Workshop on Social Protection, HIV and Key Populations: Training of Trainers in Latin America and the Caribbean
Claudia Suárez, Consultant - Rapid Diagnosis
Rapid Diagnosis: State of the art of Social Protection, HIV and Key Populations in Latin America and the Caribbean
Social Protection Systems
Introduction
1. Lack of access to employment- education opportunities – access to health services
2. Linked to poverty 3. Marginality
4. Discrimination Social Exclusion
Background
• In the Latin America and Caribbean region, AIDS continues to be a serious health condition that affects the most vulnerable and key populations. This is exacerbated by the prevailing situations of stigma and discrimination that generate unemployment, migration, an informal economy, violence against women and children, lack of health services, homelessness and a lack of access to housing, loans, credits, food security and pensions.
Background
• Recognition of the right to social security.
• Political declaration on HIV and AIDS: fast tracked to accelerate the fight against HIV and end the AIDS epidemic by 2030.
• Strengthen national social protection systems to ensure that by 2020, 75% of the people that live with HIV, at risk of HIV or are affected by HIV have access to social protection benefits
Background
Objective: Eliminate gender inequality, all forms of violence against children, adolescents and women, the exposure of key and vulnerable populations to infection by HIV as sex workers, homosexual men, transgender people, people deprived of their liberty, indigenous peoples, migrants and others.
90-90-90 Strategy:
• By 2020, 90% of people that live with HIV are aware of their serological status with respect to HIV.
• By 2020, 90% of the people diagnosed with HIV receive continuous antiretroviral therapy.
• By 2020, 90% of the people that
receive antiretroviral therapy have
viral suppression.
Rapid Diagnosis: Objective
Conduct a rapid diagnosis (RD) of the social
protection trends and schemes for HIV and key
populations in the Latin America and Caribbean
region (selected countries).
Countries analyzed
Social Protection Systems:
State of the art
Emergence of welfare states around the world: 1930s, the post- war period and the 1960s.
Response to the need for social protection.
Linked to personal rights.
Previously, the system mobilized families and community-based,
philanthropic and religious associations. This was in place until
interventions by the state through the classic functions of social
protection in the mid-nineteenth century and the start of the 20th
century.
According to the 2013 Latin America Social Panorama report (CEPAL, 2013):
• 28% of the region's population (164 million people) still live in poverty.
• 20% of homes with lower incomes earn an average of 5%
of the total income while the richest quintile’s total income is an average of 47%.
• This situation requires the redirection of interventions to favor the construction and/or consolidation of a social protection system.
Intervention modalities of the state in the social area.
a. Social Assistance;
b. Social Security: In strictly technical terms, the common
risks fund is based on a principle of solidarity in terms of
insurance that have a more family-focused and commercial
nature and are based on individually calculated risk premiums.
State-led intervention modalities in the social area
c. Social Security: consists of all of the measures that grant cash or in-kind benefits in order to guarantee protection in the event of (amongst other things):
• Lack of income (or insufficient income) caused by a disease, disability, maternity, work accidents, occupational illnesses, unemployment, old-age or the death of a family member.
• Lack of access to medical services or unaffordable medical services.
• Insufficient family support, particularly in the case of dependent children and adults.
d. Widespread poverty and social exclusion.
e. Conditional Cash Transfer Programs (CCT): this is a special category of «conditional» systems including systems that, in addition to other conditions, require the beneficiaries (and/or their parents or families) to participate in public programs (for example, specific education or health programs).
Social Protection Concepts
Social exclusion: Social exclusion is process of the accumulation of negative factors against a person, including barriers and limitations that keep people from participating in mainstream social life. These limitations and barriers are of diverse origins and go beyond a lack of income, as even a person living in extreme poverty might not experience social exclusion, although it is likely that they are at risk of social exclusion.
Social Protection Systems: Consists of the set of public and private programs and policies that societies use to respond to diverse needs in order to compensate the lack or substantial reduction of work income and provide assistance to families with children and medical assistance, housing and education to the general population.
Social Protection Schemes: Includes a Guaranteed Set of Benefits (CGP).
Social Security System: This consists of different social security systems managed by National Social Security Institutions or Funds, as well as Work Accident or Occupational Health and Safety Funds. The social security system’s family protection services are organized into a specific system.
Social Health Protection Schemes (EPSS), Proposed by PAHO/WHO: public
interventions focused on making it possible for individuals and groups to satisfy their health needs and requirements through access to health services that are high quality, easy to access and treat users in a dignified manner regardless of their payment capacity. Additionally, in order to design and implement a protection scheme, the active involvement of multiple sectors and actors is necessary to help design and implement strategies that are focused on people living with HIV/AIDS.
Social protection for people living with HIV: addresses the individual and collective programs and policies that aim to protect or alleviate the situations faced by people living with HIV in order to improve their monetary income and capacities to generate a better situation for themselves.
Families at the core of human development. All types of families are conceived as a system of social relationships that fulfill a protective role for its members and which, having the basic conditions to properly operate, are capable of efficiently and effectively fulfilling this role. This is the case for LGBT parents, a family in which a pair of men or women become parents of one or more children. LGBT couples can be parents through adoption, surrogacy or artificial insemination for women.
Analysis of the social protection schemes in the 14 countries: Findings.
• A strong focus on conditional monetary transfer programs.
• Centred on the population of mothers and children.
• Benefits are focused on food security and health services, and in some cases housing, employment and disability and/or old- age pension.
• Financed by international cooperation funds with the exception of: Brazil, Uruguay, Argentina and Mexico.
Effects of UNAIDS’ 90-90-90 Strategy
on social protection schemes.
1. 100% of the countries have social protections scheme directed at vulnerable populations. However, only Peru, Brazil, Guatemala and Argentina specifically include key populations in the provision of benefits. Below is a brief description of the schemes in different countries, including:
o Bolivia: Law # 2426 for Universal Child-Maternal Health Care (SUMI):
state policy, a component of the Bolivian Poverty Reduction Strategy and in compliance with the Millennium Development Goals. This Law aims to sustainably reduce maternal and child morbidity and mortality and went into effect on January 1 2003.
2. 100% of the countries analyzed in the diagnostic have adopted the 90-90-90 strategy. However, only Argentina, Chile, Peru, Mexico and Costa Rica provide benefits for the key population affected by HIV/AIDS within social protection programs to address stigma and discrimination caused by their diagnosis and/or sexual orientation. It is important to highlight that all countries are implementing the 90-90-90 strategy in accordance with their national contexts and available resources.
3. In terms of the Global Progress Report on the 90-90-90 goal, only Brazil has reported significant progress, but this is in the area of reducing stigma and discrimination and the full exercising of human rights for the affected population.
The situation in the rest of the countries are described below:
• By 2020, 90% of people diagnosed with HIV receive continuous antiretroviral therapy: achieved in Argentina; Chile; Peru; Panama;
Mexico; Jamaica; with the Dominican Republic increasing coverage by 60%.
• By 2020, 90% of the people that receive antiretroviral therapy have
viral suppression: only Bolivia reports 31% and Colombia 23% of
the population that receive antiretroviral therapy and have viral
suppression.
Analysis of the gap
between interventions
and effects.
In the area of health, there is a gap between epidemiology, prevention and options to address this problem, given that the criteria to prioritize preventive interventions on HIV/AIDS currently recommend:
• Focusing on central populations to avoid epidemics that are linked to the most important transmission routes, which in some cases operate as bridges between groups.
• This means prioritizing the participation of civil society and organizations for people affected by HIV/AIDS.
• When designing strategies and defining interventions, it is important not to forget the importance of redirecting health services based on primary health assistance, which continues to be a strategy after 40 years of Alma Ata.
