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Racing against HIV-sensitive safety net commitments

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KHONYONGWA—Government is off track on HIVPWP

Since 40-year-old Maria Phiri openly declared her HIV and Aids status, community and traditional leaders have been subjecting her to various forms of discrimination and systematic denial of her rights to social and economic programmes.

For instance, she was struck off the list of beneficiaries of the Malawi Social Action Fund (Masaf) Public Works Programme. The programme is a safety net scheme targeting poor households and communities which involves labor intensive construction activities to build infrastructure.

“They claimed that I was  not fit to do road maintenance works,” Phiri explained. The joint United Nations Programme on HIV and Aids (UNAids) fast-track commitments to end Aids by 2030, are challenging governments to ensure that 75 percent of  people living with, at risk of and affected by HIV benefit from HIV-Sensitive Social Protection by 2020. UNAids says the main components of social protection are programmes that provide regular and predictable support to poor and vulnerable people, and they comprise public and private actions to reduce risk, vulnerability and poverty.

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This is through social safety nets, social security, and labor market policies. They also comprise a set of policies and programmes that facilitate people’s access to social services, such as education, nutrition, housing, health among others. The organization says over the past decade, social protection has gained increasing recognition as a valuable response to a range of challenges facing developing countries including food insecurity, chronic poverty and the vulnerabilities and effects of HIV.

But as Malawi Network for People Living with HIV and Aids C) Executive Director, Lawrence Khonyongwa, notes, the Malawi Government has not yet rolled out any HIV-Sensitive social protection programmes. Khonyongwa states that discrimination and the systematic denial of rights remain significant barriers to treatment and prevention access, especially for marginalized populations. He says the UNAids commitments were, therefore, a deliberate mechanism to encourage governments to develop HIV-Sensitive social protection initiatives that could help address barriers through policies, legislation,  egulation and law enforcement. “The fast-track commitments are also among the SDGs [Sustainable Development Goals] and the 90:90:90 targets of fighting HIV and Aids.

It’s also a government policy that people living with HIV should be given all necessary support in terms of treatment, nutrition as well as social protection,” Khonyongwa explained. He said evidence has shown that persons living with HIV and Aids are not benefitting from the generalised social safety net programmes; hence, Manet+ is asking for deliberate programmes that would identify people living with HIV and Aids as a target group.

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Khonyongwa stresses that in spite of combined efforts to end stigma and discrimination, there are still some people and community leaders who are sidelining persons with HIV and Aids in distribution of social services on assumption that they are not fit to work.

“So, what we are saying is that when they are identified as a group, then the social protection services should be provided to them because currently people living with HIV and Aids are complaining that there are chiefs and other community leaders that are denying them services such as food for work and subsidized farm inputs under pretext that they do not have strength to farm. And as an organisation, we do condemn such malpractices by the chiefs and community leaders because it is also against the HIV Prevention and Management Act,” Khonyongwa said.

But National Aids Commission (Nac) Director of Programmes, Chimwemwe Mabulekesi, thinks Malawi is already doing a lot to alleviate the social and economic challenges that persons living with HIV and Aids in the country are facing. Mabulekesi disclosed in an interview that Malawi already has a social protection policy that puts into consideration the interests of persons living with HIV and Aids.

She cited Social Cash Transfer Programme (SCTP) and the Masaf, Public Works Programme (PWP) as some of the initiatives government is utilising to reach out to HIV and Aids patients with assistance.

“In this policy, there are a number of safety nets being provided. So, when they are saying HIV-sensitive social protection programmes, they are trying to say those people who are infected or are at risk of being infected with HIV are being considered; they do benefit from the social protection programmes at hand,” she said. Mabulekesi challenged that Malawi is one of the countries where HIV-Sensitive social protection programmes are working well.

She on the other hand however concurred with Khonyongwa about the need to come up with tailor-made social protection programmes targeting persons living with HIV and Aids.

“But we also need to look at issues of sustainability. We need to find a way that will ensure that assistance to them will be there forever. Again, we need to put demarcations because within the people that are HIV positive, there are some who do not qualify to be vulnerable and would not need social protection,” Mabulekesi emphasizes.

“So, we cannot suggest that simply because someone is living with HIV then he or she is supposed to be provided with social protection,” she highlighted. UNAids recommends social protection measures that are HIV-sensitive rather than HIV exclusive, as a way of promoting programmes that are equitable, inclusive, non-stigmatizing and nondiscriminatory.

The organization states with such an approach, people living with HIV and other vulnerable populations are served together; people and households affected by HIV are not singled out for targeted services. “Social protection is an all public and private initiative that provides income or consumption transfers to the poor, protect the vulnerable against livelihood risks, and enhance the social status and rights of the marginalized; with the overall objective of  reducing the economic and social vulnerability of poor, vulnerable and marginalized groups.

These efforts challenge stigma and discrimination and aim to transform the lives of vulnerable individuals,” says UNAids. However, UNAids admits that although social protection is gaining momentum in developed countries, it is highly unlikely that other countries, such as Malawi, will have sufficient funds to comprehensively address it in the near future.

And this will have two implications in the context of HIV: Where social protection measures are in place or are being developed, it is critical to make such measures HIV sensitive. Although the effects of HIV are increasing the need for social protection, particularly in low-income settings, the increased needs are unlikely to be matched by a proportionate increase in funding. In this regard, UNAids emphasizes that the efficient allocation of scarce resources will require better information on the costs and potential impacts of various social protection approaches for those most in need.

Khonyongwa insists that from the above mentioned points, one can easily see that Malawi is far from developing and implementing HIVsensitive social protection programmes. He emphasizes that HIVsensitive social protection measures need to include social protection policies, legislation and regulations designed to meet the needs and uphold the rights of the most vulnerable and socially excluded people, including those affected by HIV; financial protection for HIV-affected individuals and households, including through social transfers; access to affordable, quality services for those who are at risk, affected or HIV-positive.

“Even UNAids emphasizes that to be most effective, these three provisions should be viewed as interrelated and mutually reinforcing. The various forms of social protection need to strengthen the response to HIV in the areas of prevention, treatment, care and support,” Khonyongwa says.

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