Cash Transfers and HIV Prevention

This paper proposes some initial principles on how to optimize HIV impacts of cash transfers, by encouraging targeting that:

• focuses on communities with high rates of new HIV infections, particularly acquired via sexual transmission;
• reduces local or community levels of economic inequalities between men and women;
• focuses on periods and contexts of high risk, particularly for girls and young women;
• maximizes cost-effectiveness without compromising people’s privacy choices; and
• considers multiple dimensions of vulnerability (to both HIV and other shocks).

Due to significant ethical concerns, no cash transfer programme should target people on real or perceived HIV status, whether positive or negative. Nor should transfers condition on HIV status or on maintenance of HIV status. Also due to ethical concerns – and very real risks of coercion – cash transfers should not be directly linked to irreversible or invasive procedures, such as medical male circumcision or microbicide use, regardless of the potential for efficacy in these areas. Instead, focus should be on reducing financial and non-financial demand-side barriers, such as user fees and transport costs, to help people who wish to access these and similar services.

Importantly, the evidence demonstrates that cash transfers can achieve multiple impacts simultaneously, not just on HIV but across health and development more broadly. At a research level, HIV-related indicators, including outcome proxies, should be integrated where relevant into future cash transfer studies and into the evaluations of existing programmes at scale. At a programme level, the multiple, cross-sectoral impacts of cash transfers should be considered in programme design and monitoring and accounted for in costs, cost-effectiveness evaluations and financing.

The development of cross-sectoral structures – or the use of existing ones, such as ministries of planning and finance – may be a useful governance model in different stages of design, financing, implementation and monitoring of cash transfers. Such structures can help draw links between key design elements and opportunities for pooled financing, ensuring that cash transfers are affordable and sustainable. Crosssectoral co-financing of cash transfer programmes with HIV impacts would help realize the intersectoral linkages envisioned in investment approaches to AIDS, further embed HIV into national priorities, strengthen the sustainability of comprehensive AIDS responses and further position cash transfers as a development investment.