About Housing For HIV
Aspects of the programme
Funding the programme
  1. Without a doubt, the most vital step in the whole process is voluntary counselling and testing.
  2. Innovation: 18 years ago, H4H was the first programme to offer home testing. The home testing programme enables borrowers to be tested in the comfort and security of their own homes. Well qualified and experienced nurses contracted to H4H, visit borrowers in their homes countrywide, equipped with all the skills and tools for home based VCT. H4H has developed its VCT Protocol in line with international standards. The entire home based VCT programme is governed by this protocol without exception.
  3. If a borrower tests HIV+, a CD4 count and viral load blood test is administered, with the required post testing counselling. The blood is delivered to the laboratory for urgent analysis. This means no unnecessary waiting time between testing, results and appropriate care.
  4. A Case Manager is allocated, and contacts the patient within 24 hours. The Case Manager ‘hand holds” the patient, step by step through the treatment processes from there on in.

The HLGC programme was always intended to “top and tail” finance for treatment already available in the country. Clearly, the more people who can benefit directly from Government intervention, the more money will be available for those who will not benefit from it. Since programme inception, with the changing and improving environment, more borrowers are on medical aids, and more of these schemes have access to treatment programmes, without penalty to the borrowers. Many government clinics have also improved immeasurably over time, and access to medication and medical care has significantly improved. Therefore, primarily the programme now facilitates access to appropriate treatment rather than funding and only pays for treatment when there is no other avenue.

Salient aspects of the H4H programme

  • Treatment for HIV+ borrowers through existing medical service providers;
  • The programme builds on existing services and capacities in South Africa. Through management and service level agreements with professional providers of VCT, treatment and health management services, the programme provides for VCT and appropriate treatment.
  • Protocols provided are compatible with those offered by the Government, to ensure maximum benefit.
  • It encourages borrowers to know their HIV status, through provision of Voluntary Counselling and Testing
  • The home testing programme enables borrowers to be tested in the privacy of their own homes, which in and of itself encourages testing.
  • Through this programme, people who might not otherwise be able to do so, have access to VCT, professional counselling, Aids education, and treatment programmes. They are able to retain their homes. The social and developmental impact of these aspects is significant. It has a positive effect on the health and longevity of affected people, a direct effect on the number of orphans who are un-housed and on the ability to house the lower income population of the country, irrespective of their HIV status.
  • Where a loan default is attributable to HIV or Aids related illness, the HLGC will facilitate the payment of the loan instalments and concomitant costs, to ensure that borrowers remain in their homes.
  • The programme creates a partnership between public, philanthropic, private, non-profit and development agency sectors, maximising the effectiveness of resources and contributions from all.

Programme Design and Method – the building plan
The Housing for HIV Programme is innovative from three perspectives - the programme itself, the way in which funding is utilised and the home testing programme.
The design of the programme was driven by a need to:

• sustain the growth of home-ownership in the lower-income sector in South Africa;
• ensure that people affected by HIV can access housing and retain their homes;
• ensure that home owners affected by HIV have full funded access to appropriate treatment;
• create an incentive measure to ensure VCT and treatment maintenance;
• encourage VCT as early as possible.

With some out the box thinking, a structure was developed that enabled a funding flow to the programme as sustainable, regular and known quantum.

All credit to the Overseas Private Investment Corporation (OPIC), which at the time understood the need for innovation, confirmed a $250 million line of credit to a Special Purpose Vehicle, with the proceeds going to a Foundation. Thus was Housing for HIV Foundation, the precursor to Ngena, originally funded.

So as to isolate OPIC from market risk, $50 million of Junior or Subordinated debt had to be raised in addition to their $250 million. JP Morgan, who were deeply involved in the asset selection, were able to place this debt with a number of organisations, on a purely commercial basis. Thus, in September 2004 we closed a $300 million 10-year bullet payment transaction that would see over $30 million flow to the programme over its life-span. Regular six-monthly interest flows saw full service on the debt; this despite the securities being Collateralised Debt Obligations whose underlying assets was Credit Default Swaps. Prudent credit underwriting criteria from the outset meant that despite the financial turmoil of 2007/2008, service was never interrupted. In July 2013, 15 months before planned maturity, conditions and prices allowed for an early redemption of the securities, at no cost to either the programme or the lender, and with the lenders concurrence the transaction was redeemed early, at full value to all.