Communicable Diseases: HIV and AIDS


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  • The mature virus consists of a bar-shaped electron dense core containing the viral genome--two short strands of ribonucleic acid (RNA) about 9200 nucleotide bases long--along with the enzymes reverse transcriptase, protease, ribonuclease, and integrase, all encased in an outer lipid envelope with 72 surface projections containing an antigen, gp120, that aids in the binding of the virus to the target cells with CD4 receptors.
  • HIV has the additional ability to mutate easily, in large part due to the error rate of the reverse transcriptase enzyme, which introduces a mutation approximately once per 2000 incorporated nucleotides. This high mutation rate leads to the emergence of HIV variants within the infected person's cells that can resist immune attack, are more cytotoxic, can generate syncytia more readily, or can resist drug therapy. Over time, different tissues of the body may harbor differing HIV variants.
  • HIV infects the T helper cell because it has the protein CD4 on its surface, which HIV uses to attach itself to the cell before gaining entry. This is why the T helper cell is sometimes referred to as a CD4+ lymphocyte. Once it has found its way into a cell, HIV produces new copies of itself, which can then go on to infect other cells.
  • Most people infected with HIV do not know that they have become infected, becausethey do not feel ill immediately after infection. However, some people at the time ofseroconversion develop “Acute retroviral syndrome” which is a glandular fever-likeillness with fever, rash, joint pains and enlarged lymph nodes.After HIV has caused progressive deterioration of the immune system, increasedsusceptibility to infections may lead to symptoms.
  • HIV infection can generally be broken down into four distinct stages: primary infection, clinically asymptomatic stage, symptomatic HIV infection, and progression from HIV to AIDS. Primary HIV infection: lasts for a few weeks and is often accompanied by a short flu-like illness.Clinically asymptomatic stage:lasts for an average of ten years, free from major symptoms, although there may be swollen glands. Symptomatic HIV infection :The lymph nodes and tissues become damaged or 'burnt out' because of the years of activity; HIV mutates and becomes more pathogenic; The body fails to keep up with replacing the T helper cells that are lost. Progression from HIV to AIDS:develop increasingly severe opportunistic infections and cancers, leading eventually to an AIDS diagnosis.
  • For most people, it takes three months for these antibodies to develop. In rare cases, itcan take up to six months. During this “window period” of early infection a person is attheir most infectious.
  • However, there is still a possibility of being infected, since it can take up to three monthsfor your immune system to produce enough antibodies to show infection in a blood test.It is advisable to be re-tested at a later date, and to take appropriate precautions in themeantime. During the window period, a person is highly infectious, and should thereforetake measures to prevent any possible transmission.
  • Some of these medicines can produce side effects such as nausea and vomiting orheadaches. Usually most side effects are not serious and improve once the patient getsused to the medicines. However as with all medicines, sometimes unpleasant ordangerous side effects can appear. Some specific ARV medicines cause longer termchanges in body shape and the distribution of fat within the body, which can be upsettingfor the patient.
  • In December 2011, there were 268 new HIV Absero-positive individuals confirmed by the STD/AIDS Cooperative Central Laboratory (SACCL) and reported to the HIV and AIDS Registry 54% higher compared to the same period last year (n=174 in 2010) THUS This increased the total number of cases to 2,349 for 2011
  • Of the 2,349 HIV positive cases in 2011, ninety-four were reported as AIDS cases. Eighty-seven percent were males. Ages ranged from 1-59 years (median 31 years).
  • More than half (473) of sexual transmission was through heterosexual contact, followed by homosexual contact (317) then bisexual contact (106). Other modes of transmission include: mother-to-child transmission (18), blood transfusion (10), injecting drug use (6), and needle prick injuries (2) [Figure 4]. Three percent (28) of the AIDS cases did not report mode of HIV transmission.
  • Most (97%) of the cases were still asymptomatic at the time of reporting
  • there is a significant difference in the number of male and female cases reported. Eighty-two percent (6,890) were males. Ages ranged from 1-73 years (median 29 years). The age groups with the most number of cases were: 20-24 years (20%), 25-29 (27%) and 30-34 years (19%)
  • Among those sexually active in the 15-27 age groups, 34 percent reported having multiple sex partners. The percentage of young men and women engaging in unprotected sex was 70 percent and 68 percent, respectively. The percentage of young people who believe that there is no chance for them to contract HIV/AIDS was 60 percent. (2004 STI/HIV/AIDS Technical Report).For SHARING OF NEEDLES (IDU) - few are cases of injecting drug use. Although the proportion of IDUs sharing injecting equipment has been decreasing, the use of bleach and water in cleansing these equipments has also been decreasing since 2002.
  • In 2011, there were 271 HIV positive OFWs. Of these, 229 (84%) were males and 42 (16%) were females; all infected through sexual contact. There were 1,794 HIV positive OFWs since 1984. Seventy-seven percent (1,375) were males. Ages ranged from 18 to 69 years (median 35 years). Sexual contact (97%) was the predominant mode of transmission (Table 3). Eighty-four percent (1,516) were asymptomatic while 16% (278) were AIDS cases.
  • Mandatory HIV testing is unlawful in the Philippines (RA 8504). The process of reporting to the Registry is as follows: All blood samples from accredited HIV testing facilities that are screened HIV reactive are sent to SACCL (individuals) or RITM (blood units) for confirmation. Confirmed HIV positive individuals and blood units are reported to the DOH-National Epidemiology Center (NEC), and are recorded in the Registry.
  • The capability of private hospitals to manage PLWHAs is also inadequate since traininghas been confined mainly to public hospitals.
  • a. improving the quality and coverage of prevention programs for the most-at-risk, vulnerable, and living with HIV;b. improving the quality and coverage of the treatment, care, and support package for persons most-at-risk, vulnerable,and living with HIV and their affected families;c. enhancing policies for scaling up implementation, effective management, and coordination of HIV programs at alllevels; and d) strengthening capacities of the PNAC and its members to oversee the implementation of the 5th AMTP
  • Dr. Bernardo Villegas cites the work of Dr. Edward C. Green, Director of Harvard's AIDS Prevention Center to say that more condoms promote the spread of AIDS. Green said that according to the “best studies,” condoms makes people take wilder sexual risks, thus worsening the spread of the disease. Green showed that fidelity and abstinence are the best solutions to the AIDS epidemic
  • In order to achieve the protective effect of condoms, they must be used correctly all the time. Incorrect use canlead to condom slippage or breakage, thus diminishing their protective effect.
  • All sites have adopted a City Ordinance for the prevention of STI, HIV and AIDS. Part of the ordinance specifies a 100% condom promotion and use programme for all entertainment establishments. Organized Entertainment Establishments has contributed to the promotion of the 100% CUP.
  • For December 2011, out of 67 screened HIV reactive blood units referred for confirmation, 18 units were confirmed positive for HIV by RITM, 43 were negative for HIV, and 6 were indeterminate results
  • The country has likewise started tapping the private sector. In a few areas, resources of LGUs arenow being mobilized thru LACs. Initial efforts have also been done to reach inter-faith coalitionswhose support can be mobilized particularly for treatment, care and support.
  • The bulk of spending is from external sources. During the period 2007 to 2009, about 67 percent of the country’s totalresources spent on AIDS came from external sources, while 20 percent came from domestic sources.
  • During the same period, most of the resources went to prevention interventions (65%), followed by program managementand administration (18%), and care and treatment activities (7%).
  • Moreover, the country also need to set realis􀆟 c targets, implement a comprehensive package of preven􀆟 on interven􀆟 ons,strengthen monitoring, build a pool of competent human resources and develop a capacity building plan across all sectorsto enable the program to provide appropriate response.
  • A number of IEC initiatives have been undertaken but evaluating the effectivenessof these initiatives to help in further sharpening key messages and identifying the most costeffectivemedia mix has not been consistently pursued. There is also the absence of an inventoryand clearinghouse of STI/HIV/AIDS materials to facilitate adaptation across areas.
  • These efforts put a human face to the disease and made advocacy work gain momentum. However, advocacy activities aimed at mobilizing support from various agencies and sectors have notbeen creatively sustained at the national, sub-national and local levels. The participation of the privatesector in HIV/AIDS efforts also remains minimal.
  • Owing to limited financial resources, the reach of these training initiatives has been likewise limited. Manualshave not been produced in adequate quantities and dissemination through training has been selective.
  • Since the first prominent case (Dolzura Cortez) in 1992,
  • The early establishment of the surveillance system, particularly the conduct of sero-prevalence surveysamong most-at-risk groups starting the mid-1980s, the establishment of the HIV/AIDS Registry in1991, and the NHSSS in 1993 gave decision-makers and program planners a better understandingof the common modes of HIV transmission in the country, the age range and sex of people infectedand the groups most-at-risk to the virus.
  • Communicable Diseases: HIV and AIDS

    1. 1. EPIDEMIOLOGY:HIV/AIDS Ralph Julius Bawalan
    2. 2. AT A GLANCEHIV stands for Human Immunodeficiency Virus. It is a retrovirus that causes HIV infection. Its entrance into the body lowers the immunity (body defense system) or the ability to fight off disease.HIV Infection is the successful entry of HIV in the human host, weakening the immune system and leading to a spectrum of diseases.AIDS stands for Acquired Immune Deficiency Syndrome. It is a condition characterized by a combination of signs and symptoms, caused by HIV contracted from another which attacks and weakens the body’s immune system, making the afflicted individual susceptible to other life threatening infection.
    3. 3. • The 2010 UNAIDS Report on the Global AIDS Epidemic, reported fewer people are becoming infected with HIV and fewer people are dying from AIDS globally. However, seven countries, including the Philippines and Bangladesh, reported that between 2001 and 2009 incidence of new HIV infections has increased by more than 25%. 2010 Global Epidemic Report, UNAIDS
    4. 4. THE PHILIPPINE AIDS SITUATION• To date, an average of five (5) new HIV cases per day or one (1) in every fi ve (5) hours are reported in the country, a sharp rise from two (2) cases reported per day at the end of 2009 and one (1) reported case per day in 2007.• While the national HIV prevalence remains below one (1) percent of the adult population, HIV prevalence among the most-at-risk populations (MARPs) shows a pronounced upsurge from 0.08 percent in 2007 to 0.47 percent in 2009.
    5. 5. THE PHILIPPINE SITUATION• The country and regional consultations that kicked off the commitment to universal access and identified a number of barriers to expanding HIV programming, which can be categorized under four broad areas: • 1. inadequate financing for scaled up AIDS responses (including macro-economic constraints); • 2. weak human resource capacity, and health, social, and education systems; • 3. lack of affordable commodities and low-cost technologies; and, • 4. human rights, stigma, discrimination, and gender inequality and marginalization of key populations at higher risk.
    6. 6. COMMON STI Philippine HIV and AIDS Scenario, 2010
    7. 7. HIV/AIDS IN THE PHILIPPINES• Several factors put the Philippines in danger of a broader HIV/AIDS epidemic. They include increasing population mobility within and outside of the Philippine islands; a conservative culture, adverse to publicly discussing issues of a sexual nature; rising levels of sex work, casual sex, unsafe sex, and injecting drug use.• There is also high STI prevalence and poor health-seeking behaviors among at-risk groups; gender inequality; weak integration of HIV/AIDS responses in local government activities; shortcomings in prevention campaigns; inadequate social and behavioral research and monitoring; and the persistence of stigma and discrimination, which results in the relative invisibility of PLWHA. Lack of knowledge about HIV among the Filipino population is troubling. Approximately two-thirds of young women lack comprehensive knowledge on HIV transmission, and 90 percent of the population of reproductive age believe you can contract HIV by sharing a meal with someone.• The Philippines has high tuberculosis (TB) incidence, with 131 new cases per 100,000 people in 2005, according to the World Health Organization. HIV infects 0.1 percent of adults with TB. Although HIV-TB co-infection is low, the high incidence of TB indicates that co- infections could complicate treatment and care for both diseases in the future.
    8. 8. HUMAN IMMUNODEFICIENCY VIRUS (HIV)• The result of HIV infection is relentless destruction of the immune system.• All HIV infected persons are at risk for illness and death from opportunistic infectious and neoplastic complications as a result of the inevitable manifestations of AIDS• Retroviruses are unable to replicate outside of living host cells because they contain only RNA and and do not contain DNA.• The variant of HIV that is the cause for almost all infections is known as HIV-1.• A second HIV designated HIV-2 has been isolated. Most cases have appeared in West Africa. The genetic sequences of HIV-1 and HIV-2 are only partially homologous.• HIV-2 infection has a longer latent period before the appearance of AIDS, a less aggressive course of AIDS, and a lower viral load with higher CD4 lymphocyte counts than HIV-1 infection until late in the course of the disease when clinical AIDS is apparent
    9. 9. HOW DOES HIV ATTACK THE IMMUNE SYSTEM?• The human body is protected by the White Blood Cells in the immune system.• White Blood Cells in the immune system fight disease and germs for your body.• Strong diseases make the body sick, but the white blood cells usually win in the end.• HIV is a VERY strong germ that attacks the White Blood Cells themselves, weakening the bodys defenses against diseases and makes the body vulnerable to potentially life- threatening infections and cancers. HIV then uses human cells to manufacture more of the virus, eventually killing the host & nearby cells and overwhelms the immune system.• After a very long struggle lasting years, HIV kills most of the immune systems White Blood Cells, leaving the body unprotected.• Many other (secondary) diseases attack (bringing about the condition of AIDS) and eventually kill the body.
    10. 10. HIV IS TRANSMITTED BY:• having unprotected sexual intercourse (vaginal, anal or oral), with someone who is HIV positive. Unprotected, penetrative sex accounts for 80% of total exposures to the disease worldwide;• having a transfusion with infected blood;• sharing syringes and needles with someone who is HIV positive for drugs and tattoos or other skin piercing tools such as razor blades and surgical instruments forcircumcision or scarification.• mothers to their unborn babies and through breastfeeding.
    11. 11. Philippine HIV and AIDS Scenario, 2010
    12. 12. HIV IS TRANSMITTED THROUGH THEFOLLOWING BODY FLUIDS:• Blood• Semen• Vaginal/Cervical Fluids• Breastmilk
    13. 13. HIV IS NOT TRANSMITTED THROUGH:• Kissing• Casual contacts or handshakes• Sharing living quarters, eating or drinking with an infected person• Mosquitoes and bed bugs.
    14. 14. STAGES OF THE HIV DISEASE• Stage I: PRIMARY INFECTION • The patient starts experiencing “flu-like” symptoms• Stage II: ASYMPTOMATIC ILLNESS • The patient may remain well for years• Stage III: SYMPTOMATIC ILLNESS • The patient experiences “mild” symptoms such as lack of energy, nights sweats, etc • Some persons with clinical stage 3 have AIDS.• Stage IV: ADVANCED DISEASES (AIDS) • The patient experiences opportunistic infections from bacterial, mycobacterial, fungal, protozoal, viral and malignant sources that can cause any of the following: • Swollen glands • Mouth infections • Brain infections • Skin diseases • Lung diseases • Loss of weight • All persons with clinical stage 4 have AIDS.
    15. 15. • Exposure• Seroconversion refers to the development of antibodies to HIV and usually takes place between 1 and 6 weeks after HIV infection has happened.• Whether or not HIV infection causes initial symptoms, an HIV-infected person is highly infectious during this initial period and can transmit the virus to another person. The only way to determine whether HIV is present in a persons body is by testing for HIV antibodies or for HIV itself.• Asymptomatic Stage• AIDS• Death IMMUNOLOGICAL STAGING OF HIV INFECTION
    16. 16. WHEN DOES A PERSON HAVE AIDS?• The term AIDS applies to the most advanced stages of HIV infection, defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers. In addition, the CDC defines AIDS on the basis of a CD4 positive T cell count of less than 200 per mm3 of blood.
    18. 18. HIV DETECTION AND TESTING• HIV can be detected through the following tests:• Antibody test - an indirect test measures the response of one’s body to the presence of HIV• Antigen test - a test that directly measures the virus• HIV Testing is voluntary, confidential and anonymous, with pre and post-test counseling. The window period for testing is 6 months from the last exposure with HIV.• The results of the HIV test must be kept absolutely confidential.• There is NO vaccine and NO cure for HIV. Anti-retroviral medication (ARVs) may only slow down the replication of the virus.
    19. 19. WHY TAKE HIV TEST?• Firstly, if you are HIV positive, you can take necessary steps before symptoms appear to access treatment, care and support services, thereby potentially prolonging your life for many years.• Secondly, if you know you are infected, you can take all the necessary precautions to prevent the spread of HIV to others.• Thirdly, your health care provider may recommend it, for example if you are pregnant and want to protect your unborn child. It may also be recommended by your health care provider if you are unwell, in order to obtain a more accurate medical assessment.
    20. 20. WHAT IF NEGATIVE RESULT?• A negative test result means that no HIV antibodies were found in your blood at the time of testing. If you are negative, make sure you stay that way.• SAFER SEX • A – Abstinence • B – Be faithful • C – Condom • D – Do not Inject Drugs • E - Education
    21. 21. HOW QUICKLY DO PEOPLE INFECTED WITH HIVDEVELOP AIDS?• The length of time can vary widely between individuals. The majority of people infected with HIV, if not treated, develop signs of HIV-related illness within 5-10 years, but the time between infection with HIV and being diagnosed with AIDS can be 10–15 years.• Antiretroviral therapy can slow down disease progression to AIDS by decreasing the infected person’s viral load.
    22. 22. IS IT EVER COMPLETELY SAFE TO HAVE SEXWITH A HIV-POSITIVE PERSON?• No, there is always a risk of transmission when having sex with a HIV-positive person. The risk can be significantly reduced if condoms are properly used every time one has sex.
    23. 23. ANALYSIS / CLINICAL• How does HIV treatment – or antiretroviral (ARV) therapy - work in someone who is HIV positive? • HIV is a virus that infects cells of the human immune system and destroys or impairs their function. Infection with this virus results in the progressive deterioration of the immune system, leading to immune deficiency. Our immune systems are essential to protect us from developing infections and cancers. • Combination ARV therapy prevents the HIV virus from multiplying inside a person. If this growth stops, then the bodys immune cells - most notably the CD4 cells - are able to live longer and provide the body protection from infections. • The term Highly Active Anti-Retroviral Therapy (HAART) is another term used to describe a combination of three or more anti-HIV drugs.
    24. 24. CURRENT STATUS OF ARV TREATMENT• More than 4 million people in low- and middle-income countries were receiving HIV antiretroviral therapy at the close of 2008.• Until 2003, the high cost of the medicines, weak or inadequate health care infrastructure and lack of financing in low- and middle-income countries were problems posted.• However, enormous progress has been made and the increased political and economic commitment, stimulated by people living with HIV, civil society and other partners, has allowed dramatic expansion of access to HIV therapy
    25. 25. EPIDEMIOLOGY: HIV/AIDS• Demographic• Economic• Behavioral/ social• Modal age• Racial disposition• Sex differences• Health system issues• Costs• Trends in case fertility• Case management / early detection• Surveillance / Reporting
    26. 26. PREVALENCE• Officially, the Philippines is a low-HIV-prevalence country, with less than 0.1 percent of the adult population estimated to be HIV-positive. As of September 2008, the Department of Health (DOH) AIDS Registry in the Philippines reported 3,456 people living with HIV/AIDS (PLWHA)- . UNAIDS estimates that 12,000 Filipinos were HIV-positive by the end of 2005.
    27. 27. EPIDEMIOLOGY: DEMOGRAPHIC• Almost two-thirds (63 percent) of HIV seropositive cases were males and ninety percent were in the 20-49 age group.• Two percent were less than 10 years old. Majority (85.0%) acquired HIV through sexual contact, with heterosexual contact being the most common mode of transmission. Two percent acquired HIV from their mothers.• Median ages for all the risk groups were in the twenty’s with male respondents (clients of female sex workers, deep-sea fishermen and the injecting drug users) being older than the female respondents;• Most of the respondents were single, except for clients of female sex workers (CFSW) and deep-sea fishermen (DSF), who were mostly married; · most of the female sex workers were high school graduates or have reached high school level; MSMs and CFSW were college graduates; while fifty nine percent of the DSF were elementary graduates. (2004 STI/HIV/AIDS Surveillance Technical Report)
    28. 28. REGISTERED VS ESTIMATED CASES Philippine HIV and AIDS Scenario, 2010
    29. 29. NEW CASES PER MONTH Philippine HIV/AIDS Registry (DOH-NEC Dec 2011)
    30. 30. DECEMBER 2011 RESULTS• Most of the cases (94%) were males.• The median age was 27 years (age range:16-59 years).• The 20-29 year (62%) age-group had the most number of cases.• Forty-eight percent (128) of the reported cases were from the National Capital Region (NCR). Philippine HIV/AIDS Registry (DOH-NEC Dec 2011)
    31. 31. DECEMBER 2011 RESULTS• Reported mode of transmission were sexual contact (238) and needle sharing among injecting drug users (30).• Males having sex with other Males (86%) were the predominant type of sexual transmission • From 1984 to 2011, there were 960 AIDS cases reported, 73% (700) were males. Median age was 35 years (range 1-72 years). Of the reported AIDS cases, there were 341 (36%) deaths. • Sexual contact was the most common mode of HIV transmission, accounting for 93% (896) of all AIDS cases. Philippine HIV/AIDS Registry (DOH-NEC Dec 2011)
    32. 32. NUMBER HIV/AIDS CASES Philippine HIV/AIDS Registry (DOH-NEC Dec 2011)
    33. 33. SEX DIFFERENCES AND AGE GROUP Philippine HIV/AIDS Registry (DOH-NEC Dec 2011)
    34. 34. MODAL AGE
    35. 35. OCW• There were 640 (32.0%) HIV Ab seropositive OFWs, of which 38 percent were seamen.• While reports indicate an increasing number of HIV infection among OFWs over the years, the data on the proportion of infected OFWs over the total number of cases must be treated with caution, since this sector is the most commonly tested and therefore reported, in compliance with the requirement of the OFWs’ host country (2004 STI/HIV/AIDS Surveillance Technical Report)
    36. 36. Philippine HIV/AIDS Registry (DOH-NEC Dec 2011)
    37. 37. NUMBER OF SEXUAL PARTNERS• The number of sex partners of female sex workers varies from one to 80 per week based on the BSS conducted from 1997-2003. However, the median was two per week for RFSW and four per week for FLSW.• Some MSM reported as many as 55 sex partners per month but the norm was two per month.• While almost all men and women have heard about AIDS, only about half know the two major methods for preventing transmission of HIV (using condoms and limiting sex to one uninfected partner). 2003 Behavioral Sentinel Surveillance
    38. 38. VISION HIV/AIDS:Greater access to holistic response
    39. 39. ECONOMIC: NATIONAL RESPONSE• the Philippines was quick to recognize its own sociocultural risks and vulnerabilities to HIV/AIDS. Early responses included the 1992 creation of the Philippine National AIDS Council (PNAC), the country’s highest HIV/AIDS policymaking body. Members of the Council represent 17 governmental agencies, including local governments and the two houses of the legislature; seven nongovernmental organizations (NGOs); and an association of PLWHA.• The passing of the Philippine AIDS Prevention and Control Act in 1998 was also a landmark in the country’s fight against HIV/AIDS.• The PNAC developed the Philippines’ AIDS Medium Term Plan: 2005–2010 (AMTP IV). The AMTP IV serves as a national road map toward universal access to prevention, treatment, care, and support, outlining country-specific targets, opportunities, and obstacles along the way, as well as culturally appropriate strategies to address them. In 2006, the country established a national monitoring and evaluation system, which was tested in nine sites and is being expanded. Antiretroviral treatment is available free of charge, but only 10 percent of HIV-infected women and men were receiving it as of 2006, according to UNAIDS.• The Government of the Philippines participates in international responses to the HIV/AIDS epidemic. Most recently, in January 2007, the Philippines hosted the 12th Association of Southeast Asian Nations Summit, which had a special session on HIV/AIDS.• The Philippines is a recipient of three grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (2004 third round, 2006 fifth round, and 2007 sixth round) to scale up the national response to HIV/AIDS through the delivery of services and information to at-risk populations and PLWHA.
    40. 40. PHILIPPINE HIV & AIDS REGISTRY• The Philippine HIV & AIDS Registry is the official record of the total number of laboratory - confirmed HIV positive individuals, AIDS cases and deaths, and HIV positive blood units in the Philippines.• All individuals in the registry are confirmed by the STD/AIDS Cooperative Central Laboratory (SACCL) at San Lazaro Hospital. While all blood units are confirmed by the Research Institute for Tropical Medicine (RITM).• The Registry is a passive surveillance system. Except for HIV confirmation by the NRL, all other data submitted to the Registry are secondary and cannot be verified (eg individual’s reported place of residence).
    41. 41. ECONOMIC: TREATMENT, CARE AND SUPPORT• Treatment, care and support (TCS) are also geographically inaccessible as these services are available only in DOH medical centers (SLH, RITM and other government-retained hospitals) and the Philippine General Hospital (PGH). The travel time and the additional transportation costs make it difficult for a number of PLWHAs to access them.• The quality of laboratory services in some facilities is also deteriorating due to old equipment, fast turnover of personnel and limited reagents and other supplies.• Majority of the complaints about insensitive and discriminatory care of PLWHAs were directed at health service providers themselves.• Community support systems have been initiated by NGOs and the DSWD, but limited resources (e.g., trained social workers, limited funds for training and monitoring) impinge on their capacity to strengthen and expand. There is also no care and support program focusing on children.• There is also no assurance that these protocols are adhered to, due to lack of monitoring.
    42. 42. ECONOMIC: 5TH AIDS MEDIUM TERM PLAN 2011 –2016 (5TH AMTP)• The Fifth AIDS Medium Term Plan 2011 – 2016 (5th AMTP) presents strategies and activities to accelerate the implementation of the national response to avert new infections and provide treatment, care and support services to those who are already infected.• With adequate financing and firm political will from its leaders, the Philippines would be able achieve the expected outcomes of the 5th AMTP which are: • 1. Persons at risk for, vulnerable to, and living with HIV avoid risky behaviors to prevent HIV infection • 2. People living with HIV live longer, more productive lives • 3. The Country AIDS response is well governed and accountable
    43. 43. BEHAVIOR: CONDOM USE• In 2010, then Philippine Health Secretary Esperanza Cabral said the Philippine government had stopped allocating funds for condoms due to church pressure, a move that Secretary Cabral opposed. Catholic bishops helped build opposition in Congress to block a reproductive health bill that they said promoted sex education and artificial contraceptives.
    44. 44. HOW EFFECTIVE ARE CONDOMS INPREVENTING HIV?• Quality-assured male and female condoms are the only products currently available to protect against STIs, including HIV.• However, apart from abstinence, no protective method is 100% effective, and condom use cannot guarantee absolute protection against any STI.• The female condom is only female-controlled contraceptive barrier method currently on the market. The female condom is a strong, soft, transparent polyurethane sheath inserted in the vagina before sexual intercourse. It entirely lines the vagina and provides protection against both pregnancy and STIs including HIV, when used correctly at each act of intercourse.
    45. 45. 2007 EXTERNAL ASSESSMENT OF THE 100%CONDOM USE PROGRAMME IN SELECTED SITESIN THE PHILIPPINES (FOUR PILOT SITES + ONE)• The 100% Condom Use Program in the Philippines was introduced in the late 90’s by the Department of Health in partnership with the Program for Appropriate Technology in Health (PATH) as part of the AIDS Surveillance and Education Project (ASEP) of USAID.• In 2003, 100% CUP was introduced in four sites in Northern Luzon: the cities of Urdaneta, Dagupan, San Fernando and Laoag with support from WHO Regional and Country Offices. Prior to expansion of the programme to other sites in the Philippines, an assessment of the programme was done, which included all the above-mentioned four sites and one ASEP site (Angeles City).• Angeles City as an ASEP site was included because of the experiences gained from a site that has been implementing the program for a longer time and thus, enabling the measurement of outcomes and impact.
    46. 46. BEHAVIOR: DOES MALE CIRCUMCISIONPREVENT HIV TRANSMISSION?• Recent studies suggest that male circumcision can reduce the risk of acquiring HIV though sex. However, it is not 100% effective and circumcised men can still become infected. In addition, HIV-positive men who are circumcised can infect their sexual partners. Male circumcision should not replace other known methods of prevention, but be always considered as part of a comprehensive of prevention strategy.
    47. 47. BEHAVIOR: MORAL RESPONSE• The CBCP has continually encouraged a moral response. It said in In the Compassion of Jesus, A Pastoral Letter on AIDS: • The “safe-sex” proposal would be tantamount to condoning promiscuity and sexual permissiveness and to fostering indifference to the moral demand as long as negative social and pathological consequences can be avoided. We cannot emphasize enough the necessity of holding on to our moral beliefs regarding love and human sexuality and faithfully putting them into practice. All these, in order to prevent the spread of the disease and to provide the foundations for effective and compassionate pastoral care for those afflicted. Among these moral beliefs is the beauty, mystery and sacredness of God’s gift of human love. It reflects the very love of God, faithful, and life-giving. This marvelous gift is also a tremendous responsibility. For sexual love must be faithful, not promiscuous. It must be committed, open to life, life-long and not casual. This is why the full sexual expression of human love is reserved to husband and wife within marriage. Monogamous fidelity and chastity within marriage–these are ethical demands, flowing from human love as gift and responsibility for the married.
    48. 48. BEHAVIOR: PREVENTION SERVICES• For MSM, Female Sex Workers and Clients of FSWs• However, efforts like condom use promotion, harm reduction and provision of social hygiene services, which are aimed directly at preventing transmission of the virus among High Risk Groups have produced unclear results, implying inadequacies in both the quantity and quality of interventions.• Services from most social hygiene clinics (SHCs) are lacking in quality due to lack of adequately trained personnel and insufficient logistics like reagents. Also, the location and layout of many SHCs negate stigma reduction and discourage health-seeking behavior.
    49. 49. HEALTH SYSTEMS ISSUE: HOW CAN MOTHER-TO-CHILD TRANSMISSION BE PREVENTED?• Transmission of HIV from an infected mother to her child can occur during pregnancy, during labour or after delivery through breastfeeding. The risk of mother-to- child transmission can be reduced by the following: • 􀂃 Treatment with antiretroviral drugs • 􀂃 Caesarian section • 􀂃 Avoiding breastfeeding, but only when replacement feeding is acceptable, feasible, affordable, sustainable and safe. If not, exclusive breastfeeding is recommended for the first 6 months.
    50. 50. HEALTH SYSTEMS: WHAT IS PEP?• Antiretroviral drugs can be prescribed within 72 hours of exposure to potentially HIVinfected blood or body fluids to prevent HIV sero conversion. This is called “post4 exposure prophylaxis for HIV infection” (HIV-PEP). However HIV-PEP is not 100% effective, even when started very shortly after exposure, so it is vitally important to try to take every measure to prevent transmission of HIV in the first place.
    51. 51. HEALTH SYSTEMS: HOW CAN HEALTH-CAREWORKERS HELP TO PREVENT TRANSMISSION INHEALTH-CARE SETTINGS?• Health-care workers should follow Universal Precautions which are infection-control guidelines developed to protect health workers and their patients from exposure to diseases spread by blood and certain body fluids. • Careful handling and disposal of sharps (items that could cause cuts or puncture wounds, including needles, hypodermic needles, scalpel and other blades, knives, infusion sets, saws, broken glass, and nails) • Hand-washing with soap and water before and after all procedures; • Use of protective barriers such as gloves, gowns, aprons, masks and goggles when in direct contact with blood and other body fluids; • Safe disposal of waste contaminated with blood or body fluids; • Disinfection of instruments and other contaminated equipment; and • Proper handling of bedding and clothing stained with blood, diarrhoea or other body fluids.
    52. 52. MDGOAL 6• Combat HIV/AIDS, malaria, and other diseases• Target 9: Halt and reverse the spread of HIV/AIDS by 2015 • Between 1984 and 1992, the reported annual number of confirmed cases remained below 100. However, in the last seven years, 1993-99, the number of cases per year had exceeded 100, but remained below 200. • While the number of confirmed cases of HIV/AIDS is low and the rate of increase in the number of cases is slow, the potentials for a full-blown epidemic continue to exist.
    53. 53. HEALTH ISSUE: BLOOD UNITS SCREENED • From January to December 2011, 927 blood units were screened reactive for HIV and referred to RITM for confirmation. All these HIV reactive blood units (209) were immediately sent to RITM and not transfused to anyone.Philippine HIV/AIDS Registry (DOH-NEC Dec 2011)
    54. 54. COSTS: RESOURCES• Resources for HIV/AIDS in the Philippines were mobilized mainly from the following sources: • (1) the government’s annual budget allocation through the DOH, • (2) local public financing and • (3) external funding from multi-lateral and bilateral agencies. (WHO, USAIDS, JICA, ILO, UNICEF, UNFPA)
    55. 55. COSTS: TOTAL AIDS SPENDING National AIDS Spending Assessment, NEDA 2010
    56. 56. COSTS: HIV AND AIDS EXPENDITURE National AIDS Spending Assessment, NEDA 2010
    57. 57. COSTS: RESOURCES• With the low performance in achieving Universal Access, the country needs to invest considerably in prevention and control of HIV, as the estimated financing requirement for 2011 to 2016 is US$ 587.43 million.• This amount covers human resource capacity building; making affordable commodities and low cost technologies available and accessible; and outreach, education, referral and treatment services to key affected populations.
    58. 58. COSTS: FINANCING REQUIREMENT (2011-2016) National AIDS Spending Assessment, NEDA 2010
    59. 59. COSTS: STD/HIV/AIDS TESTING & TREATMENT• Agency: DOH / STD AIDS Cooperative Central Laboratory (SACCEL) Open from: Monday to Friday 8:00am – 3:00pm Address: Quiricada St. cor Rizal Ave., Sta Cruz, Manila Tel No.: 732-37-76 to 78 loc. 429, 309-95-28 Services: Pre and Post Test Counseling, HIV/AIDS Testing, STI Testing Confirmatory test Consultation fee: P250.00
    61. 61. SOCIAL: INFORMATION EDUCATION ANDCOMMUNICATION (IEC)• Utilizing Behavior Change Communication (BCC) as an overarching framework, these strategies employed one-on-one risk reduction counseling, community outreach and peer education complemented with IEC materials, and mass media campaigns.• Integration of HIV/AIDS into the elementary, secondary and vocational curricula is continuously being pursued, with teaching modules being revised to be life-skills based.• The tripartite partnership of the DOLE, employers and labor groups is an effective strategy in the promotion and adoption of HIV/AIDS programs in the workplace• Seminars among fisher folks, drivers, men and women in uniform and human resource groups have also been done.• Media, legislators, Parents-Teachers Associations and in-school youth were also provided with STI/HIV/AIDS orientation.• The current response has been adequate in programmatic scope, but inadequate in terms of coverage.
    62. 62. SOCIAL: THE RED RIBBON• The Red Ribbon Foundation was founded in 1993 in memory of Singer and songwriter Paul Jabara, who conceived of and distributed the first Red Ribbon, and who died of AIDS.
    63. 63. SOCIAL: BLOW THE WHISTLE• Blow the RED WHISTLE and STOP the spread of HIV Infection..Be RED - Be Aware - Be Warned and Blow the RED WHISTLE HARDER!!• R: READ and EDUCATE - It is critical for everyone to become more educated with the basic facts and fundalmentals about HIV transmissions and associated risk behaviors. After 30 years of its first outbreak isnt it time to finally get it right? Be part of our empowerment solution!• E: ERADICATE - RED WHISTLE is a local organization that initiate to eradicate the further progression and stigmas of HIV by resurrecting the level of HIV Awareness back to the forefront of every media channel available. For more than a decade we have downplayed the epidemic and missed the mark on a generation that are "At Risk" of being plagued today.• D: DEFEND and ADVOCATE - Before we can stop any epidemic, we first have to recognize the magnitude of the disease. HIV is still a threat across the United States and among our youth. Although there are treatments assisting them to live longer lives than ever before, HIV is still a significant health issue and a real threat to our youths. Surprised? Learn the facts and hear our voices.
    65. 65. SOCIAL: TRAINING• Capability building efforts had been strengthened over the years as the necessity for prevention efforts became increasingly felt• For service providers that also include the HIV/AIDS Core Teams (HACTs), training on comprehensive and syndromic STI management had been conducted.• For the labor sector, there is Occupational Safety and Health Training (AIDS 101) for key regional implementers that include DOLE and TUCP trainers.• There were also efforts to promote HIV/AIDS prevention among specific occupational groups considered exposed to higher levels of risks (e.g., tattoo artists and embalmers).• Initial efforts targeting men and women in uniform were pioneered in 1999 and again in 2002, building the capacities on HIV/AIDS prevention among enlisted personnel in the Armed Forces of the Philippines (AFP) and Philippine National Police (PNP).
    66. 66. REPUBLIC ACT 8504:THE PHILIPPINE AIDS PREVENTION ANDCONTROL ACT OF 1998• Article I: Education and Information - Section 6: HIV/AIDS Education in the Workplace All government and private employees shall be provided with standardized basic information and instruction on HIV and AIDS. H IV / AIDS education shall be integrated into orientation, training, continuing education, HR dev’t programs, etc• In collaboration with the DOH, DOLE shall oversee the anti-HIV/AIDS campaign in all private companies.• Article III: Testing, Screening and Counseling: Section 16: Prohibition on Compulsory HIV Testing Section 18: Anonymous HIV Testing• Section 19: Accreditation of HIV Testing Centers• Section 20: Pre-test and Post-test Counselling• Article VI: Confidentiality• Section 30: Medical Confidentiality All health professionals, medical instructors, workers, employers, recruitment agencies, insurance companies, data encoders, and other custodians of any medical records, file, data or test results to observe strict confidentiality particularly the identity and status of p ersons with HIV Release of HIV/AIDS Test Results will only be allowed to the following parties:• Section 34: Disclosure to Sexual Partners Any person with HIV is obliged to disclose his/her HIV status and health condition to his/her spouse or sexual partner at the earliest opportune time.• Article VII: Discriminatory Acts and Policies - Section 35: Workplace Discrimination
    67. 67. SURVEILANCE / REPORTING• Of the 268 HIV positive cases reported in December 2011, nine were classified as AIDS. Seventy-one percent of the cases received information on HIV prevention, services available for HIV cases, implications of an HIV positive result from screening and confirmation. Their sources of information were one-on-one counseling, group counseling, pre-departure orientation seminar (PDOS), pamphlets, videos, internet and seminars.• Philippine National AIDS Council• Problem: For example, the establishment of an HIV/AIDS program in the workplace is not enforced due to inadequate number of personnel in the DOLE.
    68. 68. SURVEILLANCE/ REPORTING• The DOH shall be mainly responsible for providing technical assistance to LGUs in establishing their surveillance systems, which the latter shall be responsible for operating and maintaining.• Surveillance data will follow the routine flow from the LGU and hospitals to the DOH - Center for Health Development (CHD) and DOH-national level. The DOH shall be responsible for disseminating reports to all concerned.• In research, the Phil National AIDS Council shall review and update the research agenda for the next six years which shall serve as a guide in the review and approval of research studies to be undertaken.• The local level stakeholders are encouraged to undertake their own researches on concerns applicable to their area.
    71. 71. FURTHER READING• 2010 Global Report on HIV.• 2010 Philippine UNGASS Report• AIDS Medium Term Plan. 4 th Operational Plan 2009 – 2010.• Philippine HIV and AIDS Registry, December 2011. Department of Health -National Epidemiology Center, p 3• Health Sector Response to HIV/AIDS Prevention and Control The Philippines Country Report 2008• Costed AIDS Medium Term Plan 2011-2016 (AMTP5)• National AIDS Spending Assessment (NASA), 2007-2009, NEDA p 8• Universal Access to Treatment, care, and Support. Philippine Country Report• Costing Guidelines for HIV/AIDS Intervention Strategies. Geneva: UNAIDS, 2004.
    72. 72. The End