Eastern and Southern Africa

For adolescent boys and girls, transitioning to adulthood means facing significant social, health and economic risks. These include a lack of economic opportunities, early marriage and pregnancy, sexually transmitted infections including HIV, violence, abuse and exploitation. To support a safe, healthy and productive passage to adulthood, the Tanzania Social Action Fund (TASAF), the Tanzania Commission for AIDS (TACAIDS), UNICEF and other key stakeholders have developed, implemented and evaluated an intervention where social protection and economic empowerment interventions are combined with sexual and reproductive health education and services as part of the Tanzanian government’s cash transfer programme, the Productive Social Safety Net (PSSN).

The resources available include a project brief with a summary of the programme components and impact evaluation, as well as research briefs and reports from the baseline, midline and third wave of data collection.  

An opportunity to reshape gender norms on sexual and reproductive health in Rwanda: Learning from a pilot project on male partner self-testing for HIV. Rwanda conducted a research study on using self-testing and other means to improve male partner testing and engagement in PMTCT.

This document outlines the fundamentals of PMTCT impact determination and provides considerations for development of pragmatic, streamlined and resource-efficient systems for MTCT estimate generation in high burden settings. The guidance attempts to acknowledge the current reality of PMTCT programme data and the need for reliable MTCT rates while also encouraging a forward-looking approach towards sustainable PMTCT programme data improvements.

Note that this document is intended for countries in sub-Saharan Africa with a high prevalence of HIV among women of reproductive age. Although many of the underlying principles are relevant to settings with a lower burden of HIV, the guidance is not targeted for those programmes.

The tools in appendix 2 can be accessed here.

This document evaluates the Expansion and Scale-Up of HIV-Sensitive Social Protection in Eastern and Southern Africa initiative, implemented by UNICEF in Malawi, Mozambique, Zambia and Zimbabwe from 2014-2018 with support from the Dutch government. It assesses the extent to which the initiative met its objectives and achieved the expected results and documents the successes, challenges and lessons learned in the implementation.

Under the initiative, UNICEF Eastern and Southern Africa Regional Office (ESARO) and UNICEF Country Offices provided technical assistance to the four priority countries, and documented cross-country learnings. Activities under this initiative differed in their design and execution, allowing for adaptation to country contexts. In Malawi, activities focused on monitoring and evaluation of the National Social Support Policy; designing and implementing a system to refer cash transfer beneficiaries to HIV-related social services; and creating demand for HIV services among adolescents. In Mozambique, activities focused on providing policy-level support to the operationalization of the new social protection strategy, strengthening community-based and statutory case management, and conducting social protection fairs. In Zambia, the Government and UNICEF evaluated and scaled up a package of services that aims to increase the utilization of HIV services by adolescents. In Zimbabwe, the initiative focused on strengthening the child protection case management system and ensuring linkages between the country’s flagship cash transfer programme and HIV-related services, by using payment days to deliver services. In addition, the initiative’s regional component, led by UNICEF ESARO, focused on documentation and dissemination of best practices and overall technical assistance to the country offices involved.

This review provides a conceptual framework for HIV-sensitive social protection policies and programmes and review the impact of social protection on HIV prevention and treatment outcomes in addition to social and economic care and support. It further provides recommendations for achieving core HIV impacts, comprehensive approaches, and expanding and sustaining HIV-sensitive social protection. 

Building on previous summaries, this brief summarizes the current evidence and lessons learned from the Transfer Project after more than a decade of research on cash transfers in sub-Saharan Africa.

Since 2009, the Transfer Project has generated rigorous evidence on the impacts of cash transfers in sub-Saharan Africa (SSA) and has supported their expansion. It aims to provide evidence on the effectiveness of cash transfer programmes, inform the development and design of cash transfer policy and programmes, and promote learning across SSA on the design and implementation of research and evaluations on cash transfers. The Transfer Project is a collaborative network comprising UNICEF (Innocenti, Regional and Country Offices), Food and Agriculture Organization of the United Nations (FAO), the University of North Carolina at Chapel Hill, national governments and researchers. 

Building on research findings and effective interventions in low-and middle-income countries, this policy brief identifies key risks, including bullying and stigma, and facilitators, such as positive parenting and social support, that influence pathways between mental health and HIV outcomes for adolescents. It is part of a broader series that aims to support the translation of research into improved adolescent sexual reproductive health and HIV programming.

Good mental health and psychosocial wellbeing is especially important for adolescents during their transition to adulthood. It can support resilience and help initiate healthy behaviours that shape long-term positive health outcomes. Evidence shows that adolescents living with HIV are more likely to experience mental health challenges compared to their peers who do not have HIV. Poor mental health outcomes have been linked to low rates of adherence to life-saving antiretroviral treatment (ART) and retention in care.  Understanding risk factors and protective factors that influence mental health and ART adherence amongst adolescents is critical for effective programming. Within eastern and southern Africa, there is great momentum to identify and scale-up interventions that address mental health and improve treatment, care and support for adolescents living with HIV.

This implementation brief examines the current efforts in eastern and southern Africa to accelerate and scale up evidence-based PrEP delivery platforms for adolescent girls and young women. The brief provides current knowledge and builds on WHO guidance to provide key considerations for implementation, including driving demand and improving quality, as well as focus on wider combination prevention and integration agendas.

Adolescent girls and young women (AGYW) remain disproportionately affected by HIV in eastern and southern Africa, however, they face many personal, social and structural barriers to access, uptake and use of traditional HIV prevention methods. Oral Pre-exposure Prophylaxis (PrEP) is proven to be highly effective as an additional prevention choice for reducing the risk of HIV acquisition, but the current demand for PrEP by AGYW is low with suboptimal adherence.

Within the region, there is currently great impetus to address these challenges and scale up PrEP for AGYW. A critical aspect of this is to leverage the learnings and evidence from implementation of how to improve the demand and quality of PrEP programming for this population. Improving the Quality of Pre-Exposure Prophylaxis Implementation for Adolescent Girls and Young Women in Eastern and Southern Africa is informed by knowledge and lessons learned emerging from a virtual thank tank and webinar convened by UNICEF together with WHO AFRO and the Global Fund, with support from the SIDA funded 2gether 4 SRHR programme, in early 2021.

Recognizing the persistent and harmful impact that COVID-19 and related lockdown measures pose for the HIV response, governments across ESA region continue to implement interventions to sustain and further advance hard won gains toward ending AIDS. One year after the release of UNICEF's Compendium of innovative approaches to HIV programming in Eastern and Southern Africa in the context of COVID-19, this new Volume II describes results achieved in the nine countries highlighted in Volume I and shares experiences from an additional eight countries. This collective work demonstrates how countries are building upon the learning and architecture of the HIV response to proactively mitigate the impact of the COVID-19 pandemic while scaling up efforts to achieve global HIV goals, resulting in stronger responses and resilient systems for both HIV and COVID-19. Many of the adaptations and innovations described have had a positive impact beyond sustaining HIV services during COVID-19 and are demonstrating exciting opportunities to build back better with more flexible and resilient systems.

This regional report aims to strengthen risk-informed programming and facilitate scale up of simple and effective tools to identify and reach those adolescent girls and young women who are most in need of services and support. All the available tools included in the review are linked in the annexes and included in UNICEF's AGYW Programming and Implementation Repository.