Philippine National AIDS Council

Session Objectives
At the end of the module, the participants should be able to:
Gain a clear understanding of the challenges to the country response to HIV and AIDS & how these can be addressed; and Know the significance of contributing to the national effort to halt the epidemic.
Philippine National AIDS Council

 Behavior-related factors

Programmatic factors Governance-related factors

Philippine National AIDS Council

1. Continuing risky behavior among the most-at-risk populations (MARPs)

2. Stigma & discrimination against persons living with HIV (PLHIVs) complicate the situation 3. Both behaviors (1 & 2) stem from a low knowledge of HIV and AIDS
Philippine National AIDS Council

1. Inadequacies in the system

2. Mainstreaming of STI and HIV 3. Funding Concerns 4. Monitoring & Evaluation

Philippine National AIDS Council

 Promoting correct & consistent use of condoms & ensuring their availability
Strengthening client-initiated counseling and testing (CICT) & ensuring quality assurance in HIV testing Institutionalizing programs on HIV&AIDS in the workplace
Philippine National AIDS Council

 Enabling all PLHIVs to access

ARV, ensuring more support Lab work-ups, expanding the referral system; facilitating OFW access to TCS

Ensuring & sustaining availability of ARVs

Source of Graphic: franklincountyhealthdepartment.health.officelive.com

Philippine National AIDS Council

 Need for an effective mechanism:

(a) for inclusion of STI, HIV & AIDS in all health-related programs for high-risk groups & the general public (b) for full engagement of LGUs in the delivery of the HIV & AIDS program at the local level
Philippine National AIDS Council

 Need for a bigger budget allocation from the national government Need for varied sources of funding to sustain the HIV & AIDS program Ensuring greater efficiency in the utilization of funds and resources

Philippine National AIDS Council

Getting both the national and local governments on board

Alignment of indicators

Gradual roll-out of the system

Philippine National AIDS Council

1. Lack of political support from the national and local levels

2. Lack of policy guidelines for effective implementation of STI, HIV and AIDS program

Philippine National AIDS Council

 Need for national leaders to see the urgency of supporting the HIV &AIDS country response Need for more LGUs to recognize the importance of HIV and AIDS prevention activities Need for more political champions

Frequent leadership changes

Philippine National AIDS Council

 Lack of political support = inadequate government funding for the country response Inadequate funding = shortfalls in key target areas
Philippine National AIDS Council

a. Lack of enabling policies b. Conflicting provisions of laws affecting HIV and AIDS program implementation

Philippine National AIDS Council

Need for policy guidelines on:

a. HIV counseling & testing in diagnostic centers for OFWs
b. PhilHealths Outpatient HIV and AIDS benefit

c. Referral and redress mechanisms in the workplace & the community

d. Reducing stigmatization & protecting PLHIVs from discrimination in the workplace and in seeking employment
Philippine National AIDS Council

Philippine National AIDS Council

5th AMTP Strategies Framework

GOAL
By 2016, the country will have prevented the further spread of HIV infection and reduced the impact of the disease on individuals, families, sectors and communities

STRATEGIC OBJECTIVES
To improve the coverage and quality of prevention programs for persons at most risk, vulnerable and living with HIV To improve the coverage and quality of TCS programs for people living with HIV (including those who remain at risk and vulnerable) and their families To enhance policies for scaling up implementation, effective management and coordination of HIV programs at all levels To strengthen capacities of the PNAC and its members to oversee the implementation of the 5th AMTP To strengthen partnerships and develop capacities for the 5th AMTP implementation of LGUs, private sector, civil society, including communities of atrisk, vulnerable, and living with HIV

KEY STRATEGIES
Develop evidence-based, targeted, comprehensive programs Capacitate service providers Provide equitable access to programs Enhance decentralized implementation Provide enabling environment Expand, build, strengthen management, partnerships and collaboration Develop capacity of partners

Philippine National AIDS Council

Indicator

2006 Baseline
19%

2010 Progress
29%

Status
OFF TRACK

Coverage
(Prevention)

Behavior
(Condom Use)

32%

32%

OFF TRACK

HIV Prevalence

0.28%

0.99%

PREVALENCE QUADRUPLED

Philippine National AIDS Council

Indicator

2006 Baseline 2010 Progress

14% 55%

Status
OFF TRACK

Coverage
(Prevention)

Behavior
(Condom Use)

65%

65%

OFF TRACK

HIV Prevalence

0.16%

0.24%

PREVALENCE DOUBLED

Philippine National AIDS Council

Indicator

2006 Baseline 2010 Progress

14% 2%

Status
OFF TRACK

Coverage
(Prevention)

Behavior
(Condom Use) As FSW Client As Sex Worker
No Data No Data 0.13% 22% 11% 0.21%
OFF TRACK OFF TRACK PREVALENCE DOUBLED (Grew by 53% in one site)

HIV Prevalence

Philippine National AIDS Council

Targets & Status of Efforts to Meet Targets

The huge shortfall in funding (expenditure) adversely affected all the other three indicators (coverage, behavior, & HIV Infection prevalence)

Philippine National AIDS Council

The Epidemic
On average, 6 new HIV cases per day (1 in every 4 hours) is reported in the country From 2006 to 2010, the number of males reported to have contracted HIV increased compared to that during the 2001-2005 period 72 of the countrys 80 provinces in all 17 regions have reported HIV cases In 2011, the NCR had 54% of reported HIV cases, Region IV-A 10%, Region XI (7%), Region VII (6%), Region III (6%), Region VI (3%) and Region I (2%)
Philippine National AIDS Council

The Epidemic
Since 2007, there has been a big shift from heterosexual transmission to homosexual transmission, peaking in 2010

HIV transmission among Persons Who Inject Drugs (PWIDs) is rapidly increasing from just 7 reported cases in the last 22 years (1984-2006) to 147 cases in 2010 alone

Philippine National AIDS Council

2009
Registered Female Sex Workers (RFSW) Freelance Female Sex Workers (FFSWs) Males having Sex with Males (MSMs) Persons Who Inject Drugs (PWID) (selected sites)
Source: IHBSS
Philippine National AIDS Council

2011
0.13% 0.68% 2.12% 13%

0.23% 0.54% 1.05% 0.21%

5th AMTP Target Populations and Sectors

Most-at-Risk Populations (MARPs) Female sex workers (FSW) Registered Establishments (RFSW) 2009 Estimates Low Estimate 109,732 (0.49%) High Estimate 125,662 (0.56%) 2015 Projections Low Estimate 128,003 (0.49%) High Estimate 146,289 (0.56%)

94,049 (0.42%)

n.a.

Freelance (FFSW)

15,682 (0.07%) 436,702 (1.90%) 390,733 (1.70%) 12,705 (0.03%)

31,612 (0.14%) 1,149,215 (5.00%) 689,529 (3.00%) 21,567 (0.05%)

n.a. 509,205 (1.90%) 455,604 (1.70%) 15,877 (0.03%)

n.a. 1,340,012 (5.00%) 804,007 (3.00%) 26,462 (0.05%)

Male Clients of FSW Males who have Sex with Males (MSM) Injecting Drug Users (IDU)

Philippine National AIDS Council

5th AMTP Target Populations and Sectors

Yearly Projections (2010 to 2015) Population Groups 2010 HIV Incidence in Adults (%) Adults and Children Living with HIV Male PLHIV Female PLHIV Adults with HIV (15 and above) Children with HIV (Below 15) HIV Prevalence in Adults (%) Adults, Children Newly Infected Adults, Children Dying from AIDS Adults Eligible for ART Male PLHIV Eligible for ART Female PLHIV Eligible for ART Female PLHIV in Need of PMTCT 0.01 12,027 8,439 3,587 11,870 157 0.02 3,622 250 1,494 1,043 450 215 2011 0.01 18,376 12,919 5,457 18,172 204 0.03 6,768 360 1,937 1,357 580 311 2012 0.01 25,224 17,744 7,480 24,953 271 0.05 7,434 501 2,596 1,821 775 440 2013 0.01 31,254 21,980 9,274 30,899 355 0.06 6,871 728 3,507 2,463 1,044 562 2014 0.01 38,131 26,805 11,325 37,678 453 0.07 8,039 1,024 4,641 3,260 1,381 682 2015 0.01 46,505 32,679 13,826 45,934 571 0.08 9,926 1,385 5,986 4,201 1,784 822

Prioritization of Resources: Averting New Infections

Cost of Interventions
Effect (averting new infections)
High-cost, High-impact Low-cost, High-impact (prevention among most-at-risk (antiretroviral treatment and prevention of mother-to-child populations) transmission) (with 95% of infection averted) Low-cost, Low-impact (general awareness programmes through mass media and other channels)

High-cost, Low-impact (health systems strengthening through universal precautions and injection safety)

Source: Commission on AIDS in Asia Report

Philippine National AIDS Council

Priority Directions
Prevention: cover 80% of most-at-risk
populations or MARPs (e.g., registered and freelance FSW, male sex workers or MSW, males having sex with males or MSM, & persons who inject drugs or PWID) by 2013 in areas where most infections are coming from.

Sites: Category A, Category B, Category C

Treatment: support 90% of PLHIV needing

anti-retroviral therapy (ART)
Philippine National AIDS Council

Priority Sites
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Category A Manila City Mandaluyong City Marikina City Pasig City Quezon City San Juan City Caloocan City Malabon City Navotas City Valenzuela City Las Pias City Makati City Muntinlupa City Paraaque City Pasay City Taguig City Pateros Danao City (Cebu) Cebu City Mandaue City (Cebu) Davao City Angeles City Category B Lapu-Lapu City (Cebu) Talisay City (Cebu) Antipolo City (Rizal) Cainta (Rizal) Bacoor (Cavite) Imus (Cavite) Dasmarias (Cavite) Lipa City (Batangas) Batangas City Bacolod City Puerto Princesa City (Palawan) Baguio City Iloilo City (Iloilo) Olongapo City Cagayan de Oro City Zamboanga City General Santos City Butuan City Category C San Fernando (Pampanga) Tarlac City, Tarlac Mabalacat (Pampanga) Dagupan City (Pangasinan) San Fernando (La Union) Iligan City Tagum (Davao del Norte) Panabo (Davao del Norte) Cotabato City Legaspi City Naga City Toledo (Cebu) Lucena City Cavite City San Pedro (Laguna) Calamba (Laguna) San Pablo (Laguna) Sta. Rosa (Laguna) Malolos (Bulacan) Meycauayan (Bulacan) San Jose del Monte (Bulacan) Marilao (Bulacan) Sta. Maria (Bulacan) San Mateo (Rizal) Taytay (Rizal) Tagbilaran City Tacloban City Malay (Aklan) Puerto Galera Tuguegarao City (Cagayan)

Philippine National AIDS Council

Key Strategies

Prevention for MARPs

Treatment services Systems strengthening

Philippine National AIDS Council

Basic Prevention Interventions for MARPs

STI diagnosis & treatment Condom provision Peer education HIV testing

Philippine National AIDS Council

Funding Targets for Prevention (2011-2016)

MARPs coverage Nationwide Category A, B & C Category A & B Category A only
In Philippine Pesos (PhP)

Investment target 11,885,375,404 3,629,770,247 2,896,968,612 1,996,853,868

Philippine National AIDS Council

Treatment Services for MARPs Anti-retroviral (ARV) drugs Monitoring of anti-retroviral therapy (ART) Drugs for opportunistic infections (OIs)
Philippine National AIDS Council

Treatment Investment Targets

2011 Projected ART need Target (90%) Pre-ARV work up 2,288 2,059 10,296,000 2012 5,190 4,671 23,355,000 2013 6,779 6,101 30,505,500 2014 8,732 7,859 39,294,000 2015 10,941 9,847 49,234,500 2016 13,709 12,338 61,689,723 214,374,723

PLHIV on 1st line (94% of target ) Cost of ARV 1st line PLHIV on 2nd line (6% Target)

1,936 12,775,277

4,391 28,978,884

5,735 37,851,224

7,387 48,755,995

9,256 61,090,168

11,598 76,544,609 265,996,157

124 Cost of ARV 2nd line Total cost of ARV Cost of monitoring Cost of OI tx Total cost of Tx (PhP) 9,241,690 22,016,966

280 20,963,448 49,942,332

366 27,381,737 65,232,961

472
35,270,294 84,026,290

591 44,192,887 105,283,055 168,596,062 66,358,259

740 55,372,696 131,917,304 192,422,752 458,418,908

35,257,087
13,876,949

79,975,648
31,477,869

104,461,448
41,115,313

134,556,330
52,960,453

211,247,081
83,145,409

734,093,655
288,934,252

Php81,447,002 Php184,750,849 Php241,315,222 Php310,837,073 Php389,471,876 Php487,999,518 1,695,821,539

Philippine National AIDS Council

Systems Strengthening
Capacity building, operations research, advocacy Social services Policy formulation Surveillance Partnership, localization

Philippine National AIDS Council

Systems Strengthening Funding Targets

SYSTEMS STRENGTHENING Capacity-building, advocacy Social Services and other treatmentrelated activities Policy environment 2011 2012 2013 2014 2015 2016 Total

22,471,400

92,043,200 18,543,200

18,543,200 18,543,200 18,543,200 188,687,400

258,132,333 247,618,833 244,968,833 244,968,833 244,968,833 244,968,833 1,485,626,500

8,780,200

7,132,500

3,592,500

3,642,500

3,592,500

3,642,500 30,382,700

27,900,000 28,900,000 29,900,000 30,900,000 Monitoring, Management support Partnership-building Total (in PhP) 3,796,000 1,693,000 993,000 993,000

31,900,000 993,000

32,900,000 182,400,000 993,000 9,461,000

321,079,933 377,387,533 297,997,533 299,047,533 299,997,533 301,047,533 1,896,557,600

Philippine National AIDS Council

Total Investment Targets

Prevention for MARPs (workplace, school-based, mass media)
Treatment services (medical) Systems strengthening (program management support)

Philippine National AIDS Council

Total Investment Targets

Investment coverage
Total (nationwide) Total (A, B, & C) Total (A & B)

2011

2012

2013

2014

2015

2016

SUM TOTAL
18,899,888,952

1,896,431,403

2,574,255,531

3,061,291,339

3,504,357,623

3,783,609,737

4,079,943,319

825,121,352

1,156,318,410

1,330,163,829

1,423,735,627

1,542,873,643

1,681,890,472

7,960,103,333

736,740,910

1,029,106,262

1,178,630,135

1,257,839,833

1,351,482,877

1,465,004,734

7,018,804,751

Total (A only)

621,982,878

878,147,819

984,770,883

1,051,308,761

1,132,636,538

1,233,843,128

5,902,690,007

Philippine National AIDS Council

Estimated Available Resources

Agency DOH DSWD DOLE DepEd USAID UN GF LGUs Total in Php 2011 95,000,000 15,000,000 3,000,000 1,500,000 43,000,000 64,500,000 94,600,000 119,000,000 435,600,000

Philippine National AIDS Council

Resource Gap Scenarios

Investment coverage Total Investments (2011-2016) 18,899,888,952 7,960,103,333 7,018,804,751 5,902,690,007 Est. funding gap (2011-2016) 16,286,288,952 5,346,503,333 4,405,204,751 3,289,090,007 Annual average funding gap 2,714,381,492 891,083,889 734,200,792 548,181,668

Nationwide Category A, B & C Category A & B Category A only

In Philippine Pesos

Philippine National AIDS Council

Financing
National Government (Systems Strengthening, TCS, Prevention) Local Government (Prevention for MARPs) Philhealth (Treatment) Private sector (Prevention) ODA and international organizations (Prevention, Systems Strengthening, TCS)

Philippine National AIDS Council

Major challenges to the country response

Generating more political support Need for enabling policies for efficient execution of programs Mainstreaming STI, HIV and AIDS in all healthrelated programs

Monitoring & evaluation More funding for STI, HIV & AIDS programs
Raising public awareness of STI, HIV and AIDS & translating knowledge to behavior change
Philippine National AIDS Council

 The 5th AMTP is the national blueprint for a comprehensive approach to the HIV challenge. But its goal of halting the spread of HIV & AIDS by 2016 can be realized only thru an aggressive campaign focused at high-risk & vulnerable groups, firm commitment to the campaign by government and key stakeholders, & sustained and adequate funding and resources for prevention and TCS.
Philippine National AIDS Council

Source of Graphic: franklincountyhealthdepartment.health.officelive.com

Philippine National AIDS Council