This literature review identifies and outlines the international literature on access to and the impact of social protection programming on people living with or affected by HIV (PLHIV) and their households in low- and middle-income countries.
It explores 26 studies identified through a modified systematic review process. These studies are rigorous and in many instances innovative, offering evidence on impacts and/or access, and providing methodologies with potential for replication within and across regions. These 26 studies are discussed in detail and summarised for ease of reference in appendices. The findings of these studies, the research methodologies adopted, and the indicators used are presented and critically discussed in order to provide a key reference and resource for the next phase of the ILO Programme on HIV/AIDS.
Key Findings:
- The impact on HIV-affected household vulnerability is contingent on the nature of the social protection intervention adopted and whether the objective is to address vulnerability in terms of prevention, treatment, care or support. An intervention is likely to reduce vulnerabilities insofar as the provision of social protection in the form of cash, in-kind goods, or free or subsidised services relieves budget constraints limiting the consumption of key goods and services.
- The evidence relating to social protection and prevention has been weak until the last few years, which have seen the completion of a number of randomised control trials (RCTs) and robust observational studies, and the initiation of several more that are still ongoing. This has encouraged the prevention discourse to expand beyond proximate indicators and to a greater accommodation of outcome indicators directly related to infection rates. This shift is primarily limited to the Africa region and has yet to be trialled similarly in other regions.
- In terms of treatment impacts, the literature offers more evidence, in part due to the possibility of adopting empirically recorded treatment indicators, but few studies adopt direct morbidity indicators, and there is a risk of conflating antiretroviral (ARV) possession or clinic participation with actual health outcomes.
- Overall, this review identified a relatively limited number of high-quality studies globally from which robust insights into programme performance in relation to the three outcome areas – prevention, treatment and care – could be drawn, with research concentrated in the Africa region. The adoption of robust methodologies such as RCTs or quasi-experimental studies was limited, with the result that it is not readily possible to identify robust evidence on many programmes or to compare findings within and between countries.
Recommendations:
- Identify and disseminate information on a core menu of effective indicators for various outcomes and effective research methodologies. Ensure that programmes gather data on indicators that will enable performance evaluation and promote some consistency across programmes to facilitate meta-analysis.
- Carry out systematic reviews in key areas of social protection relevant to PLHIV where programme evaluations exist, but no overview or synthesis is available. Commission research into areas of social protection where the evidence base in terms of linkages with PLHIV is weak, but there is an ongoing policy interest, e.g. public works programming.
- Ensure that theories of change identify where causal linkages are hypothesised and empirically grounded, and test out the underlying assumptions empirically through evaluation, where possible.
