ABSTRACT
Sustaining adherence to antiretroviral treatment (ART) and reducing sexual risk-taking are among the most critical health priorities for adolescents living with HIV (ALHIV) for two inter-related reasons: first, for the well-being of ALHIV themselves; and second, because both behaviours are crucial for ‘positive prevention’ – the prevention of onward HIV transmission. The findings of the HPTN052 study have challenged the assumption that HIV treatment and prevention are distinct, with a growing body of research demonstrating how HIV treatment and prevention are intrinsically connected, summarised by the maxim, ‘Undetectable = Untransmittable’ – that is, that an undetectable viral load drastically reduces the possibility of onward transmission.
Limited but promising evidence indicates that cash transfers, particularly in the form of social grants, improve ART adherence and reduce risk-taking among adolescents living with HIV. There is also nascent research that investigates which social protection combinations or packages may alleviate the vulnerabilities of children and adolescents living with HIV. Research from South Africa suggests that access to cash/in-kind benefits (such as social grants, uniforms, food security, transport vouchers, food support and school feeding schemes) and certain types of ‘care’ (such as good parental supervision, clinical care, psychosocial support initiatives and supported disclosure), can both improve adolescents’ adherence to ART and promote safer sexual practices.
This chapter makes the case for social protection programmes as vital means to implement the positive prevention agenda. Through reviewing the rapidly expanding literature on social protection and adolescent HIV and sexual health, we argue that efforts to improve adherence must go hand in hand with those aimed at reducing sexual risk-taking among adolescents living with HIV. The chapter reflects on current issues in expanding social protection for adolescents living with HIV in the region, with a focus on adolescents most likely to need positive prevention support.
