1st HIV SUMMIT

Call for Action and Broad-

based Responses to AIDS
by Leaders.

April 12, 2010

Diamond Hotel, Manila
Opening activities
Dr. Rhoderick Poblete, Master of Ceremonies

Good morning. Welcome everyone. To start the day right, we will

be privileged to have a presentation from the Molave Theater Guild of
the PUP.
This is a good day to meet new friends and old friends alike. The
Molave Theater Group discussed and sang about the Millennium
Development Goals so that summed it up, tayu-tayo rin ang magso-
solve. We only have five years to meet our commitments; particularly we
are targeting Goal 6 today - halting and reversing the spread of HIV and
AIDS.
To introduce our distinguished leader and speaker, I’d like to call
on my friend, an epidemiologist and the director of the Philippine
National AIDS Council, Dr. Ferchito Avelino.

Introduction of the Keynote Speaker

Dr. Ferchito Avelino, PNAC Executive Director

Renowned cardiologist and top ranked physician, Dr. Cabral is a teacher,

scientist, and doctor; with countless hours spent tending to her patients,
students, and research. A graduate of medicine at the University of the
Philippines; Dr. Cabral completed her training in internal medicine, cardiology,
and pharmacology at the Philippine General Hospital and Harvard Medical
School, Massachusetts General Hospital, and Joslin Clinic in Boston. She has
served as professor at the UP College of Medicine - Department of
Pharmacology, director of the Philippine Heart Center, as well as chief of
cardiology at the Asian Hospital and Medical Center.

Her distinguished and multifaceted career has been recognized with

notable citations, such as the National Young Scientist for Medicine Award for
1981 by the Department of Science and Technology, the Outstanding Woman in
the Nation’s Service Award for Medicine in 1986, and the first Dr. Jose Rizal
Award by the Philippine Medical Association in 1981.

With more than 30 years of success and accomplishment behind her, Dr.
Cabral moved on to head the Department of Social Welfare and Development
(DSWD) in 2006. With her at the helm, the DSWD was rated consistently as the
country’s top ranking government agency by Pulse Asia’s Ulat ng Bayan survey
with the highest approval rating for performance in the entire bureaucracy.
 The DSWD also enjoyed the lowest disapproval rating among all government
agencies surveyed. The DSWD also leads the government bureaucracy in the
fight against corruption and has topped the Presidential Anti Graft Commission
List of agencies compliant with the Integrity Development Action Plan from
2007 until the time Secretary Cabral left it.

Dr. Cabral has also gained other honors in the years that she has been a
cabinet secretary. She was named a Paragon of the Civil Service by the Civil
Service Commission in 2008. In the same year, she was named Outstanding
Professional in the field of medicine by the Professional Regulation Committee.
After more than three years as DSWD secretary, she continued her
legacy of excellent public service with her appointment as secretary at the
Department of Health in 2010. Now, it is the turn of the Department of Health
for her style of leadership. Two months into her incumbency, the Department of
Health has become the number one government agency with approval rating for
performance in the survey conducted by the Issues and Advocacy Center survey.

A tireless advocate, her personal exemplification of the ideals and

values she believes in is a source of inspiration for the many who have come to
know her.
Ladies and gentlemen, the secretary of the Department of Health and
chairperson of the Philippine National AIDS Council, with great pride, our
champion, Hon. Esperanza I. Cabral.

2
 Document Title
Welcome Remarks & Keynote Speech
Dr. Esperanza I. Cabral, Secretary of the Department of Health

Good morning everybody. Secretary of DSWD, Sec. Celia Capadocia;

Secretary of the Department of Interior and Local Government, Sec. Marianito
Roque; our national scientist, Dr. Mercedes Concepcion; our guest from
Malaysia, Dr. Sha’ari Ngadiman; our international partners; Department of
Health and other government co-workers; our partners in the civil society, the
faith-based organization and the non-governmental organizations; our people
who are positive. Ladies and gentlemen, once again, let me greet you with a
very pleasant and meaningful morning.
The Philippine National AIDS Council, represented by its 26 member
organizations and its secretariat welcomes you to this event to which we seek
to reaffirm our commitment to address this complex and evolving development
concerns. Last year alone, about two million people died of AIDS and about the
same numbers were newly infected with HIV.
Infections with HIV and deaths from AIDS are unevenly distributed
geographically and for a long time, the Philippines lulled itself into complacency
by the seeming immunity of Filipinos to the AIDS virus. No longer. Over the
past few years, the PNAC and the Department of Health has raised the alarm on
a growing and expanding epidemic of HIV in our country. Data from our
Philippine National HIV and AIDS surveillance revealed that the number of
Filipinos who have contracted HIV has increased significantly especially in the
last two years as compared to the period before 2007. Dr. Eric Tayag of the
National Epidemiology Center will tackle this alarming situation later in the
program.
The virus does not discriminate by age, gender, sexual orientation, or
economic status; everyone is susceptible. And in our country, certain groups
have been found to be a particular risk, including men who have sex with men,
injecting drug users, and young adults engaging in risky sexual behavior.

HIV and AIDS causes serious illness and eventual death – often in people
in the prime of their lives and leaves devastated families in its wake. It
complicates effort to fight poverty and promote developments as it diminishes
the victim’s ability to provide for himself and his family, while consuming
personal and household resources for treatment costs. It widens socio-
economic and gender divide, even as it strains the already limited resources of
our nation . The circumstances are daunting, but they are also unacceptable
considering that nothing less than the law, particularly RA 8504, also known as
the National AIDS Prevention and Control Act of 1998 recognizes HIV and AIDS
as a pressing national concern and mandates all concerned to take decisive
actions. It warns us of the dangerous nature of the HIV and AIDS scourge,
providing in its declaration of policy that AIDS is a disease that recognizes no
territorial, social, political, and economic boundaries and for which there is no
known cure. A problem of such scale must be addressed decisively and
comprehensively. We call therefore for collective action in facing the HIV and
3
 AIDS situation in our nation.
The PNAC and DoH recognize the need for a strong multi-sectoral
collaboration in responding to this threat, a theme reiterated in our media
forum over the past four weeks. Undersecretary Austere Panadero of DILG and
Undersecretary Alice Bala of DSWD will provide us with a picture of where we
are now with the national response to HIV and AIDS, and what we can do to
further our cause.
I am also glad to know that Filipinos do not stand alone in this fight. Dr.
Sha’ari Ngadiman will also share experiences from our neighboring ASEAN
countries, particularly those with similar epidemiology as ours. Our
collaborative effort to scale up the national response will be guided by the
principles embodied in our national response plan that recognize initiating
target interventions; improving access to preventive, treatment, and
We need to show support services; and dismantling the barriers of discrimination and
the entire world wrong information. To achieve this end, we need to have a
that we are significant domestic investment for AIDS prevention and control both
serious in our at the national and local level, and for public and private sources.
aim to bring More than 70 percent of spending has come from the international
down, if not community during the past years. We need to show the entire world
eliminate HIV that we are serious in our aim to bring down, if not eliminate HIV and
and AIDS by AIDS by putting our money where our mouth is, so to speak.
putting our Some people say that we should not be spending government
money where our money. My question is why not, when we are spending money for
mouth is, so to less important concerns. Why not when prophylactics have been
speak. proven to prevent HIV in those who cannot abstain or remain faithful
to one partner. The treatment and care of people living with HIV and
AIDS is absolutely essential, but aggressive prevention is not only cost
effective, but a sound and efficient towards preventing a global epidemic. My
final question is why not when we have been perfectly willing for other nations
and other organizations to spend their money on us?

This summit is aptly themed Call for Action and Broad-based Responses
to AIDS by Leaders. Most, if not everyone here, are in a position, whether by our
authority or expertise to make a world of difference. Our collective power is
meant to be wielded effectively in presenting a united front against HIV and
AIDS. The campaign will be long and hard. But I know that our passion and
effort will not be lacking.
I extend my warmest appreciation to our partners, all stalwarts and
leaders in their respective fields, including other government agencies, local
government units, NGOs, and members of the media. All of you have and will
continue to play indispensable role in this vision. Finally I would like to thank
the hard working men and women of PNAC, especially the technical working

4
 group and the PNAC Secretariat under Dr. Ferchito Avelino. I thank them for
their unparalleled dedication and creativity in bringing to life not just this
summit but countless other anti AIDS projects.
I thank all of you, our partners in this fight against this dreaded disease.
You have been in this struggle for longer than I have and you’ll still be in it way
after I have turned over my responsibility to someone else. I know that each
and everyone of you will remain steadfast and stay the course. Nothing is
impossible with the strength of your collective will. I wish you and our fight
against HIV and AIDS success.
Maraming salamat. Mabuhay kayong lahat.

5
 Message from the Positive Community
Mr. Jericho Paterno, President of Pinoy Plus Association

S e cr et a ry E sp er an za Ca b ra l , U nd e r s e cr et a ry A ust e re
Panade rio , U nde rse cret a ry A licia Ba la , our se ct o r dev elop ment s
part ner s , L GU chief e xe cut iv es , Chur ch and F ait h ba sed L eader s ,
deleg at es , f ell ow HIV and A IDS adv ocat e s , ladi es and gent l e men ,
Magandang u maga sa i sang ma aliw alas na araw ! Go od morn ing t o
each and ev ery one!!!

T oday is indeed a v ery w onderf ul day ; a v ery remark a ble d ay

esp ecia lly f or us f ro m t he po sit iv e communit y , be caus e it t ak es
one per s on , Dr . E s per anza Ca bral t o brin g t o t he highe st lev el t he
f ocus , t he at t ent ion on c ond o m, and HIV and A IDS . W e hav e f ound
a s ecr et ary of Healt h w ho has t he w ill and t he gut s t o br ing t hi s
issue t o de bat e an d t o t he ag enda of our se ct o r pa rt ners , a
secr et ary w ho k now s w hat she is doin g - f or a s lon g as w e w ill
j oint ly , col lab orat iv ely w ork w it h her in t his f ight . E rg o , she w ill
not g o w rong . T hank y ou S ecr et ary Cabra l f or being p ro act iv e and
brav e enough t o d o t he ri ght t hing s . T hank y ou f or n ot be ing
pol it iciz ed in t he c ondu ct of y our t ask s . T hank y ou f or enj oin ing
us p eo ple liv ing w it h HIV and A IDS in t hi s mo ment ous HIV Su mmit
2 0 10 .

W e are al l he re t o put al l our act i ons t o ge t her t o br ing a gain

t o t he highe st ag enda t he chal leng es w e are c onf ront e d w it h
brou ght a bout by an inc rea sing nu mb er of HIV cas es in t he
count ry . I sai d “A GA IN “ be cause f or us pers on s liv ing w it h HIV ,
T HE A IDS pr ogra m an d it s f und ing sup p ort h av e dw indled in t he
past y ears c o mpa red t o w hat hav e happen ed in t he 1 9 9 0 ’s .
Pro ces se s , st ruct ur es , sy st ems , re sou rc es w ere f rag ment e d . S o
many lay ers of st ruct ures w ere creat e d and t heir l ink s w ere not
ma de clea r , and h ow all of t h ese me cha nis ms rel at e t o t he ov er
all healt h se ct or r ef or m and ev ent ually cont ribut e t o t he nat i ona l
O bj ect iv es of Healt h and t he Mill enni um Dev elop ment G oal 6
w hich is t o c o mbat HIV and A IDS and ot h er di sea ses . T his Su mmit
is inde ed t i mely t o addr es s w hat w e need t o put sol ut ion s int o . W e
cannot b e f orev er be dep end ent on Gl ob a l F und . W e w ant ed t o see
a cl ear blue print of w here w e are hea din g t o , t he supp ort of t he
Philip pine G ov ernment , d on or s lik e U N, W HO , U SA ID, E ur op ean
Co mmis si on , W orld bank , A DB , A usA id, CIDA , et c . W e NEE D not
only t echnical as sist an ce , w e need y our MO NE Y so t hat w e can
cont inu e c o mpl e ment ing t he ef f ort s of o ur g ov ernment . W e do a
lot of t hings cre at iv ely t hat only t he po sit iv e co mmunit y can
deliv er. T his is t he v ery essenc e of a gre at er and mean ingf ul
inv olv ement of pe opl e liv ing w it h HIV and A IDS .
6
 W e, f r o m t h e po sit iv e co mmunit y , ar e act iv e part ner s in t he
univ ersal ac ces s and are pr o mot in g t he c onc ept s of ‘p os it iv e
healt h , dign ity and pr ev ent ion ‘ in a numb er of w ay s, t ak ing
lead ershi p in c reat ing st rong er link s an d increa sing co llab orat i on
bet w een healt h sect or , civ il soci ety organizat ion s and F ait h ba se d
organ izat ion s f o r pr ov iding prev ent ion, t reat ment an d c are
serv ices .

It is v it al of us t o hav e a go od healt h sy st em an d hu man

res ourc es t hat ar e c rucia l of a chiev ing t he goa ls of univ ersal
acc ess t o HIV p rev ent ion, t reat ment , car e and su pp ort . R e me mb er ,
A IDS is p art of t he gl obal healt h a ge nda is part of t he A IDS
resp on se .

T o lead u s t o w hat w e should b e d oing t oday , I ’d l ik e t o

po se t he se quest i ons : D id w e do t he rig ht t hing ? A re w e doing
enough ? W here and w hat did w e miss ? If t here are g aps , w hat are
t hese an d w hat are t he st o pgap s?

L ast ly , v ery import ant f o r us an d our f a mil ies , w e w ant t o

see a sust aina ble HIV pr ev ent ion p oli cy w hich includ es con do m
use , se xualit y educat i on and 5 y ears t rea t ment plan - t he un iv ersal
acc ess t o t re at ment plan 2 0 1 1 t o 2 0 16 w it h or w it hout t he Gl obal
F und.

Re min der t o y ou all: “ W e are not a p ro bl em but w e are part

of t he s olut i on .”

A im high f or K alusug an Pin oy !

Mara ming Sal a mat p o !!! A Pleas ant day t o each and ev ery one !!!

7
 Tracking HIV
Dr. Eric Tayag, Director of the National Epidemiology Center

We have been tracking HIV for several years now. We will share with you
data from important sources coming from IHBSS, as well as other sources. The
presentation will give you interpretations of the data we have collected. This
evidence can be used for important decisions for our important interventions
against the epidemic

Philippine National AIDS Registry:

• Official national registry of

• HIV & AIDS cases in the Philippines

• Strictly confidential

• Passive reporting system

• Does not follow-up cases after being reported

• Gives data on trends

We count patients passively. These patients are reported by health

providers; they are confirmed at SACCL. Blood units for confirmation are done
by RITM.

4817 people living with HIV:

In this slide, we show you the red line represents our AIDS cases; the
green line, asymptomatic; and the black line, the total of the two lines.
Asymptomatic in this slide represents 82 percent of the total number. What is
the implication for monitoring the number of AIDS? If we are reporting more
new cases, we are in trouble.
In our AIDS Registry, we are able to capture early HIV infection. The bad
news is that it is steadily climbing every year since 2007.

8
 140
2010: FOUR new cases a day!
131
120
A v erag e N o. of N ew C as es

100
2009: Two new cases a day
80

2007: One new case a day 63

60
44
40 26 29
15 15 16 17 18
20 10
2000: One new case every 3 days
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Y ear

1500 new cases by Christmas

1600

1400
1 year
1200

1000

800 2 years
600
6 years
400
17 years
200

0
'84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 08 09 10

It has now shortened to one year that by Christmas this year, there
would be 1500 new infections based on our projection from the registry. Now
you want to ask, who are getting sick? Where are they coming from? The AIDS
registry gives us clues.

9
 HIV & AIDS Demographics
It’s raining men:

2006 to 2010
2001 to 2005
1996 to 2000
1991 to 1995
1984 to 1990

0% 20% 40% 60% 80% 100%

Before it rained men, in 1984 to 1990, there were more women infected
with HIV compared to men. Today, from 1984 to March 2010, there are more
men than women. 74 percent would be men and the ratio is 3.5 to 1.
The younger and the restless men:

If this was an animation, the colored circles have meanings. The size
represents the numbers of men who are infected. Please take note that all ages
are affected. When the epidemic started 25 years ago, the age group affected
belonged to 20 to 40 years old. Now there was a separation among this age
groups.

10
 The younger and the restless female:

The women started during the first decade of the epidemic among the
20 to 30 years old and stayed that way; this was most possibly due to HIV
infection among sex workers. But slowly, it has declined. We’ve since infection
among partners of other MARPs.
OFWs are here to stay:
Twenty nine percent of all
cases reported to the
registry, please take note
than in 2000 – 2005, the
number of OFWs were the
same as those of non-OFWs.
While the proportion of
OFWs has declined, the
absolute number continues
to rise. It is a problem that
never goes away.

11
 Nowhere to hide:

• ALL 17 Regions are re-

porting HIV cases

• 72 of the 80 provinces
are reporting HIV cases

All regions have reported at least one case in the last 25 years. Only
eight of our provinces have yet to report their first case.
Urban jungle:

From 1984 to 2006, more than half of the cases came from NCR and
region 4A. 18 percent would come from region 3. In 2007 to 2009, the NCR
and 4A will comprise 70 percent of all new cases. In 2010, there is a shift. Look
at the green pie, represented by Region 7. The green pie is now one of the
predominant region. Why?

12
 Extreme caution:
We get HIV three ways: sexual contact; exposure to contaminated blood,
especially among IDUs; and mother to child transmission. Sexual transmission
account for 89 percent of all modes of transmission. From 1984 to 2006,
unprotected heterosexual transmission is the most common; only in the last
two years did we see the sudden increase in homosexual and bisexual
transmission. In 2010, we have seen the rise of HIV among IDUs who shared
needles.
Please take note that beginning in 2007, there are more males having
sex with males getting infected, compared to heterosexual transmission. It has
climbed steadily in the last three years and we don’t see any reason where the
trend will be different in the next few years
Sharing is not caring:

63 cases in just three

months and expanding

7 cases in 22 years

In 2008, another one was included in the list. But in 2010 alone, 63 HIV
infected IDUs were reported in the registry. The IDUs all came from Region 7.

13
 Why are there more males:
MARP Estimates: More males practicing high risk behavior

516, 511 clients of SW 1,199,561 males

10: 1 ratio
665,395 MSM

159,408 female sex workers 161,590 females

HIV Registry:

• 53 percent of all HIV cases were reported in the last five years. Of these, 62
percent were males having sex with other males
• 86 percent of all IDU cases reported were males

Consider this. The ratio of males to female is that there would be 1ten
males infected to one female. Males would be clients of sex workers, MSM,
IDUs. 53 percent of all cases reported in the last five years were males and of
these, 6 out of 10 were MSM. 86 percent of IDUs were males.

So what’s causing the increase? The increase in risky behaviors and a

decline in our prevention coverage spelled the difference. It’s not your
occupation…. it’s your behavior that makes you HIGH RISK! The debate is over;
we sleep around.
Chain of HIV spread:
Let’s take for example, IDUs. They share needles, imagine that they also
have sexual relations with other people. Just one HIV infected individual can
trigger the acceleration of spread of HIV among IDUs. This chain of
transmission is what epidemiologist will call downstream infection emanating
from IUDs. At the end of the line would be babies born to innocent mothers.
That is the situation we hope to prevent at this juncture.

The truth about FSW: (red: registered, pink: freelance)

Knowledge on HIV Reached with prevention Used condom
and HIV prevention activities

14
 For the uninformed, we differentiate between a freelance and registered
sex worker. Registered sex workers; they work in establishments that are
registered. The freelance are those who are street-based. Look at those who
have been reached; those who are registered were most likely reached with any
prevention activities. How about using condom? There is a big discrepancy
between being a freelance and registered sex worker.
MSM:

Knowledge on HIV Reached with prevention Used condom

and HIV prevention activities last ANAL sex

Their knowledge and prevention, they flunked the test. Have they been
reached? We failed them. Did they use condom? 68 to 69 percent did not.
IDUs:
Did not share
Knowledge on Reached with prevention needles during
HIV and HIV activities last injection

Condom use last sex:

Condom use
IDU-Sex Workers
last sex: IDU-
SW Clients

The knowledge after all these years, we still have to reach 60 percent.
We only reached less than 12 percent. How about their practices of sharing
needles? Most of them shared needles. In one of our latest surveys, they are all
co-infected with Hepatitis C virus. The inconvenient truth about IDU is they
share needles, they work as sex workers, they have clients, and they spread
HIV.

15
 Survey says

MARP HIV Prevalence

MSM
MSM in Metro Manila 1 in 60 are HIV+
MSM in Davao 1 in 30 are HIV+
MSM in rest of the country 1 in 300 are HIV+

IDU
IDU in Cebu 1 in 3 are HIV+
IDU in the rest of the country 1 in 5000 are HIV+

FSW
Registered Establishment-based 1 in 1000 are HIV+
Freelance 1 in 250 are HIV+

For MSM, the overall prevalence is one in 300. That is not the figure I
want you to focus on. Focus on MSM prevalence in Metro Manila and Davao. In
our survey, there are more MSMs who are HIV-infected in Davao compared to
Metro manila . And they are five times more likely to be infected
Look at the IDU, 1 in 5000. In Cebu, if you meet three, one of them is
HIV positive. It looks like HIV infection among IDUs in one part of Cebu is a
done deal. It is finished. It is over. We hope to prevent downstream infection,
but there would be new recruits and the numbers would get higher.
Should we spend for treatment:

16
 Our present estimate is we need 50 thousand per person per year;
treatment becomes a bottomless pit. It will drain our resources but we have to
provide treatment because treatment with prevention can halt the spread of
HIV.

AIDS Deaths: the sound of silence

Assumption: Without treatment, an HIV infected person can live for another 11
years
1984 to 1998: 1169 have probably died of AIDS
Situation: Without treatment, many more will suffer and die of AIDS:
By the end of 2010: 158 will die of AIDS
By 2021: 1,500 will die of AIDS

The fuse about facts:

FACT #1
Yes, the Philippines is still a low prevalence country
What’s the fuse?
It would take 1,000,000 HIV cases to become high prevalence. That’s
50 billion pesos a year for treatment alone! 2x the entire DOH budget!

Prevalence rate do not mean a thing right now. One million cases
translate to 50 billion a year.
FACT #2

Yes, the total number of HIV cases in the country from 1984 to 2009 is less
than 5,000
What’s the fuse?
Our epidemic is growing – There may be a projected…
2,500 newly infected Filipinos by December 2010

4,000 - 7,000 newly infected by 2011

17
 FACT #3
Yes, HIV infections are not generalized. Not all Filipinos are at risk. HIV
spreads among people with high risk behavior and their partners.
What’s the fuse?
Among those at-risk, only….

• 18.6% of FSW know their HIV status

• 6.8% of MSM

• 1.5% of IDU

Where do we go from here:

Option 1: Do nothing until we become a high prevalence country.

But, can we really afford to spend 50 billion pesos EACH YEAR on treatment
alone?
This will most likely cripple our workforce, and cause economic set-backs
Option 2: Business as usual
FSWs at the Social Hygiene Clinic will most likely stay HIV negative. But the
others who are at risk won’t know how to protect themselves and that they are
infecting others.
This will cause the number of new HIV cases to increase at a rate we might not
be able to handle.

We talked to our colleagues in Region 7. It takes them hours and days to

counsel just one IDU. It is draining their resources, it is draining them
physically, and they need help right now.
Option 3: HALT HIV spread now and reverse these:
High Risk Behaviors

• multiple sexual partners

• unprotected sex (especially during anal sex)

• sharing of needles

Aversion To HIV Testing

Limiting Activities For Prevention

Too Few --

• people who know about HIV and how to prevent it

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 • Partners who are helping stop HIV spread in the Philippines
We have an automated generation of our estimate. Let’s look at FSW. At
a prevalence of 39 percent, we estimate that there would be three new HIV
infection and that among their clients, that would number up to 12. Do less for
FSW, more clients will be infected. Let’s look at when we use condom. The
debate is over about the effectiveness of condom. Talking about holes, talking
about condom causing HIV is being irresponsible because we have evidences. It
does not eliminate risk, but it reduces it. If we increase condom risk among
FSW, we reduce the number of FSW from three to just two.
Let’s look at MSM. Our estimate is there are more than 4000 who are
infected. At a prevalence of one percent, if we increase the prevalence to four,
the number of HIV infected MSM jumps to 15,000. Going back to the original
prevalence, and let’s reduce their partners. If we reduce their partners from 12
to let’s say they are going to abstain and they will reduce their partners to half,
we reduce the number of MSM from over 4000 to over a thousand.
Ladies and gentlemen, we just presented you with the inconvenient
truth; it’s going to get worse before it gets better. We want a headline that we
are able to halt the spread of HIV. Maraming salamat po.

19
 Strategies in Addressing HIV & AIDS Epidemic
Dr. Sha’ari Ngadiman, Malaysia Ministry of Health

It is a great honor for me to be here. I’ll try to bring you into the scenario in the region.
The Philippines is not an isolated country.

Estimation using the Asian Model

Source : Asian Epidemic Model for Typical Asian country

HIV & AIDS in selected countries

Indonesia

20
 Thailand

In Indonesia, first was through sharing needles; in Thailand through

sexual contact. For Malaysia, the most transmission now is through sharing
needles and heterosexual activity. Whatever country in this region, it is through
sexual activity and needle sharing.

21
 HIV & AIDS in selected age groups

22
 Strategies in Managing HIV and AIDS
1. Prevent people becoming infected with HIV;
2. To expand the availability of treatment;
3. To provide the best care for people living with HIV and AIDS and their
families— by bringing down the viral load, we reduce the risk of
transmission;
4. To expand access and uptake of HIV testing and counseling so that people
can learn their HIV status— to me, knowing your status is the best
approach. people must understand what is their level of infection. VCT
facility must be available
5. To strengthen health care systems so that they can deliver quality and
sustainable HIV and AIDS programs & services;
6. To improve HIV and AIDS information systems, including HIV surveillance,
monitoring, evaluation and operational research.

Interventions
• Know your epidemic— Countries must know the epidemic. What are the
other driver? They must do a study, a survey.
• Preventions activities with evidence-informed— There is no argument on the
usefulness of needles, condom.

• Improve coverage / Universal Access— What is the best coverage? For

epidemiologists, it is 60 percent at minimum.

• Encourage for individual to know their status and act on it—I don’t
encourage for self test; I encourage for VCT. The moment they know their
status, they should be able to act immediately. If they are not able to act
immediately, the test means nothing

• Addressing stigma and discrimination— We cannot run away. We try to

bring down stigma. The moment stigma is there, they run away.

23
 New Infection if We Implement Best Practices Intervention Packages for SW
and Clients, MSM and IDUs

If we do the intervention effectively, we will manage to bring down cases

either from the MSM group, FSW.

Malaysia National Strategic Plan 2006 - 2010

Approaches

1. The ONLY MDG not achieved— Our government is really committed and
asked us to please tackle HIV. Since main driver is through sharing needles,
what we are trying to do is to tackle those men or women who share
needles. We have a multi-sectoral approach.
2. Epidemic characteristic of the country
3. Multi-sectoral approach – Government, NGO, Communities, Religious
leaders, UN agencies

The Strategies

• Strengthening Leadership and Advocacy

• Training and Capacity Enhancement

• Reducing HIV vulnerability among Injecting Drug Users (IDUs) and their
Partners (NSEP and MMT)

• Reducing HIV vulnerability among Women, Young people and Children

• Reducing HIV vulnerability among marginalized and vulnerable groups

• Improving Access to Prevention, Treatment, Care and Support

24
 Annual New HIV Cases, Screening, Estimate, and Surveillance

We offer anybody at risk to come forward for VCT. We offer antenatal

screening. If you go to the figure on the top right and bottom right, the top
right is the figure from our estimation. In 2009, the estimate showed that
Malaysia should have roughly 89,000 people living with HIV. The bottom is our
surveillance data. It shows that at the end of 2009, Malaysia had 77,000 PLHA.
In Malaysia, HIV is a notifiable disease. We should notify when the patient is
diagnose, we should also notify when the patient died. We go to the left
bottom. The blue bar shows the number of screening. Despite the number of
screening, the figure is going down constantly. 2009, it was 10.8 per 100,000
population. Last year, we managed to reach out target of below 11. This year
we try to continue to show that HIV is no longer a target.
The HIV prevalence among MARP. The blue is IDU; it is plateauing, but
the other two is increasing a bit. there are the things we are trying to work
hard. In Malaysia, we are trying to address MSMs, clients of sex workers, and
sex workers.

Reducing HIV Vulnerability Among IDUs and Their Partners

Harm reduction
12th April 2006 : Cabinet approval
Targeted : 40,000 IDUs by 2010

(25,000 – MMT, 15,000 – NSEP)

Budget (Gov) : USD 56 mil (2006 – 2010)
National Task Force on Harm Reduction: (Various agencies) Health Disease
Control, Psychiatrist, ID Physician, Pharmaceutical, Anti-Drug, Police, Prison,
Religious, University, Internal Security, NGO

25
 We just have a pilot project. At the same time, we tried to tackle our
cabinet and prime minister on harm reduction. The cabinet approved on 2006.
From 2006 to 2010, we tried to tackle 30 percent of our estimate. The
government allocated 56 million dollar. To deal with that there is a national
task force on harm reduction. These people discuss how the best approach to
deal with this problem. We didn’t even changed a single policy through
harmonization.

Achievements of the Needle and Syringe Exchange Program

NSEP 2006 2007 2008 2009

NGO-Based
• DIC 3 5 4 2

• Outreach pt 42 64 106 206

NSEP Health Center 0 0 6 22

Total 45 69 116 230

Year 2006 2007 2008 2009

Target (cumulative) 1,200 7,200 10,800 15,000

Registered clients 4,357 2,301 5,572 6,147

Total clients 4,357 6,658 12,230 18,377

(cumulative)
Return rate of needles 58.6 62.2 63.2 65.9
(%)
Retention rate 75.1% 78.4% 71.1 % 69.5%

The approach being used by the government is we asked NGOs to do

the exchange program and at the same time, we have a public facility for the
program; at least one public clinic running the NSEP. The government will
allocate a fund to fund these program.

26
 MMT Achievement

MMT 2006 2007 2008 2009

Target (cumulative) 1,200 5,000 10,000 15,000
Registered clients 1,241 2,777 3,047 3,665

Cumulative clients 1,241 4,018 7,065 10,730

Active clients 932 3,242 5,024 7,455

Retention rate 75.1% 78.4% 71.1 % 69.5%

Death : 283
2008 2009 June
Stop : 297
HIV Screening 7065 7928
% HIV Detected 21.9 18.7 Defaulted : 1,461

Lessons learned

• Strong leadership needed in implementing interventions

• Smart Partnership (Government, Non-government, Private and Communities)

is important in scaling-up programmes - In Malaysia, on strategy number 5,
we know that the best persons to handle these are the NGOs and
communities. That is why we fund them. there is mutual respect between
governments, NGOs, and community; they are the best person who know
the best thing to do for this group. That is why the Malaysian government
agreed to fund NGOs to run these projects.
• Good surveillance data important in drafting policy

• Monitoring and Evaluation must be in place for any interventions

• Workable Strategic Plan and Setting target are important in implementing

prevention, treatment, care and support for HIV and AIDS

27
 Status of the National Response: Philippines Progress
Report on HIV and AIDS
Undersecretary Austere Panadero, Dept. of the Interior and Local
Government

Honorable Guests, Ladies and gentlemen, Good morning!

Experts classify the Philippines HIV situation as “low prevalence with
accelerated spread amongst men having sex with men or MSM and people who
inject drugs or PWID”, which means that the HIV prevalence is still low.
However, this is no reason for us to be complacent. Dir. Tayag in his
presentation showed to us the alarming increase in trend of HIV infection noted
especially in the last four years. For a low HIV prevalent country like ours, we
were early to institute actions on prevention that aimed at averting a large-scale
epidemic. Our HIV program through our AIDS Medium Term Plan directs and
works on to prevent the maximum number of new HIV infections by focusing
interventions on population groups that are most-at-risk of getting infected.
However, the question remains: in spite our efforts to respond to our epidemic,
what could have brought about the change in trend and why is it that the HIV in
the Philippine continues to increase?
My talk aims at presenting to you the status of our national response to
HIV and AIDS and in the end will try to answer the question, what could have
brought about this shift in our epidemic?
The Guiding Principle of the national response to avert the possibility of
having a full-blown HIV epidemic is anchored on the Republic Act 8504 or the
Philippine AIDS Prevention and Control Act of 1998. To strengthen the existing
law and makes its provisions relevant to the changing times and ever evolving
dynamics of HIV prevention in the country, Bill No. 1389 or An Act
Strengthening Further the Philippine Comprehensive Policy on the Prevention
and Control of AIDS was proposed in the last 14th Congress of the House of
Representatives.

Some legal issues relating to HIV and AIDS in the Philippines that need
to be considered in the provisions of the bill are the issues on confidentiality,
non-discrimination of persons living with HIV and prohibition of compulsory
testing. Sex work being illegal, yet common in many areas; drug use is often
treated as a criminal, rather than social or health issue; and, the need to
legislate harm reduction strategies for people who inject drugs.
To promote greater access to treatment, care and support to HIV
services and commodities, the country has in placed in its national response
one coordinating authority. The Philippine National AIDS Council (PNAC),
constituted in 1992, is the central coordinating body on HIV and AIDS in the
country. It has its legal mandate to set policy directions and monitor measures
and programs that are responsive to the identified needs of sectors, individuals,
and groups most affected by the epidemic, give priority to the infected and
affected individuals and to existing and emergent highly vulnerable groups.
The AIDS Medium Term Plan, the strategic plan on HIV and AIDS articulates the
provision of the law based on the current epidemic. This year, we will start

28
 formulating the strategic country plan on HIV and AIDS for 2011 to 2016.
Aside from coordinating the national response, the PNAC also ensures that our
country response is aligned to the vision, goals, and purposes of the Medium
Term Philippine Development Plan (MTPDP), the Millennium Development Goals
(MDG), UNGASS Declaration of Commitment on HIV and AIDS and the ASEAN
Joint Ministerial Statement and other international commitments relevant to the
country.

Governance
From 2007 to 2009, the country was successful in establishing guidelines and
protocols through the following documents:

• Operating Guidelines for HIV and AIDS Core Team (HACT)

• AO 2009 - 0016: Policies and Guidelines on the Prevention of Mother to

Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV)
• AO 2009 - 0006: Guidelines on Antiretroviral Therapy (ART) among Adults
and Adolescents with Human Immunodeficiency Virus (HIV)

• AO 2008 - 0022: Policies and Guidelines in the Collaborative Approach of TB

and HIV Prevention and Control

• 2008 Antiretroviral Therapy For HIV Infection, Recommendations for Adults

in the Philippines
With these protocols and guidelines formulated, full implementation of
its provision remains to be a major challenge.
Prevention
The National Response focuses on prevention of HIV infection amongst
the country-identified most at risk population or MARPs. These are sex workers
with their clients, men who have sex with men and persons who inject drugs.
The response also pays particular attention to vulnerable groups like the
Overseas Filipino Workers or OFWs, children and youth in difficult situations.
This thrust is in keeping with the low prevalence and concentrated epidemic
status.
In 2009, the Department of the Interior and Local Government,
Department of Social Welfare and Development and the Department of Health
jointly signed a memorandum circular creating the Regional AIDS Assistance
Team or RAAT. Seventeen (17) regional teams composed of technical persons
from the regional offices of the three mentioned national agencies were
organized. The team is tasked primarily to provide technical assistance to LGUs
needing assistance in developing their local response to HIV and AIDS. The
capacitation of RAATs to meet its objective is overseen by the Local Government
Academy of the Department of the Interior and Local Government.

29
 While we are building the capacity of regional offices to provide
technical assistance on HIV, the local government units especially in areas with
high cases of reported STI infections and with high presence of MARPS have
started organized local AIDS response. With assistance from the national level,
to date, there are 39 LGUs with organized local response to STI and HIV.

The National AIDS, STI Prevention and Control Program of the

Department of Health coordinates and provide policy guidance, technical
assistance, capacity building to service points in the implementation of program
delivery on STI and HIV and AIDS treatment, care and support. At present,
there are 32 public voluntary counseling and treatment or VCT centers with
trained counselors and medical technologist established in the country.
National program records at end of 2009 showed that there are nine (9)
LGUs that adopted injecting drug use harm reduction programmes to prevent
HIV transmission through this mode. Thirty Thousand eight hundred twenty
four (33,824) needles/syringes were distributed for an estimated 20,000 people
who inject drugs, or 1.69 needles/syringes per PWID. None of the sites
implements substitution therapy because there is no established evidence for
substitution therapy for Nalbuphine, the commonly used substance among local
IDU. Other HIV related interventions for IDU include drug dependency
treatment; HIV testing and counseling; antiretroviral therapy; STI prevention and
treatment; condom programs for IDU and their sexual partners; targeted IEC;
and prevention diagnosis and treatment of TB.

One of the significant developments that the country has achieved in the
area of prevention is the involvement of faith-based organisations in the
promotion of preventive measures against HIV transmission. Starting 2008, the
Catholic Church Pastoral Workers initiated their prevention and care programme
in two (2) dioceses in the country. Communication message underscores the
value of abstinence and mutual monogamous relationship amongst its
parishioners.
Treatment, Care, and Support

In 2009, 114 local administrative units in the country are in need of HIV
service facilities. From a previously reported 16 facilities, there are now 23
health facilities that offer antiretroviral therapy - 13 of these public facilities, 6
are private, 4 are "unspecified."
Community and home based care services are provided by NGOs, peers,
and community representatives. However, the capacity to implement interim
comprehensive treatment, care and support services package (both human
resource and logistics) needs to be strengthened.
Through the Department of Health, 13 treatment hubs across the
country are now in place where patients can access free anti-retroviral drugs or

30
 ARV. This is with support from Rounds 3, 5 and 6 of the Global Funds: AIDS, TB
and Malaria. Treatment hubs, which are hospital-based facilities, are currently
the platform for HIV counseling and testing, treatment of opportunistic
infection, universal precaution and infection control and psychosocial support
to people living with HIV and AIDS. Key medical examinations are also being
provided free through the treatment Hubs. Furthermore, early infant diagnosis
is now being done centrally to ensure that treatment is provided at the earliest
opportune time for infants and children infected.
Aside from the 13 treatment hubs established, 68 hospitals, both public
and private are with organized HIV and AIDS Core Teams or HACTs, which have
been capacitated and updated on HIV and AIDS clinical management. Among
these are three (3) private facilities serve as access points for ARV like Makati
Medical Center in Luzon and two (2) clinics in Cebu, (Chong Hua and Cebu
Doctors hospitals). The program continues engaging private hospitals to set up
a private-public partnership for HIV and AIDS care, treatment and support.

People being afflicted with a lifetime diagnosis of HIV infection need

continuing support for a better quality of life. Psychosocial, spiritual, self-
empowerment and values orientation training, micro-financing/livelihood
support, and even burial assistance are currently being provided by the
Department of Social Welfare and Development, the Department of Health, Faith
-based organizations, Positive Action Foundation, Phil (PAFPI) and Pinoy PLUS
Association. Care and support activities include hospital, home and community
visits, peer education and counseling.
In addition to the DOH, the DSWD also institutionalized a treatment,
care and support program under its own mandate. Services facilitated by this
agency ranges from policy development and capability building of local leaders
and volunteers who provide care and support to PLWHAs; as well as direct
livelihood assistance to PLHIVs.
With GFATM support, the National Health Insurance Program enrolled
200 PLHIVs. To date the Department of Health and positive community are
working together with Philhealth to finalize the implementing rules and
regulation of HIV Out-Patient Benefit Package.
Aspect of the response with improvements
A mechanism for the country to assess progress in the development and
implementation of national level HIV and AIDS policies, strategies and law is
gauged through the National Composite Policy Index. In some aspect of the
response, significant improvements have been noted by both the government
and the civil society sectors. These are efforts pertaining to:

• the implementation of HIV treatment, care and support programs;

• monitoring and evaluation of the HIV program;

31
 • enforcement of existing policies, laws and regulations; and,

• increase participation of civil society.

Areas that need scaling-up of efforts

While areas that require efforts to scale-up are:
• Policies, laws and regulations to promote and protect human rights in
relation to HIV as well as policies in support to HIV prevention;

• political support for the HIV programs;

• inclusion of HIV in strategy planning efforts;

♦ to really implement of HIV prevention programs focusing more on the

most at risk population especially the free lance sex workers, men having
sex with men and person who inject drugs; also,

♦ to meet the HIV-related needs of orphans and other vulnerable children.

National spending on HIV and AIDS: 2007 - 2009

20% (Domestic)

(External )
67%

(Private)
13%

After presenting the aspects of the national response, allow me to

present the National Spending on HIV and AIDS from 2007 to 2009. This figure
shows that the bulk of spending is from external sources. From 2007 to 2009,
about 67 percent of the country’s total resources spent on AIDS came from
external sources, while 20 percent came from domestic sources. Among the
external sources, the biggest contribution in 2007 came from the bilateral
funds, specifically the German Development Bank (Kfw) contributing about Php
88 million. Global Fund contributed about Php128 million in 2008, and Php318
million in 2009. Other external contributors include UN agencies, Asian
Development Bank (ADB), European Commission (EC), United States Agency for
International Development (USAID), World Bank and World Health Organization.

32
 Domestic resources on the other hand include spending by the
Department of Health (DOH), the Philippine National AIDS Council Secretariat,
San Lazaro Hospital, Department of Social Welfare and Development (DSWD),
the Occupational Safety and Health Center (OSHC) of the Department of Labor
and Employment (DOLE), Department of the Interior and Local Government
(DILG), and five local government units.
The expenditures of non-government organizations are usually sourced
out from development partners and international NGOs. Notably, most of AIDS-
related activities are being carried out by NGOs. These NGOs include: Action
for Health Care Initiatives (ACHIEVE), AIDS Society of the Philippines (ASP),
Health Action Information Network, Lunduyan, Philippine NGO Council (PNGOC),
Pinoy Plus, Positive Action Foundation Phils., Inc., TLF-SHARE Collective and
Tropical Disease Foundation amongst others. Private spending also includes
corporate contributions (like Levis) and internally generated funds from civil
society group as in the case of the DKT Philippines.

One must take note though that in spite of the increasing trend in
support coming from the external and domestic sectors; still what we are
putting into our national response is not enough to address the magnitude of
the HIV and AIDS problem.
Philippine Scorecard in selected HIV key indicators
Given with these information the primordial question remains: What
could have brought about this shift in the Philippine HIV epidemic?
The succeeding slides of my presentation present the results of different
studies conducted from 2007 to 2009. For us to better appreciate the meaning
of the figures that will be presented, allow me to briefly talk about Universal
Access or UA to Treatment Care and Support. Universal Access pertains to our
national commitment to improve access to HIV prevention, treatment, care and
support such as coverage of anti-retroviral drugs, prevention of mother to child
transmission, coverage of prevention programs for most at risk groups and
testing coverage. Achieving Universal access is a critical mid-way point to
reaching the Millennium Development Goal to ‘halt and reverse the AIDS
epidemic.’ Eighty percent (80%) coverage of prevention programs to make an
impact on the epidemic, and 60 percent of target populations with correct
knowledge and behavior to reverse and stop it is our UA goal.
• Low level of knowledge on HIV among women and men 15-24 years old:

Know preventive measures : 54.3%

Reject misconception : 20.7%

• 2.1% (2009) as compared to 1%(2007) of women reported to have had

sexual intercourse before the age of 15 (NDHS data)

33
 The National Demographic Health Survey of 2008 showed that 54.3
percent of 4,896 women aged 15-49 surveyed correctly identified ways of
preventing the sexual transmission of HIV and 20.7 percent rejected major
misconceptions on HIV transmission. Both figure are way below the 60 percent
UA benchmark that we set for our country.

Further, the same survey showed that women who reported to have had
sexual intercourse before the age of 15 increased from one percent in 2007 to
2.1 percent in 2009.

• 6.7% (N= 8415) of women aged 15-49 years who participated in NDHS
reported to have had sexual intercourse with more than one (1) partner in
the last 12 months
• 12.6% (N=276) of women 15-49 years old who have had sexual intercourse
with more than one (1) partner in the last 12 month who reported to have
used condom
The 2008 NDHS revealed that 6.7 percent of 8415 women from age
group 15-49 years old interviewed admitted to have had multiple sexual
partners in the last 12 month. Breakdown of prevalence as to age showed the
following results: 16 percent for women aged 15 to 19 years old; nine percent
for 20 to 24 year old and six percent for 25 to 49.
While reported use of a condom during the last intercourse amongst
women who reported to have had more than one (1) partner in the past 12
months was at 12.6%. This figure is below the 60 percent UA benchmark.

2007 2009
Low but improving reach of prevention programs among most at risk population
(MARPs)
Female sex workers 14% 55%
Males having sex with males 19% 29%
Injecting drug users 14% 11&
Low but improving level of knowledge on HIV
Female sex workers 2% 30%
Males having sex with males 10% 34.3%
Injecting drug users 26% 44.6%

34
 The slide showed the extent of reach or coverage of our intervention
program as well as the level of knowledge on HIV amongst the most at risk
population. As we can see in this slide, there was an improvement in the level
of reach or coverage of our prevention programs for FSW and MSM from 2007
as compared to 2009 but if we have to compare to the UA target, still fall shorts
of the benchmark of 60 percent.
If we will look at the low level of knowledge on HIV amongst the groups,
we will note that there has been an improvement in the knowledge amongst
them. However, for the knowledge to have an impact on the course of the
epidemic, we need to double up our efforts and really be more aggressive in
our education campaign.

• Adequate (65% in 2007 and in 2009) condom use among “registered” FSW,
but low condom use for MSM and PWID
2007 2009

MSM 32% 32%

PWID as clients 22%
as sex workers 11%

• High (85% in 2009) reported use of sterile injecting equipment among

PWIDs as compared to 48 percent in 2007.

The use of prophylactic has remained the same amongst the female sex
workers in the findings of the recently completed Integrated HIV Serologic and
Behavioral Surveillance. However as shown in this slide, the use of condom
remains below the 60 percent UA benchmark for men having sex with men and
persons who inject blood. One must note also that the high practice of using of
sterile injecting equipment is high amongst persons who inject drugs. Why it
then that infection of HIV amongst this group is high? Possible reason for such
may be due to the low use of condom amongst this group (either as a client of a
sex worker or as a sex worker). Hence, transmission of the virus continues to
spread.

Low percentage of MARPS that had an HIV test and know the result
2007 2009
FSW 12% 19%
MSM 16% 7%
PWID 4% 1.4%

This slide shows the percentage of MARPS who had HIV test and know
their result. As shown, the 2009 revealed a general decrease amongst the
MARP. This information informs us of a need to formulate and design more
innovative and appealing ways of promoting and ensuring access to voluntary
35
 counseling and testing. Though this is primarily a part health program, it is
vital that concerted effort to encourage people especially those with high-risk
behavior to know their HIV status. It is crucial that we have to make available in
all appropriate venues for people to self assess their risk to HIV.
• Good number (96%) of blood units are screened for HIV

• Good number (84%) of PLHIV adults and children with advanced HIV are
receiving ART as compared to 56% in 2007

• Good number (80 %) of HIV+ TB co-infected cases treated for TB and HIV as
compared to 49% in 2007
As a country, we have achieved good coverage in areas of ensuring the
blood unit are screened for HIV in a quality assured manner. Data from the
DOH-NVSBP showed that 96 percent of 658,884 blood units donated have been
screened for HIV. In addition to this information, data from Global Fund Round
6 reports a 102% accomplishment in blood screening for 2009.
As to the Anti retroviral therapy or ART coverage, (84%) of PLHIV adults
and children with advanced HIV are receiving ART as compared to 56 percent in
2007. Eighty percent (80%) of estimated HIV+ incident TB cases received
treatment for TB and HIV. This figure is much higher to the 2007 figure of 49
percent.
Challenges

Having presented the factors that have bearing on the epidemic, we are left
here with the challenges that need to be addressed by us as a country:

• Resolve inconsistencies between R.A. 8504 and other existing policies;

• Active involvement of all stakeholders in planning and implementation of
strategies in addressing the epidemic;
• Lobbying for Political support among National and Local leaders for a
sustainable investment on HIV;
• Scale -up coverage of intervention program both at the national and local
level; and,
• Strengthening of Monitoring and Evaluation System.

In closing, what we have initiated as a country to address the issue on

HIV is far from completion. The spread of the virus continues and the impact it
will effect to our people will be determined by the level of response we put in
place now and the manner we prioritize and sustain quality interventions to the
future.
A pleasant day to all! Thank you!

36
 A Call to Action: How Must We Address HIV and AIDS
Undersecretary Alice Bala, Department of Social Welfare and
Development

Good morning to everyone. Sec. Cabral, my former boss. And I am very

glad to see her because she is the moving force, now that we are having an HIV
Summit.
A call to action lays down our agenda. It is an agenda that is based on
the evidence we have learned from the previous presentation. We have heard
form Dr. Tayag about where we are right now. We have heard Usec. Panadero
on the responses at the national level and at the local level. Later, during the
afternoon sessions, delegates have the opportunity to respond how as
representatives your sectors could contribute actions in this Agenda. Starting
hereon, we face the challenges posed by our partners from DoH, DILG, in
consideration as well as recommendations made during the midterm
assessment of the 4th AMTP. This call to action anticipates the country’s
transition into the 5th AMTP.
For purposes of our discussion, let’s look at emerging imperative
actions to respond to challenges, presented in five themes or areas – policy and
governance, investments, physical and human resources, coverage of
programmes, and evidence-based decisions to influence programmes.
Even with an accelerating epidemic, we must note that with the guidance
of Republic Act 8504, its implementing rules, regulations, succeeding program
guidelines and strategic plans were the policy structures that facilitated gains in
our responses. Without R.A. 8504, we could have been in worse state, sooner.
From scientific evidence, we know that we have employed the right
approaches. The essence of the challenge posed by the accelerating epidemic is
the sufficiency to meet the promise of our policy – i.e. TO GET AHEAD of the
epidemic.
So in having the right policy framework, we need to strengthen it –
updating rules and regulations, proposing key amendments, developing further
policy guidance. Immediately, these policy agenda emerge as “top of the heap”
– preventing sexual transmission of HIV, preventing HIV transmission through
sharing contaminated needles and syringes, mechanism for redress on HIV
related discrimination, instituting impact mitigation of HIV and AIDS, sustaining
antiretroviral therapy for people living with HIV.
The implementation of this policy guidance should already inform the
design of AMTP-5.
Institutions and people are the living and breathing bodies of the
national response, the policies the soul. To counter the invisibility of HIV is to
raise the visibility of institutions and people in action. These action points strive
to fulfil the vision of coordinated partnerships to empower the nation against
HIV.
PNAC has mandated “centrality” to the response. But a comprehensive,
decentralized system involving all sectors is equally mandated, organized from
within our sectors and vitally interlinked with each other.
Learning from past medium-term planning, AMTP-5 will have a stronger
framework; it will be operationalized with an investment plan.
An investment plan shall be influenced by what we know of our past
AIDS spending. We have heard the presentation of Usec. Panadero on the

37
 amount, and sad to say, as Sec. Cabral also mentioned, most of these came
from external sources. This is a challenge for all of us
While I was listening to Dr. Tayag, 50 thousand per year per person. And
I was computing that since the number of MARP are in the young generation,
and I was trying to compute a call center agent earning P20,000 a month. At 12
months, you will have P240,000 in terms of productivity cost. And it takes 11
years and you will have something like 2.6 million in terms of loss of
productivity cost for just one person. If you look at the figures being presented
at 50,000 per person.
It aligns with the resource needs of the MOST URGENT interventions (as
we will see later). And it also has to be an instrument of putting all stakeholders
on one table. The investment plan will be guided by these parameters.
Earlier, we have seen the likely scenario if we don’t calibrate and ante up
our efforts. Our increasing HIV cases can cripple the economy. Money that we
will spend to prevent HIV and care for those affected are not mere expenses,
they are an INVESTMENT.
Where should investments go? Our investments should ensure a
functional system of management and delivery of services with quality and
capacity to the scale of the urgency. We’re talking here of physical and
human resources, represented namely by these agenda.

Our increasing Put together, we should be guided by the steady responsive

three E’s - Engage people into the response, equip those who are
HIV cases can engaged, and ensure resources are always available.
cripple the
Policies, investments and structures – all these should clearly
economy.
benefit services that have the best evidence to halt the spread of HIV.
There are services that should fulfill the promise that HIV prevention is
everybody’s right and responsibility. But we should have more
intensive efforts where the epidemic has most burden, namely among
these populations.
For most-at-risk populations, essential combination of interventions
include sexuality and HIV education, access to commodities such as clean
needles and condoms, HIV counseling and testing and STI and HIV treatment.
The services may be differentiated according to the risk setting, but it should
never be taken as “multiple choice;” it is a PACKAGE.
Interventions focused to most-at-risk groups and to the general
populace are not mutually exclusive or two options for the choice of one.
Environment to sustain life-time commitment to HIV prevention means having
the populace benefit from both.
Our Law recognizes this. Education for HIV prevention and skills for
healthy, risk-free lives are for people from all walks of life. Education for HIV
prevention refers to knowledge on how to prevent the infection, rejection of
major myths and misconceptions, referral to services like HIV counseling and
testing.
Comprehensive and sustained programs for people living with HIV also
enhances the effectiveness of HIV prevention. Similarly quality treatment
programmes are economically feasible when prevention programs reach their

38
 universal coverage targets. Getting ahead of the epidemic means pulling back
the speed of HIV from ravaging the populace – which is what the continuum
from prevention to treatment can do. As with prevention, these action points
are never meant to be broken apart.
Though its proportion with “local transmission” decreased, migrant
workers infected with HIV continue to rise. Targeted interventions for OFWs
across the country greatly vary. While not within the agenda of massive scale-in
in the first three years of AMTP-V, migrant worker interventions will remain a
strategic component in the entire life of the Plan.
Other vulnerable social conditions in the populace have probable
implications to health risk. With an accelerating rate, we don’t have the luxury
to wait and see HIV’s entry into other groups. To establish HIV risks and
vulnerabilities of these populations shall be strategic.
R.A. 8504 also recognizes that our responses must be multi-sectoral,
multi-faceted and seamlessly linked. The roots to people’s HIV vulnerability are
never the ambit of health sector alone. This is not just a health; it is economic,
political, and more importantly, it is a socio-cultural issue.
MARPs interventions will be most accessible and effective in an
environment that is aware of what HIV means for every person, sensitive to the
issues that drive the epidemic, and in a continuum and range of responses that
affirms dignity of every person.
We are here today, constructively looking at our current situation,
because for one, we know the epidemic better now. The picture painted by the
presentations today must not scare us; it should alert us that we all have to do
our part in the response.
After this event, we take our learning towards planning an even more
robust and finely tuned response. The following points are very strong
reminders. The information we don’t have now should not impede our effort to
a greater area. It should inform us what more we need to do.
Strategies, approaches and targets – as we should, we will anchor them
on timely response, accurate, best available scientific evidence. It is not myths,
naririnig lang. We relate them with the principles and provisions enshrined in
the Law. With your sustained participation in the future, we hope to jointly
witness the figures progressively changing for the better. If you have seen the
extrapolation, we would have seen the difference from a 100 percent
intervention and we will have zero infections.
Sa inyong lahat, mabuhay tayo and good morning to everyone.

39
 Open Forum

Philippine Hospital Association, VP for Luzon: This is not really a question,

but I was intrigued by a very irresponsible remark from one of the speakers,
again pinpointing a young call center agent with regards to HIV. In the past, a
very direct statement was mentioned in media, pinpointing the source of HIV
among the young workers of call centers. Let us stop using the word culture-
sensitive, compassion, or confidentiality if we continue to pinpoint a group or
individuals that might have HIV or AIDS.

Usec. Bala: Thank you, doctor. There was no intention. I just mentioned an
example because this is where most young people are working now. Just to
illustrate that when the presentation was made, nowadays, most of the young
are working at call centers.
Dr. Soe, WHO Country Representative: I would like to highlight the point that
Usec. Bala made. In terms of looking at the consequence of the disease, we
should not be looking only at the cost of treatment; we should also be looking
at the cost of loss. Although HIV is a communicable disease, we need to look at
the productivity loss of a patient. It is not pinpointing a particular group, but as
a group that we all know have a lot of young professionals. When you have
young professionals with HIV, you are looking at a productive loss down the
road. When you add up all these loss, the loss to society is tremendous.
Mr. Mario Taguiwalo: I would like to think that this summit has involved many
people and groups that have been working on preventing a larger epidemic. My
question is how should our efforts be different because we have been doing
this for the past ten years? We saw the data, the spending has increased. Yet
the data shows that the epidemic continues to grow. How different should our
efforts be? That should be the question that we should ask ourselves. What
kind of changes do you think is necessary?
Dr. Eric Tayag: The NEC looks at the evolution of the epidemic and looking at
the responses attendant to the evolution of the epidemic, we know for a fact
that for FSW, we were able to held in check the HIV infection. We have a reversal
in the female to male ration. We look at the Social Hygiene Clinic for the success
in FSW. But we are also wondering if change has happened in the last three
years. Let me give you this scenario: is it because FSWs have access to social
clinics and were able to negotiate with their clients and have protected sex, or
are we looking at a different scenario where young people sleep around and
they don’t have to pay for sex anymore? And so we have a changing picture of
the epidemic. In the past, we look at interventions and these catered more to
FSWs. Only in the last three years did we see the writing on the wall. There was
a lag before the NGOs and government can calibrate interventions. What has
changed now in the equation is that MSMs are hidden population, unlike the
FSWs. As well as the IDU. It has been a dilemma among our groups how to
handle MSM. In the US, we reviewed evidence on how they were successful. First
the group of MSM brought It upon themselves to police themselves and reduce
40
 their partners and refrain from anal sex. Here, how do we do that? We don’t see
any models where there is a cohesive group of MSM. Right now, we find their
access in the Internet and it is going to be a challenge. With IDUs, the writings
were on the wall. We know that if our HIV epidemic becomes worse, it is
because it would probably start from IDUs. What has happened is that they were
sharing needles. We attempted a harm reduction but our resources did not
allow us to sustain it. So when HIV was introduced into the group of IDUS, it
spread like wildfire. Looking back, there was a problem with harm reduction
because it is not acceptable. That is something we should change. For example,
those health providers who are able to engage in harm reduction, some of them
got killed along the way because they were branded as drug pushers, criminals.
I have to say this because the time for sharing this information is now. We really
have to face the problem. Exactly how we will respond to this new situation is
how the summit was planned so we can get our acts together. What we are
doing in the past two years will not work now.

Usec. Panadero: While we have successes with FSW, the strategy we do then
would not apply with MSM and IDUs. I’d like to focus on the issue of coverage.
It is time to map ourselves, who will reach who? How can we strengthen
partnership between NGOs and government? We have experimented with this
way back, working in projects. It is about time we find a way to scale it up.
Ms. Emilyne Verzosa, Philippine Commission on Women: I would like to
believe that if we infuse a gender-perspective in all of the policies and programs
we plan, hopefully we can get somewhere. We can get for example, in terms of
FSW, the correct term is people in prostitution. The male population who use
prostituted women, that is a factor that we can perhaps look into. We did host
an ASEAN conference on programming and legislating the connection between
gender-based violence and HIV and we’ve had some recommendations. In that
conference, the positive women didn’t even realize that they’ve already
experienced violence. So I’d like to propose that we deepen our understanding
on gender-based violence and infuse this in our program.
Dr. Eric Tayag: The way I understood your questions is if development can
come into equation. We reviewed the evidence and most interventions failed
when it became a developmental issue. To reduce prostitution, ahead of what
we can actually provide interventions for effective protection is a recipe for
failure. We reviewed evidence that developmental interventions can only do so
much but after you have initiated and provided sustainable intervention. I would
also like to add that the abstinence, be faithful, and condom should not be
simplified. And we want tor reiterate this because there should be a better
understanding of where they are coming from. For example, when we say that
we are going to promote condom, it is not as simple as that. There are studies
that say condom may reduce the risk, but it will not eliminate the risk. There
are studies also that we have to have a better understanding of our sexual risk

41
 behavior. For example, now is the time not to tell MSMs that it all about
condom because they have to be told of the risk of a plethora of sexual
behaviors. For example, kissing has no risk. On the other hand of the spectrum
is your receptive anal sex. In between is your fellatio or oral sex. Unless you
understand the spectrum of the risk of sexual behaviors, then we are not going
to move forward. We’ll be stymied. For example, young women who giggle
when they talk about condom. It’s a long road, but we don’t have enough time
because the evidence shows that we have to move fast and we have to move
fast in Region 7, where we have the IDUs; Davao and Metro Manila. We do not
have to spread ourselves thinly. There is a debate even among our groups on
whether we go focused, or we go universal.
Dr. Jondee Flavier: I was saddened by the news I hear regarding the increase in
HIV among MSM and in Region 7. But I’d also like to look at the silver lining.
You pointed out that in region 3, in fact, incidence has decreased. And among
OFWs, while it is still increasing, the increase is not as bas as the general
population. I was trying to look at what we are doing right in region, among
OFWs?
Dr. Eric Tayag: One of the challenges is if we are able to measure and evaluate
our interventions. Those of you who have actually implemented interventions,
that you share with us your assessment of these interventions so they can be
shared as bets practices and they can be duplicated in similar situation. We
don’t have enough information what really works under what situations, so you
really have to share that information with us. For example with region 3. Is it
just plain luck? We don’t want to put all our money in the same basket. We want
to make sure that we gather enough information and we use them so we can
calibrate our response.
Dr. Soe: What Eric is saying is because of the very sensitive nature of HIV, what
we have in our hand is not a complete evidence. We still have to fill most gaps.
We are trying our best effort and in most of those, we have to rely on sentinel
sites and surveys. As you all know, those will not catch 100 percent of the data.
But one thing that interest me from the presentation of my colleague in
Malaysia, and which is something that the Philippines should aim for, in terms
of looking at the recipe and looking at your estimation from different models.
Our strategy should be to get the estimation of the registry as close to that of
the estimation model. One thing that our colleague has presented is the
relationship of VCT and the coverage of that test. It is very important for us to
promote. Even now that we have PICT. The bigger the population who know
their status, the better for us. I would like to ask my colleague, how do they
manage to get the VCT to a very high level? This is one thing that Mario
mentioned, what needs to be done? One of the things we have to do is to
promote VCT.

Dr. Ngadiman: Regarding VCT, we tried to assure that every facility is able to
42
 do VCT. Following that, this testing is available, even in NGO in the
communities. Beside the VCT, we have anonymous testing. It is not famous;
nobody likes to join anonymous testing. What we do is we ask for volunteer
couples. Initially, this was rejected, but surprisingly, 16,000 couples came. Last
year, we had 179,000. All our health facilities are able to do testing on anyone
who wants to get married. On the VCT, we have about 20,000. Of those in
prison, we have routine screening. One more thing is we do a contact tracing on
those who are positive. So far, 70 percent of them came for testing. If you try to
work on contact tracing, I know that much of the country disagree with contract
tracing. They thought that we tried to break confidentiality. Actually, it is not.
My staff, they do not wear uniforms, they will come to you and ask you who are
your contacts. We ask them to come forward to get VCT. Six months later, if
they are negative, and every six months. By doing that we try to ensure that all
those who are negative will same that way.
Dr. Poblete: You must understand that we were Malaysia was, ten years ago.
When the epidemic hit Malaysia, they had an intact health system and a
maternal health program.
Dr. Mon San Pascual: I am very pleased with the leadership of DoH for bringing
this to the public. When this first broke out in the news, about the condom
distribution, the DoH spokesperson tried to focus that action to be associated
with HIV prevention. And yet, condom is also controversial, being a part of the
whole range of family planning methods being proposed in the RH bill. As an
advocate of RH and AIDS prevention, we are a bit worried when there is a
segregation. How do we address this very much related issue, of lack of family
planning services visibly, condom distribution.
Ms. Beth Angsioco, DSWP and RHAN: In relation with what Mon has said, my
general observation in all the presentations is that it gives me the idea that HIV
is a problem all by itself. It does not exist in a certain situation, and as an RH
advocate, we very strongly feel that HIV is integral to people’s RH. Even in DoH,
there is such a thing as STI and HIV prevention and treatment as an aspect of
the total program., When we speak of education, what came to my mind is that
if RH Bill passes, then this thing could be taken up because of the very
progressive provision of the bill, which would empower young and old people
alike in terms of everything that has to do with sexuality. Therefore, our appeal
to this summit is not to forget that HIV is very much related to RH.
Mr. Carlo Alcala, PAFPI: I was thinking about the roles of the court because this
has a relation in reconciling the mandates of the Dangerous Drug Board and
DoH. I don’t know how a common statement, if it has been forged, could stop
the police from killing health workers because they are simply following their
legislative mandate. The solution is through the court. Second, if we have to
reconcile concepts of morality with our faith-based organizations. Recently, the
Supreme Court released its decision on Ang Ladlad. It deals with the issue of
43
 morality, of what is politically acceptable. think we have to work under this
framework of secular morality. Politicians and implementors should not bow to
the dictates of faith-based organization, but should take morality in the context
of secular morality.
Mr. Mario Taguiwalo: Let me share my observation. The first point, why should
the DOH regard condom simply as an STI product? The other question was, why
would the whole HIV effort simply deal with HIV, removed from the larger issue
of RH?
Dr. Edsel, UP-PHG: My question is about contract tracing. I’ve been very
disappointed with how contact tracing has happened with my patients. The law
itself says that the DoH may conduct contact tracing. It’s a mandatory thing that
has to be done because it is to their best interest. Until now, I tell my patients
you know we really have to know your sexual contact. When I was doing my
training in the US, the infection control nurse would trace everybody all the way
down and it could be done in a confidential manner. For the AIDS Law, there
has to be a stronger law that mandates contact tracing because if we are talking
about an epidemic, we really have to find where the cases are.
Mr. Humphrey Gorriceta: I want to go back to the RH issue because I am
working on the logic of what everyone has given. From how I see it, it’s not a
question of what we can do. The question is how are we going to do it.
Currently, we have laws in place. The AIDS law has been there for a while,
unfortunately it is not being implemented. Another one is sex education. We
have a policy governing that, another unfortunate situation is it is not being
implemented. Now we have the RH bill being put in place, and hopefully it
would be approved. But what if it is not implemented? That is the question. We
can put all the bills and policies, but how strongly can we implement them?
Another thing is incorporating sex education in formal schools. From the
presentations, I’ve heard many of our presentors mentioned that we need to
have a deeper knowledge of understanding. How much do we understand of
what we are up against? How confident are we that the policies we have and we
are pushing for will be implemented?
Dr. Catiboc, DOH: The query was regarding the use of condom both as a family
planning method and also as part of the prevention program. As far as the DoH
is concerned, the policy on family planning is still the same. What changes was
the pronouncement of Pres. Arroyo on the mainstreaming of the Natural Family
Planning at the national level. There was a devolution of basic health services,
including family planning services. So the service component is now under the
ambit of the LGUs. But in terms of RH policy, there is really a need for a
legislation on RH. There was a question on the problem of implementation. At
the level of the DoH, we have an existing policy as far back as 1998. There were
two AOs which reiterated the adoption of an integrated RH program covering
the ten essential elements. I hope that settles down the controversy.
44
 Dr. Jay Del Mundo: I was so proud of DOH during that Dangwa caper. I am now
representing the Jesus is Lord Church. I could see the drift of the summit. The
drug rehabilitation centers were under my supervision before. I’d like to quote a
study by Chris and Floyd which was published in the Lancet. This study showed
that the cost effectiveness of HIV blood testing and targeted condom
distribution with a cost of 11 dollars. And a gain in DLY by one year which
showed that HIV testing is cost effective. I’d like to go back on Article 17 Sec 3
of RA 8504. Tying this up with RA 9960, I did not see an exception for drug
addicts confined to rehabilitation centers and it is my wish that this be included
in the amendment to the law. That those who will be confided in drug
rehabilitation centers should undergo testing. There has been an increased
prevalence in IDUs. It is very important that this should be included as an
exception to the prohibition on compulsory testing. There is a part in Cebu,
which is very notorious for Novain injection. In fact, they can get it for only ten
pesos.
Mr. Alex Castro, Advertising Board of the Philippines: I just like to make an
observation from a communications stand point. It’s a cardinal rule in our
profession that single mindedness in the message is very important. I have an
observation today that in seems from the point of views being raised that this
idea of single mindedness is somehow being violated. Obviously, what I see is
the trend seems to point towards HIV being a concern of two particular
markets; MSM and IDUs. When I look at these two markets, if we may call them,
this would be a non-RH concern. For purposes of effectiveness in
communications, I think we have to take it into consideration.

Dr. Eric Tayag: Gathered around a campfire where teen scouts sharing needles.
When this practice was pointed out to them by their scout master, one of them
quickly repartee and told the teacher: “Don’t worry teacher, we’re all using
condom.” It takes some time before you get the meaning of this. I have
described the downstream infections. HIV transmission in the Philippines is
complex. It’s not like it is only among IDUs, or that MSMs do not have sex with
women. We are taking pains so tthat there would be a better understanding of
how the epidemic is evolving. That is why we wanted to share with you a good
data. For example, I would also like to share data and this would bring your
heart down, the advocates of reproductive health. There has been evidence that
sex education, while it may delay sexual initiation, it has not affected the
incidence of STI. We are looking at evidence. That is why we want to know from
you if you have successes in your interventions. You share it with us.
For family planning, you don’t use condom every time. For HIV and AIDS, there
is only one standard. You use it always and consistently.
Ms. Nenneth Ortega: Based on the presentation of Usec. Panadero, it showed
that the Philippines is really donor-dependent, but it was said that there would
be an investment plan for HIV. Aside from the investment planning, what can
45
 we do differently? It was also mentioned earlier that there has been 200 PLHIV
that has been enrolled by the Philhealth. Is this part of the program or is it part
of Global Fund? How do we roll out the enrollment of those who are qualified?
Second, sabi ni Usec. Bala, we should be informed by evidences in making
decisions. At the local level, this is where the actions are supposed to happen.
National is supposed to provide resources and assistance to the LGUs. How can
they start something when there are no geographical data provided for them?
For LGUs, it is an important data for them so they can start somewehere. For
example in Pangasinan, there are 27 people living with HIV and AIDS. The LGU
did not know that there are already cases. What are the packages of
intervention that we can provide so that the LGUs can start somewhere else?
The next one, particular ako sa buhay ng PLHA. We understand that ARV has
been provided through GF. What about sustainability after GF? Are there plans
to come up with a treatment plan? How do we increase funding support for
NGOs?

Usec. Panadero: There are two local main sources. One is to propose to the
congress that the national should allocate more funds. Two is really a
continuing advocacy with LGUs as well. There are LGUs who have done
significant work. I don’t know if there are representatives from Angeles, Baguio,
and Zamboanga. Dapat natin silang i-congratulate. Zamboanga won an award
for their effort, largely with a partnership with NGO. We have to figure out a
more aggressive strategy to encourage our local governments to increase their
investments. On the package of assistance for LGUs, the RAATs would have
this package that they could roll out to LGUs. They are based at the regional
office and they can be tapped to support the local efforts.
Dr. Gerard Belimac: This is in response to the query a while ago regarding the
sustainability of treatment. The enrollment of 200 PLHA to Philhealth is part of
the commitment of the department in providing comprehensive prevention,
treatment, care, and support. Incidentally, this initiative is, this gap is filled in
by GF. The priority of the 200 is the category is those who are really poor. The
grant manager for enrollment is PAFPI but they are working with other
organizations to ensure that there is equity. as for sustainability, we don’t really
assure the UA access to treatment covers the P200 million requirement for ARV.
Last year, we worked with the positive community in setting up a livelihood
program. This livelihood program, supported by Global Fund, would hopefully
sustain their treatment beyond the GF project. On top of this livelihood
program, the Philhealth has now assumed its responsibility in implementing the
ARV package, in the form of P30,000 person per year.
Mr. Ryan Trani, Filipino Free Thinkers: One of the speaker said that the
debate was over when it came to condom use. I agree that the debate is over, at
least in this room and for all rational people in this country. But one huge
powerful influential organization disagrees and I’m surprised that they haven’t

46
 been mentioned yet. They are the CBCP. The DoH can do al it can to educate the
country on sexual health matters, but the people who go to schools, people
who go to church, candidates who run for public positions are influenced by
this organization. If this were some organization that is spreading massive lies,
the government will definitely do something about this. The fact is most of us
here are still members of this organization. What are we going t o do about it?
Mr. Ferdie Buenviaje, TLF-Share Collective: Yung discussions about RH hindi
naman kailangang magbangga. Yung appreciation ko sa RH is it helps you
improve your health systems; it sets up the base. If we have good RH program
now, as our colleague in Malaysia said, they have a very good health system.
Yung encouraging VCT is easier to do. Second, yung isang kailangang tignan,
ano ba ang mga health systems improvements ang kailangang gawin? Ano ang
socio-political reforms na kailangang gawin para ma-improve mo ang capacity
ng community to participate. For example, ang capacity ng community is to be
recognized, to be less afraid of the strong hand of the law as with IDUs. Pero
agree ako sa sinabi ng kasama natin sa Adboard na kailangan mo talaga ang
message discipline. Baka meron talagang ibang mensahe sa AIDS while
sinusuportahan ng RH ang AIDS.
Dr. Delen dela Paz, Health Action Information Network: While I agree with
Ferdie that we need to look at the context of HIV in the broader frameworks of
socio-economic determinants of health and PHC, looking at the message from
advertising, looking at the theme, there are a lot of sectors here. We are looking
at a broad response. This is really addressing how we as multisectoral can be
acting together. The message will be tailor fit to your organization, but certainly
we will converge. I’d like to add that RH is very much a part of this discussion
because STI and HIV is one of the ten elements of RH as identified in the 1994
International Conference on Population and Development so we should not
disassociate one from another. Lastly, I’d like to comment on investment. While
I appreciate the support of the local governments in introducing a lot of
projects in their local areas, I think the national government still has a lot of
roles to play, particularly PNAC. There are 36 members, most of which are
government agencies. And every time we have a meeting and we will be asking,
they would say that we have incorporated it in our projects but DBM cuts it
down because it says that it is a health problem. HIV and AIDS is not a problem
of the health sector alone. So the national government should really have a
stronger role. The DoH says it has an existing policy, but where is the
implementing program? That is what we are looking for. The program really has
to be supported by budget allocation. National budget should be released. But
where is the national budget?

Mr. Jericho Paterno: One of our major concerns and of course yung goal namin
is magkaroon ng UA to treatment. Kami ay worried na yung free access to ARV

47
 ay until 2012. Since then, maganda naman ang reply ng DOH. Sana matugunan
ito para tuloy tuloy ang treatment namin.

SUMMARY OF RECOMMENDATIONS

The following are the recommendations that emerged from the plenary, as
synthesized by Mr. Mario Taguiwalo:
1. Learn from the successful reduction of HIV and AIDS prevalence among
female sex workers, which is partly attributed to the success of social
hygiene clinics in reaching out to this sector;
2. Greater efforts to reach MSM to understand them better and to
implement prevention activities;
3. More effective reach and prevention among IDUs;
4. Main intervention measures should focus on attaining the UA targets (60
to 80%);
5. Better application of gender perspective;
6. Priority should be given to areas with higher concentration of HIV and
AIDS cases (Metro Manila, Cebu, and Davao);
7. Increase the practice of VCT and transform this into a routine service
and remove the stigma attached to VCT (e.g., perception that people
who avail of VCT are HIV positive);
8. Balance the issue of HIV in relation to the larger issue of reproductive
health;
9. Wider and more consistent practice of contact tracing to immediately
identify people at risk and to modify their behavior as quickly as
possible;
10. Provision of blood testing among substance abuse patients in drug
rehabilitation facilities – this may warrant an amendment to the existing
law;
11. Use the participants’ collective knowledge on adolescent reproductive
health, given the fact that sexual activity is occurring among the youth;
12. Find ways to increase the coverage of Philhealth on HIV prevention and
treatment;
13. Link treatment and care with LGUs where people living with HIV and
AIDS reside – this will assure treatment sustainability when the Global
Fund ends;
14. The national government, through the Philippine National AIDS Council,
should have a stronger role in the fight against HIV and AIDS. This can
be made possible through an increased budgetary funding which can
flow through NGOs and LGUs.
48
 Break-out Groups Plenary

Policy

• Identification of policies and laws that are often violated or not

implemented or that impedes implementation of HIV programs. This
entails the popularization and advocacy for a common interpretation at
all levels
• Identification of aspects that would need a policy, law, or amendments
(e.g., RA 8504, harm reduction policy, Anti-Vagrancy Act)

• Harmonize contravening laws and policies

• Implementation of the law, especially the AIDS Law

• Participate in budget deliberation in the new Congress to ensure that

sufficient resources are allotted equitably for treatment, care, support,
and prevention.
Key program areas

• Harm reduction

• Access to treatment that is comprehensive and sustainable

• package of interventions for young people and children who are at risk

• Stigma, discrimination, and access to justice for PLHIV

• Mandatory HIV testing and its implications on foreign policy

negotiations

• Passage of the RH law with strengthened HIV provision

Investment

• Investment in a good AMTP

• In-house HIV education within sector

• Continuing advocacy and leadership

• Care and support for PLHIV

• Harm reduction task force

• Sustainable treatment

• Accountability, M&E system

• Human resource development

• Full implementation of RA 8504

• Advocacy on RH bill

49
 Resources

• Create an HIV and AIDS advocacy module that is appropriate for its
target audience

• Form a lobby group in Congress to get the needed budget for HIV and
AIDS program

• For stronger and longer-term sustainable partnership between NGOs

and GOs

• Implement existing sex education programs in schools comprehensively

• Integrate sectoral and multisectoral efforts

• Use social networking, websites, and other technology to gather and

coordinate volunteers

• Make advocacy efforts gender-responsive, rights-based, and culture-

sensitive

• Invest more in HIV and AIDS prevention effort

• Gather resources for VCT

• Pass the RH bill, Anti-prostitution bill, and the Magna Carta for Women

• Maximize National Health Insurance programs through innovative ways

Coverage

• An effective coverage would require good collaboration and partnership

• Resources of each agency should be maximized

• Education coverage should include the general population, MARPs, and

PLHA.

• Existing policies should be strengthened

• Inclusion of HIV and AIDS in curriculum development

M&E

• Form database for ongoing and completed researches

• Review RA 8504 and the Dangerous Drug Board in light of the present
situation

• Make preliminary survey on relevance of provision of RA 8504 and

problems therein

• Set research agenda and research priorities based on gaps and

deficiencies of data
• Set minimum research standards to maximize research impacts

50
 • For specific research, use key words to facilitate searching

• Specific research priorities: population size, high risk behavior, program

coverage

• Translation of data and utilization of data to change policy

• Explore legal and ethical dilemmas in relation to research

51
 Summit Synthesis
Mr. Mario Taguiwalo

From what we’ve heard this morning, this is the story that we get - we
remain a low prevalence country with a relatively small number of cases, but we
are experiencing a rapid growth of cases from a relatively small base.
Number two, if we just follow our present course, given the status of the
epidemic and the state of our response, we will have a bigger epidemic down
the road. How much bigger and when, these are things that can be discussed
and debated.
Our current efforts at prevention has not been effective even at a
relatively small base of infection. So you have to think about, if the base of
infection becomes bigger, how much less effective would our effort be? If we
cannot handle it at the level we have now, ho much able are we to handle a
bigger base of infection?

Clearly, a different and better effort is needed that uses the assets that
we have built up over the years. What are these assets? Institutions like PNAC,
knowledge-base resources, capabilities in our social hygiene clinics and at the
hospitals, organizations such as NGOs. Most important are the relationship of
trust, cooperation, mutual respect, and finally, whatever laws and policies we
have already passed.
What I thought this summit was all t is to begin to describe what are the
features of these efforts to prevent further rapid increase of HIV infection. We
are simply beginning to describe the solution we are looking for. We may not
be in a position yet to define the solutions.

Earlier, I shared with you 13 recommendations coming from our plenary.

I thought those were good recommendations that our PNAC and those groups
will have to follow through. Let me share with you what I thought are the most
important things that we should be thinking about. Clearly, number one, I just
thought if I were to come out of this summit with the three most important
things that we should be trying to find a way to get done in the next six
months, or the next years, this is my personal three priorities:
A legal policy guidance that would enable harm reduction among IDUs.
What are these guidance? If you look at the amendment of the Dangerous Drug
Board, it would take years… It may not even happen because there might be
people who would play politics with this issue. However, we could start thinking
about a Department of Justice opinion that defines under what conditions might
a harm reduction program might be legally permissible and what are the
conditions under which it can be done. If the sectary of health would take that
position and say that this is an emergency, we need a legal approach; it should
be possible.
My second priority is what I call a budget strategy for national
government funding of effective HIV prevention. Whatever action that you need

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 to take, you have to admit, it would require resources. We should begin by
adopting a policy that which will begin by domestic resources matching
external funding. The 70-30 ratio should be shortly changed to at least 50-50
so that the national government should raise the level, or a level of at least 300
to 400 million a year. In that strategy you can start talking about linking the
national government funding with LGU funding on some kind of a matching
grant basis, that should possibly be multi-tiered to allow organizations and
agencies to learn how to reach the target population and how to improve
prevention, and the national government funding should be a window that
would enable NGOs to access these funding whenever they perform activities
that the government is not suited for. It is not realistic for us to expect the
NGOs to raise their own funding to perform the work of the national
government; the national government should make available funding that
would enable NGOs. Finally, the budget strategy should link funding with
results on reducing risk for a specific population. If you have a funding for
Metro Davao, you should allow LGUs, NGOs to start working on reducing the
prevalence of risky behavior in Davao, and use the funding to an improved
situation.
We may not know at this moment how to reach MSM and how to reach
MSM and how to modify their risky behaviors. But we certainly could think up of
creating multi-years funding program that would accelerate organized learning.
We might begin by saying that in the next five years, we will have a 100-million
pesos available. As we move along, we wean away those organizations that are
not effective, and pretty soon, we will have the most effective organizations. Via
that mechanism we can begin to learn to be more effective in reaching this
group.
Let me now proceed with the results of your group work; as usual there
are many different perspective. What I thought useful is to advice PNAC and its
related agencies on how to proceed with moving beyond this summit. There are
several frameworks that emerged. I call this framework for future efforts in HIV
prevention
One framework said let’s take the AIDS Law and let’s implement it. That
is one framework that you can follow.
Another framework is let’s look at the current knowledge and let’s use
this knowledge to serve as a basis for action. We use whatever is available in
the AIDS Law but you look at other items that are not in the AIDS Law. These
are two different approaches. One is a legal framework that mandates
implementation according to the law. If we have followed this at the beginning
of the law’s approval, we could have been in a different place. Time has passed
and this situation is there. The next thing is what would be the viable mandate
of PNAC to direct whatever is the national effort to prevent the spread of this
epidemic. I thought that the presentation of where we are and where we could
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 be was a premise to say that it’s not as if our national epidemic is zero, or our
knowledge is zero. We are in a situation where we have some knowledge. As we
say, we know what we know. We also know what we don’t know. At the very
least, we have this available knowledge. The idea is let’s attempt to build a new
program based on available information about our epidemic.

What we really trying to do is what should guide our planning an

organized action. My recommendation is let us use what we know now as the
basis for building our action, keeping in mind that what we know will continue
to change. And I hope that you will have a good day and a good week ahead of
you.

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 Closing Remarks
Mr. Humprey Gorriceta

Good afternoon. I personally want to thank Tita Charie for that heart-
warming song. I want to reiterate. I am currently the spokesperson for the Na-
tional Federation of Filipinos Living With HIV. On behalf of the positive commu-
nity, I would like to express my utmost gratitude, to all of you for prioritizing
this. I personally would like to thank PNAC for putting up with this activity. The
fight against HIV is one of the greatest challenge our country is facing. In the
course of human history there has never been a greater threat than the HIV and
AIDS epidemic. The epidemic is made worse by the unbearable stigma and
discrimination that continues to exist in our everyday lives. The first HIV infec-
tion in the Philippines was reported back in 1984. Nevertheless, we have
achieved a number of important breakthrough and milestones. More than ten
years ago, the first therapies were discovered, sparing thousands of lives and
giving hope to millions of people living with HIV. Right now, we have the poten-
tial for mobilizing the logistics to stem the epidemic. What is lacking however is
the political will of our leaders.

Today we are all gathered here to unite and reach the goal of stopping
HIV. All of us is definitely going to be criticized if we do not respond with all the
resources and efforts we can mobilize. We should stay focused and determined
to put a stop to the enemy. As we agreed on the conclusion of this gathering,
we should all ensure that the national response should be sufficient to change
the course of the epidemic.
Before we come to a close, I would like to leave the following messages.
First, to our national and local governments, as the people seated in position,
you hold the candle of hope for our survival. I urged all of you, national and lo-
cal leaders, to push for HIV treatment plan to a higher level and put it in action.
I called for the Filipino HIV treatment plan. This is our constitutional right. I
know this is easier said than done. It would mean that we have to allocate more
budget for health. The health care infrastructure should be improved and the
inequity between the private and public health sector need to be reduced. As
the cliché goes, if there is a will, there is a way. And let me translate that in Fili-
pino: kung gusto may paraan, kung ayaw may dahilan.
To the church leaders, we are proud that the church has strongly shaped
our values. The sanctity of life is fundamental in all of us and we also believe in
strong family ties. For this reason, we would like to recommend to the church
leader to please continue with your promotion of positive values. However,
please do not be a hindrance to the government’s advocacy to impart further
education on how we can protect ourselves. Can we efficiently exercise the
same values we acquire from you? What is the use of the values you give us if
we are not going to use it?
To the media and the academe, you are powerful social agents of
change. For this reason you play a very important role in the fight against HIV
and AIDS. I would like to ask the media to be more responsible in their coverage
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 and to help our spread accurate information. And the academe, please support
sex education that is unbiased, informed, and scientifically sound. We trust you
will not fail us on this.
To the civil society and funders, from the bottom of our hearts, we would like to
express our sincerest gratitude for your unwavering support in our fight against
HIV and AIDS. Let us maintain good relationship until we reach our goals and
aspiration. And lastly, to the positive community, we would like to remind eve-
ryone to continue to strive to be productive members of the community and the
society. Continue to be active in education, advocacy, care and support to en-
hance our lives and others. Continue to strive for improvements in the quality
of lives of your infected and affected brothers and sisters. We should work bet-
ter to ensure better communications among stakeholders and key partners. We
owe nothing less to our young people and future generation. This is our obliga-
tion. To show responsibility, a spirit of partnership, a spirit of solidarity to put
an end to this dreadful experience caused by this irreversible disease. Let us all
work together to make this nation a safer, a healthier, and a better place to live
in.
Thank you very much and ingat lagi.

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