Sustainable Livelihood Programs and HIV/AIDS

Fact Sheet on Youth Reproductive Health Policy

Facts & Figures Youth ages 15-24 years old constitute nearly half of unemployed people globally (UNDESA, 2007). Most sex workers are young women under the age of 25 (UNAIDS, 2006). About two-thirds (6.2 million) of all HIV-positive youth live in sub-Saharan Africa(Hallman, 2005; Lukas, 2008; UNAIDS, 2004). Seventy-five percent of HIV infections among youth are endured by girls (ibid).

Youth reproductive health is compromised by poverty (see the “Poverty and Youth Reproductive Health” Fact Sheet), which also results in vulnerability to HIV and other sexually transmitted infection (STIs). Studies have found that girls living in poor households are more likely to engage in high-risk behaviors, such as transactional sex, nonconsensual sex, and having sex with multiple partners, compared with those who are better off (Bruce,2006b; Hallman et al., 2007; UNAIDS,2004). Poverty and social isolation may increase girls’ risk of sexual coercion, which increases their risk of pregnancy and HIV infection. A study in South Africa found that males and females ages 15-24 years old from poor families are less likely to discuss safe sex options and use preventative measures when engaging in sexual activities, compared with their better-off peers (Hallman et al., 2007). To alleviate poverty and reduce the transmission of HIV, attention is being focused on how sustainable livelihood and microfinance initiatives can help youth lead empowered and productive lives that result in improved health outcomes.  

“Livelihood is defined as a means of living, and the capabilities, assets, and activities required for it. A livelihood encompasses income, as well as social institutions, gender relations, and property rights required to support and sustain a certain standard of living. It also includes access to and benefits derived from social and public services provided by the state, such as education, health services, and other infrastructure” (Masanjala, 2006, p. 1033). Sustainable livelihood programs seek to create long-lasting solutions to poverty by empowering their target population and addressing their overall well-being. The programs are varied in their focus, approach, and target audience, although many of them

• provide youth with salaried jobs and other opportunities to earn income;
• provide financial services and related on-the-job training;
• develop institutions, alliances, and networks for youth to advance their economic interests; and
• promote policy and social changes that improve young people’s livelihood prospects (Rosen, 2001).

Microfinance programs can help the poor manage their financial affairs and access financial services that are otherwise unavailable in the regular commercial sector (Clark, 1999). Traditional microfinance programs can help youth address some of the risk factors for HIV vulnerability if donors and microfinance institutions find a way to provide creative financial incentives to older adolescents that improve their economic status and prospects. Although these approaches may not be ideal for younger adolescents, sustainable livelihood programs geared toward adolescent girls (ages 10-19 years old) may be the key to integrating HIV prevention strategies. These programs could be strategically placed to address various risk factors for HIV infections faced by adolescent girls, including social isolation, child marriage, low socioeconomic status, lack of education, and pressure to provide productive labor and income (Lukas, 2008).

Importance of Sustainable Livelihood Programs in Improving Youth Reproductive Health

• Youth livelihood programs can improve their reproductive health by preventing child labor, reducing the spread of HIV and other STIs, supporting reproductive health programs, and reducing harmful social behavior, such as gang membership (Rosen, 2001).
• Most livelihood programs are small-scale, community-based interventions. These demand-driven, bottom-up initiatives vary greatly, because they reflect the needs of their target population, rather than donor interest (Ogden, 2004).
• It is important for HIV-positive youth and youth caretakers of family members with HIV and/or AIDS to earn an income, because they are often unable to find employment (Rosen et al., 2001). 
• Livelihood strategies can help prevent HIV and mitigate its impact on children and youth. HIV programs must continue to focus on the immediate needs of youth for reproductive health information and services, while incorporating a livelihoods perspective into their activities.

Key Areas for Policy Action

Policies that support sustainable livelihood strategies seek to do the following:

• Reduce poverty and allocate social benefits to help people living with HIV. Policies that focus on helping those living with and affected by HIV will ensure greater support of and funding for sustainable livelihood approaches.
• Improve girls’ schooling, job opportunities, and ability to access credit in order to reduce their vulnerability to sexual exploitation. Increasing livelihood options for girls reduces their chance of falling into high-risk behavior that could lead to HIV infection (Bruce and Joyce, 2006).
• Create and formulate national policies to protect and support vulnerable youth, such as street children, refugees, and orphans. Street children and refugees are at a greater risk of contracting HIV because of poverty and unstable living conditions. Orphans are much more likely to engage in economically motivated sexual encounters than non-orphans (Hallman, 2004).
• Implement national legislation to protect the property rights of AIDS orphans and address the needs of youth affected by or infected with HIV. Theissue of inheritance rights may require governments to ensure that each child has a birth certificate and national identification (which many children in developing countries do not have) to strengthen coordination and administration of government child service and social service departments that offer safety nets to children. National legislation is needed to establish and/or enforce inheritance rights of child- and widow-headed households. Such laws could help to curb the escalating number of street children and minimize the practice among young girls and women of trading sex for security and shelter, thus contributing to HIV prevention (Strobbe, 2005).

The State of Policymaking

The United Nations Convention on the Rights of the Child and the Convention to End All Forms of Discrimination against Women set the foundation for policymaking focused on children and youth, spurring the development of several other policies that further define and provide for the needs of children and youth. However, more work needs to be done in the policy and legal arena, because no single piece of legislation has been enacted to facilitate and fund the implementation of sustainable livelihood approaches.

The most effective policies to support sustainable livelihood programs are those that focus on schooling. Schooling is a key element in preventing poverty and improving health outcomes (Bruce and Chong, 2006a). Policies that focus on strengthening school systems and increasing attendance and continuation, especially for older youth, have positive effects on youth reproductive health (Lloyd, 2005).

Policies that ban early marriage and discourage intergenerational sex also support sustainable livelihood programs (Luke and Kurtz, 2002). These policies can reduce the prevalence of HIV and validate the efforts of livelihood programs. Policies that seek to improve gender norms are also instrumental, because they support the attempts of sustainable livelihood programs to instill more equitable gender norms among youth at an early age (Hallman, 2005). In addition, sustainable livelihoods programs are also supported by policies that promote poverty alleviation (see the fact sheet “Poverty and Youth Reproductive Health”).

To search for more policies related to sustainable livelihoods, see the Youth-Policy Database.

General Questions for Discussion for Programs

• To what extent are rural youth a significant “social category” with specific social and economic needs that should be addressed through targeted interventions?
• Should development project preparation include a youth analysis along the same lines as the methodology for gender analysis?
• Should governments do more to support specific pro-poor youth policies? What would these policies entail?
• What are the comparative advantages and disadvantages of programs working with youth?

Illustrative Sustainable Livelihood Program Examples
The examples described below are just a few of the sustainable livelihood programs that seek to improve youth reproductive health globally. They are excerpted from a review of sustainable livelihood programs conducted by the Futures Group in 2008 (see Lukas (2008) for the full document).

• The Cama Seed Money Scheme is implemented in Zimbabwe, Zambia, and Ghana. It gives small grants to out-of-school women to help them start businesses and participate in training to build their capacity as business leaders. Through this scheme, young women in rural areas have become economically independent and gained a means of livelihood. Communities in which the Campaign for Female Education International (Camfed) works have experienced positive changes away from gender-inequitable norms and traditions.
• FINCA Uganda, an affiliate of FINCA International, has partnered with local hospitals and institutions to provide healthcare services and insurance to clients affected by HIV. Clients have been able to generate income and create savings accounts. Seventy percent of clients’ children attend school, and people affected by HIV are able to build support networks.
• The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) Project in South Africa created a 12-15 month training curriculum on microfinance. It also provides a program called Sisters for Life that promotes gender equity in microfinance. Outcomes of the project include greater women’s empowerment (according to nine indicators created by IMAGE), a 50 percent reduction in physical and sexual violence, and increased awareness in intimate partner violence.

Research Findings to Support Policy Development

The Diverse Universe of Adolescents, and the Girls and Boys Left Behind: A Note on Research, Program and Policy Priorities. Bruce and Chong (2006b). This 2006 UN Millennium Project paper reviews existing policies on adolescent reproductive health and the scope for innovative strategies, such as sustainable livelihood approaches to reduce the incidence of HIV.

Microfinance Brief: Tap and Reposition Youth (TRY): Providing Social Support, Savings, and Microcredit Opportunities for Young Women in Areas with High HIV Prevalence. New York: Population Council. Hall et al. (2006). This report describes a successful sustainable livelihood program in Kenya. It discusses the success and failures of the program.

Youth Skills Enterprise Initiative: A Zambian Case Study of Micro-Enterprise and Microcredit Support for Street-Based Youth. SKI (2002). This case study presents lessons learned from a microfinance program in Zambia.

Change, Choice and Power: Young Women, Livelihoods, and HIV Prevention. Urdang (2007). This report examines the role of microfinance as the only potential source of income for impoverished young women and adolescent girls. It includes several microfinance interventions to improve sexual and reproductive health and empower young women.

FAQs

Q. What is the difference between sustainable livelihood approaches and microfinance programs?

The sustainable livelihood approach shares with microfinance a focus on eradicating poverty, a “bottom-up” foundation in communities, a client base to which it is responsive, and a link to private markets. The sustainable livelihood approach acknowledges that family and work demands dominate much of adolescents’ lives and work is often a means of fulfilling family obligations. Because formal education is acknowledged as important, but is not always possible, opportunities to develop workplace skills through informal means are also sought (Population Council and ICRW, 2000).

The primary focus of microfinance programs is on credit, whereas a sustainable livelihood approach employs a broader strategy to find safe, productive employment for youth by building their capabilities and providing resources and opportunities to enable them to define and pursue their goals. Capabilities include skills, self-confidence, and good health; resources can be financial (e.g., microfinance or savings), physical (e.g., housing), or social (e.g., networks). Opportunities include self-employment, wage employment, and home-based work (Population Council, 2005; Population Council and ICRW, 2000). Advocates of this approach consider the synergy among building capabilities, resources, and opportunities to be important, but not every program response needs to include all three domains (Population Council and ICRW, 2000).

References

Bennell, P. 2007. “Promoting Livelihood Opportunities for Rural Youth.” Knowledge and Skills for Development Paper. Prepared for the International Fund for Agricultural Development (IFAD). Rome.

Bruce, Judith, and Amy Joyce, eds. 2006. “The Girls Left Behind: The Failed Reach of Current Schooling, Child Health, Youth-serving, and Livelihoods Programs for Girls Living in the Path of HIV.” New York: Population Council.

Bruce, J., and E. Chong. 2006a. Investing in the Diverse Universe of Adolescents: A Note on Research, Program, and Policy Priorities. UN Millennium Project.New York: United Nations.

Bruce, J., and E. Chong. 2006b. The Diverse Universe of Adolescents, and the Girls and Boys Left Behind: A Note on Research, Program and Policy Priorities. UNMillennium Project. New York: United Nations.

Clark, Heather. 1999. “Some Issues for Consideration for the Workshop on Microfinance and HIV/AIDS.” Paper prepared for the UNAIDS Workshop, September 15–18, New York.

Esim, Simel, Anju Malhotra, Sanyukta Mathur, Guadalupe Duron, and Charlotte Johnson-Welch.
2001. Making It Work: Linking Youth Reproductive Health and Livelihoods. Washington, DC: ICRW. Available at: www.icrw.org/docs/Makingitwork.pdf (accessed October 14, 2009).

Hall, Joan, Aleke Dondo, and Jennefer Sebstad. 2006. Microfinance Brief: Tap and Reposition Youth (TRY): Providing Social Support, Savings, and Microcredit Opportunities for Young Women in Areas with High HIV Prevalence. New York: Population Council.

Hallman, Kelly. 2004. “Socioeconomic Disadvantage and Unsafe Sexual Behaviors Among
Young Women and Men in South Africa.” Policy Research Division: Working Paper.  New York, NY: Population Council.

Hallman, Kelly. 2005. “Gendered Socioeconomic Conditions and HIV Risk Behaviors Among Young People in South Africa.” African Journal of AIDS Research 4(1): 37–50.

Hallman, Kelly, Kasthuri Govender, Eva Roca, Rob Pattman, Emmanuel Mbatha, and Deevia Bhana. 2007. “Enhancing Financial Literacy, HIV/AIDS Skills, and Safe Social Spaces among Vulnerable South African Youth.” Promoting Healthy, Safe, and Productive Transitions to Adulthood. Brief No. 4. New York: Population Council.

Krantz, Lasse. 2001. The Sustainable Livelihood Approach to Poverty Reduction: An Introduction. Stockholm: Swedish International Development Cooperation Agency.

Lloyd, Cynthia B. 2005. “Schooling and Adolescent Reproductive Behavior in Developing Countries.” Growing up Global: The Changing Transitions to Adulthood in Developing Countries. Washington, DC: The National Academies Press.

Lukas, Terri. 2008. Reducing Adolescent Girls’ Vulnerability to HIV Infection: Examining Microfinance and Sustainable Livelihood Approaches: A Literature and Program Review. Washington, DC: Health Policy Initiative, Task Order 1, Futures Group. Available at: www.youth-policy.com/documents/541_1_Youth_Livelihoods_Microfinance_Paper_FINAL_7_25_08.pdf (accessed October 14, 2009).

Luke, N., and K. Kurtz. 2002. Cross-Generational and Transactional Sexual Relations in Sub-
Saharan Africa: Prevalence of Behavior and Implications for Negotiating Safer Sexual
Practices. Washington, DC: Population Services International and International Center for
Research on Women.
 
Masanjala, Winford. 2007. “The Poverty-HIV/AIDS Nexus in Africa: A Livelihood Approach.” Journal of Social Science & Medicine 64(5): 1032–41.

Ogden, J., S. Esim, and C. Grown. 2004. Expanding the Care Continuum for HIV/AIDS: Bringing Carers into Focus,. Horizons Report. Washington, DC: Population Council and International Center for Research on Women.

Population Council. 2005. Building Assets for Safe, Productive Lives: A Report on a Workshop on Adolescent Girls’ Livelihood, 7-8 April 2004. Available at: www.popcouncil.org/pdfs/BuildingAssets_Oct05.pdf (accessed October 14, 2009).

Population Council and ICRW (International Center for Research on Women). 2000. Adolescent Girls’ Livelihoods, Essential Questions, Essential Tools: A Report on a Workshop. Available at: www.popcouncil.org/pdfs/adoles.pdf (accessed October 14, 2009).

Rosen, James. 2001. “Youth Livelihoods and HIV/AIDS.” InFocus (January). Washington, DC: Pathfinder International. Available at: http://pf.convio.com/pf/pubs/focus/IN%20FOCUS/jan_2001.htm (accessed October 14, 2009).

Street Kids International (SKI). 2002. Youth Skills Enterprise Initiative: A Zambian Case Study of Micro-Enterprise and Microcredit Support for Street-Based Youth. Toronto.

Strobbe, Francisco. 2005. “The Role of Microfinance in Addressing the HIV/AIDS Pandemic in Africa: The Rainbow Model Provides a Future for AIDS Orphans.” Microfinance Matters (11). UN Capital Development Fund. Available at: www.uncdf.org/english/microfinance/pubs/newsletter/pages/2005_04/news_pandemic.php (accessed October 14, 2009).

United Nations Department of Economic and Social Affairs (UNDESA).  2007.“ Ensuring Youth Development around the World: The Way Forward.” World Youth Report 2007: The Global Situation of Young People. Available at: www.un.org/esa/socdev/unyin/documents/wyr07_chapter_8.pdf (accessed October 14, 2009).

United Nations Joint Program on HIV/AIDS (UNAIDS). 2004. 2004 Report on the Global HIV/AIDS Epidemic: 4th Global Report. Geneva: UNAIDS.

UNAIDS and World Health Organization (WHO). 2006. AIDS Epidemic Update. December. Available at: http://data.unaids.org/pub/EpiReport/2006/2006_EpiUpdate_en.pdf (accessed October 14, 2009).

Urdang, Stephanie. 2007. Change, Choice, and Power: Young Women, Livelihoods, and HIV Prevention. New York: International Planned Parenthood Federation, United Nations Population Fund, and Young Positives.

World Bank. 2009. “Microfinance.” Available at: http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSOCIALDEVELOPMENT/EXTCDD/0, ,contentMDK:20281035~menuPK:559252~pagePK:148956~piPK:216618~theSitePK:430161,00.html (accessed October 14, 2009).