CONCLUSIONS 169


can play an important role in the mitigation of HIV/AIDS impacts, as well as in prevention.


Targeting Targeting transfers in the context of HIV and AIDS involves decisions around who most needs benefits, whether to target AIDS-affected families or very poor families and how to reach both, and what criteria and processes will best reach them. There is ample evidence that HIV/AIDS drives many pro- cesses that undermine food security and increase poverty. Targeting through indicators that capture the poor and proxies for AIDS-affected households can most effectively reach those who are the most vulnerable and least resilient in the face of HIV and AIDS. In a country like South Africa, where cash trans- fers are not rationed, poverty criteria alone are sufficient to reach AIDS- affected households (although only those with children, which is problem- atic). In countries such as Malawi and Zambia, where the grants are rationed to 10 percent of a given community, reaching AIDS-affected households requires overlaying poverty criteria with proxy indicators of AIDS-affected households: labor constraints, illnesses, and high dependency ratios have been effectively used thus far. An alternative approach is to use categorical targeting of the elderly.


More than half of the orphans living in six countries in southern and East Africa were living with grandparents, and there is considerable evidence of the positive impact of OAPs on children. An OAP could be targeted based on means testing (depending on costs and benefits), or additional criteria such as dependency ratios could be applied where narrower targeting was neces- sary. However, this approach would miss adults and children in households without elderly members and would leave others vulnerable to the death of the elderly member. If the goal is to reach children, a per-child designated grant is probably the most effective means, although evidence based on com- parative impact assessments is lacking in this debate. Political considerations will also be relevant—what types of grants are most likely to garner political support. An important process of political mobilization for social protection in the


context of HIV and AIDS has convened largely around OVC, but this has proved problematic. Questions have arisen as to how to define a vulnerable child, whether orphans are disadvantaged in relation to nonorphans—including children with ill parents as well as those suffering other forms of deprivation and trauma—and whether children affected by AIDS are more in need of material assistance than poor children affected by other misfortunes, for example, other diseases, conflicts, or conditions making their families chron- ically unable to secure a livelihood. The evidence is complex. Orphans are in


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