GLOBAL DIALOGUE UPDATE
On 18 - 19 May, UNDP and the ILO hosted a Global Dialogue on Social Protection for People Living with HIV and Key Populations Most at Risk of HIV. The dialogue brought together 234 participants from 52 countries over two days to share strategies and good practices. It provided a forum for governments, civil society organisations, communities of people living with HIV and key populations (gay men and other men who have sex with men, sex workers, transgender people, people who use drugs and people in prisons) and other partners to engage in constructive dialogue on how social protection schemes can be more inclusive.
Countries are failing to ensure access to social protection to people living with and vulnerable to HIV infection, and COVID-19 has exposed the weakness of social protections worldwide. According to the ILO, only 29% of the world’s population has access to adequate social protection coverage and the new Global AIDS Strategy notes that key populations most at risk of HIV are recognized as social protection beneficiaries in only 26 countries.
On Day 1, speakers highlighted the challenges and barriers for people living with HIV and key populations to access social protection. Stigma and discrimination were repeatedly mentioned as one of the main barriers for the uptake of social protection. Other challenges noted included documentation issues, complicated procedures for accessing programmes and the absence of a fixed address. The criminalization of key populations was highlighted as a critical issue that pushes key populations into hiding and increases their “invisibility”. Coupled with an absence of data on key populations, this inhibits their access to social protection programmes. People living with HIV and key populations also experienced increased hardship during COVID-19 lockdowns and emergency measures – by losing their dwellings, or informal income, by being unable to go out due to gender insensitive restrictions, unable to safely access harm reduction services, contracting COVID-19 in overcrowded prisons - and other ways. One of the main takeaways from the session was that the different key population groups have diverse needs and barriers that are not always taken into consideration when developing social protection programmes.
“What is not counted, is not well accounted for. When people are afraid because of stigma and discrimination, when systems can’t – or simply aren’t expected to – reach marginalized populations where they are, these communities are left out.” Dr. Addo, Programme Manager National AIDS/STI Control, Ghana.
Panelists also discussed good practices and strategies for inclusive social protection schemes. Trade unions in Kenya advocated successfully for laws and policies that prohibit discrimination against people living with HIV, enhancing the inclusion of people living with HIV in social protection schemes. Costa Rica shared the experience of building the capacity of government officials on stigma and discrimination reduction and sensitising them on sexual orientation and gender identity. Examples from India included free legal aid to people living with HIV and key populations, transgender welfare boards and providing free transportation to clinics. Community organisations described programmes to gather data on key populations to inform the development of social protection programmes, as well as partnerships between unions of sex workers and the private sector to increase access to health insurance. Pakistan shared information about Ehsaas, the Government’s flagship social protection program which ensures that most vulnerable and marginalized people have access to social protection, including people living with HIV and key populations. Access the intervention here.
“We need more than just a seat at the table - we need to be in leadership positions for everything regarding social protection & the HIV response.” Erika Castellanos, Director of Programs, Global Action for Trans Equality (GATE)
On Day 2, speakers addressed the important question of financing for inclusive social protection. Panelists noted that while the response to COVID-19 resulted in an expansion of (temporary) social protection schemes, criteria for inclusion were usually based on poverty data. In most cases there was no specific targeting for different vulnerable populations thereby often leaving out people living with HIV and key populations. The Global Fund highlighted examples of specific social protection undertaken that was targeted towards these groups. South Africa noted the challenge of integrating vertical health funding streams into broader health system strengthening and social protection efforts. Malawi noted the current dependency on international funding for social protection programmes. Indonesia shared an example of expanding its social health insurance scheme and moving to a single-payer system where the poorest part of the population is covered by the government. The London School of Economics highlighted the work undertaken together with UNDP in Eastern Europe on social contracting, where civil society organizations (which include and serve key populations) receive government funding to deliver HIV and health services. The results have shown social contracting to be cost-effective with a significant return on investment.
“It is vital to build broader coalitions with people facing the same marginalization. We cannot address this on an issue by issue basis with the same effectiveness.” Dr. David Wilson, Program Director, Health, Nutrition and Population, World Bank
The final part of the discussion looked towards the future and explored strategies for strengthening the inclusion of people living with HIV and key populations in social protection schemes. Six key actions for policymakers and practitioners were identified:
- focusing on measurement and accountability
- building on existing commitments, such as the 2030 Agenda and Universal Health Coverage
- creating an enabling legal and policy environment where key populations are decriminalized
- focusing on those left furthest behind first
- using a human rights-based approach
- engaging relevant stakeholders in the design, implementation and monitoring of social protection policies and programmes
“It is important to highlight that access to healthcare without hardship and income security are central to global and country responses to HIV.” Shahrashoub Razavi, Director of the Social Protection Department, ILO on social protection floors.
"Going forward we need to conduct social protection literacy training for communities of people living with HIV and key populations, provide accessible information in communities on existing programmes, and commit to stigma and discrimination-free settings.” Dr. Shannon Hader, Deputy Executive Director, Programme, UNAIDS
“Fundamentally, this is an issue about human dignity. If we are going to have more inclusive social protection, we need enabling legal and policy environments.” Dr. Mandeep Dhaliwal, Director HIV, Health and Development Group, UNDP
Inputs from the global dialogue are currently being collated. A link to the dialogue recording will be shared shortly. Stay tuned for updates through the Community of Practice (CoP) on HIV and Health.
UNDP is already planning to use the outcomes of the dialogue to inform policy and programming on the ground. For example, in UNDP-managed Global Fund grants focusing on key populations and supporting countries to consider including social protection for people living with HIV and key populations in Global Fund C19RM proposals. UNDP will also connect the dots between our HIV and social protection portfolios.
We would like to thank all panelists, participants, and organizers for their excellent contributions!
With best wishes,
Boyan and Ludo
Access the Global Dialogue recordings here:
DAY 1: Challenges, barriers, good practices, and strategies for inclusive social protection schemes.
DAY 2: Financing for inclusive social protection and looking towards the future.
Welcome!
UNDP, in partnership with ILO, welcomes you to the online consultation on social protection for people living with HIV and key populations most at risk of HIV.
Please join the discussion below and help answer the following questions:
- What are the needs and challenges of people with HIV and key populations (in general and for specific populations) and social protection, including in the context of COVID-19, in your country and region?
- What is the funding situation of social protection schemes for people living with HIV and key populations – how much are they covered from international donors, domestic government sources, private sources? What is paid out of pocket?
- Identify and discuss good practices and lessons learned, as well as opportunities for future action in social protection in national HIV responses and in making social protection schemes HIV and key populations – sensitive. Provide examples from your country and region.
- What is the main message on social protection for people with HIV and key populations that should be included in the next Political Declaration on HIV and AIDS?
Target audience:
We are inviting representatives of people living with HIV, key populations, relevant government authorities, such as ministries of health, labour, social protection and finance, multilateral organizations such as ILO, WHO, the UNAIDS Secretariat, the World Bank, and funding mechanisms and donors such as the Global Fund to Fight AIDS, TB and Malaria (Global Fund), the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), as well as the private sector and academics.
Impact:
The specific concerns, proposals, good practices, lessons learnt, and targeted recommendations outlined during the consultation will feed into a Global Dialogue, "Connecting the Dots on Social Protection for People Living with HIV and Key Populations Most At Risk of HIV" - and comprehensive document.
Join us for our Global Dialogue event!
The two-day Global Dialogue will take place on 18-19 May 2021 starting at 8 AM Eastern Standard Time. You can find more information and RSVP here.
Looking for practical guidance on how to add your voice to the consultation? Check our 5-step infographic here.
