Friday, July 29, 2016
Philippines - Advocates call for highest political recognition of HIV/AIDS epidemic
Advocates say political will and leadership at the national and local government levels are needed to create, scale, up and sustain comprehensive programs on HIV/AIDS prevention in communities
MANILA, Philippines – The next 6 years will be a make-or-break situation for the Philippines as it faces crucial prospects of slowing down the human immunodeficiency virus (HIV) epidemic that has surged rapidly in the last 10 years, with government experts saying the acquired immunodeficiency syndrome (AIDS) virus now causes 25 new infections a day.
Individuals and groups working for HIV awareness and prevention toughened their stance to air this admonition on the eve of the inauguration of the new government, as they called the attention of the country's leaders to put a stop to the epidemic.
According to advocates, this can be done through better-managed government programs, bigger investments, standardized procedures in counseling and testing, deeper outreach and better access to treatment and care. (READ: DOH scaling up community approach to end HIV epidemic)
Joshua Formentera, the longest living Filipino with HIV, said the past governments seem to have ended without paying close attention to the HIV/AIDS problem.
“My concern with the new administration is that I am afraid that the HIV issue will be bypassed once again because of other political priorities,” Formentera said.
Formentera, who was diagnosed in the early 1990s, added: “It is now imperative for the new government to focus more on access to treatment, both generic and non-generic, and to make all of them available. We all know that HIV treatment is essential in halting further infections on an HIV-positive individual and to other persons as well.”
Noel Quinto is a person living with HIV (PLHIV) who was diagnosed in the late 1990s, and a former president of Pinoy Plus Association, the first organization of PLHIVs in the Philippines.
Quinto is keen on immediate treatment for all who are positively diagnosed.
“Our numbers are increasing every year, and it is imperative that the government also increases its coverage and leaves no one untreated.”
The Department of Health (DOH) refers to HIV treatment, called anti-retroviral (ARV) therapy, as medicines that retrogress or slow down the progression of HIV infection to AIDS, the condition where the body’s immune system can no longer defend itself against more virulent infections. Every person diagnosed with HIV is prescribed a certain regimen, usually a combination of medicines, depending on the health condition of the person.
Both Formentera, who founded the Positive Action Foundation Philippines Inc, a support group of PLHIVs who help their peers and their families live normally, and Quinto have witnessed the country’s experience with ARV drugs – when drug trials entailed taking in a handful of tablets that caused toxicities.
Prevention, the most common intervention to HIV infection, has meandered among government programs, according to Teresita Marie Bagasao, country director of the Joint UN Programme on HIV/AIDS (UNAIDS). Bagasao saw the beginnings of the epidemic when she was still with a nongovernment group providing help to workers in the sex industry.
“The support for prevention programs has lagged and it is not surprising that the country is seeing an ongoing steep increase in new infections in the last two years,” she said. “There is still no prevention policy to guide programs and services.”
While the HIV budget has increased and access to testing and treatment has greatly improved, Bagasao said there is a need to increase domestic investment in AIDS, especially on prevention backed up by policy and programs.
UNITED. Joshua Formentera (3rd from left) with advocates of the Positive Action Foundation Philippines. Photo by Diana Mendoza/ Rappler
Corruption has also caused undue strain to HIV programs as the Priority Development Assistance Fund (PDAF) scam that saw politicians misusing their discretionary funds. This resulted in nongovernment organizations (NGOs) not being able to reach out to key populations that they collaborate with because of court-imposed restrictions on NGOs.
Bagasao's perspective is shared by Dr Jose Narciso Melchor Sescon, an adviser to the board of the AIDS Society of the Philippines, a professional NGO.
Sescon said the invasion of corruption into such tasks as preventing HIV infections has worsened the already dismal resources of NGOs and civil society groups working on HIV prevention.
The former head of the Remedios AIDS Foundation, one of the pioneer NGOs on HIV/AIDS work, said the funding landscape has also become highly competitive for even the seasoned community-based organizations (CBOs) that now have to work with short funds.
“I have seen them come and go because funding support has put them in a dilemma,” Sescon explained.
He added: “To run a development program, we used to obtain management costs and operational costs on utilities, rentals, administrative personnel and internal auditors. But nowadays, the projects tend to be more activity-driven, and while doing their work, the NGOs and CBOs have to shoulder first the cost of operations and get reimbursed in three months. Other projects may need to wait for 6 months to one year to get paid.”
Sescon said not all organizations have enough funds for this kind of system which started in 2003.
“The result is extinction and the loss of creativity and innovation,” he said. “We no longer have NGOs and CBOs that are able to go to hard-to-reach populations of injecting drug users, the sex industry and the more complex cyber world."
Not enough resources
Former Pinoy Plus president Quinto recalled that since 2003, his organization of 200 members nationwide has experienced lack of resources to sustain their main work on volunteer counseling. The organization might even be forced to vacate its offices this September as a funded project is completed.
Sescon and Bagasao put forward what HIV/ AIDS advocacy workers have considered a cry for help. In recent forums, Bagasao said “what participants called for is the highest level political recognition of the HIV situation, coupled with commitment to resource the response with tested, rights-based approaches."
“This means calling a spade a spade – national leaders speaking openly about the challenge of HIV and committing to address this,” said Bagasao.
Sescon, who is also the chief of clinics of Sta Ana Hospital that is run by the Manila city government, said “seeing HIV being accepted just like any other chronic or lifestyle disease,” devoid of stigma, would help reinforce a national government-level response."
“I have yet to see HIV and AIDS comfortably talked about with care and compassion in the different clinics and hospitals by health providers," Sescon added.
Political will needed
The new administration, Sescon believes, is “pro-people's welfare,” although HIV/AIDS have not been mentioned in the priorities, unlike family planning and a better implementation of the reproductive health law, which also include HIV prevention.
He said that what is needed is political will and leadership at the local government levels to create, scale, up and sustain comprehensive programs in the communities. Bagasao noted that there are a number of local leaders in a handful of cities that are demonstrating commitment through local policies, increased investments in key populations, and appropriate programs and services.
Bagasao, however, said that a handful is not enough to reverse the trajectory.
There are 22 cities now in the DOH-defined category A sites that have 70% of newly diagnosed HIV and AIDS cases beginning in 2007, when the most affected population has also shifted to males to have sex with males. These cities are Caloocan, Las Pinas, Manila, Mandaluyong, Marikina, Makati, Muntinlupa, Malabon, Navotas, Paranaque, Pasay, Pasig, Quezon, San Juan, Taguig, Pateros, Valenzuela, Angeles, Cebu, Danao, Davao and Mandaue.
Dr Jose Gerard Belimac, manager of the DOH HIV/AIDS prevention and control program, said the department has projected a total of 36,000 PLHIVs by 2015 and has acknowledged that with increasing HIV cases, the challenges will mount as foreign funding is limited and treatment is expensive and lifelong.
"The DOH budget for HIV programs doubled from P300 million in 2015 to P600 million in 2016, and by the end of 2015, over 13,500 PLHIVs who are eligible patients for HIV treatment were covered," Belimac said.
The government forecasts a monthly average of 1,000 new cases that will need HIV treatment, he added.
Outgoing health secretary Janette Garin said in a recent forum, “We kept on believing that HIV is low and we had low death rates, and we have held this false assumption for years,” a problem, she said, that added to the limited testing capabilities and resources.
DOH projected that from 2016 onwards, the government would need P4 billion per year for the Philippine Health Insurance Corporation (PhilHealth) to cover outpatient HIV/AIDS treatment for PLHIVs, as there will be 133,000 newly infected persons by 2022 if treatment and prevention are not done.
Formentera said the new government needs to look at Republic Act 8504, or the AIDS law, and even the new reproductive health law and use them to strengthen its mandate of engaging with non-government, private and business sectors in doing awareness and education activities.
“The AIDS Law was not implement well by past governments, and it might need to be amended. But clearly, the government is now more empowered with these measures to do better,” he said.
Sescon said access to various HIV services is now more readily available and have been popular to the key affected populations but much is yet to be done in prevention services and to dispel stigma and discrimination.
“Do I see it slow down in the next 5 years? There is still long way to go in intensifying coverage and reaching the most affected populations who need to consistently practice safer sex and other harmful practices that put them at risk of infection,” he said.
Bagasao noted that the Philippines can end AIDS by 2030, the global goal of countries, and even by 2022, “if the game changing strategies are implemented and resourced.” With about one third of new HIV infections among young people, she said that there is need for a policy to improve access to services and information.
Bagasao said that the RH law, if implemented fully, would have addressed the need for sex education. Although the country has not rolled out age-appropriate sex education modules and instruction, related to this is the appreciation that HIV is not only a health concern, so that line agencies such as those in education, labor and local government can collaborate more effectively and fund their programs.
Diana G. Mendoza