institute: Anyona S. Gichuru (Editor), Marystella Machimbo (Designer)

Copyright © 2015 HelpAge International

This technical brief was produced with financial assistance of Sweden/Norad. However, the views contained herein are the sole responsibly of HelpAge International and may not be taken to reflect the position of Sweded/Norad