報告書『HIV陽性の労働者およびその家族にとっての社会保障アクセスとその効果』（ http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---ilo_aids/documents/publication/wcms_248447.pdf ）はグアテマラ、インドネシア、ルワンダ、ウクライナの4カ国で行った調査結果をまとめ、分析している。いずれも近年、社会保障システムの充実に取り組んでいる国だ。
Urgent need for sensitive social protection schemes for people living with HIV
30 June 2014
People living with HIV who have access to social protection programmes enjoy a range of benefits, such as being more likely to retain their jobs and keep their children in school, but too many of the most vulnerable are out of reach of these programmes, says a new report by the International Labour Organization (ILO).
Access to and effects of social protection on workers living with HIV and their households draws its conclusions from research conducted in four countries, Guatemala, Indonesia, Rwanda and Ukraine, that are currently developing or scaling up their social security systems.
Across the countries a variety of social protection schemes are used to support the most vulnerable and to avoid increased vulnerability. These include establishing poverty alleviation and reduction programmes, prioritizing the poor in economic development strategies, providing access to social security systems, greater labour opportunities for women, and providing health insurance and pensions and social assistance for low-income individuals and families.
The report notes that social protection programmes can reduce the disadvantages, inequalities and structural barriers that make people more vulnerable to HIV. It reveals that, in the studied countries, between 63% and 95% of people living with HIV who had access to social protection were able to keep their jobs or some form of productive activity, 49–99% said that their children remained in school and 72–86% were able to access life-saving antiretroviral treatment.
It notes that the social protection systems of the four governments are much more readily accessed by those under the umbrella of the public and formal sectors. People living with HIV are often in the informal economy and therefore much more likely to miss out. This may be a particular issue for women and key populations at higher risk.
There is a tendency to address HIV by concentrating on enabling access to HIV treatment. The study stresses that in order to be effective, a social protection safety net that works for HIV-positive people must be multilayered, addressing wider social and economic vulnerabilities, and not just about making free antiretroviral medicines available.
“Access to antiretroviral treatment keeps people living with HIV alive. But too often, the lack of broader social protection benefits keeps women and men, and their households, vulnerable and poor,” said Alice Ouedraogo, Chief of ILO’s HIV/AIDS and the World of Work Branch, which produced the report.
The study examines a number of challenges to accessing services, such as a lack of awareness that the programmes actually exist or that the process involved in getting services is too complicated or cumbersome.
There is also the issue of out-of-pocket expenses, including transport costs to get to health centres and money to pay for treatment of opportunistic infections. ILO argues that a combination of income, livelihood and employment support is needed, in addition to health services, to further increase the impact of social protection.
“As we prepare for the post-2015 development agenda, it is important to invest in policies and programmes that leave no one behind, including people living with HIV and key populations,” Ms Ouedraogo concluded.
Aditya Wardhana, Executive Director of the Indonesia AIDS Coalition, welcomed the new research and the light it shines on a key area that has so far received relatively little attention. He said, “ILO’s research has opened a discourse on the urgent need for a sensitive social protection scheme towards people living with HIV and AIDS-affected communities, who have been long neglected by the existing social protection system.”