title: Social protection: potential for improving HIV outcomes among adolescents.
abstract: BACKGROUND
  Advances in biomedical technologies provide potential for adolescent HIV prevention and HIV-positive survival. The UNAIDS 90-90-90 treatment targets provide a new roadmap for ending the HIV epidemic, principally through antiretroviral treatment, HIV testing and viral suppression among people with HIV. However, while imperative, HIV treatment and testing will not be sufficient to address the epidemic among adolescents in Southern and Eastern Africa. In particular, use of condoms and adherence to antiretroviral therapy (ART) remain haphazard, with evidence that social and structural deprivation is negatively impacting adolescents' capacity to protect themselves and others. This paper examines the evidence for and potential of interventions addressing these structural deprivations.
  
  
  CONCLUSIONS
  New evidence is emerging around social protection interventions, including cash transfers, parenting support and educational support ("cash, care and classroom"). These interventions have the potential to reduce the social and economic drivers of HIV risk, improve utilization of prevention technologies and improve adherence to ART for adolescent populations in the hyper-endemic settings of Southern and Eastern Africa. Studies show that the integration of social and economic interventions has high acceptability and reach and that it holds powerful potential for improved HIV, health and development outcomes.
  
  
  CONCLUSIONS
  Social protection is a largely untapped means of reducing HIV-risk behaviours and increasing uptake of and adherence to biomedical prevention and treatment technologies. There is now sufficient evidence to include social protection programming as a key strategy not only to mitigate the negative impacts of the HIV epidemic among families, but also to contribute to HIV prevention among adolescents and potentially to remove social and economic barriers to accessing treatment. We urge a further research and programming agenda: to actively combine programmes that increase availability of biomedical solutions with social protection policies that can boost their utilization.
authors.affiliation: Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK.|Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Lucie.Cluver@spi.ox.ac.uk.
authors.forename: Lucie D
authors.initials: LD
authors.lastname: Cluver
authors.affiliation: AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.|Department of Historical Studies, University of Cape Town, Cape Town, South Africa.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Hodes
authors.affiliation: Health Psychology Unit, Department of Infection & Population Health, University College London, London, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
authors.affiliation: School of Clinical Medicine and DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: F Mark
authors.initials: FM
authors.lastname: Orkin
authors.affiliation: Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK.
authors.forename: Franziska
authors.initials: F
authors.lastname: Meinck
authors.affiliation: HIV and AIDS Section, UNICEF, New York, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lim Ah Ken
authors.affiliation: UNICEF Regional Office for Eastern and Southern Africa, Nairobi, Kenya.
authors.forename: Natalia E
authors.initials: NE
authors.lastname: Winder-Rossi
authors.affiliation: Office of HIV/AIDS, Bureau for Global Health, US Agency for International Development, Washington, DC, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Wolfe
authors.affiliation: Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), International AIDS Society, Geneva, Switzerland.
authors.forename: Marissa
authors.initials: M
authors.lastname: Vicari
mesh_terms: D000293:Adolescent; D000351:Africa, Eastern; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D008403:Mass Screening; D040242:Risk Reduction Behavior; D012944:Social Support
keywords: HIV prevention; HIV/AIDS; adherence; adolescents; social protection