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1 IIn nt tr ro od du uc ct tiio on n

HIV and AIDS Situation in Philippines


The Republic of Philippines is known to be a low HIV prevalence country. However, there is an increasing cause for concern that the disease could grow at an exponential rate. Since 1984 cumulatively there were 3,456 registered HIV patients. Like in most countries, HIV affects Filipino adults during their peak economically productive years (58% of the registered cases were aged 25-39 years old1). Current data indicates that young adults, men who have sex with men (MSMs), people in prostitution (PIPs), injecting drug users (IDUs), overseas Filipino workers (OFWs) and the partners of all these groups are particularly vulnerable to HIV infection. Compared to the monthly average registration in the last five years (2003-2007) which was 20 per month, the AIDS Registry showed an average of 29 new HIV cases per month for 2007. The first and second quarter of 2008 had an average of 40-50 new cases/month. This has surpassed the total number of HIV cases annually since the AIDS registry started. The numbers obtained in October 2008 59 cases, were the highest ever recorded in the Registry. However, national adult HIV prevalence remains under 0.1%.

Trends of the Epidemic HIV prevalence among the most-at-risk-populations (MARPs) remains below 1%;. The general low prevalence in Philippines leaves no room for complacency since the rate of new cases per month is increasing in trend. Among the transmission modes that have been reported, sexual transmission is the most common (88%). Condom use among MARPs (e.g. FSW: 65%; MSM: 32%) is below universal access (UA) targets (80%) and lower still among the general population. According to 2007 estimates, there are 7,490 adults (15-49) living with HIV, of which 24 % are women. Prevalence is currently at 0.0168%. Most recent estimates of the Most at risk and vulnerable populations were arrived at after a series of workshops from September to December 2007. Estimates of the number of PLHIVs were arrived at during a National Consensus Meeting held on November 22, 2007. The AIDS Medium Term Plan (AMTP) IV categorizes the OFWs as vulnerable population. Of the 8 to 12 million OFWs, it is estimated that 883,897 are deemed at most risk due to their work situation and behavior. The following table (Table 1) lays out critical data on Most at risk populations, from the latest estimates in 2007.
MARPs Population Estimates in 2007 Low (in nos.) 139,999 223,042 9,984 892,165 High (in nos.) 180,001 669,323 20,316 1,561,290 Estimate HIV prevalence in various sites Low High 0.02% 0.23% 0.07% 1.02% 0.01% 0.01% 0.85% 0.10%

Female Sex Workers Men who have sex with men Injecting Drug Users Male Clients of female sex workers

Cumulative figure

Vulnerable Populations Migrant Workers (OFWs: only those deemed vulnerable and who returned to the country) Total Out of school youth Current OFW Former OFW 883,897 1,700,000 3,849,385 883,897 1,700,000 5,014,427 Not Available 0.l0% 0.05% 0.26% 0.13%

Street children

11.6 M (Source: 2003 Functional Literacy, Education and Mass Media Survey FLEMMS) 224,417 (Source:http://www.streetchildren. org.uk/reports/southeastasia.pdf 2003)

Not Available

Source: 2007 Estimates of Adults Living with HIV in the Philippines. DOH, [2008] Note: MARPs estimates are based on situations prevailing in the 10 sentinel sites: Cities of Pasay, Quezon, Baguio, Angeles, Cebu, Iloilo, Cagayan de Oro, Davao, General Santos, and Zamboanga.

Dynamics of the Epidemic The AIDS Registry reports that for the last three years (2005-2007), and up to the third quarter of 2008, there has been a significant increase in the number of new cases. In 2005, 210 new cases were reported; there were 309 in 2006, 342 in 2007 and 395 in the third quarter of 2008.2 Majority of the reported cases are males. The Registry also showed that reported cases amongst MSMs are steadily climbing with a sharp increase in 2007. Overseas Filipino Workers (OFWs) consistently comprise 34% of all reported cases and the majority are males. It should be noted that OFWs are subjected to compulsory testing prior to employment. It was observed in 2007 that more and more young people were getting HIV3. The HIV prevalence among MARPs remains at 0.08% and is disaggregated - MSMs 0.28%, IDUs 0.13% and FSW at 0.06%.4 Figure 1. New Cases of HIV from January 1984 -October 2008

2 3

Philippine HIV and AIDS Registry, September 2008. Proceedings of the National Dissemination Forum, 2008.

The AIDS Registry shows that new cases of HIV is significantly increasing every year with an average of 2 cases being reported daily in 2008 (till Sep 2008). This is indeed an alarming trend, since AMTP IV has been implemented since 2005, and the trend of the epidemic seems to be rising sharply. The outcome of the national HIV program needs to be questioned.

Figure 2. Distribution of PLHIV among MARPS and vulnerable populations

Based on the estimated number of MARPs, MSMs had the highest proportion of HIV infections in 2007.

Mode of Transmission The main mode of HIV transmission is primarily through sexual contact: heterosexuals-- through paid sex, homosexuals practicing anal sex, and some reported bisexual. Among OFWs, a substantial number reported homosexual or bisexual transmission. The Registry showed that MSMs present the biggest threat of an accelerated growth in the spread of HIV in the country.5
4 5

Philippine UNGASS Report on HIV and AIDS, 2008 Natividad, JN, [et al.]. The HIV/AIDS Situation in the Philippines: Final Report, 2008.

Figure 3. Sexual Transmission Routes from January 1984 to October 2008

The table above suggests the predominantly heterosexual routes of transmission. There was however an increase in homosexual and bisexual transmission in 2007, whereas by 2008, heterosexual to homosexual and bisexual activity was more by 50%.

Vulnerabilities Lack of awareness, education etc leads to risky behaviour that increases vulnerability to HIV. IHBSS 2007 results show that HIV knowledge among MARPs is extremely low FSW 2%, MSM 10%, and IDU 26%. Data from OFWs are not captured in IHBSS but studies have shown that HIV information given in PDOS (Pre-Departure Orientation Seminar) is minimal and probably insufficient to gain adequate knowledge and skills to understand their risks and to protect themselves from possible infection. In addition, prolonged isolation from normal social situations and lack of awareness about local cultures of countries of destination are factored in to their vulnerability.6 Condom use among MARPs is dismally low. According to the IHBSS 2007 report, 20% of MSMs who practice anal sex report a low percentage (32%) of condom use; IDUs report 27%. Condom use among FSW is 65%. In addition, 48% of IDUs used sterile injecting equipment the last time they injected.7

6 7

Ibid UNGASS Report 2008.

Figure 4. Condom Use among MARPs 2007

In summary, vulnerabilities of these populations are high due to almost negligible HIV awareness, low utilization of condoms and occupational environment like in the case of OFWs. The data shows that there is an increasing trend of new cases, awareness is low among the MARPs and vulnerable populations and the behaviours remain risky exhibiting the less than optimal performance of the National HIV program This is the comprehensive Operational Plan for the years 2009 to 2010 under the AIDS Medium Term Plan IV (AMTP IV). This operational plan went through a series of consultation with field implementers, program planners and managers from various stakeholders, positive community and the external assistance sector during its development over a period of four (4) months. The Philippine National AIDS Council (PNAC) approved the Operational Plan in July 2009 to become the overall framework and guide for all HIV prevention initiatives and actions in the country. The Operational Plan reflects the essential prevention intervention packages for each target population and the attendant health systems and community systems strengthening activities necessary for efficient service provision and reporting. The Operational Plan also significantly considers the target set by the country under its Roadmap to Universal Access (UA) document.8 The UA targets are actually the universes under which the costing was based. The UA targets are also the AMTP IV targets. The sites where the intervention will be implemented as well as the organizations and institutions that will be implementing the activities are also identified in the plan. The plan includes the funding available for the program from various current programs and projects of various government, civil society organizations and Official Development (ODA) partners up to 2010. The operational plan costs a total of PhP4, 697,411,420 (US$99,944,923) with ten percent (US$10.243million) already with funding and 90 percent (PhP 3,734,493,078) still unfunded. Funding to cover the gaps will be sought from various sources, both domestic-public, bilateral and multilateral donors and private international organizations.

Scaling Up towards Universal Access by 2010: A Renewed Commitment to Prevention, Treatment, Care and Support for HIV and AIDS: Philippine Country Report. Manila: Philippine National AIDS Council, 2006.

2T V Th he eA AI ID DS SM Me ed diiu um mT Te er rm mP Plla an n( (A AM MT TP P) )I IV
The AIDS Medium Term Plan IV covers six (6) years - 2005 to 2010. It is the blueprint for action in accelerating the countrys response to STI/HIV/AIDS. An Operational Plan including an indicative resource requirement that is updated every two years accompanies the AMTP IV. The AMTP IV carries the following program directions: 1. Intensify prevention interventions among populations most at risk 2. scale-up prevention efforts towards other vulnerable groups (e.g., overseas Filipino Workers or OFWs, youth and children) 3. expand coverage and integrate HIV/AIDS in the development priorities at the local level, giving priority to identified risk zones; 4. improve the coverage and quality of care and support for people living with HIV/ AIDS; and, 5. strengthen management support systems for the national response Goal: To prevent the further spread of HIV/AIDS infection and reduce the impact of the disease on individuals, families and communities. Specific objectives: 1. To increase the proportion of population using risk free practices 2. To increase the access of persons, infected and affected with HIV/IDS, to quality information, treatment, care and support services 3. To improve the attitude of society towards people infected and affected with HIV/AIDS 4. To improve the efficiency and quality of management systems in support of HIV/AIDS programs and services

This AMTP IV Operational Plan 2009 - 2010, anchored on the goal and objectives of AMTP IV have the following targets: Prevention Targets
Population Group Males who have sex with males (MSM) Female Sex Workers (FSWs) Injecting Drug Users (IDUs) Overseas Filipino Workers (OFWs) Out of School Youth Street children People in the Workplace In-school Youth Total * Sex disaggregation not available Denominator 669,323 180,001 20,316 (f=5%)9 883,897 (f=26%)10 11,600,000* 224,317* No data 19.8m 2009 % 45 45 40 60 15 15 40 40 2010 % 60 60 60 100 45 45 50 60 Total reach by end 2010 401,594 108,006 12,190 883,897 5,220,000 33,648 no data 11.9m

Treatment, Care and Support Targets About 23.9% of adults living with HIV are women11
Population Group
9

Denominator

2009

2010

Total reach by end 2010

10 11

2007 Estimates of Adults Living with HIV in the Philippines. Manila: National Epidemiology Center, Department of Health, [2008]. Ibid. Ibid.

PLHIV receiving OI treatment PLHIV adhering to ARV/OI treatment PLHIV receiving prophylaxis treatment PLHIV eligible for ARV treatment and receiving Babies of HIV positive mothers receiving ARV Known HIV positive pregnant women receiving ARV Total

Number of reported case (no data) Number of reported case (no data) 100% of reported cases

% 90 95 50 50 100 95

% 90 95 75 75 100 100

90% of reported cases 95% of reported cases 75% of reported cases 75% of reported cases 100% of reported cases 100% of reported cases

3D Plla an n2 20 00 09 92 20 01 10 0 De ev ve ello op pm me en nt tP Pr ro oc ce es ss so offO Op pe er ra at tiio on na allP


The development of the Operational Plan was an activity that witnessed a multi-sectoral and multidisciplinary involvement of stakeholders from across the country. Under the leadership of the Philippine National AIDS Council (PNAC), a core team was formed to plan and guide the development process. The Core Team had a series of preparatory and planning meetings before and after the national operational planning workshops. The core team did a review of the key documents that included the Results of the AMTP IV Midterm Assessment, Philippine UNGASS Report 2008, Commission on AIDS Asia Report, Roadmap to Universal Access, and Costing Guidelines for HIV Intervention Strategies. The results of that review became the framework upon which the AMPT IV Operational Plan 2009 2010 was based. Two (2) national workshops were held on January 24 to 27, 2009 and February 26 to 28, 2009. Implementers across the country labored on putting together costed prevention intervention packages per target MARP and VPs, treatment, care and support packages, based on their programmatic and costing experiences. Support activities like program management and monitoring and evaluation were detailed and costed as well. The INPUT12 model on costing HIV prevention was used in determining resource needs of the Operational Plan with expertise coming from members of the Core Team that attended the costing training in Bangkok, Thailand in 2008. The workshops valuable outcomes are:
12

INPUT is an Excel/spreadsheet program developed by UNAIDS and Asian Development Bank. It calculates unit costs for common HIV/AIDS interventions using the prevailing local costs in a particular country.

a. Establishment of key programme directions for scaling up to catch up on the UA/AMTP IV targets of the country; b. Setting up the MARP and VP specific package of intervention; c. Determination of local unit costs for specific intervention package per population group, which became the basis for costing future HIV plans and programmes for the country; d. Mapping of Intervention Sites where current actions and initiatives on prevention, treatment, care and support were identified; e. Mapping of available resources where funding and intervention implementers and where these resources are, were identified; and f. Determination of resource gaps The outputs of the workshops were refined by the Core Team, disseminated and validated to the stakeholders, further refined and finalized, and then presented to PNAC for approval and endorsement. The Operational Plan is also scheduled for circulation to all stakeholders for everyones utilization. The AMTP IV Operational Plan 2009 2010 is only as helpful to the achievement of the country AIDS control objectives when the HIV and AIDS stakeholders refer to its programmatic directions and apply them in their respective actions. The targets set in the Operational Plan is the blueprint for all program implementers and therefore will be the document against which the countrys HIV and AIDS national response will be measured.

4T 2 20 01 10 0 Th he eA AM MT TP PI IV VO Op pe er ra at tiio on na allP Plla an n2 20 00 09 9


This two-year operational plan follows the strategic direction of AMTP IV but scaling up prevention intervention among males who have sex with males where increasing HIV infections are occurring; and begins to look to employed young people as a potential hub of the infection. This nascent trend in the epidemic was noted by the AMTP IV mid-term assessment as revealed by the most recent Integrated HIV Behavioral and Surveillance Sentinel Surveillance (IHBSS)13. The Operational Plan scales up the endeavor to achieve the countrys Universal Access /AMTP IV targets by 2010. A. Key Issues

The Operational Plan responds to some of the most urgent recommendations raised from the recently completed AMTP IV mid-term assessment, reports of ongoing interventions, and that of the AIDS Commission. It picks the recommendations that are urgent and deemed doable during the two-year period remaining for AMTP IV implementation. Other similar urgent recommendations, but which implementation require more resources and time are for inclusion in the succeeding AIDS medium term strategic plan (AMTP V), which PNAC plans to formulate in 2010. The recommendations being responded to by this Operational Plan are: 1. Build an evidence base for responses

13

IHBSS 2007, DOH National Epidemiology Center

Per the UNGASS 2008 report, prevention coverage among MARPs and VPs is seriously underachieved- below 30% coverage in any of the MARPs putting the probability of fulfilling the country targets dimly. Results of recently conducted research and evaluation studies14 suggest poor quality of existing interventions. This is further confirmed by low level of knowledge of risky behavior among MARPs, the youth and even among migrants. This raises the question of the appropriateness of interventions and/or the correctness even of the current intervention sites. To be able to address these questions, geographic mapping of vulnerability to HIV and AIDS is top priority in 2009. Assessing the burden of MARPS in key cities and municipalities is important to realistically identify and prioritize intervention sites and package services for each MARP. PNAC needs to update the risk zones to enable the program to make decisions on where to put the interventions where they can impact more. Geographic mapping of priority and potential risk zones will also inform future costing of the national strategic plan AMTP V for 2011 to 2015. 2. Facilitation of decentralized program implementation, including guidelines and processes The response at the local level is critical for the success of the national program. Building the capacity of Local AIDS Councils (LACs), especially on program planning, and management and fund raising are imperative. Some LACs are very effective and PNAC should provide the platform for sharing and cross learning. 15 The geographic mapping of MARPs and risk zones will also inform the program planners and managers advocacy strategies and where and who to beam the advocacies to.

3.

Enhance M&E systems There is a need to fully roll out the National AIDS Monitoring and Evaluation System at all levels of program implementation. The M & E system can be strengthened by clearly defining baselines, targets and performance indicators and rigorous capacity building on operating and using M&E systems at all levels of the program implementation continuum. Partnership and agreement with development partners is necessary and should be geared towards sharing information with PNAC.

4.

Increase the effectiveness of existing structures (PNAC and its Secretariat) There needs to be a Capacity Development Plan for PNAC and PNAC Secretariat. One of the areas of urgency is addressing transient leadership and move towards semi-permanence and systems for continuity.16 A planned and interactive organization development process as a followup to the PNAC organizational and capacity assessments will help hasten the road to effectiveness. During the development of this Operational Plan PNAC was also concurrently finalizing its organizational development plan (embodied in the PNAC Communication Plan), which is envisioned to address the above.

B.

Strategic Directions of AMTP IV Operational Plan for 2009 to 2010 The recommendations mentioned earlier in this document form the bases for the strategic directions of this operational plan. The Philippines HIV situation is a latent epidemic where HIV prevalence is still very low and early and effective action on prevention will avert a large-scale epidemic. Thus, the countrys HIV program should aim to prevent the maximum number of new HIV infections and this

14
15

Surveillance evaluation, 100% Condom Use Program Evaluation, PMTCT Evaluation, Behavioral Surveys among IDUs and OFWs Mid term Review of AMTP IV Philippines 16 Ibid

10

means focusing interventions on population groups that are most-at-risk of getting infected.17 A package of services approach will be adopted and applied in reaching the MARPs and VPs. The MARP/VP- specific packages of intervention have common contents, like peer education, condom promotion and provision, and management of sexually transmitted infections (STIs) but take special consideration the unique characteristics of the particular population group. Standardizing the MARP/VP-specific package of interventions will also streamline and harmonize the program in the various program sites. The country needs to take the intervention to scale. The Commissions research, using the Asian Epidemic Model, shows that a behavior change among 60% of the high-risk populations can effectively halt the epidemics growth.18 It is thus imperative that the UA/AMTP 4 targets be achieved by 2010 to have an impact on the trend of the AIDS situation in the country.

Prioritization of Key Directions The tables in the succeeding pages show program performance targets during 2009 and 2010 against the countrys UA /AMTP IV targets. The baseline performance as of 2008 against the denominator figures per population group, if compared to the targets for the two years show how much the program needs to accelerate implementation for the two years remaining of AMTP IV. Note also that some impact indicators are left blank. This is because pending the completion of geographic vulnerability mapping and other researches that need to be conducted to establish evidence bases to inform future programming.

1.

Prevention- Promoting risk free behavior among MARPs and VPs

While the GFATM supported AIDS projects and initiatives have on the average, reached almost 150% of performance targets for MARPs, the outputs, at less than 15%, relative to the Universal Access/AMTP IV targets is very low. The country needs to develop sector-specific behavior change communication (BCC) strategies and find innovative approaches to bridge the gap between knowledge and safe behaviors among MARPs and VPs. Another important step is looking at the particular intervention needs of MARPs who belong to the under-aged population. Recognizing the uniqueness of this sub-group, the children and youth Sector, under this Operational Plan will develop strategies tailored to the needs of young MARPs. This operational plan also accelerates actions to reach MARPs specially the MSM communities, who are now seen to have increasing HIV infections per 2007 IHBSS. a. Most at Risk Populations: i. Males having sex with males (MSM) born male who reported oral or anal sex with another man in the past year. (2007 IHBSS).

17 18

Redefining AIDS in Asia, Crafting an Effective Response. Report of the Commission on AIDS in Asia. March 2008 Ibid

11

Denominator in figures19

AMTP IV Universal Access Targets Prevention Coverage: 2009: 45% 2010: 60% Knowledge: 2009: 90% 2010: 90% Condom use: 2009: 85% 2010: 95% HIV Tested and know the results: 2009: 30% 2010: 60% STI prevalence: 2009: less than 5% 2010: less than 5% HIV among MSM: 2009: less than 1% 2010: less than 1%

Baseline: Targets Achieved in 2008 19% (127,154) UNGASS 07 2% (14,530) , GF3 0.83% (5,564), GF5: 10% (66,932) 32% (214,183) 16% (107,092)

Intervention Sites

MSM 669,323

Cities of : Manila, Makati, Pasig, Marikina, Laoag, Candon, San Fernando, Baguio, Dagupan, Tuguegarao , Cauayan, Santiago, Angeles, City Of San Fernando, San Pablo, Baliwag, Gapan, Munoz, Cabanatuan, Palayan, San Jose, Batangas, Lucena, Naga, Legazpi, Daraga, Sorsogon, Calapan and Puerto Galera, Palawan, Iloilo, Boracay, Kalibo (Aklan), Cebu, Mandaue, Lapulapu, Ormoc, Bacolod, Dumaguete, Tacloban, Catarman, Catbalogan, Tagbilaran, Butuan, Dipolog, Cotabato, Cagayan de Oro , Zamboanga, Davao, and General Santos; municipalities of Bauang, Gumaca, Matnog, Allen, and Isabel.

Impact Indicator

ii. Sex Workers (SWs) - operational definition is born female who accepted cash or in kind for sex in the past there months. It is further segmented into two categories: Non-registered Female Sex Worker born female who accepted cash or in-kind for sex in the past three months; has not accessed services at social hygiene clinics in the past three months20 Registered female sex worker (RFSW) born female who accepted cash or inkind for sex in the past three months; accessed services at social hygiene clinics in the past three months, regardless if she is connected with an establishment or not.21 Denominator in figures22 FSW 180,001 AMTP IV Universal Access Targets Prevention Coverage: 2009: 45% 2010: 60% Baseline: Targets Achieved in 2008 14% (25,200) UNGASS 07 8% (14,087), GF3 3% (5,997), GF5 2% (3,600) 65% (117,001) Intervention Sites Cities of : Manila, Makati, Pasig, Marikina, Laoag, Candon, San Fernando, Baguio, Dagupan, Tuguegarao , Cauayan, Santiago, Angeles, City Of San Fernando, San Pablo, Baliwag, Gapan, Munoz, Cabanatuan, Palayan, San Jose, Batangas, Lucena, Naga, Legazpi, Daraga, Sorsogon, Calapan and Puerto Galera, Palawan, Iloilo, Boracay, Kalibo (Aklan), Cebu, Mandaue, Lapulapu, Ormoc, Bacolod, Dumaguete, Tacloban, Catarman, Catbalogan, Tagbilaran,

Knowledge: 2009: 90% 2010: 90% Condom use: 2009: 85%


19
20

2007 Estimates of Adults Living with HIV in the Philippines, 2008 2007 2009 IHBSS Ibid 2007 Estimates of Adults Living with HIV in the Philippines, 2008

21 22

12

Impact Indicator iii.

2010: 95% HIV Tested and know the results: 2009: 30% 2010: 60% STI prevalence: 2009: less than 5% 2010: less than 5% HIV among FSW: 2009: less than 1% 2010: less than 1%

12% (21,600)

Butuan, Dipolog, Cotabato, Cagayan de Oro , Zamboanga, Davao, and General Santos; municipalities of Bauang, Gumaca, Matnog, Allen, and Isabel.

Injecting Drug Users (IDU) are male or female who has been injecting drugs for the past six months. AMTP IV Universal Access Targets Prevention Coverage: 2009: 40% 2010: 60% Knowledge: 2009: 90% 2010: 90% Condom use: 2009: 85% 2010: 95% Use of sterile equipment: 2009: 30% 2010: 60% HIV Tested and know the results: 2009: 15% 2010: 30% STI prevalence: 2009: less than 5% 2010: less than 5% HIV among IDUs: 2009: less than 1% 2010: less than 1% Baseline: Targets Achieved in 2008 14% (2,844) UNGASS 07 4.4% (899), GF5 26% (5,282) UNGASS 07 No data 48% (9,752) UNGASS 07 4% (813) UNGASS 07 Intervention Sites Cities of Cebu, Lapulapu, Mandaue, Danao, Toledo, Lilioan, Danao, Talisay, San Fernando, Minglanilla, Carcar, Balamban, Gen Santos, and Zamboanga,

Denominator in figures23 IDU 20,316

Impact Indicator

b.

Vulnerable Populations (VPs):

The AMTP IV zeroes in on the Overseas Filipino Workers (OFWs), children, youth in difficult circumstances like the street children, and out-of-school youth as the VPs to be focused the interventions on. Overseas Filipino Worker (OFW) person who is to be engaged, is engaged, and has engaged in a remunerated activity in a state of which he/she is just a legal resident: OFW Act of 1995)

23

Ibid.

13

OFW (at risk) In-country (temporary or permanent) and has worked outside of the country in the last two years; currently out of country or who has left the country in the last two year; 2007 Estimates The OFWs meanwhile, for this Operational Plan were further segmented into four (4) subgroups owing to the differences in the situations and conditions obtaining in their places of work. The segmentation of OFWs into distinct subgroups stems from the unique situation they find themselves in due to the nature and culture of their work environment and/ or sexual relationship to a seafarer (in the case of female spouses of male seafarers). The OFW sub-groupings are: OFW- Male seafarers (OFW-MS) OFW- Spouses of Male Seafarers (OFW-SMS) estimated at 11,15024 OFW- (Female Seafarers (OFW-FS)- 6,436 as of 200625 and were found to need gender-based policies on board ships to protect them from certain vulnerabilities to HIV and other RH problems OFW Land based (OFW-LB) estimated to be 851,82326 The spouses of male seafarers, although not strictly OFWs will be provided services due to the unique situation they find themselves in as spouses of people who have risk behaviors. i. OFWs Denominator in figures27 Current OFWs 883,897 AMTP IV Universal Access Targets Prevention Coverage: 2009: 60% 2010: 100% Knowledge: 2009: 60% 2010: 90% Condom use: 2009: 45% 2010: 67.5% STI prevalence: 2009: less than 5% 2010: less than 5% HIV prevalence among OFWs: 2009: less than 1% 2010: less than 1% Baseline: Targets Achieved in 2008 2% (14,250), GF3 0.95% (8376), GF5 No data No data Intervention Sites Nationwide

Impact Indicator

ii. Children/ Youth in Difficult Circumstances They are operationally defined as: Out of School children and youth are 7-24 years of age who have dropped out of school, those who never attended school, or those who participate in alternative school programs and who are not formally employed.28

24 25 26 27
28

estimated to be 0.05% of male seafarers. 2007 IHBSS RETA 6143, Contract No.-COSO-080-081,ADB Ibid 2007 Estimates of Adults Living with HIV in the Philippines, 2008 http://www.census.gov. Ph/data/sectordata/fl 94-osy.html. Date accessed: January 25, 2009

14

Street children refers to children (<18) who stay on the streets and in public places at least four hours and above every day, are engaging in varied types of activities in the streets or public places such as playing with friends as well as peers, sleeping and earning a living. Included in this operational definition are street children housed in temporary shelters, drop-in centers and processing centers.29 Urban / working children (a child (<18) in work or economic activity, including child labor30 AMTP IV Universal Access Targets Prevention Coverage: 2009: 15% 2010: 45% Impact Indicator STI Prevalence: 2009: less than 5% 2010: less than 2.5% Prevention Coverage: 2009: 15% 2010: 45% Impact Indicator STI Prevalence: 2009: less than 5% 2010: less than 2.5% Baseline: Targets Achieved in 2008 No Data Intervention Sites 136 cities across the country

Denominator in figures31 OSYs 11.6 million32

No Data

136 cities across the country

Street Children 224,417

2. Increasing access of persons, infected and affected with HIV/AIDS, to


Treatment, Care and Support (TCS) services As of May 2009, a cumulative total of 3,911 HIV infections since 1984 have been reported in the AIDS Registry. Of these, 3,597 are still living. Of the living 604 (as of march 2009) are under antiretroviral (ARV) treatment including treatment of opportunistic infections in 13 treatment hubs in the country. The GFATM supported projects and the government can cover ARV needs until mid 2010. However, ARV availability remains uncertain beginning the last half of 2010 and beyond. Community and home based care services are provided by NGOs, peers, and community representatives. However, the capacity to implement interim comprehensive TCS services package (both human resource and logistics) needs to be strengthened. Prevention of mother to child transmission (PMTCT) is another aspect that needs to be strengthened. Treatment Hubs and other hospitals Through the leadership of the NASPCP, 13 treatment hubs across the country are now in place where patients can access free ARV with support from GFATM Rounds 3, 5 and 6. The treatment hubs (hospitals) do VCT, make diagnosis and provide ARV treatment and prophylaxis and treatment of HIV and opportunistic infections. The treatment hubs with HIV AIDS Core Teams (HACTs) in place are:

29 30

: "Ours to protect and nurture", page 6 Republic Act No 9231 - Law for the elimination of the worst forms of child labor 2007 Estimates of Adults Living with HIV in the Philippines, 2008 UNGASS Report 2007

31 32

15

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Ilocos Training Regional Medical Center Baguio General Hospital San Lazaro Hospital Research Institute of Tropical Medicine UP- Philippine General Hospital Bicol Regional and Training Hospital Don Vicente Sotto Memorial Medical Center Corazon Locsin Medical Center Western Visayas Medical Center Davao Medical Center Zamboanga City Medical Center Cagayan Valley Medical Center Jose B. Lingad Medical Center

- San Fernando, La Union - Baguio City - Manila - Manila - Manila - Legazpi, Albay - Cebu City - Bacolod City - Iloilo City - Davao City - Zamboanga City - Tuguegarao City - San Fernando City, Pampanga

Aside from the 13 treatment hubs, there are also some 68 hospitals, both public and private with HACTs that have been capacitated and updated on HIV/AIDS clinical management. The program will continue engaging private hospitals to set up a private-public partnership for HIV and AIDS care, treatment and support. The program will improve the networking and referral system to facilitate access of patients to free ARV. TCS targets Indicators33
Percentage of PLHIV receiving Opportunistic Infection (OI) treatment. Percentage of PLHIV who adhered to ARV and OI treatment. Denominator: Number of reported cases: 395 (AIDS Registry Sept 08) Percentage of PLHIV receiving prophylaxis treatment. Percentage of PLHIV eligible for treatment and receiving ARV.

Baseline: Targets Achieved in 2008


no data Denominator: Number of reported cases: 395 (AIDS Registry Sept 08) no data

AMTP IV Universal Access Target


2010: 90% (2008 target)

Intervention Sites 2009 / 2010


none yet

Indicator 15.1 Indicator 15.2

2010: 95% (2008 target)

none yet

no data

Indicator 16 Indicator 17

Indicator 18.1 Indicator 18.2

Percentage of babies of HIVpositive mothers receiving ARV. Percentage of known HIV+ pregnant women receiving ARV.

GF5: 227 (Grant Performance Report 2008) 2006: 99% 2007: 56% UNGASS 2007 no data

2009: 50% 2010: 75% (2007-2008 targets) 2009: 50% 2010: 75% (2007-2008 targets) GF5 Target: 90% 2009: 100% 2010: 100% (2007-2008 targets) 2009: 95% 2010: 100% (2007-2008 targets)

none yet

none yet

none yet

no data

none yet

3.
33

Impact Mitigation

The indicator numbers refer to the national M&E indicator

16

Impact mitigation programmes are needed to protect the livelihoods of HIV-infected and affected households and families who bear the heaviest burden of illness and death. The Commission has found that this aspect of the HIV response remains particularly underdeveloped and poorly resourced in Asia. As a result, the household- level impact of the epidemic is especially severe for poor families.34 The operational plan will initiate impact mitigation interventions to help PLHIVs and their families cope with the social and economic stress caused by HIV. Among the proposed assistance are alternative livelihood training for PLHIVs and family members, support for orphans and carer of the orphan, and burial assistance. 4. HIV education among General Population The latest data being gathered as of 2008 by the National AIDS Registry show that HIV infection is slowly but steadily affecting some sectors within the working and youth population. The national response will now consciously move towards invigorating HIV prevention initiatives among people in the workplace and in-school youth. (Refer to Annex 1) The move towards expediting interventions at the workplace and schools is also envisaged to improve the attitude of society towards people infected and affected with HIV/AIDSwhich is Objective 3 of AMTP IV. i. People in the Workplace The operational definition is people who are wage earners and/or those earning from their trade. They are segmented into the following categories: Formal sector employees -wage and income earners from large, medium, and small scale enterprises estimated to be 17.8 million Informal sector - people earning from their trade like vendors, drivers, including those in the undergound economy, estimated to be 16.2 million Government Employees - those who work for the government at all levels or units of the government bureaucracy, estimated to be 1.4 million. Only a handful of enterprises (usually the multi-national companies) have HIV programs in place. The Operational Plan sees the wisdom of doing advocacy and strategic communication activities to engage enterprises (Large scale, Medium scale, Small scale); labor Unions and government offices to understand HIV and its implications to good business practice. At this juncture, the Operational Plan targets at least 40 employers for advocacy activities, in order for these enterprises to invest in establishing HIV prevention activities within their workplaces. Initial activities are conduct of CEO Forums and educating labor unions on HIV/AIDS to advocate for the institution of a Philippine Business Coalition for HIV/AIDS. Subsequently if these organizations buy in into the Program, BCC activities and condom distribution in the workplace can happen.

Other country targets and indicators Indicator35 s Baseline: Targets Achieved in 2008 AMTP Universal Access Targets 36 Intervention Sites 2009 / 2010

34

Ibid 35 The indicator numbers refer to the national M&E indicator 36 Targets set during Operational Planning at Antipolo, 27-30 January 2009

17

Indicator 20.1

Percentage of large-scale enterprises/ companies that have HIV and AIDS workplace policies and programmes. Percentage of medium-scale enterprises/companies that have HIV and AIDS workplace policies and programmes. Percentage of small-scale enterprises/companies that have HIV and AIDS workplace policies and programmes

No data Estimate: 5,000 largescale companies No data Estimate: 795,000 companies (both small and medium) No data

2009: 50% 2010: 70%

None yet

2009: 25% 2010: 35%

None yet

Indicator 20.2

Indicator 20.3

2009: 15% 2010: 25%

None yet

i.

In-school Children and Youth

This population group, aged 7 to 24 is large- almost half of the entire Philippine population. Unit costing for the package of intervention for these segments of the general population show a lot less resource requirement but greater future impact on the trend of the disease burden in the country. HIV education can be achieved with collaboration with the Department of Education (DepEd), Commission on Higher Education (CHED) and Technical Education and Skills Development Authority (TESDA) and private schools and youth organizations like the Girl Scouts of the Philippines.

Other country targets and indicators Note: the indicator numbers refer to the national indicator listing. Percentage of primary schools where life-skills based HIV and AIDS education is taught. Baseline: Targets Achieved (quote source) in 2008 No data Public: 37,807 Private: 6,664 Total: 44,471 No data Public: 5,110 Private: 4,392 Total: 9,502 AMTP Universal Access Targets 2010: 60% (26,683) (2008 target) Target Sites 2009 / 2010

Nationwide

Indicator 12.1

Indicator 12.2

Percentage of secondary schools where life-skills based HIV and AIDS education is taught.

2010: 60% (5,701) (2008 target)

Nationwide

Safe Blood Supply Other HIV and AIDS related an activity happening is ensuring that blood supply is safe through the DOHs National Voluntary Blood Services Program (NVBSP). The NVBSP and the National AIDS and STI Prevention and Control Program (NASPCP) have started to

18

collaborate through the GFATM-supported Round 6 AIDS country project. Country performance targets for blood safety are: 49,680 volunteer blood donors recruited and screened for HIV 250,000 blood units tested for HIV and other transfusion-transmissible infections (TTIs)

5.

Program Support

All the above plans for HIV/AIDS programs and services cannot be realized unless program support structures and systems to enhance the efficiency and quality of management are put in place. The plan attends to essential improvements to fulfill the requisites for efficient oversight and supervision. i. Program management

The national response is under the supervision of the Philippine National AIDS Council (PNAC)- the highest policy recommending body on AIDS and is composed of 26 government agencies, NGOs, professional organizations and representative from people living with HIV. It is charged with planning, coordinating and monitoring the countrys national response to HIV and AIDS. It sees to it that all HIV and AIDS projects and initiatives in the country respond to the current and future AIDS Medium Term Plan. PNAC is supported by a Secretariat whose functions is to support PNAC plenary in its policy-decision making, insure availability and utilization of strategic information for program planning, coordinate and monitor implementation of sector-specific responses, and provide administrative support to PNAC. Assisting PNAC in the management of various aspects of AIDS prevention and control are the following agencies: Department of Health - National Center of Disease Prevention and Control (DOHNCDPC), National AIDS and STI Prevention and Control Program (NASPCP) provides technical leadership for the health sector response, through policy guidance, technical assistance, capacity building and other resource augmentation, monitoring and evaluation within the ambit of the health system. Department of Health - National Voluntary Blood Safety Program (DOH-NVBSP) is the program management arm of the DOH in implementing. Republic Act 7719, also known as the National Blood Services Act of 1994, which aims to provide Filipinos with safe, adequate, and accessible blood coming exclusively from voluntary blood donors. Department of Labor and Employment (DOLE) is the program management arm of PNAC in HIV /AIDS prevention in the workplace. Department of Education (DepEd) is the management and implementing arm of PNAC in the Education response to HIV/AIDS. Department of Social Welfare and Development (DSWD) is the management and implementing arm of PNAC in insuring that indigent PLHIVs are provided welfare services such as care and support and other assistance to mitigate impact of the disease to poor Filipino PLHIVs. Department of Interior and Local Government (DILG) sets the directions for local response.

Other government agencies such as National Economic and Development Authority (NEDA), Philippine Information Agency (PIA), Department of Foreign Affairs (DFA),

19

Department of Budget and Management and Department of Tourism (DOT) have provided support in the overall planning. The work plan of program management is geared towards improving systems and procedures, capacity building and infrastructures for efficient and effective program planning and implementation. ii. Monitoring and Evaluation (M&E)

A vital component of Program Support is the availability of accurate, timely and accessible data to inform program planning. Monitoring is needed to verify step by step the progress of project implementation at the municipal, city, provincial, regional and national levels e.g. to verify whether activities have been implemented as planned, to ensure accountability, and to detect any problems and/or constraints. This in turn can provide feedback to the relevant authorities for them to take remedial measures thus promote better planning through careful selection of strategies for future action. Evaluation is the periodic assessment of the relevance, effectiveness and impact of activities in the light of the goals and objectives of the program. PNAC, being the overall manager of the national response is also responsible for its monitoring and evaluation. The national line agencies and civil society implementers report their accomplishments to PNAC. Assisting PNAC in the monitoring of various aspects of AIDS prevention and control are the following agencies: DOH- National Epidemiology Center (NEC) manages AIDSWATCH, the HIV monitoring system, which includes the AIDS Registry. It reports the output of the health sector to PNAC. The government line agencies managing the other aspects of HIV prevention (education, labor and social welfare and services) are also responsible for reporting to PNAC. Health Action Information Network (HAIN) is the NGO tasked by PNAC to manage the data coming from the civil society sector and report them to the National AIDS Monitoring and Evaluation System. A PNAC resolution to formalize HAINs role in the AIDS monitoring and evaluation system is under process.

Among the essential tasks of Monitoring and Evaluation is the building of evidence base to inform program planning. Part of this evidence base is the geographic vulnerability mapping and IHBSS, among others. Research is also essential in building evidences. A separate HIV/AIDS Research Agenda 2005-2010 was developed as a basis for future research activities. C. Institutional Arrangement for Implementation of Operational Plan

Previous sections of this document cited the management roles of lead agencies for the health, labor, education and social welfare and services responses to HIV/AIDS. This section describes the key direct players in realizing the operational plan. They range from the positive community, national government and civil society organizations, multilateral and bilateral institutions, local government units and local NGOs.

Key Direct Implementers 1. Health Sector Response

20

Department of Health NASPCP is the key coordinating and implementing agency for STI and HIV/AIDS program delivery specifically on treatment, care and support. The NEC manages the national HIV sentinel surveillance system which monitors and records new cases of HIV through the Philippine HIV and AIDS Registry. It also manages and coordinates STI surveillance and services and provides capacity development among LGUs. It regularly conducts the IHBSS, the active surveillance of new HIV cases. Local Government Units (LGUs), as health program implementers, but not limited to HIV prevention are the lifeblood of the prevention component of the national response to AIDS. LGUs implement HIV/STI prevention activities in coordination with various stakeholders including their NGO partners. The City/Municipal Health Office-Social Hygiene Clinics (CHO/MHO-SHCs) are tasked to do STI diagnosis, provide STI treatment, do voluntary counseling and testing (VCT), conduct blood donation education and activities, and report regularly on their outputs to the DOH. Non-governmental organizations and peoples organizations (NGOs and POs) implement the community-based outreach and education in close partnership with the CHDs, LGUs and/or treatment hubs. National Voluntary Blood Services Program (NVBSP) Unit assists and works with the Regional Blood Service Facilities nationwide and the CHD Metro Manila Lead Blood Service, Philippine National Red Cross (PNRC) and Philippine Blood Coordinating Council (PBCC), and National Hemophilia Center. The identified blood service facilities will conduct advocacy, public education, pep talks and donor recruitment. The PBC tests the blood units collected from volunteer blood donors in Metro Manila to insure safety of blood supply. Treatment Hubs and HIV AIDS Core Team (HACT) is the focal point for all HIV related services in a hospital setting, which is currently the platform for HIV counseling and testing, treatment of opportunistic infection, universal precaution and infection control and psychosocial support to people living with HIV and AIDS. Centers for Health Development (CHDs) provide technical supervision and assistance to the LGU health offices/units in the areas of health programme advocacy, implementation and monitoring. Three (3) focal persons- STI/AIDS Coordinator, Regional Blood Program Coordinator and the Regional Epidemiological Surveillance Unit (RESU) are involved in the program. The CHD STI/AIDS Coordinator and Blood Program Coordinator provide technical support, regularly collect, and validate programmatic reports of the involved social hygiene clinics (SHCs) and blood service facilities respectively in their area of jurisdiction. The RESU collate the SSESS reports from the SHCs. The Provincial Health Offices (PHOs) for component cities are involved in the planning, supervision and monitoring of LGU and NGO implementers. For chartered cities, the CHD is tasked to ensure that the PHO is furnished with reports and invited to provide technical assistance in the project. Education Sector Response The elementary and secondary schools under the DepEd, tertiary schools under CHED and trade and technical schools under TESDA; both public and private are the ones tasked to implement HIV/AIDS education to pupils and students across the country. However, this aspect of the national response has yet to take off. Labor Sector Response The large, medium and small-scale businesses, which are under the regulatory supervision of DOLE are the key actors for this aspect of the national response. Social Welfare Sector Response

2.

3.

4.

21

The DSWD through its regional offices and city/municipal social welfare offices are the implementing arm for this particular component of the national response. Among the government line agencies that are members of PNAC, the DSWD is very active in fulfilling its role in the AIDS program. 5. Civil Society Sector Response The civil society sector assists the national agencies and local government units in implementing sector-specific responses at various geographic sites. There are approximately more than 50 civil society organizations implementing various HIV prevention interventions across the country.

5R on na allP Plla an n Re es so ou ur rc ce eR Re eq qu uiir re em me en nt to offt th he eO Op pe er ra at tiio


The costing lens used in computing for the program resource requirement is the package of intervention approach and classification of expenditure used is that of the National AIDS Spending Assessment (NASA). 1. Summary of Resource Requirement for 2009 -2010

This summary of resource required for the two-year period of the Operational Plan include both funded and unfunded initiatives. The package of interventions for MARPs (SW, MSM, IDU) and VPs (OFWs, children and youth in difficult circumstances) generally cover the following cost components: behavior change (training, outreach, IEC), commodities and services (condoms, STI services), enabling environment, program management, and M&E. Summary of Financial Requirements and Available Resources by Expenditure Category

22

Summary of Financial Requirements and Available Resources by spending category (in US dollars) Total Resource Available Resources Expenditure Items Requirement (ave per year) (one year only) 1. Prevention-related activities 46,734,802 1,504,647 2. Treatment and care components 1,029,862 904,759 3. Orphan and Vulnerable Children 65,895 22,750 2,082,404 4,071,083 4. AIDS programme support costs 5. Incentives for human resources 0 2,443,068 6. Social Protection and Social Services 59,498 165,226 0 1,002,459 7. Enabling Environment and Development 8. Research excluding operations research 0 129,820 TOTAL 49,972,462 10,243,812 Annual resource gap Resource Gap for 2009-2010 (1 US$ = 47PhP)
Summary of Financial Requirements and Available Resources by spending category (in Philippine pesos) Total Resource Available Resources Expenditure Items Requirement (ave per year) (one year only) 1. Prevention-related activities 2,196,535,713 70,718,409 2. Treatment and care components 48,403,527 42,523,657 3. Orphan and Vulnerable Children 3,097,050 1,069,250 4. AIDS programme support costs 97,873,000 191,340,899 5. Incentives for human resources 0 114,824,214 6. Social Protection and Social Services 2,796,420 7,765,638 7. Enabling Environment and Development 0 47,115,565 8. Research excluding operations research 0 6,101,540 TOTAL 2,348,705,710 481,459,171 Annual resource gap Resource Gap for 2009-2010 (1 US$ = 47PhP) 1,867,246,539 3,734,493,078

39,728,650 79,457,300

Important Notes: 1. Surveillance activities are part of Monitoring and Evaluation which is under the expenditure category AIDS programme support costs. 2. Although Incentives for human resources and Enabling Environment in the above table appear zero, training activities as well as advocacy and communication are already incorporated in the various intervention packages. 3. Resource requirement for research activities have not yet been determined except for some evaluation studies and operations research which fall under Programme support costs. 4. Available resources reflect funding from selected National Government agencies (DOH, DOHPNAC, DSWD, DOLE-OSHC, non-government organizations (PAFPI, PNGOC, WHCF), and Development Partners (UN agencies, GFATM). *It is assumed that available resources for 2010 are the same as 2009. Resource requirements is based on cost estimates and INPUT model.

23

2.

Budget by Package of Intervention Category


P hilippine P es os 2010 T otal 2,354,925,967.01 4,697,411,420.11 368,739,045.01 737,478,090.01 1,208,318,783.31 2,416,637,566.61 21,335,921.22 42,671,842.45 47,422,318.81 94,844,637.61 20,757,052.07 41,514,104.13 8,577,491.24 17,154,982.48 53,167,354.13 96,807,054.36 4,752,000.00 6,194,100.00 4,660,700.00 5,592,840.00 11,039,900.00 22,079,800.00 6,881,314.22 13,762,628.44 244,663,010.94 489,326,021.87 255,275,376.06 510,550,752.13 5,150,200.00 7,051,000.00 5,851,500.00 11,703,000.00 88,334,000.00 184,043,000.00

Intervention P ac kag e 2009 TOTAL 2,352,685,453.11 FS W 368,739,045.01 MS M 1,208,318,783.31 ID U 21,335,921.22 O F W land bas ed 47,422,318.81 O F W s eafarers 20,757,052.07 O F W s pous es 8,577,491.24 T reatment 43,639,700.23 C are and S upport (O V C ) 1,442,100.00 Impact Mitig ation (s ocial protec 932,140.00 In s chool youth 11,039,900.00 S treetchildren 6,881,314.22 O ut of s chool youth 244,663,010.94 VC T 255,275,376.06 Workplace 1,900,800.00 P rog ramme S uppport 5,851,500.00 105,909,000.00 M&E
Intervention P ac kag e 2009 TOTAL 50,057,137.30 FS W 7,845,511.60 MS M 25,708,910.28 ID U 453,955.77 O F W land bas ed 1,008,985.51 O F W s eafarers 441,639.41 O F W s pous es 182,499.81 T reatment 928,504.26 C are and S upport (O V C ) 30,682.98 Impact Mitigation (s ocial protec 19,832.77 In s chool youth 234,891.49 S treetchildren 146,410.94 O ut of s chool youth 5,205,595.98 VC T 5,431,390.98 Workplace 40,442.55 P rogramme S uppport 124,500.00 M&E 2,253,382.98

A ve per year 2,348,705,710.06


368,739,045.01 1,208,318,783.31 21,335,921.22 47,422,318.81 20,757,052.07 8,577,491.24 48,403,527.18 3,097,050.00 2,796,420.00 11,039,900.00 6,881,314.22 244,663,010.94 255,275,376.06 3,525,500.00 5,851,500.00 92,021,500.00

US D ollars 2010 T otal A ve per year 50,104,807.81 99,944,923.83 49,972,461.92 7,845,511.60 15,691,023.19 7,845,511.60 25,708,910.28 51,417,820.57 25,708,910.28 453,955.77 907,911.54 453,955.77 1,008,985.51 2,017,971.01 1,008,985.51 441,639.41 883,278.81 441,639.41 182,499.81 364,999.63 182,499.81 1,131,220.30 2,059,724.56 1,029,862.28 101,106.38 131,789.36 65,894.68 99,163.83 118,996.60 59,498.30 234,891.49 469,782.98 234,891.49 146,410.94 292,821.88 146,410.94 5,205,595.98 10,411,191.95 5,205,595.98 5,431,390.98 10,862,781.96 5,431,390.98 109,578.72 150,021.28 75,010.64 124,500.00 249,000.00 124,500.00 1,879,446.81 3,915,808.51 1,957,904.26

Resource Gaps against Resource Requirement


The operational plan costs a total of PhP 4,697,411,420 (US$99,944,923) with 10 percent (US$10.2million) already with funding and 90 percent (US$79 million) still unfunded. Annual resource gap is US$ 39,728, 650. or US$ 79,457,300. for two years.

24

Annex 1: Summary of Intervention Package and Unit Cost 1. FSW 2. MSM 3. IDU 4. OFWs a. Land-based b. Male seafarers c. Female seafarers d. Spouses of male seafarers e. Out of school youth (OSY) f. Streetchildren This section illustrates the components of an intervention per target population with corresponding total and unit costs. Calculation of unit cost was based on the INPUT model (excel worksheets)

25

Female Sex Workers (FSW) Target number of FSW Cost per FSW Total cost Components Subcomponents/Description 1. Behaviour Change Training and incentives Communication Outreach IEC and events 2. Commodities Condoms STI diagnosis and treatment 3. Enabling Environment
Reaching out to local decision makers in the communities to strengthen and support community-based interventions Establishing understanding and cooperation in local communities regarding HIV/AIDS programs Involvement of target community (addressing needs, involvement in decision-making of all project activities) Recruitment, recurring costs, and recruitment of staff, setting up of project office, facilities for services one time and can be depreciated over time Continued measurement of coverage, knowledge and behavior change, utilization of local staff and PEs for regular revision of program

180,001 $107 $11,522,713 $3,000,000 39,362 1,300 1,500,000 304,822

4. Program Management

508,037

5. Investment 6. Monitoring and Evaluation

426 548,680

26

Males having sex with males (MSM) Target number of MSM Cost per MSM (with lubricant/without lubricant) Total cost Components 1. Behaviour Change Communication 2. Commodities Subcomponents/Description Training and incentives Outreach IEC and events Condoms Lubricant STI diagnosis and treatment Reaching out to local decision makers in the communities to strengthen and support community-based interventions Establishing understanding and cooperation in local communities regarding HIV/AIDS programs. Involvement of target community (addressing needs, involvement in decision-making of all project activities) Recruitment, recurring costs, and recruitment of staff, setting up of project office, facilities for services one time and can be depreciated over time Continued measurement of coverage, knowledge and behavior change, utilisation of local staff and PEs for regular revision of programme

401,000 $121/68 $ 48,393,710 (P22,274,504,382) $10,800,000 39,000 1,300 6,500,000 20,900,000 4,300,000 1,300,000

3. Enabling Environment

4. Program Management 5. Investment 6. Monitoring and Evaluation

2,100,000

426 2,300,000

27

Injecting Drug Users (IDU) Target number of IDU Cost per IDU Total cost Components 1. Behaviour Change Communication 2. Commodities Subcomponents/Description Training and incentives Outreach IEC and events Syringes & needles Condoms Primary Health Care Reaching out to local decision makers in the communities to strengthen and support community-based interventions Establishing understanding and cooperation in local communities regarding HIV/AIDS programmes. Involvement of target community (addressing needs, involvement in decision-making of all project activities) Recruitment, recurring costs, and recruitment of staff, setting up of project office, facilities for services one time and can be depreciated over time Continued measurement of coverage, knowledge and behavior change, utilisation of local staff and PEs for regular revision of programme

12,190 $97 $ 1,180,397 (P55,478,676) $308,036 33,191 2,553 409,327 175,530 6,484 93,682

3. Enabling Environment

4. Program Management 5. Investment 6. Monitoring and Evaluation

93,682

426 56,209

28

Vulnerable population OFWs- Land based Target number of OFW-Land based Cost per OFW-Land based Total cost Components 1. Behaviour Change Communication Subcomponents/Description Training Incentives Outreach IEC and events Condoms STI services Reaching out to local decision makers in the communities to strengthen and support communitybased interventions Establishing understanding and cooperation in local communities regarding HIV/AIDS programmes. Involvement of target community (addressing needs, involvement in decision-making of all project activities) Recruitment, recurring costs, and recruitment of staff, setting up of project office, facilities for services one time and can be depreciated over time Continued measurement of coverage, knowledge and behavior change, utilization of local staff and PEs for regular revision of program

851,823 $4.11 $ 3,500,557 (P164,526,170) $15,251 47,122 7,660 181,239 2,718,584 6,997 36,170

2. Commodities 3. Enabling Environment

4. Program Management 5. Investment 6. Monitoring and Evaluation

320,117

426

166,673

29

OFWs-Male Seafarers Target number Unit cost Total cost Components 1. Behaviour Change Communication Subcomponents/Description Training Incentives Outreach IEC and events Condoms STI services Reaching out to local decision makers in the communities to strengthen and support communitybased interventions Establishing understanding and cooperation in local communities regarding HIV/AIDS programmes. Involvement of target community (addressing needs, involvement in decision-making of all project activities) Recruitment, recurring costs, and recruitment of staff, setting up of project office, facilities for services one time and can be depreciated over time Continued measurement of coverage, knowledge and behavior change, utilization of local staff and PEs for regular revision of program

223,586 $2 $ 381,324 (P17,922,206) $333,020 0 3,830 638 0 0 21,702

2. Commodities 3. Enabling Environment

4. Program Management 5. Investment 6. Monitoring and Evaluation

3,570

426

18,138

30

OFW-Female seafarers Target number Unit cost Total cost Components 1. Behaviour Change Communication Subcomponents/Description Training Incentives Outreach IEC and events Condoms STI services Reaching out to local decision makers in the communities to strengthen and support communitybased interventions Establishing understanding and cooperation in local communities regarding HIV/AIDS programmes. Involvement of target community (addressing needs, involvement in decision-making of all project activities) Recruitment, recurring costs, and recruitment of staff, setting up of project office, facilities for services one time and can be depreciated over time Continued measurement of coverage, knowledge and behavior change, utilization of local staff and PEs for regular revision of program

6,436 $4 $ 28,941 (P1,360,241) $9,605 0 0 638 0 0


12,660

2. Commodities 3. Enabling Environment

4. Program Management 5. Investment 6. Monitoring and Evaluation

4,255

426 1,358

31

Spouses of male seafarers Target number Unit cost Total cost Components 1. Behaviour Change Communication Subcomponents/Description PE Training PE Incentives Outreach workers Outreach/drop in centers IEC and events Condoms STI services Reaching out to local decision makers in the communities to strengthen and support communitybased interventions Establishing understanding and cooperation in local communities regarding HIV/AIDS programmes. Involvement of target community (addressing needs, involvement in decision-making of all project activities) Recruitment, recurring costs, and recruitment of staff, setting up of project office, facilities for services one time and can be depreciated over time Continued measurement of coverage, knowledge and behavior change, utilization of local staff and PEs for regular revision of program

11,150 $6 $ 65,064 (P3,058,022)


$15,967 24,672 11,489

2. Commodities 3. Enabling Environment

319 638 0 92
1,809

4. Program Management 5. Investment 6. Monitoring and Evaluation

6,574

426 3,078

32

Out of school youth (OSY) Target number Unit cost Total cost Components 1. Behaviour Change Communication Subcomponents/Description PE Training PE Incentives Supervision Outreach/drop in centers IEC and events Transport/daily allowance Condoms STI services Reaching out to local decision makers in the communities to strengthen and support communitybased interventions Establishing understanding and cooperation in local communities regarding HIV/AIDS programmes. Involvement of target community (addressing needs, involvement in decision-making of all project activities) Recruitment, recurring costs, and recruitment of staff, setting up of project office, facilities for services one time and can be depreciated over time Continued measurement of coverage, knowledge and behavior change, utilization of local staff and PEs for regular revision of program

1,089,000 $2.16 $2,349,128 (P110,409,015)


1,344,249 240,970 2,298

0 639,790
2,298

2. Commodities 3. Enabling Environment

0 0
0

4. Program Management 5. Investment 6. Monitoring and Evaluation

7,660

426 111,683

33

Streetchildren
Peer education Training PE renumeration Supervision IEC/events Transport/DA Programme Manag. M+E (5%) TOTAL UNIT PHP 2,940,900 524,160 108,000 1,386,321 108,000 360,000 271,369 5,698,750 113.07043 USD 62,572 11,152 2,298 29,496 2,298 7,660 5,774 121,250 2.41

Target number Unit cost Total cost Components 1. Behaviour Change Communication Subcomponents/Description PE Training PE Incentives Supervision Outreach/drop in centers IEC and events Transport/daily allowance Condoms STI services Reaching out to local decision makers in the communities to strengthen and support communitybased interventions Establishing understanding and cooperation in local communities regarding HIV/AIDS programmes. Involvement of target community (addressing needs, involvement in decision-making of all project activities) Recruitment, recurring costs, and recruitment of staff, setting up of project office, facilities for services one time and can be depreciated over time Continued measurement of coverage, knowledge and behavior change, utilization of local staff and PEs for regular revision of program

50,400 $2.41 $121,250 (P5,698,750)


62,572 11,152 2,298

0
29,496 2,298

2. Commodities 3. Enabling Environment

0 0
0

4. Program Management 5. Investment 6. Monitoring and Evaluation

7,660

426 5,774

34

Annex 3: Participants in the development of the AMTP 4 Operational Plan 2009 - 2010
Representatives from Government 1. 2. 3. 4. 5. 6. 7. 8. 9. Dr. Ann Quizon Mr. Cesar Montances Mr. Joel Atienza Dr. Teresita Cucueco Dr. Ethel Dao Dr. Cherry Tactacan-Abrenica Ms. Nerissa Mercado Ms. Caroline Jimenez Mr. Edgardo Esteban DepEd DILG DOH-NASPCP/GFR6 DOLE- OSCH DOH-NASPCP DOH-San Lazaro Hospital DOLE-OWWA DSWD TESDA

Representatives from NGOs 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Ms. Maria Lourdes Marin Dr. Jose Narciso Sescon Ms. Alma Mondragon Mr. Joseph Carillo Dr. Edelina dela Paz Ms. Irene F. Fellizar Ms. Nellie Sevidal Ms. Yasmin Pimentel Ms. Marvi Trudeau Ms. Margaux Diaz Mr. Meynard David Mr. Jerico Paterno Ms. Imelda Rizo Ms. Ma. Loida Sevilla Mr. Aureo De Castro Ms. Eleony Monding Mr. Marvin Rivera Ms. Cristina Ignacio Mr. Philip Castro Mr. Hunter Cuabo Tiro Action for Health Initiatives AIDS Society of the Philippines ALAGAD Mindanao Butterfly Brigade Health Action Information Network Lunduyan Lunduyan Philippine NGO Council on Population, Health and Welfare Pilipinas Shell Foundation, Inc Pilipinas Shell Foundation, Inc Pinoy Plus Association Pinoy Plus Association Pinoy Plus Association Plan International Positive Action Foundation Phi. Inc. Tingog sa Kasanag TLF Share Tropical Disease Foundation, Inc Tropical Disease Foundation, Inc Womens Health Care Foundation

Representatives from International Support Organizations 1. Ms. Mercedes Apilado UNAIDS 2. Ms. Teresita Marie P. Bagasao UNAIDS 3. Mr. Zimmbodilion Mosende UNAIDS 4. Ms. Ma. Lourdes Quintos UNAIDS 5. Ms. Gudrun Nadoll UNICEF 6. Dr. Roderick Poblete UNFPA 7. Dr. Giovanni Templonuevo UNFPA PNAC Secretariat 1. Dr. Susan Gregorio 2. Mr. Rench Chanliongco 3. Ms. Virginia Evangelista 4. Ms. Mildred Publico 5. Mr. Alven Antonio

35

Facilitators/Core Team 1. Ms. Ruthy D. Libatique 2. Ms. Noemi Bayoneta-Leis 3. Mr. Dune Aranjuez 4. Ms. Arlene Ruiz 5. Dr. Ferchito Avelino 6. Dr. Jessie Fantone

Consultant Health Action Information Network National Economic and Development Authority National Economic and Development Authority PNAC Secretariat PNAC Secretariat

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Annex 4 References/Bibliography

4th AIDS Medium Term Plan: 2005-2010 Philippines. Philippines: Philippine National AIDS Council, [2006]. 4th AIDS Medium Term Plan: 2005-2010 & Operational Plan 2007-2008 Philippines. Philippines: Philippine National AIDS Council, [2007]. 2007 Estimates of Adults Living with HIV in the Philippines. Manila: Department of Health, National Epidemiology Center, [2007]. AIDS in Asia. India: Oxford University Press, 2008. Costing Guidelines for HIV/AIDS Intervention Strategies. Geneva: UNAIDS, 2004. External assessment of the 100% Condom Use Programme in Selected Sites in the Philippines (four pilot sites + one), 9 April-30 June 2007. Philippines: Health and Development Initiatives Institute, 2007. Follow-up to the Declaration of Commitment on HIV and AIDS United Nations General Assembly Special Session (UNGASS): Country Report of the Philippines January 2006-December 2007. Manila: Philippine National AIDS Council, 2008. http://www.census.gov. ph/data/sectordata/fl 94-osy.html . Date accessed January 25, 2009 Mid Term Review Report: AIDS Medium Term Plan IV. Manila: Philippine National AIDS Council, 2008. Monitoring and Evaluation Manual: Philippine Response to HIV and AIDS, Version 2. Manila: Philippine National AIDS Council, 2007. National Strategic Plan for HIV & AIDS in Myanmar: Progress Report 2006. Myanmar: Department of Health, [2006]. Redefining AIDS in Asia: Crafting an Effective Response: Report of the Commission on AIDS in Asia. New Delhi: Oxford University Press, 2008 RETA 6143: Supporting Women at Risk and Vulnerable to HIV/AIDS in the Philippines (Contract No. COSO-080-081): Final Dissemination Forum, Astoria Plaza Hotel, J. Escriva Drive, Pasig City, 20 March 2009. Manila: Primex, 2009. Review of the Pilot Phase of Prevention of Mother-to-Child Transmission of HIV (PMTCT): Davao Medical Center. Manila: Unicef, 2008. Scaling Up towards Universal Access by 2010: A Renewed Commitment to Prevention, Treatment, Care and Support for HIV and AIDS: Philippine Country Report. Manila: Philippine National AIDS Council, 2006.

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