Social protection and cash transfers: To strengthen families affected by HIV and AIDS

xiv SUMMARY

ing the economy, creating jobs, and improving living standards, countries in Sub-Saharan Africa face the added challenge of dramatic escalations in the number of adults and children whose livelihoods are threatened by HIV and AIDS. In 2009 an estimated 22.5 million people in Sub-Saharan Africa were living with HIV, 67 percent of the global total, and there were an estimated 1.3 million deaths. The number of newly infected adults and children stood at an estimated 1.8 million. Despite a modest decline in adult HIV prevalence globally in the past decade and increased access to treatment, the number of children who have lost one or both parents to AIDS increased, from approx- imately 14.6 million in 2005 to 16.6 million in 2009. Nearly 90 percent are in Sub-Saharan Africa (UNAIDS 2010). Most of these children are being taken care of by extended families and communities, but many of these families were already very poor and are now in even greater need of external support. In addition to orphaned children, millions more children are also affected by HIV and AIDS as illness in families and communities undermines livelihoods systems, human capital, and physical and psychological well-being. There is growing evidence that HIV/AIDS is significantly intertwined with

other sources of vulnerability; for instance, HIV/AIDS has a two-directional relationship with food insecurity and malnutrition. Articulations of the epi- demic with forms of chronic poverty have made social protection a moral and economic imperative. While preserving basic levels of comfort and human dignity among the sick, social protection interventions may also be the only means of preventing the destitution of entire households, as well as irrevers- ible health, nutrition, and education deprivation among children—with lifelong consequences. CCT programs have demonstrated large, statistically significant impacts

on poverty and on education, health, and nutrition outcomes, mainly for chil- dren. The research on this issue has been done in Asian and Latin American countries, where HIV prevalence is very low. However, the impacts of CCTs are reviewed in this monograph because they offer the best evidence to date of the potential of cash transfers to protect and improve the human capital of poor children. With respect to education indicators, most CCTs have sig- nificantly increased school enrollment and attendance, and some have af- fected other indicators such as grade progression and dropout rates. There has been less demonstration of impacts on achievement, calling for more attention to the quality of schools—a challenge that will be even greater when CCTs move to Sub-Saharan Africa. CCT programs have increased health service use and reduced the incidence of illness, although evidence of the latter is weaker. CCTs have achieved strong results with respect to increases in the quantity and quality of food consumption and improvements in nutri- tional status, although the latter varies considerably across countries and

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