United Nations General Assembly Special Sessions on HIV/AIDS Monitoring of the Declaration of Commitment on HIV/AIDS Peru - 2005 United Nations General Assembly Special Sessions on HIV/AIDS REPORT ON MONITORING THE DECLARATION OF COMMITMENT ON HIV/AIDS 2005* Written by: Dr. Lourdes Kusunoki Dr. Juan Gunaira Economist Carmen Navarro Dr. Carlos Velásquez Lima, December 2005 • (Preliminary Version, may be amended) 1 United Nations General Assembly Special Sessions on HIV/AIDS Monitoring of the Declaration of Commitment on HIV/AIDS Peru - 2005 REPORT ON MONITORING THE DECLARATION OF COMMITMENT ON HIV/AIDS 2005 INTRODUCTION AIDS is a public health problem and one of the most serious challenges to the life and dignity of human beings. It affects everyone, regardless of their financial situation, age, sex or race, and it is noticeable that the populations of developing countries are the most affected, where the women, young people and children, particularly girls are very vulnerable. In Latin America some vulnerabilities result in the most affected groups being found in socially excluded populations, such as injecting drug users, male and female sex workers, men who have sex with men, prison inmates, boys, girls and adolescents in conditions of social exclusion (on the street, workers, sexually exploited, MSM), amongst others. Poverty, underdevelopment and illiteracy are amongst the main factors that contribute to the spread of HIV/AIDS, and this in turn has had an adverse effect by worsening poverty and hindering development in many countries1. From the social demographic point of view, Peru has around 26.7 million inhabitants in 20052, with a population growth range of 1.7% in the same year3. The urban population is around 73.9%; infant mortality for the year 2005 was 26 per 1,000 live births and the maternal mortality rate is 185 per 100,000 live births4. Measure Peru Population (millions) 2005 26.7 Rural population (%) (1) 26.1 Urban population (%) (1) 73.9 Population growth (%) (1) 1.7 Maternal mortality x 100,000 Live Births (3) 185 Infant mortality x 1,000 Live Births (1) 26 Chronic malnutrition (%) (2) 25 Source: (1) PNUD [UN Development Programme] Global Report on Human Development http://hdr.undp.org/reports/global/2005/espanol/pdf/HDR05_sp_HDI.pdf (2) CEPAL, Statistics Yearbook for Latin America and the Caribbean 2004 http://www.eclac.cl/publicaciones/Estadisticas/4/LCG2264PB/p1_1.pdf (3) INEI [National Statistics & IT Institute Peru] ENDES 2004 There is no uniform approach to defining, identifying and measuring poverty, which in turn also implies differences with regard to what “reduction of poverty” means. The first Development Objective for the Millennium (ODM), “Reduce by half the proportion of the population who 1 UNAIDS. Declaration of commitment on HIV/AIDS “World Crisis – World Action”, New York 25-27 June 2001. 2 2005 Census INEI [National Inst. For Statistics & IT of Peru] Web page www.inei.gob.pe 3 PNUD [UN Development Programme] Global Report on Human Development 2005 (http://hdr.undp.org/reports/global/2005/espanol/pdf/HDR05_sp_HDI.pdf) 4 INEI: ENDES 2004 2 United Nations General Assembly Special Sessions on HIV/AIDS Monitoring of the Declaration of Commitment on HIV/AIDS Peru - 2005 live on less than one dollar a day and reduce by half the proportion of the population suffering from hunger, between 1990 and 2015”, is one of the most important current challenges. Government policies to reduce poverty have not turned out as hoped, and worse still, is that some countries have not developed any policies in this respect as they did not wish to fall into the World Bank category of “low income” countries, due to having a GDP per capita classified as “medium income”. The country classifies the population according to levels of poverty and of abject or extreme poverty based on the measurement of the cost of meeting basic needs, both food and non- food; such as the lack of a minimum level of resources for access to goods and services available to society, and on the basis of information obtained from surveys in homes and about family budgets. Poverty can also be defined from a human rights approach as proposed by Amartya Sen, who defines poverty as the absence or inadequate fulfilment of certain basic liberties. Respect for human rights is vital for a person’s dignity and poverty threatens this dignity. From the gender aspect, it is poverty based on the socio-cultural and historical connotations that have brought about sexual differences in discrimination and which have become clear in the sexual divide of work and a differential and hierarchical access to material and symbolic resources.5 54.1% of the country’s total population is below the poverty line, with incomes less than those necessary to meet their basic needs; 20% of the population cannot meet their basic food needs6, meaning that they are in the extreme poverty band7. The proportion of the population in the country who live with inappropriate basic conditions is high in rural areas, as well as in the border areas. The unemployment rate reached 10.2% in 2000 and underemployment reached 50.8%. In spite of the proportion of the population in poverty declining from 57.4% to 50.7% between 1991 And 1997, it increased to 54.1% in 2004. The policies that were solely intended to reduce poverty in absolute terms may be limited for a society where there are parallel processes of exclusion, stigma and discrimination amongst groups, especially those which are intensely involved in the HIV/AIDS epidemic. Often, in these population groups, these factors contribute to perpetuating many of the social exclusion conditions which probably led to acquiring the disease. Reducing poverty may be understood as an increase in a person’s monetary income, or as having better access to education, health, social protection and other social services, in order for their rights to be met and to increase their abilities. 5 A.Minujin, E. Delamonica & Others. Children Living in Poverty: A Review of Child Poverty Definitions, Measurements and Policy 6 The Andes Community: “Hacia una estrategia Humanitaria para el desarrollo Social” 2002[Towards a Humanitarian Strategy for Social Development] 7 INEI: ENAHO 2004-IV Peru 3 United Nations General Assembly Special Sessions on HIV/AIDS Monitoring of the Declaration of Commitment on HIV/AIDS Peru - 2005 In general, the health of the Peruvian population is a reflection of their social reality. A major improvement has been reached in some of the country’s health indicators; however, the great differences disguising the national averages hide inequalities in health. A greater or lesser probability of falling ill, or dying, is related to factors such as socioeconomic strata, ruralism condition, educational type and level of persons and communities. Health cover in the country is currently provided in the following manner: MINSA [Ministry of Health] 59%, EsSALUD [Social Security] 26%, personal 12%, Armed Forces and police 3%. The Seguro Integral de Salud (SIS) part of the MINSA, administers the funds for the financing of individual health care, in accordance with the Sector Policies and, within the Universal Insurance Policy, guarantees that health care is provided to the vulnerable population in circumstances of extreme poverty and poverty. This contributes to protection for non-insured Peruvians through a non-contributory health insurance policy. It has different schemes according to age; these are Plans A, B, C D and E, with “care of the child born with HIV/AIDS” explicitly in the first two. 26% of the total population is registered and covered by EsSALUD, who are assuring us that, of the total number of PLWHA [People Living with Aids] who need AVR Therapy, approximately one quarter of the population affected would be covered by EsSALUD: Total population cover, by sex and age Age/Sex Total Insured % Cover Both sexes 27,308,177 7,093,535 26.0 Men 13,733,780 3,416,098 24.9 Women 13,574,397 3,677,437 27.1 All ages 27,308,177 7,093,535 26.0 Under 15 8,928,046 2,496,002 28.0 15 to 59 16,315,867 3,776,402 23.1 Source: Author’s estimates based on figures from EsSalud and ENAHO 2003. According to the UNAIDS 2005 Report, the AIDS epidemic claimed the lives of around three million people that year, and it estimates that five million people will contract HIV throughout the year. The cumulative number of people living with HIV/AIDS (PLWHA) is 40 million worldwide (36.7-45.3 million) and 1.8 million in Latin America (1.4-2.4 million)8. For October 2005, the Ministry of Health in Peru has reported that, apart from the 23,657 persons with HIV, there are 17,678 persons with AIDS9. There are 7,000 PLWHAs needing treatment, of whom approximately 6,298 (89.97%) are already receiving AVR Therapy as at November 200510. This is due to a great effort made by the country over the last few months, 8 UNAIDS. Global summary of the HIV/AIDS epidemic, 2005 9 Ministry of Health. Office of Epidemiology Gazette October 2005. Aids cases by year of diagnosis. Peru 1983-2005. 10 Information provided by the ESN PCITS/HIV/AIDS. Ministry of Health Peru. 4 United Nations General Assembly Special Sessions on HIV/AIDS Monitoring of the Declaration of Commitment on HIV/AIDS Peru - 2005 with the technical and financial support of the Proyecto Fortalecimiento de la Prevención y Control del SIDA y la Tuberculosis [Project for Reinforcement of the Prevention and Control of AIDS and Tuberculosis] in Peru, financed by the Global Fund to fight AIDS, Tuberculosis and Malaria. However, it is possible to understand the true magnitude and spread of the HIV/AIDS epidemic through the seroprevalence studies being made on certain population groups.