The document summarizes the findings of a baseline survey on access to HIV/AIDS services and social protection in 5 Sub-Saharan African countries. The survey found that 48% of households headed by older people had orphans and 24% had someone with a disability. Only 30% of older people had accurate HIV information. While countries had free medical policies, limited resources inhibited access. It recommends policies to strengthen multi-sectoral social protection approaches, increase agriculture support for older households to improve food security, and advocacy policies to promote social protection as a right.

1. AIDS Technical Brief No. 1
Social Protection to Mitigate Impacts of
HIV and AIDS Project Summary
AIDSTechnical Brief No.1
Background
P
romotion 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.
1,333households with older persons surveyed
20Focus Group Discussions &
40 Key Informant Interviews
Baseline survey covered 5
Countries
Contents
Background 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
HelpAgeInternational

2. 2 AIDS Technical Brief No. 1
Background Information
The 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.
HelpAgeInternational

3. 3AIDS Technical Brief No. 1
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 Mechanisms
Across 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 Services
Majority 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

4. 4 AIDS Technical Brief No. 1
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.
References
1) 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
Tel: +254 20 2637854 | Mobile: +254 721 361 608 or +254 733 333 246
www.helpage.org
Registered charity number: 288180
Any parts of this publication may be reproduced for non-profit and educational purposes unless indicated otherwise.
Kindly credit HelpAge International and send us a copy of reprinted sections.
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