1 Decent Work for All ASIAN DECENT WORK DECADE Extending Social Protection to People with HIV in Indonesia: Richard Howard & Risya Kori, ILO

Asian Epidemic Trends MSM IDU Sex workers Clients Lower risk Females Newborn infants

Graph5: HIV Prevalence by respondents Group 2007 & 2011 * This is comparing the same place in 2007 and 2011 IDUs Transgender DFSWs MSM IDFSWs Hi Risk Men

Graph10: Condom Use at the Last Commercial Sex (Always) among FSWs and last one year (High Risk Men and IDUs), 2007 & 2011* 4 IDFSWsTrans- gender DFSWs MSM Motorcycle Driver Truck Driver Port Laborer IDUsSailorMSM * This is comparing the same place

% distribution of cumulative AIDS cases by gender, as of June Source: Prepared by based on Directorate General of Disease Control and Environmental Health, Ministry of Health, Indonesia (2011). Progress Report HIV & AIDS Situation in Indonesia up to June 2011, the Ministry of Health (Laporan Situasi Perkembangan HIV & AIDS di Indonesia Sampai dengan Juni 2011, Kementerian Kesehatan RI) General of Disease Control and Environmental Health, Ministry of Health, Indonesia (2011). Progress Report HIV & AIDS Situation in Indonesia up to June 2011, the Ministry of Health (Laporan Situasi Perkembangan HIV & AIDS di Indonesia Sampai dengan Juni 2011, Kementerian Kesehatan RI)

The Social Protection Floor Basic Income Security (in cash or in kind) - -in come support, pensions for elderly, child benefits, people with disabilities Universal Access to essential social services – health, nutrition, water, education

What is HIV Sensitive Social Protection Social protection is HIV sensitive when it is inclusive of people who are either at risk of HIV infection or susceptible to the consequences of HIV. policies, legislation and regulation to meet the needs and uphold the rights of the most vulnerable and excluded. financial protection through predictable transfers of cash, food, or other transfers for those affected by HIV and those who are most vulnerable; programmes that support access to affordable quality services, including treatment, health, and education services through for example social health insurance and school fees exemption;

Legal Support Adherence and Nutritional support Skills and jobs Health care STI, VCT, HR Community health centres Education, life skills STI and reproductive health Health Promotion Adovocacy – community and media Legal Services Income, Employment, Skills Education Treatment, Care and Support Social Protection Prevention (links to VCT & STI) Evidence Based Sectoral Approaches Stigma and Discrimination Right to health

9  Purpose: to analyze and document evidence of existing social protection mechanisms which could contribute to reduction of the negative economic impact of HIV and HIV-TB co-infection among affected populations in Indonesia  Objectives: 1. To identify types and characteristics of the social protection mechanism used by People Living with HIV (PLHIV) 2. To provide the framework on scaling-up the social protection for PLHIV& their families 3. To provide the recommendations for the implementation of HIV – Sensitive Social Protection for PLHIV & their families The Research: Analysis of Practices on HIV-Sensitive Social Protection Mechanisms Contributing to Reducing HIV and TB Vulnerabilities in Indonesia (ILO – ARC, Atmajaya University, National & 3 Provinces)

SP Health Schemes 10 Funded by National Government Budget 76.4 Million Users (Largestly used by PLHIV) Membership: based on the Poor & Near Poor data listed by Central Bureau Statistic. PLHIV could also listed through “SKTM” card recommended by NGO. Level of healthcare coverage: In & out patient services at Public Health Centre and Public Hospital JAMKESMAS (National Coverage) Funded by Local Government Budget, varies at each province 10.8 Million Users Membership: the Poor & Near Poor who do not covered by Jamkesmas Level of healthcare coverage: In & out patient services at Public Health Centre and Public Hospital Implementation varies in each province JAMKESDA (Provincial & District Coverage) Funded by Yogyakarta City Budget Used by 500 PLHIV in Yogyakarta Membership: Referal system (through Social Welfare Office & NGO) Level of healthcare coverage: In & out patient services at Public Health Centre and Public Hospital with no AIDS related services (ARV, HIV & CD4 test) JAMKESOS (Local Coverage, only at Yogyakarta City)

11 Acessibility for PLHIV:  JAMKESMAS -No formal discrimination at national level - Coverage basic medical care for the eligible (poor & near poor, including PLHIV)  JAMKESDA – access for PLHIV varies by province  NGOs play a life saving role  Private health insurance still discriminates

12 Barriers to use:  PLHIV access varies by province and hospital  Administrative requirements (ID Cards) i.e: sex workers and transgendered people and other  Lack of transparency on coverage levels  Unclear procedures – how to access services  Confidentiality for PLHIV  Attitude of healthcare providers toward poor, key population and PLHIV  Coverage often insufficient

13 RECOMMENDATIONS  Integrate social protection into the existing HIV and AIDS national program  Enforce policies and international commitments on non discrimination at national and local levels  Create reporting system and dispute resolution mechanisms  Expand coverage to the informal sector  Include sexual and reproductive health services in all schemes  Integrated health promotion and prevention into schemes

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