TakingStock_COVER.indd 1 7/3/2013 9:17:42 PM TakingStock_COVER.indd 2 7/3/2013 9:18:54 PM TakingStock_final-072013.indd 1 7/3/2013 9:22:29 PM Copyright © 2013 Health Action Information Network 26 Sampaguita Avenue Mapayapa Village 1127 Quezon City Philippines Tel. (+632) 952.6312 Fax. (+632) 952.6409 Email: [email protected] Website: www.hain.org ISBN - 978-971-8508-38-1 Disclaimer: The information contained in this report is drawn from multiple sources including key informant interviews, focus group discussion and extensive literature review. The views expressed in this publication are those of the authors and do not necessarily represent those of the United Nations Development Programme. THE QUOTES USED APPEAR VERBATIM AND WERE VALIDATED BY THE INFORMANTS. TakingStock_final-072013.indd 2 7/3/2013 9:22:29 PM Table of Contents EXECUTIVE SUMMARY 1. INTRODUCTION 1.1 Rationale 1.2 Objectives 1.3 MSM and TGs 1.4 Analytical Framework 2. METHODOLOGY 2.1 Data Sources and Data Gathering 2.2 Study Respondents and Study Sites 2.3 Survey Instruments 2.4 Scope and Limitations 3. OVERVIEW: Asia-Pacific and Philippine HIV Situation and Survey of Initiatives 3.1 Asia-Pacific and the Philippines 3.2 Interventions 3.2.1 Prevention 3.2.2 Treatment, Care and Support 3.2.3 Enabling Environment 3.2.4 Strategic Information 3.2.5 Supportive Interventions 4. SURVEY OF PHILIPPINE INTERVENTIONS 4.1 Key National Programs Implemented 4.1.1 Prevention 4.1.2 Treatment, Care and Support 4.1.3 Enabling Environment 4.1.4 Strategic Information 4.1.5 Supportive Interventions 4.2 Current Community Interventions 4.2.1 Prevention 4.2.2 Support 5. DISCUSSION 6. RECOMMENDATIONS ANNEX Taking Stock 3 TakingStock_final-072013.indd 3 7/3/2013 9:22:29 PM Acronyms AIDS Acquired Immune Deficiency Syndrome AMTP AIDS Medium Term Plan AMTP IV Fourth AIDS Medium Term Plan AMTP V Fifth AIDS Medium Term Plan ART Anti-Retroviral Therapy ASEP AIDS Surveillance and Education Project ASP AIDS Society of the Philippines BHWs Barangay Health Workers CHD Center for Health and Development CSO Civil Society Organization CUP Condom Use Program CEMSHAD Centre for Multidisciplinary Studies on Health and Development DepEd Department of Education DILG Department of the Interior and Local Government DOH Department of Health DSWD Department of Social Welfare and Development FLSW Freelance Female Sex Worker FHI Family Health International GFATM Global Fund for AIDS, TB and Malaria HIV Human Immunodeficiency Virus HDES Human Development and Empowerment Services IEC Information, Education and Communication ICT Information Communication Technology LAC Local AIDS Council LGU Local Government Unit LGBTIQ Lesbian, Gay, Bisexual, Transgender, Intersexed,Questioning M&E Monitoring and Evaluation MARP Most-At-Risk Population MDG Millennium Development Goals MSM Men Who Have Sex with Men MTDP Medium Term Development Plan NEC National Epidemiology Center NDHS National Demographic and Health Survey NGO Non-Governmental Organization OI Opportunistic Infections PIP People in Prostitution PLHIV People Living with HIV PNAC Philippine National AIDS Council PAMA-Q Peer Educators Movement for Empowerment – Pasay, Manila, Caloocan and Quezon City PBSP Philippine Business for Social Progress PHANSuP Philippine NGO Support Program Inc. PNGOC Philippine NGO Council on Population, Health and Welfare PRRM Philippine Rural Reconstruction Movement RA Republic Act RAAT Regional AIDS Assistance Teams RHWC Reproductive Health Wellness Center SHED Social Health Environment and Development Foundation, Inc. SMS Short Messaging Service SPMC Southern Philippines Medical Center (Formerly Davao Medical Center) SHC Social Hygiene Clinic STD Sexually Transmitted Disease STI Sexually Transmitted Infection TCS Treatment, Care and Support TLF-SHARE COLLECTIVE TLF Sexuality, Health and Rights Educators Collective Inc. UNAIDS Joint United Nations Programme on HIV/AIDS UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session VCT Voluntary Counseling and Testing UNICEF United Nations Children’s Fund WHO World Health Organization 4 TakingStock_final-072013.indd 4 7/3/2013 9:22:29 PM Acknowledgements This survey was conducted by the Health Action Information Network, Inc. (HAIN) in partnership with the United Nations Development Programme. INFORMANTS RESEARCH TEAM THE PLHIV COMMUNITY EFENITA MAY TAQUEBAN PEER EDUCATORS MIKAEL N. NAVARRO JEFF Y. FUENTES The MSM and transgender participants of the different focus NOEMI D. BAYONETA-LEIS group discussions that were conducted. EMILY C. MAGHARING DR. CARMINA AQUINO, USAID MR. EDDIE BATOON, Iwag Dabaw HAIN wishes to acknowledge a range of stakeholders who DR. JOSE GERARD BELIMAC, NASPCP-DOH contributed to the development of this study. MR. FERDIE BUENVIAJE, TLF-SHARE Collective MR. NICOLO COSME, The Project Headshot Clinic and The REVIEW Red Whistle Campaign WILLIAM WELLS, World Health Organization MR. GLENN CRUZ, TLF-SHARE Collective PHILIP CASTRO, United Nations Development Programme MS. CHARMAINE CU-UNJIENG, Yoga for Life EDMUND SETTLE, United Nations Development MR. JOSEL DE MESA, TLF-SHARE Collective Programme, Asia-Pacific Regional Centre DR. ROSANNA DITANGCO, Research Institute for Tropical NALYN SIRIPONG, East-West Center, Hawaii Medicine DR. MA. SUZETTE B. ENCISA, Social Hygiene Clinicn, EDITING Bernardo NOEMI D. BAYONETA-LEIS DR. ALICIA LAYUG, Southern Philippines Medical Center MICHAEL DAVID C. TAN MR. PAOLO LENIDO, Yoga for Life MS. RUTHY LIBATIQUE, PNGOC DESIGN MR. ANASTACIO MARASIGAN, TLF-SHARE Collective JANIS DEI O. ABAD DR. DIANE MENDOZA, Social Hygiene Clinic, Manila City MR. MICHAEL MAHINAY, ALAGAD Mindanao MR. RONIVIN PAGTAKHAN, The Loveyourself MRS. MARIFE PERLADE, Social Hygience Clinic Nurse, Pasay City DR. JORDANA RAMITERRE. Reproductive Health and Wellness Center, Davao City DR. JOANNE CARLOTA RAÑESES, Social Hygiene Clinic Physician, Pasay City MR. NICO JOSE SANTOS, Community Health Office Worker, Pasay City DR. ROSARIO JESSICA TACTACAN-ABRENICA, San Lazaro Hospital Taking Stock 5 TakingStock_final-072013.indd 5 7/3/2013 9:22:29 PM Executive Summary This survey focuses The year 2007 signaled a shift in the Phil- CONCLUSIONS ippine HIV epidemic. The Philippine HIV on the learnings and AIDS Registry indicates that from 2007, m National and local government health insti- and feedback of the there has been a significant spike in the tutions are the primary delivery institutions number of newly infected individuals, and a for prevention services. While there have proponents involved in shift in the dominant trend in sexual trans- been serious efforts to better systems and the implementation of mission of HIV infection from heterosexual deliver a more comprehensive and multi- key national programs contact at 29% to Men who have sex with disciplinary prevention package, this is men (MSM) at 71% (PNAC, 2010). From Jan- often challenged by the lack of resources and the emerging uary to May 2011, new HIV cases registered – i.e. the lack of commodities, understaff- community initiatives. a 20% increase relative to the same peri- ing and the lack of specialized personnel, od of the previous year, and 80% of which inadequate and inappropriate infrastruc- This survey also were MSM. ture, and the lack of support programs like includes highlights psychosocial counseling. Until recently, In March 2012, 313 Filipinos were recorded to there have been no specific interventions from PLHIV focus have acquired the virus, 82% more compared to address MSM and transgender people group discussions to the previous year. It was the highest number sexual health needs, and quality and ac- since 1984 in the history of the Philippine HIV cessible HIV treatment and care needs im- (FGDs). Three methods and AIDS registry. According to the report of the provements, reflecting an overall poor in- were used for the data National Epidemiology Center, sexual contact vestment in health. Collaborative efforts by gathering: desk review remains as the number one mode of transmis- public-NGO/community partnerships are sion, and MSM remain to be the number one strategies for augmenting the lack in ser- of relevant documents, trend of transmission at 83%. This seems to vices, e.g. NGO volunteers would augment key informant belie what has been said as an improving and the staffing of government hospitals. The expanding comprehensive prevention program collaborations have become the founda- interviews, and FGDs. in the country. tion of a sustained service delivery system. This survey focuses on the learnings and m There is a lack of consensus and consis- feedback of the proponents involved in the tency of service delivery throughout the implementation of key national programs country. Disinterest and lack of political and the emerging community initiatives. prioritization of HIV and AIDS program This survey also includes highlights from by local government units (LGUs) result PLHIV focus group discussions (FGDs). in conflicting, competing, and at times Three methods were used for the data outright lack of policies in LGUs. Where gathering: desk review of relevant docu- there are existing programs, snags in the ments, key informant interviews, and FGDs. implementation are attributed to unclear and conflicting mandates regarding MSM Specifically, the survey attempts to: and TGs, further aggravated by compet- ing policies on resource allocation. 1. Highlight the strengths and gaps of existing interventions (the current national response Documented best practices for service and the key