A livelihoods issue

Historically, HIV/AIDS policies have underestimated the extent to which it is a livelihoods issue. This has resulted in tensions between priorities associated with poverty and social protection and those associated with HIV and AIDS and leads to questions around whether setting up distinctions between HIV and other livelihoods crises is productive and whether there is a need for more systematic thought about the implications of these policies.

South Africa has addressed HIV as both a health and social issue. It has provided social security grants for people living with HIV and AIDS (PLWHA), as well as child support grants for vulnerable children. However, problems arise when special benefits are provided for people with HIV and AIDS, creating an incentive for declaring oneself to be HIV positive. This points to the need to clearly define when benefits should be provided on the basis of general categories of need and vulnerability and when they should be earmarked for particular needs, such as HIV.

In terms of vulnerability to infection participatory approaches from development practice have proved effective in helping community groups shift from a pure 'risk behaviour' analysis in prevention to a vulnerability focus. Many examples highlight how vulnerability to HIV is related to group’s poverty and/or marginalisation and how a bottom-up approach allows HIV to be linked to problems in other areas. This can be through responses that integrate related areas like reproductive health or discrimination with HIV and AIDS. This could also be done by linking HIV and AIDS activities with other programmes and services such as literacy activities or income generation.

There is a need to move beyond the 'charity model' of social welfare, to a recognition that adequate social protection is a basic right of citizenship. This move requires a comprehensive social protection agenda that engages with interventions that support livelihoods and that minimises the risk of long-term dependence on external support.