Localizing aids response in the philippines (2012)

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  • Despite the apparent low prevalence of HIV in the Philippines, the exponential rise of new HIV and AIDS cases in the country for the past years had been a cause of great concern. As early as 2008, the United Nations (UN) in the Philippines has raised the warning on Millennium Development Goal (MDG) 6 (i.e., halt and begin to reverse the spread of HIV and AIDS) as among the goals least likely to be achieved by the country by 2015. The most recent years saw the highest incidence of new HIV infections. From one case detected every three days in 2000, the HIV incidence increased to an alarming rate of one every three hours (or eight per day) in 2011.
  • According to the 2010 UNAIDS Report on the Global AIDS Epidemic, the Philippines is one of only seven countries globally with more than 25 percent increase in HIV incidence in the last ten years. This is while in most parts of the world the rates of HIV infection are either stabilizing or decreasing.
  • The fact is all the main ingredients are present for a full-blown epidemic to take hold in the country. Unprotected sex accounts for more than 95% of all transmissions for the last five years. Despite of this condom use remains dismally low. Based on the 2009 Integrated HIV Behavioral and Serologic Surveillance, none of the most at-risk-populations in the country – men who have sex with men (MSM), female sex workers (FSWs), or injecting drug users (IDUs) – reported higher than 44% condom usage. Moreover, there is a growing epidemic among injecting drug users driven by widespread needles and syringe sharing.
  • From heterosexual contact, there has been a shift in the predominant trend of sexual transmission starting 2007 to male-to-male sex. In the first half of 2011, sexual transmission through MSM represented 82% of all new cases reported, up from 56% in 2007. At present, seven of the eight Filipinos being infected with HIV each day are MSM, arguably making them the most affected population in the country. Further, the underlying risk factors for this population are incredibly worrying. The 2009 IHBSS showed that prevention programs reached only 19% of the estimated 670,000 MSMs, while only 10% were knowledgeable about HIV. In addition, only 32% of the people who practice anal sex reported the use of a condom. Given these inherent gaps between real and preventive behaviors, the current growth in cases may very well be just the start of a period of explosive and exponential growth in HIV among the MSM population.
  • Challenges in the National AIDS Response The response to prevent this epidemic from exploding in the country is governed by Republic Act 8504 or the Philippine AIDS Prevention and Control Act of 1998. However, due to the decentralized system of government in the country, operational responsibility for HIV prevention and control efforts falls on local government units (LGUs) and Local AIDS Councils wherever they exist. The difficulty in establishing a national response is that LGUs are largely autonomous; national policy is guidance for local governments and not a decree. An assessment of the AIDS Medium Term Plan from the Philippine National AIDS Council (PNAC) showed that only 18 of the 48 localities identified as highly vulnerable were reached with prevention programmes while only 10 received comprehensive essential prevention measures. As of 2007, on-going projects supported by the Global Fund to fight AIDS, TB, and Malaria (GFATM) covered 37 cities – only 2% of the country – even though they represented at least 75% of the total national AIDS budget. The National Capital Region, where rates of new infections are growing fastest in the country, did not even have a full-scale AIDS response yet. The reality on the ground was that while HIV policies were strong, interventions to prevent and provide services for HIV positive people has been disjointed and uncoordinated. Technical, human, and financial resources at the local levels do not meet the needs for effective HIV prevention. Further, since HIV and AIDS has traditionally been viewed as a health issue and not a development issue, it has been hard to pull in different government departments together and to coordinate policies more effectively. The need for clearer policies and greater funding was clear, but the dramatic rise in HIV cases among the most-at-risk populations also raised a more fundamental concern about how effective past intervention programs undertaken throughout the country. In fact, as discussions progressed on how to adequately address the needs of these populations, it became clear that little was clearly known about them, most notably the MSM. The country’s ability to respond to and plan for the growing HIV epidemic has been seriously hampered by the foregoing factors and the result can be seen through the stunning acceleration of HIV cases in the country.
  • To help strengthen national responses to HIV and AIDS, UNDP and the Philippine Government launched a three-year programme, “Promoting Leadership and Mitigating the Negative Impacts of HIV and AIDS on Human Development.” The five-pronged response focused on firming up capacity development particularly leadership to reinforce local responses and lessen the negative impacts on human development of the epidemic. However, beyond the projects, the Programme also did wider advocacy on AIDS awareness to various stakeholders to leverage support to AIDS response. Similarly, to support enabling environment that would help facilitate access and utilization of HIV services by most-at-risk populations, the Programme also addressed AIDS-related stigma and discrimination, and promoted anti-discrimination interventions related to sexual orientation and gender identity. In all of these, UNDP enjoined the support and participation of all relevant stakeholders including national , sub-national and local governments, civil society organizations, groups of people at-most-risk, living with and affected by HIV, and the private sector.
  • However, for this particular presentation, I’ll be focusing on the outcomes and key innovations for Components 1 and 4 of the Philippine Country Programme on AIDS.
  • As the anchor component of the country Programme, “Leadership for Effective and Sustained Responses to HIV and AIDS” sought to harmonize efforts with the Philippine National AIDS Council (PNAC) and the UN Joint Team on AIDS (UNJTA) to strengthen sustainable local responses through the development of leadership capacities of local governments units and the Regional AIDS Assistance Teams. Particularly, it aimed to address three key factors that contributed to inconsistent and low rates of local interventions. The lack of a sub-national mechanism for advocacy and technical support was a primary reason that national policies were not being translated into local projects and thus the programme sought to reinvigorate a network of Regional AIDS Assistance Teams (RAATs) first set up by PNAC in 2007. These teams would bring together three main government departments – the Department of Interior and Local Government (DILG), Department of Social Welfare and Development (DSWD), and the Department of Health (DOH) – and facilitate regional coordination and translation of national policies. At the same time, a group of AIDS Champions would be identified in major municipalities that the RAATs could tap in order to serve as technical advisors and support for local governments. Finally, to address low awareness of the HIV issue at the local level and build support for the establishment of Local AIDS Councils and increase local responses, the programme partnered with the Local Government Academy (LGA) to include HIV and AIDS awareness training in orientation sessions for all incoming local government officials. Together, these three approaches would lay the systemic foundation for local AIDS responses in the future.
  • Component Four, “Strategic Information and Community Leadership among Men Who Have Sex with Men (MSM) and Transgender (TG) Population,” sought to review and analyze current community-based responses to HIV among MSMs and construct a comprehensive package of services to encourage effective community responses. This project also aimed to build and support the capacity of civil society organizations (CSOs) to effectively utilize strategic information and actively participate in local government processes that respond to HIV and AIDS.
  • In 2010, the Programme began integrating general HIV and AIDS awareness courses into the orientation curriculum of the Local Government Academy that all newly elected local officials undergo. The timing was ideal, since 2010 was a major election year, and the corresponding trainings would be a perfect vehicle to emphasize the importance of local programming for HIV responses. The Joint Memorandum, specifying the individual roles of each department also led to greater clarity for local government officials who sought assistance in developing response. Equally important, the establishment of the RAATs allowed them to become a resource for local governments. The Programme worked with RAATs to identify vulnerable LGUs in target regions and potential candidates for Local AIDS Champions. This information was then utilized by RAATs to provide more in-depth training and orientations to newly elected officials in 2010, following up on the introduction in the LGA curriculum. Starting 2010, UNDP sponsored the first annual CHAMP (Catalytic HIV and AIDS Mitigation Programme) awards, which recognized the best local AIDS responses in the country.
  • Through a series of capacity trainings, the Programme helped build capacities of RAATs to provide technical support to local governments in establishing and strengthening local AIDS response. To support the RAATs, UNDP also set up a website for RAAT members, providing them with a central repository of research, policies, and other resources that they could then pass along to LGUs. Throughout 2010 and 2011, the programme began a series of initiatives that aimed to contribute to better understanding the needs of LGUs and greater knowledge sharing. The RAATs served as a focal point for gathering information on existing Local AIDS Councils. Working with the University of the Philippines in Diliman, the programme sponsored a study that resulted in a step-by-step guide for setting up Local AIDS Councils.
  • In partnership with the non-governmental organization ACHIEVE, the programme supported a policy review of local HIV ordinances in selected cities in Metro Manila area, which afforded recommendations in enhancing current policy environment and programme implementation among LGUs. The value of the Programme’s work in building sub-national institutions and advancing local interventions can already be seen. RAATs have been instrumental in facilitating dialogues between local governments and community-based MSM and transgender groups. These groups, which are the focus of Component 4, have been mostly under-targeted and misunderstood in traditional HIV responses. However, the identification of local AIDS champions and the formation of Local AIDS Councils, has given them a forum to express their needs and voices and become more involved in crafting prevention programmes.
  • By 2011, 99 new Local AIDS Councils had been established and 250 local AIDS champions and advocates identified. RAATs were operationalized in all 17 regions, and five regional governments had already issued their own policies mandating the establishment of Local AIDS Councils. In addition, 44 local AIDS policies had been developed. While the long-term impacts of the programme have yet to be proven, in three short years the programme has successfully laid the institutional foundations with the relevant departments, supporting increased and deeper local responses for HIV and AIDS.
  • The community-based MSM and TG groups have assumed a more pro-active and pivotal roles in the AIDS response through self-organization and peer-based collaborations. A total of 18 community-based groups and about 200 MSM and TG individuals from Metro Manila, Metro Cebu and Davao were trained on sexual health, organizational development and programme development. In the process, three organizations of MSM and TG were organized. These MSM and TG leaders and advocates conducted active dialogues among their peers and with local government officials. With the Programme providing the necessary platform, these community leaders have articulated their issues and concerns related to gender and HIV for appropriate action by relevant government agencies/offices, which paved the way for collaborative and coordinated initiatives from both the MSM and TG groups and their respective local government units.
  • The findings and recommendations generated by the research studies of the Programme had made an impact on the development and enhancement of the 5 th AIDS Medium Term Plan, the national AIDS strategic plan for 2012-2016. Particularly, they helped inform and improve the AIDS programming and strategic responses for MSM and transgender people. The findings helped fill in critical gaps in establishing behavioral profiles for MSM and TGs, which are necessary inputs to design more effective and targeted HIV and AIDS programme for the population. While the knowledge products developed under Component 1, as presented earlier, served as valuable tools for RAATs and local governments.
  • The greater awareness of the specialized needs of MSM and TGs served as a basis for an expansion of cooperation between local MSM and TG groups and LGUs. Components 1 and 2 of the Programme synergized to help MSM and TG groups engage LGUs, facilitating greater understanding by both parties of needs and planning processes. The work in bringing together LGUs and MSM/TG community groups has resulted in a deeper understanding and awareness of the unique development challenges that face MSM and TG communities in relation to the spread of HIV and AIDS, as well as increased participation of MSM and TG groups in LGU activities and greater funding by LGUs for MSM and TG specific interventions in some cases.
  • The Philippine country office hosted the Multi-Country Training on Strategic Information on HIV among MSM and Transgender People. This is a follow up to the APRC-supported Six-City MSM and HIV Initiative , which assessed six mega-cities across the Asia Pacific for their capacity and potential to scale up HIV interventions to MSM and TG. This strategic training aimed to provide skills for stakeholders involved in HIV prevention work among MSM and transgender persons on research methods that can be crucial in generating and utilizing strategic information that can impact policy and program development. Following the experience of the Programme in the Philippines, the training provided venue for South-South cooperation where participants from three other Asian countries (i.e., Indonesia, Malaysia and Thailand) were afforded possible model to replicate subject to their varying local socio-religious contexts. In doing so, the endeavor was able to build in-country expertise that will be beneficial to addressing the critical issue of the rising rates of HIV among these populations in each country.
  • UNDP also supported a national campaign through the Human Soul exhibit to address stigma and discrimination against MSM and Transgender persons considering that homophobia is one of the main obstacles in implementing HIV prevention strategies. This exhibit was initially launched at the Philippine Congress on 16 May 2011, on the eve of the International Day against Homophobia and Transphobia or (IDAHO). There are currently two House Bills (HB 515 and HB 1483) pending in Congress that address stigma and discrimination against the community. The proposed Anti-Discrimination Act being put forth by Rep. Teddy Casiño of Bayan Muna and Rep. Kaka Bag-ao and Rep. Walden Bello of AKBAYAN defines the prohibition of and penalties for discrimination on the basis of sexual orientation and gender identity. This enabling policy aims to remedy the long-standing discrimination against the GLBT community in the Philippines. I am very happy to note that similar legislations are currently being put forward at the City Councils of Davao and Cebu. If enacted, these cities would purportedly be the first local governments in the entire country to institute LGBT-supportive legislation. A similar initiative was also undertaken by the Provincial Government of Albay. Therefore, to generate greater awareness on stigma and discrimination against the LGBT community, and leverage needed support for enabling policies, UNDP supported the tour of the exhibit to various localities (i.e., Manila, Cebu, Davao and Albay) and settings (i.e., schools, malls and communities).
  • The Programme had come up with an innovative way of promoting AIDS awareness. In partnership with Starbucks Philippines, the Programme brought AIDS education to Starbucks clientele and employees with a series of HIV and AIDS Dialogues in two store branches (for 2011) and posting of informational materials in bulletin boards of Starbucks branches across the country. The Programme also assisted the company in laying the foundation for their HIV workplace policy and programme.
  • The Programme had come up with an innovative way of promoting AIDS awareness. In partnership with Starbucks Philippines, the Programme brought AIDS education to Starbucks clientele and employees with a series of HIV and AIDS Dialogues in two store branches (for 2011) and posting of informational materials in bulletin boards of Starbucks branches across the country. The Programme also assisted the company in laying the foundation for their HIV workplace policy and programme.
  • Through the course of this work, the programme learned valuable lessons that can be applied elsewhere. Any broad-based multi-stakeholder initiatives such as those undertaken by the programme require significant investment up-front in creating buy-in and ownership. While it may mean a longer lead-time before tangible results can be seen, it ensures greater sustainability and more relevant results. For example, in the planning workshops for the RAATs, important discussions took place that highlighted local issues and concerns that may otherwise have gone overlooked. Taking these issues into consideration when defining how the RAATs would work, means that both RAATs and local institutions will be more responsive in the long-term. Further, in the Philippines, HIV and AIDS has traditionally been considered a health issue. The Department of Health was clearly ahead in terms of knowledge, and was often the default choice to lead. It was clear from the start though, that for the long-term viability of the initiative, each partner would have to play their own unique and equally important roles. Indeed, each partner would have to see itself as an integral actor in the solution to HIV. Thus, the programme worked to clearly define the expected contributions from each department and to undertake “levelling” exercises with relevant actors. The impacts on the three government departments have been far-reaching; DILG has been the first department in the government to adopt a general workplace HIV policy, while DSWD now sees its role in delivering services to people living with HIV and AIDS as an integral piece of its work. Working with multiple government departments can lead to bureaucratic paralysis, especially when dealing with a division of duties and responsibilities. In order to avoid this, a key decision was made to allow flexibility by setting leadership roles within the regional teams; rather than make it an issue between national level departments, RAAT leadership would be determined by individuals and interests by each team. The programme’s willingness to adopt practices outside of the box has been key to its success in establishing new sub-national institutions. As for strategic information development and utilization, it was important to utilize a highly participatory process. From completing the studies to assessing existing interventions, the cooperation of key stakeholders was necessary to ensure that the results were not only valid but also accepted as the basis for forward-looking policies and planning.
  • We also found the following factors crucial in order to ensure sustained and effective AIDS response: Strong leadership from national and local governments as well as civil society; Enactment of policies that enable national and local governments and stakeholders to formulate and implement programmes that improve the lives of people at-risk, infected with and affected by HIV and AIDS; Establishment and strengthening of local coordinating mechanisms (such as Local AIDS Councils) to coordinate and monitor local AIDS responses, and provide guidance on issues related to HIV risks, vulnerabilities, and impact with AIDS; Strengthening partnership with civil society groups and the community to raise public awareness about the HIV epidemic and mobilize multi-sectoral support required to combat it; and Allocation of resources required to mount an effective, comprehensive, and sustained HIV prevention, treatment, care and support programme.
  • In line with the UNDAF and the 5 th AIDS Medium term Plan, the HIV and AIDS Country Programme for the next cycle will harness UNDPs corporate mandate and comparative strengths. Its overall approach will be to strengthen capacities of national and local governments and communities to plan and implement sustained, comprehensive and effective responses to HIV and AIDS with localization at its core. The next Programme’s potential areas of support include the following: Policy reforms at the national and local levels, harmonizing conflicting provisions that limit comprehensive and effective interventions, and address critical gaps ; Development of gender-responsive, age-sensitive and context-specific normative guidelines for targeted HIV prevention, treatment, care and support programmes, particularly among MSM and TG; Capacity development of national government agencies, Regional AIDS Assistance Teams, local government units and civil society organizations, including empowerment of community groups, particularly MSM and TG groups, to participate in the national and local response to AIDS; and Institutional capacity enhancement of the national and local AIDS coordinating bodies to plan, coordinate, monitor and evaluate AIDS responses.
  • We’re happy to note that the country situation is not all grim as we are witnessing a number of local governments, in partnership with a range of stakeholders, taking on the challenge of instituting their own local responses to HIV and AIDS. The on-going developments are encouraging, and this is only the beginning. As UNDP works hand in hand with national agencies and local stakeholders in building leadership and strengthening capacities, sustained local responses will rise to the challenge of halting and reversing the spread of HIV and AIDS in the Philippines.
  • Localizing aids response in the philippines (2012)

    1. 1. Experience from UNDP Philippines
    2. 2. PhilippinePhilippine AIDSAIDS SituationSituation 2000: 1 new case every 3 days 2007: 1 new case every day 2009: 2 new cases a day 2010: 5 new cases a day 2011: 8 new cases a day
    3. 3. PhilippinePhilippine AIDSAIDS SituationSituation Changes in Incidence Rate of HIV Infection, 2001 to 2009, Selected Countries
    4. 4. PhilippinePhilippine AIDSAIDS SituationSituation
    5. 5. PhilippinePhilippine AIDSAIDS SituationSituation
    6. 6. PhilippinePhilippine AIDSAIDS SituationSituation Weak national AIDS Council (PNAC) Decentralization has relegated implementation of national AIDS policy to local governments; Low coverage of HIV programme coupled with low domestic spending; Disjointed and uncoordinated response Lack of strategic information among most-at-risk populations to inform effective interventions. Conservative forces in society Strong stigma and discrimination against PLHIV
    7. 7. UNDP Country Programme onUNDP Country Programme on AIDSAIDS
    8. 8. UNDP Country Programme onUNDP Country Programme on AIDSAIDS
    9. 9. UNDP Country Programme onUNDP Country Programme on AIDSAIDS Strategies:  Strengthen technical support mechanism (i.e. Regional AIDS Assistance Teams) on AIDS response for local governments and develop tools;  Enhance institutional capacity of local government coordinating bodies; and  Establish institutional mechanisms within DILG
    10. 10. UNDP Country Programme onUNDP Country Programme on AIDSAIDS Strategies:  Develop profile of MSM and their changing behaviors;  Map and assess existing programs, services, and interventions for MSM and transgender;  Recommend strategies for advocacy and cost of intervention packages; and  Strengthen local MSM groups to participate in local governance
    11. 11. Programme OutcomesProgramme Outcomes Institutional Arrangements  Integration of HIV and AIDS in the Orientation Programme for Newly Elected Officials of the Local Government Academy;  Development and implementation of policies in support to local action;  Development of Local Response Framework/Strategy in support for the implementation and localization of the 5th AIDS Medium Term Plan; and  Instituting award mechanism for best local AIDS response to encourage proactive LGU response. I. Strengthened capacities of national, sub-national and local government institutions in responding to HIV and AIDS.
    12. 12. Programme OutcomesProgramme Outcomes Knowledge  Increased capacities of Regional AIDS Assistance Teams (RAATs) and local AIDS champions in provision of technical assistance to LGUs through continued capacity trainings;  Development of online resource on HIV and AIDS for RAATs and LGUs (i.e., www.lga.gov.ph/hiv); and  Development of a step-by-step guide in establishing local AIDS response for local government officials, including tools to assess the local AIDS situation and monitor response (i.e., Localizing the HIV and AIDS Response: Local Government Guide for Practical Action). I. Strengthened capacities of national, sub-national and local government institutions in responding to HIV and AIDS.
    13. 13. Programme OutcomesProgramme Outcomes Accountability  Assessment of local HIV and AIDS policies in selected sites (i.e., Quezon City and Pasay City) in terms of its relevance, responsiveness and implementation, which afforded recommendations in enhancing current policy environment and programme implementation among LGUs; and  Consultations conducted between LGUs and MSM and TG groups to facilitate greater engagement and collaborative efforts in AIDS response. I. Strengthened capacities of national, sub-national and local government institutions in responding to HIV and AIDS.
    14. 14. Programme OutcomesProgramme Outcomes  Established and revitalized 99 Local AIDS Councils in different local governments across the country;  Identified 250 local AIDS Champions; and  Developed 44 local AIDS policies. II. Increased commitment and engagement of local institutions to addressing HIV and AIDS challenges.
    15. 15. Programme OutcomesProgramme Outcomes  18 community community-based groups and about 200 MSM and transgender individuals were trained on sexual health, organizational development and programme development  Series of consultation workshops paved the way for collaborative and coordinated initiatives from both the MSM and TG groups and their respective local government units . III. Improved engagement of MSM and transgender groups in local governance process.
    16. 16. Programme OutcomesProgramme Outcomes  Informed development of the 5th AIDS Medium Term Plan, particularly strategic response for MSM and TG;  Helped concretize the National Strategic HIV Comprehensive Plan for MSM and TG;  Guided localization of AIDS response;  Helped assess programme and policy gaps; and  Served as advocacy tools. IV. Enhanced strategic information to advise AIDS policy and programming.
    17. 17. Innovative ApproachesInnovative Approaches  Facilitated dialogues between community-based MSM and transgender groups and local governments Advancing MSM Interventions with Local Governments
    18. 18. Innovative ApproachesInnovative Approaches  Hosted Multi-Country Training on Strategic Information on HIV among MSM and Transgender People South-to-South Sharing of Information
    19. 19. Innovative ApproachesInnovative Approaches  Human Soul: A Multimedia Exhibit on the Fight against Discrimination, which leveraged support for passage of anti-discrimination legislations in Philippine Congress and local governments. Fighting Discrimination against MSM and Transgender
    20. 20. Innovative ApproachesInnovative Approaches  Large and multi-sectoral delegation to regional meeting of the Commission on HIV and the Law (Commission on Human Rights, Parliamentarians, Department of Justice, CSOs)  Adoption of the approach at national level led by CHR  Conducted training on HIV for CHR officials “Nationalizing” the Commission on HIV and the Law
    21. 21. Innovative ApproachesInnovative Approaches  In partnership with Starbucks Philippines, brought AIDS education to clientele and employees with a series of HIV and AIDS Dialogues in Starbucks branches and posting of informational materials;  Assisted the company in setting up HIV workplace policy and programme. Building Private Sector Partnership in Promoting AIDS Awareness
    22. 22. Lessons LearnedLessons Learned  The need for buy-in and ownership;  Defining expected roles and responsibilities of all relevant actors;  Flexibility on leadership roles within the team;  Importance of participatory process.
    23. 23. Lessons LearnedLessons Learned Enactment of policy Active coordinating mechanism Multi-sectoral partnership Allocation of resources Strong political leadership 5 Key Elements for Sustained and Effective Local AIDS Response
    24. 24. Ways ForwardWays Forward UNDAF Sub- outcome By 2018, more people at-most-risk, living with and affected by HIV have access to quality HIV prevention, treatment, care and support services. UNDAF Outputs Policy reform Development of standards and guidelines Capacity development for NGAs, LGUs and CSOs PNAC institutional strengthening Joint Programme Outcome Coverage of quality prevention services expanded towards Universal Access. Joint Programme Outputs Policy reform at the national and local levels Development of HIV prevention guidelines Community mobilization Capacity dev’t of CSOs and LGUs PNAC and LAC institutional strengthening CP Outputs Policy reform at the national and local levels Development of standards and guidelines Community mobilization (MSM/TG) Capacity dev’t for NGAs, RAATs, LGUs and CSOs PNAC and LAC institutional strengthening
    25. 25. THANK YOUTHANK YOU

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