Vol 1 Issue 1
Gazette
For the partnership on HIV and AIDS
March 2011
EDITORIAL NOTE With this maiden issue of the AIDS Gazette, the Philippine National AIDS Council aims for the wide dissemination of the outcomes of the HIV Summit, or the “Call to Action for Broad-based Responses to AIDS by Leaders,” convened by former Health Secretary and PNAC Chairperson Esperanza I. Cabral on April 12, 2010 at Diamond Hotel in Manila. The Summit informed many decision-makers and stakeholders of the current HIV situation, and generated valuable insights and recommendations. This issue summarizes statements from Secretary Cabral, Pinoy Plus Association, and National Federation of Filipinos Living with HIV and AIDS, and presentations from Chief Epidemiologist Enrique Tayag, Interior and Local Government Undersecretary Austere Panadero, and Social Welfare and Development Undersecretary Alicia Bala. Highlights of the Summit’s open forum, participants’ reports from breakout sessions, and synthesis of lead rapporteur Mario Taguiwalo are also included. With assistance from UNAIDS, the Summit’s attendees also met Dr. Sha’ari Bin Ngadiman and learned from our neighbor Malaysia’s responses to HIV and AIDS. After the Summit, PNAC developed the Fifth AIDS Medium Term Plan 2011-2016, the Philippines’ strategy to halt the spread of the epidemic. The strategy framework, which was launched in December 2010 is the concluding feature of this issue. On behalf of the council, we thank the Secretariat, the technical assistance, and our development partners who have helped make the AIDS Gazette a reality. We dedicate this endeavor to our partners at the national and local levels, in the public and private sectors, and among the communities at-risk, vulnerable, living with, and affected by HIV and AIDS. - PNAC ADVOCACY COMMITTEE
For more updates from PNAC, visit the website www.PNAC.org.ph
The Time to
ACT is NOW!
HIV and AIDS are on the rise in the country. Although prevention and treatment programs are well in place, there still is an upsurge in the number of new cases for the past three years. To present the current situation, a one-day summit was held on April 12, 2010. Dubbed “Call to Action for Broad-based Responses to AIDS by Leaders,” the Summit had the following objectives: •
To inform leaders and other participants on the current state of HIV in the Philippines and the status of the national response
•
To present the intensified National HIV Program and how everyone can work together to prevent the further spread of HIV and AIDS
Former Health Secretary Esperanza Cabral set the tone of the summit in her welcome remarks. Secretary Cabral expressed an urgency to stem the tide of infection through a proactive and multisectoral approach in combating the infection. She added that more than a health issue, HIV also has a socio-economic dimension. “It complicates effort to fight poverty and promote developments as it diminishes the victim’s ability to provide for himself and his family, while consuming personal and household resources for treatment costs. It (also) widens socio-economic and gender divide,” she said. Secretary Cabral acknowledged that the government should spend money on prevention and treatment if it is intent in halting the rising number of cases. She noted that while there have been criticisms regarding the use of government money in HIV programs, the country has been willing to accept assistance from other nations and organizations. For the past few years, she said, the international community accounts for 70 percent of the country’s HIV and AIDS spending. “We need to show the entire world that we are serious in our aim to bring down, if not eliminate, HIV and AIDS by putting our money where our mouth is, so to speak,” she said. Her observations were echoed by Mr. Jerico Paterno, president of Pinoy Plus Association. According to Mr. Paterno, the country’s HIV response is dependent on the assistance provided by the international community, particularly the Global Fund to Fight AIDS, TB, and Malaria. He said that the country should have a blueprint that it could implement with or without international assistance. Lastly, he reiterated the role of the positive community in addressing HIV. “We do a lot of things creatively that only the positive community can deliver. This is the very essence of a greater and meaningful involvement of people living with HIV and AIDS,” he said. Former DoH Sec. Cabral: We need to show the entire world that we are serious in our aim to bring down...HIV and AIDS by putting our money where our mouth is...”
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The Philippines a country at the crossroads of an epidemic For quite some time, the country’s HIV epidemic status has been described as low and slow. That characterization may soon be a thing of the past. Dr. Enrique Tayag, director of the National Epidemiology Center, presented data from the Philippine AIDS Registry, the 2009 Integrated HIV Behavioral and Serological Surveillance, and the voluntary counseling and testing activity in Cebu. Dr. Enrique Tayag reported that from 2000 until 2005, the Philippine National AIDS Registry registered an average of one new infection every three days. In 2010, the average was four new cases a day. Data from the Philippine HIV and AIDS Registry showed that from 1984 to March 2010, 74 percent of all HIV cases in the country were males. The seeming preponderance of HIV-positive males is due to the fact that more males are engaging in risky behaviors such as having unprotected sex with a female sex worker (FSW) or with other males, and injecting drug use. More cases are also coming from the younger age groups. In the early years of the epidemic, only one age category – 20 to 40 years old – was used. This was broken down to better reflect the age characteristics of people living with HIV (PLHIV), and the result is quite revealing. While the number of cases coming from the 30 and older age categories is going down, the number from those in the 20 to 29 year age category is peaking. The same is true for the group 19 years and younger.
2010: FOUR new cases a day 2009: Two new cases a day 2007: One new case a day 2000: One new case every 3 days
Source: Philippine HIV and AIDS Registry
MARP Estimates: More males practicing high risk behavior 516,511 clients of SW 665,395 MSM 17,655 PWID 159,408 FSW 2,182 PWID
1,199,561
161,590
In terms of geographic locations, only eight of the country’s 80 provinces are yet to report their first case. Since the start of the surveillance in 1984, the National Capital Region (NCR) consistently registers the most number of cases. What is
Continued on page 4
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The Philippines...from page 2 glaring is the sudden spike in the number of cases coming from Region 7; from four percent in 2007 to 2009, the region now accounts for 24 percent of the cases. Most at risk populations (MARP) Certain populations are more at risk of contracting HIV either because of their behavior or their work. Three of these MARPs are males having sex with males (MSM), FSW, and people who inject drugs (PWID). Based on the 2009 IHBSS, the three MARP have the following HIV prevalence: • • • •
1 in 300 MSM; 1 in 5,000 PWID; 1 in 1,000 registered and establishment-based FSW; and 1 in 250 freelance FSW.
It is worth noting that while prevalence among PWID in the rest of the country is quite low, the prevalence in Cebu is high. One in three PWID in Cebu is HIV-positive, accounting for the sudden increase in the number of new cases coming from Region 7. From 1984 until 2008, only seven cases of HIV infection among PWID were recorded. In 2010 alone however, the number spiked to 63. Dr. Tayag said that unless harm reduction program is systematically institutionalized in the country, the country may reel from the effects of downstream infections emanating from PWID. Knowledge may help the MARPs protect themselves from HIV, but this too is sorely lacking. Among registered and freelance FSW, knowledge on HIV and preventing infection are only 39.9 percent and 18.4 percent respectively. Knowledge among MSM is only 34.3 percent and 44.6 percent among PWID. In addition, only 18.6 percent of FSW, 6.8 percent of MSM, and 1.5 percent of PWID know their HIV status. “It’s your behavior that makes you HIGH RISK!”
Dr. Enrique Tayag cautioned that the number of new HIV cases is the country is rapidly rising.
Unprotected sexual activity is the primary mode of transmission in the country. Other reported modes of transmission include needle prick injury, injecting drug use, mother to child, and blood transfusion. From 1984 to 2006, most infections were transmitted through heterosexual contact. Starting in 2007, however, there was a flip in transmission; male to male sexual contact is now the leading driver of the epidemic.
The 2009 IHBSS showed that condom use among MSM and PWID remains low. For MSM, only 31.7 percent used a condom in their last anal sex preceding the survey. For PWID who are sex workers, 22 percent used a condom, and for PWID who are clients of sex workers, condom use was even lower at just 10.8 percent. In addition to low condom use, needle sharing among PWID is also rampant. As Dr. Tayag put it, “It’s not your occupation…. it’s your behavior that makes you HIGH RISK!” Continued on page 5
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Sharing from our neighbor
Malaysia’s response to HIV and AIDS Malaysia’s multisectoral partnership is effectively stemming the tide of HIV infections among people who inject drugs (PWID). Dr. Sha’ari Ngadiman from the Malaysian health ministry shared their experience in reaching out to PWID. Harm reduction, which involves needle exchange and drug substitution, is proven to be an effective prevention program for PWID. Unfortunately, it is yet to be institutionalized in the country owing to stringent anti-drugs laws. The country, however, can learn from Malaysia, which has succeeded in implementing harm reduction programs without repealing its anti-drugs law. Dr. Sha’ari Bin Ngadiman of the Malaysian Ministry of Health shared his country’s experience in curbing the spread of HIV. Malaysia has a concentrated HIV epidemic. According to Dr. Ngadiman, as of 2009, Malaysia had 77,000 people living with HIV and AIDS. HIV prevalence among MSM and FSW is peaking. However, Malaysia is making headway in curbing the spread of infection among PWID. It also instituted a series of programs and interventions designed to keep the spread of infection at bay. Walking the talk The government of Malaysia, in response to the country’s failure to meet Goal 6 of the Millennium Development Goals, asked the Ministry of Health to address the growing number of HIV cases. Since PWID are the main drivers of the epidemic, the ministry initiated a four-year harm reduction program for PWID and their partners. On April 12, 2006, no less than the Cabinet approved its implementation. Equally important, a budget of 56 million US dollars was allotted for the needle and syringe exchange program (NSEP) and Methadone Maintenance Treatment (MMT). Continued on page 6
The Philippines...from page 3 Why spend more on treatment and prevention Doubling time, which refers to the number of years it takes before the number of cases doubled, has considerably shortened from 17 years to one year. For the Philippines to be considered a high prevalence country, there should be one million HIV cases. If the country opts to wait for this to happen before acting, the financial cost would be staggering: 50 billion pesos a year for treatment alone. It would also cause untold social and economic setbacks that could cripple the country. Dr. Tayag warned that the current range of services and programs is no longer enough to halt the spread of HIV. He cited the case in Region 7 where health workers and program implementers could barely cope with the number of PWID they have to counsel and help. He challenged the audience to HALT the spread of HIV by reversing these: • • • •
High risk behaviors Aversion to HIV testing Limiting activities for prevention Too few people who know their HIV status, as well as too few partners who are working to stop the spread of HIV.
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Sharing from our neighbor...from page 5 The NSEP is facilitated by both non-government organizations (NGO) and public clinics. In 2009, NSEP had 18,377 clients. Return rate of needle was 65.9 percent. MMT, on the other hand, had 7,455 active clients during the same period, with a retention rate of 69.5 percent. HIV screening done among PWID showed that the programs had been effective. From a high of 21.9 percent in 2008, the percentage of HIV cases among PWID went down to 18.7 percent in June 2009. Critical to the success of the program was the multisectoral nature of the National Task Force on Harm Reduction which implemented the program. By getting the support of all key players, laws were harmonized, allowing the unimpeded implementation of the program. High screening coverage Malaysia has a relatively high screening rate. Voluntary counseling and testing (VCT) is widely available in all Dr. Sha’ari Ngadiman acknowledged the importance health facilities, as well as in community-based NGOs. It also of a multisectoral approach in implementing prevention implements anonymous testing, antenatal screening, and programs. routine screening among prison inmates. Contact tracing Contact tracing is done in Malaysia. To maintain confidentiality, the staff assigned to do contact tracing do not wear uniforms when they encourage the contacts to undergo VCT. So far, 70 percent of those who were traced had themselves tested.
Key lessons from Malaysia’s experience Dr. Sha’ari Ngadiman shared five key lessons from their experience in implementing HIV programs: 1. Strong leadership: The Malaysian government made funds readily available for programs and interventions. Aside from funding its harm reduction program, it also ensured that health facilities would be able to accommodate the demand for VCT and other prevention and treatment services. 2. Multisectoral partnership: The government actively solicited the participation of the public and the assistance of the private sector and NGOs. As Dr. Ngadiman put it, “We know that the best persons to handle these are the NGOs and communities. That is why we fund them.” 3. Good surveillance data can help in drafting policy: Through the data generated by its surveillance system, the government realized that it could face a potentially bigger problem if they do not act. 4. Every intervention should have a monitoring and evaluation component: Monitoring and evaluation would ensure that interventions are producing the desired impact. 5. Having a workable strategic plan and targets are important in any HIV program.
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Reporting our gains
The Philippine response to HIV and AIDS As early as the 1980’s the country has already instituted programs to monitor HIV and AIDS and keep the spread of infections at bay. Undersecretary Austere A. Panadero of the Department of the Interior and Local Government presented the Philippine responses’ gains through the years as well as critical gaps that needed to be addressed.
Undersecretary Austere Panadero gave a comprehensive report on the actions undertaken by the country to stem the tide of HIV infection. According to Undersecretary Panadero, the Philippines is among the first countries to enact a law specifically for HIV. Republic Act (RA) 8504, or the Philippine AIDS Prevention and Control Act of 1998, is a comprehensive law that provides provisions on the prevention and control of HIV. It also protects the rights of people living with HIV and AIDS by safeguarding their right to treatment and confidentiality. To further strengthen the law and its implementation, House Bill No. 1389, or An Act Strengthening Further the Philippine Comprehensive Policy on the Prevention and Control of AIDS was filed at the 14th Congress. To unify the country’s response to HIV and AIDS, the Philippine National AIDS Council (PNAC) was established in 1992. PNAC, which is composed of representatives from government agencies, the private sector, and civil society, is mandated to coordinate all HIV programs and activities. It also develops the AIDS Medium Term Plan (AMTP), which serves as the country’s blueprint for all programs and interventions in the next five years. The national response can be categorized into three major components: governance, prevention, and treatment, care, and support. Governance
Usec. Austere Panadero outlined the country’s response to the epidemic as The Department of Health continuously releases and revises well as the challenges that still need to be administrative orders (AO) and guidelines to ensure that treatment addressed. protocols are updated. From 2007 to 2009, four AOs and revised
guidelines were issued. These were the following:
• • • • •
Operating Guidelines for HIV and AIDS Core Team (HACT) AO 2009-0016: Policies and Guidelines on the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) AO 2009-0006: Guidelines on Antiretroviral Therapy (ART) among Adults and Adolescents with Human Immunodeficiency Virus (HIV) AO 2008-0022: Policies and Guidelines in the Collaborative Approach of TB and HIV Prevention and Control 2008 Antiretroviral Therapy for HIV Infection, Recommendations for Adults in the Philippines
Continued on page 8
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Reporting our gains...from page 7 Prevention The bulk of the country’s prevention programs focuses on MARPs and vulnerable groups such as overseas Filipino workers (OFWs), children, and out of school youth. The Regional AIDS Assistance Team (RAAT) was created in 2009 through a memorandum circular jointly signed by the DoH, DILG, and Department of Social Welfare and Development (DSWD). The team is composed of technical persons from the three agencies. There are 17 RAATs tasked to assist local government units (LGUs) in developing and strengthening their local responses. To date, 39 LGUs already have organized local responses. Nine of these LGUs already implement needle exchange programs for PWIDs. So far, 33,824 needles and syringes have been distributed among an estimated 20,000 PWIDs. Treatment for drug dependency is also included in the prevention package for PWID. Faith-based organizations have also started their own prevention and care programs. In 2008, the Catholic Church Pastoral Workers initiated such a program in two dioceses, with a focus on abstinence and mutual monogamy. Treatment, Care, and Support There are now 23 health facilities offering antiretroviral therapy (ART). Thirteen of these are treatment hubs where PLHIVs can access free antiretrovirals. Treatment hubs are hospital-based facilities providing a wide range of services such as counseling and testing, treatment of opportunistic infection, and early infant diagnosis. These hubs are developed and strengthened with assistance National Composite Policy from the third, fifth, and sixth rounds of country grants from Index* the Global Funds to Fight AIDS, TB and Malaria (GFATM). Areas with significant improvements 1. Implementation of HIV treatment, care, and support programs 2. Monitoring and evaluation of the HIV program 3. Enforcement of existing policies, laws, and regulations 4. Increased participation of civil society Areas that require scaling up 1. Policies, law, and regulations to promote and protect human rights in relation to HIV as well as policies in support of HIV prevention 2. Political support for HIV programs 3. Inclusion of HIV in strategy planning efforts 4. Implementation of HIV prevention programs focusing more on the most at risk population, especially FSWs, MSM, and PWIDs 5. Meeting of the HIV-related needs of orphans and other vulnerable children *The National Composite Policy Index gauges the country’s response to HIV and AIDS. It includes a questionnaire which government agencies and civil society organizations answer.
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Aside from the treatment hubs, 68 public and private hospitals have HIV and AIDS Core Teams (HACT), which are tasked to handle the medical management of PLHIVs, counseling and testing, and prevention of HIV infection in the workplace. The national government is also actively developing private-public partnership for treatment, care, and support. So far, three private facilities and two clinics serve as access point for ARVs. To help with the cost of treatment, 200 PLHIVs were enrolled in the National Health Insurance Program with the support of GFATM. The DoH and the positive community are also working with the Philippine Health Insurance Corporation (Philhealth) in finalizing the implementing rules and regulations for the HIV Out-Patient Benefit Package. The assistance given to PLHIVs is not limited to treatment and the provision of ARVs. The DoH, DSWD, nongovernment organizations, and faith-based organizations also actively conducts hospital, home, and community visits to provide PLHIVs with psychosocial and spiritual support. PLHIVs are also given training on values orientation, micro-finance, and livelihood. The DSWD, in particular, provides burial assistance and capacity building training for local leaders and volunteers on the provision of care and support to PLHIVs.
Continued on page 9
Reporting our gains...from page 8 Why the rise in cases Despite the wide range of prevention and treatment programs, the Philippines is yet to meet its Universal Access (UA) targets. UA is the country’s commitment to halting and reversing the epidemic by meeting key targets: 80 percent coverage for prevention programs and 60 percent of target population with correct knowledge and safer behavior. Table 1. In terms of knowledge and behavior, studies showed Low but improving level of knowledge on HIV that the Philippines is still way below the 60-percent 2007 2009 target (see Table 1). According to the 2008 National 2% 30% Demographic Health Survey, only 54.3 percent Female sex workers of women identified ways of preventing sexual Males having sex with males 10% 34.3% transmission of HIV and only 20.7 percent rejected People who inject drug 26% 44.6% misconceptions about HIV. On the other hand, more women seemed to be practicing risky sex behavior. The same survey showed the following: •
The percentage of women who have had sex before the age of 15 went up from one percent in 2007 to 2.1 percent in 2009; • 6.7 percent of women had more than one sex partner in the last 12 months preceding the survey; of these, only 12.6 percent used condom. Table 2. Among MARP, condom use is still low among MSM Low but improving MARPs reach for prevention and PWID. However, condom use is relatively high 2007 2009 among registered FSW. The percentage of MARP 14% 15% who had an HIV test and who knew the result is Female sex workers also low: 19 percent for FSW, seven percent for Male having sex with male 19% 29% MSM, and 1.4 percent for PWID. People who inject drug 14% 11% The low level of knowledge may be attributed to the fact that prevention coverage is still low (see Table 2). Although there has been a marked improvement on the coverage for FSW (55%) and MSM (29%), the figure is still below the UA targets. Furthermore, coverage for PWID dropped from 14 percent in 2007 to 11 percent in 2009. What needs to be done For the country to meet its UA targets, it is important to get the full support of the government. As it is, the bulk of the country’s AIDS spending, or about 67 percent, came from external sources. These sources include the German Technical Cooperation, GFATM, UN agencies, Asian Development Bank, European Commission, United States Agency for International Development, World Bank, and World Health Organization. Domestic spending accounts for only 20 percent of the bulk. NGOs and and private spending account for the rest of the expenditures. The national government can also show its full political support in terms of crafting policies that would give teeth to RA 8504. While the law is comprehensive enough, some of its key components are not harmonized with other existing policies. For instance, sex work and drug use are considered criminal issues. These have repercussions on prevention programs because sex workers and PWID tend to go underground, making them harder to reach. In the case of intervention for PWID, there is an urgent need to harmonize harm reduction programs with existing policies on drug abuse. Other challenges that need to be addressed are the following: • • • •
Active involvement of all stakeholders in planning and program implementation; Lobbying for political support for a sustainable investment; Scaling up of coverage; and Strengthening of the monitoring and evaluation system.
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A call to action
How must we address HIV and AIDS The direction of the country’s response to HIV and AIDS is anchored on five key areas. Undersecretary Alicia R. Bala of the Department of Social Welfare and Development presented directions in policy and governance, investments, physical and human resources, scaling up of program coverage, and strategic information to influence programs. To improve the country’s HIV response, Undersecretary Alice Bala outlined the actions that should be taken in five key areas. Policy and governance RA 8504 serves as the cornerstone of the country’s response to HIV and AIDS. According to Undersecretary Bala, if not for RA 8504, the country “could have been in worse state.” “From scientific evidence, we know that we have employed the right approaches.... the challenge posed by the accelerating epidemic is the sufficiency to meet the promise of our policy,” she added. To make RA 8504 more responsive, there is a need to strengthen it by updating existing rules and regulations, amending certain provisions, and developing policy guidelines. In particular, five priority areas have to be addressed. These are the prevention of HIV transmission, resolution of policy conflicts (i.e. harm reduction program vis-à-vis anti-drugs laws and policies), setting up of a redress mechanism for HIV-related discrimination, impact mitigation, and sustaining antiretroviral therapy. In terms of governance, there is a need to raise the profile of HIV and AIDS as a national priority by soliciting the support of key government officials. The structure of PNAC and its secretariat should also be strengthened. There is also a need to veer away from the thinking that HIV is purely a medical issue and is therefore the sole responsibility of the health sector. Towards this end, there is a need to capacitate HIV and AIDS focal units in other government agencies. A network should also be established to allow linkages between non-government organizations from all sectors. Usec. Alice Bala outlined the concrete steps that should be taken to make the country’s HIV program more responsive.
Investment The 5th AIDS Medium Term Plan or the 5th AMTP which is currently being developed, will have an investment plan. It will serve as guide in aligning resources where these are most needed.
Included in the said plan are the following: 1. 2. 3. 4. 5.
Packages for critical intervention strategies, MARPs, and vulnerable sites Substantial increase in national and local funds Sharing “cost” between public and private sources Equity between Government and Community investments Support from development partners harmonized to the national strategy Continued on page 11
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A call to action...from page 10 Physical and human resources There is a need to ensure that resources go towards the development and strengthening of management system and service delivery such as the improvement of both public and private facilities and ensuring a steady supply of drugs and commodities for prevention, treatment, and care. In strengthening the country’s physical and human resources, Undersecretary Bala said that the country should be guided by the concept of Three E’s: 1. Engage people into the response 2. Equip those who are engaged 3. Ensure resources are always available Sustaining of program coverage Given the rising number of cases of infection, there is an urgent need to sustain and scale up the coverage of prevention and treatment, care, and support programs. For MARPs, intervention packages should include sexuality and HIV education; access to commodities like condoms, needles, and syringes; counseling and testing; and treatment. Scaling up of coverage necessitates the creation of an environment where those who are most at risk could freely access services and commodities without fear. “MARPs interventions will be most accessible and effective in an environment that is aware of what HIV means for every person, sensitive to the issues that drive the epidemic, and in a continuum and range of responses that affirms dignity of every person,” said Undersecretary. Bala. For the general population, there should be a comprehensive HIV education that teaches prevention of infection and rejection of myths and misconceptions. There should also be a referral service for counseling and testing. Treating PLHIVs is also an important component of prevention. Thus, scaling up of treatment coverage for this population means ensuring a steady supply of antiretrovirals and medicines for opportunistic infection, improving health facilities, inclusion of tuberculosis in treatment programs, and prevention of mother-to-child transmission. Equally important, there is a need to look into the psycho-social needs of not just PLHIVs but their families as well. To ensure that the country would be ahead of the epidemic, programs should look beyond HIV. It should be linked with other health issues such as primary health; maternal, child, and family health; mental health; and drug and alcohol abuse treatment. It should also be linked with other social programs such as legal and livelihood assistance and alternative learning services. Evidence-based decisions The importance of having reliable data obtained through scientific means cannot be emphasized enough. Through the data generated by various studies, the country now has a clearer picture of the epidemic which would help in crafting strategies, approaches, and targets. There is thus a need to make these data available to all those who need it. While available data are comprehensive enough to reveal the extent of the problem, there are still information gaps that must be filled. Undersecretary Bala said that these information gaps should not deter stakeholders from doing what needs to be done. “The information we don’t have now should not impede our effort to a greater area. It should inform us what more we need to do,” she said.
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HIV Summit hosts dynamic interaction of multisectoral responses to AIDS Almost 400 participants registered their attendance at the HIV Summit. Participants represented agencies and organizations from the different sectors of the HIV and AIDS response – national and local government, civil society, faith-based groups, academe, private commercial companies, development partners, and community organizations of at-risk, vulnerable people, and PLHIV. After the Summit's morning presentations, Dr. Rhoderick Poblete of RIT-JATA Philippines moderated an open forum between participants and speakers Dr. Tayag, Dr. Sha'ari and Undersecretaries Panadero and Bala. Former DoH official and renowned health policy expert Mario Taguiwalo summed up the forum’s highlights. (See Open forum highlights on next page.) In the afternoon, participants broke off in smaller groups, where further recommendations were generated based on the key areas earlier presented by Usec. Bala: policies, investments, physical and human resources, program coverage and strategic information. Volunteer discussants and facilitators, who guided the break-out sessions included Dr. Poblete, Ms. Teresita Marie Bagasao of UNAIDS, Ms. Ruthy Libatique of the Philippine NGO Council on Population, Health and Welfare, Marvi Trudeau of Pilipinas Shell Petroleum Corporation (PSPC), Ferdinand Buenviaje of TLF SHARE Collective, Celestino Ramirez of Positive Action Foundation Philippines (PAFPI), Noemi Leis of Health Action Information Network (HAIN), Marries Concepcion and Nelson Yap of AIDS Society of the Philippines (ASP), Patrick Erestain of the Local Government Academy, Mary Joy Morin of the DOH Global Fund Project, and a spokesperson of Babae Plus.
Dr. Ferchito Avelino, director of PNAC Secretariat, and Bishop Deogracias Iñiguez of the Commission on Public Affairs of the Catholic Bishop’s Conference of Results of the discussion groups were reported at the the Philippines viewed a poster presentation outside concluding plenary session by volunteer participants, which the session hall. included Ms. Libatique, Dr. Edsel Salvana of the Philippine
General Hospital, Maria Loida Sevilla of Plan International, Ryan Tani of Filipino Free Thinkers, and Brother John Jay Magpusao of the Order of the Ministers of the Infirm. As lead rapporteur, Mr. Taguiwalo rejoined to offer his synthesis of all exchanges experienced during the Summit. (Key points of reports from the discussion groups are on page 13 and 14, and Mr. Taguiwalo’s synthesis on page 15.) The Summit also featured performances from the youth sector of Samahan ng Mamamayan-Zone One Tondo Organization, the Molave Theater Guild of Polytechnic University of the Philippines, and Charity Perea of DOH Region VI Center for Health Development. Outside the session hall, poster presentations, materials distribution and product sampling were conducted. Participants included the local governments of Angeles and Zamboanga cities, DOH Region VI, DOH National AIDS/STI Prevention and Control and National Voluntary Blood Service programs, Population Commission, ASP, HAIN, PAFPI, Pinoy Plus, TLF SHARE Collective, PSPC, Philippine Catholic HIV/AIDS Network, UN Population Fund, Durex (marketed by Getz Brothers), Trust, Lick and Frenzy (marketed by DKT Philippines), and 101 Condoms (introduced by U Life Corporation).
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Open forum highlights •
Learn from the successful reduction of HIV and AIDS prevalence among FSW which is partly attributed to the success of social hygiene clinics in reaching out to this sector
•
Greater efforts to reach MSM and PWID to understand them better and to implement prevention activities
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Main intervention measures should focus on attaining the UA targets (60 to 80%)
•
Better application of gender perspective
•
Priority should be given to areas with higher concentration of HIV and AIDS cases (Metro Manila, Cebu, and Davao)
•
Increase the practice of VCT and transform this into a routine service and remove the stigma attached to VCT (e.g., perception that people who avail of VCT are HIV positive)
•
Balance the issue of HIV in relation to the larger issue of reproductive health
•
•
•
• •
•
Plenary reports
Attendees push recommendations The following key points are consolidated from reports of discussion groups held during the HIV Summit. Policy Environment • • • • • • •
Popularization of enabling laws and policies, including their common interpretation at all levels of the response Identification of policies and laws that are often violated, not implemented, or impede implementation of HIV programs Development of a policy agenda that respondto needs in formulation of policies, new laws or amendments to existing laws Harmonization of contravening laws and policies Address of mandatory HIV testing and its implications on foreign policy negotiations Formation of lobby group in Congress to advocate needed resources for the response Greater participation in legislating national budget to ensure sufficient and equitable allocation of resources for HIV and AIDS programs Passage of the reproductive health bill with provisions that strengthen response to HIV and AIDS, the anti-prostitution bill, and the Magna Carta for Women
Wider and more consistent practice of contact tracing to immediately identify people at risk and to modify their behavior as quickly as possible
•
Provision of blood testing among substance abuse patients in drug rehabilitation facilities – this may warrant an amendment to the existing law
Program Development
Use the participants’ collective knowledge on adolescent reproductive health, given the fact that sexual activity is occurring among the youth
•
Find ways to increase the coverage of Philhealth on HIV prevention and treatment
• •
• •
Link treatment and care with LGUs where PLHIVs reside – this will assure treatment sustainability when the GFATM ends
•
The national government, through PNAC, should have a stronger role in the fight against HIV and AIDS. This can be made possible through an increased budgetary funding which can flow through LGUs and NGOs.
•
• •
Fuller implementation of R.A. 8504 Ensuring maximization of strengthened policies in comprehensive responses Investment in developing a good national strategic plan that includes also investments for a scaled up, comprehensive response Sustaining of advocacy and leadership for a scaled up, comprehensive response Integration of HIV and AIDS and reproductive health advocacies Development of HIV and AIDS advocacy guides, differentiated across target audiences Developing curricula on HIV and AIDS for schools Ensuring advocacy efforts are rights-based, genderresponsive and culturally sensitive Formation of a task force to facilitate comprehensive harm reduction program design Continued on page 14
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Group report...from page 13 • • •
Implement comprehensively existing sex education programs in schools Form stronger and more sustainable longer-term partnerships between NGOs and the government Ensure HIV and AIDS in sectoral programs and efficiency in multisectoral efforts
Program Coverage • • • Summit attendees were asked to identify concrete steps in scaling up the country’s HIV response.
• •
Ensuring coverage of HIV education is encompassing and inclusive of the general population, MARPs and PLHIVs Ensuring sustainable treatment, care and support services for PLHIV Enabling access of young people and children at risk to comprehensive and sustainable interventions Enabling access of PLHIVs to justice and redress mechanisms for HIV-related stigma and discrimination Enabling collaboration and partnership mechanisms to be effective in achieving UA coverage
Program Resources • • • • •
Ensuring more investments into HIV prevention efforts, including resources for expanding voluntary counseling and HIV testing services Ensuring government agencies to utilize respective resources for HIV and AIDS efforts Maximization of the National Health Insurance program, including development of innovative approaches to benefit HIV and AIDS programs Development of human resources to deliver scaled up, comprehensive responses Utilization of websites, online social networking and other technologies increase and improve coordination in volunteer work
Strategic Information • • • Bro. John Jay Magpusao reported on their group output.
• • • • •
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Development of information systems for HIV and AIDS researches, including accessible interfaces such as keyword search Development of research agenda, including its priorities in addressing information gaps Development of research standards, including guidance to maximizing findings for program utilization Exploration of legal and ethical dilemmas related to research Advance research priorities in determining population sizes, highrisk behaviors and program coverage Assessment on R.A. 8504 provisions against evidence of their challenges in implementation Utilization of strategic information to influence policy development such as in the review of the AIDS Prevention and Control and Dangerous Drugs laws Strengthening of the National Monitoring and Evaluation System towards achieving accountability among actors in the response
Summit synthesis
Be a step ahead of the epidemic In summing up the HIV Summit, Mr. Mario Taguiwalo highlighted that while the Philippines remains to be a low prevalence country, a bigger epidemic looms in the horizon unless the country improves its HIV program. “Our current efforts at prevention has not been effective even at a relatively small base of infection. If the base of infection becomes bigger, how much less effective would our effort be? If we cannot handle it at the level we have now, how much able are we to handle a bigger base of infection?” To be a step ahead of the epidemic, an improved national response should be anchored on the strengths of existing institutions and programs that have been proven to be successful. These should be complemented by the adoption of innovative ideas. Existing assets Mr. Taguiwalo identified five assets that should be strengthened and scaled up: • • • • •
Institutions like PNAC Availability of knowledge-based resources Capable social hygiene clinics, hospitals, and NGOs Trust, cooperation, and mutual respect among stakeholders Existing laws and policies
Out-of-the- box He identified three priority areas where out-of-the-box solutions are warranted: • • •
Policy guidance on harm reduction programs for PWID National government funding Increasing coverage through multi-tiered funding Policy guidance on harm reduction Mr. Taguiwalo admitted that amending the Dangerous Drug Board might take years, given that there might be people who would play politics with it. Instead, the Health Secretary may declare an emergency, and solicit an opinion from the Department of Justice. The said opinion will define the conditions where harm reduction programs might be conducted legally. National government fundings The ratio of domestic funding and external funding should be increased to 50:50. To achieve this ratio, national funding should be linked with local government unit (LGU) funding on a match grant basis. Non-government organizations should be allowed to tap on this fund if they are conducting activities that the government is not suited for. Mr. Taguiwalo noted that it is unrealistic “to expect the NGOs to raise their own funding to perform the work of the national government.”
Mr. Mario Taguiwalo: “If we cannot handle it at the level we have now, how much able are we to handle a bigger base of infection?”
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An urgent appeal To close the HIV Summit, Mr. Humphrey Gorriceta, spokesperson of the National Federation of Filipinos Living with HIV, appealed to all stakeholders to seriously work together to reverse the current trend of the epidemic as well as to ensure that the rights of PLHIVs are protected. Mr. Gorriceta appealed to national and local leaders to exert political will in combating the spread of HIV and in treating those who are already afflicted. Towards this end, the government should allocate more funding for the improvement and strengthening of the healthcare infrastructure. Although this is easier said than done, he said that nothing is impossible if the government puts its heart to it. “As the cliché goes, if there is a will, there is a way,” he said. To the church, he acknowledged that its teachings on the sanctity of life help shape values. Nevertheless, he called on the church to allow the government’s effort to educate the people go unimpeded. “Can we efficiently exercise the same values we acquire from you? What is the use of the values you give us if we are not going to use it?,” he asked. Mr. Gorriceta also acknowledged the roles of the media and the academe as “powerful social agents of change.” He enjoined the two sectors to help in spreading accurate information on HIV. In particular, he asked the media to be more responsible in covering HIV-related news. He expressed gratitude to civil society and funders for their commitment in the fight against HIV and AIDS. To the positive community, Mr. Gorriceta encouraged them to keep on striving to become productive members of the community. Mr. Humphrey Gorriceta urged all In concluding his speech, Mr. Gorriceta called on all stakeholders to keep stakeholders to work together to halt the on working together to stop the spread of HIV. “We owe nothing less to our young people and future generation. This is our obligation,” he said. epidemic.
Summit synthesis...from page 15 Increasing coverage through multi-tiered funding Multi-tiered fundings should be adopted. With this strategy, funding will be made available for a certain number of years. LGUs and NGOs can access this fund for prevention activities targeting the MARPs. Their performance should be regularly assessed and those who fail to implement an effective approach would be weaned out of the program. Through this approach, only the most effective organizations would be left, ensuring that the money is well spent. Mr. Taguiwalo cautioned that while the recommendations provide valuable insights, it should still be further refined. “We are simply beginning to describe the solution we are looking for. We may not be in a position yet to define the solutions,” he said. To further refine the recommendations, the country can utilize two frameworks. Mr. Taguiwalo called these frameworks for future efforts in HIV prevention. 1. Legal framework: This framework necessitates the implementation of RA 8504 to its fullest. “If we have followed this at the beginning of the law’s approval, we could have been in a different place,” he said. 2. Knowledge framework: This framework utilizes the existing knowledge as basis for action. Based on this available knowledge, the country can then identify information gaps. “Let’s attempt to build a new program based on available information about our epidemic,” Mr. Taguiwalo explained. “Let us use what we know now as the basis for building our action, keeping in mind that what we know will continue to change.”
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The 5th AMTP
Philippine Strategy on HIV and AIDS from 2011 to 2016 After the Summit, PNAC engaged different sectors in the development of the Fifth AIDS Medium-Term Plan, 2011 to 2016 (or the 5th AMTP). Launched on December 2010, the 5th AMTP was formulated against the backdrop of the epidemic's transforming landscape and further acceleration, and its strategy framework intended to orient partnerships in and commitments to HIV and AIDS (see framework). VISION
The spread of HIV infection is halted in the Philippines
GOAL
By 2016, the country will have maintained an HIV prevalence of less than 66 cases per 100,000 population by preventing further spread of HIV infection and reducing the impact of the disease on individuals, families, sectors and communities
OUTCOMES OF CHANGE
Persons at-risk, vulnerable, and living with HIV avoid risky behaviors to prevent HIV infection
People living with HIV live longer, more productive lives
Country AIDS response is well governed and accountable
STRATEGIC OBJECTIVES
To improve coverage and quality of prevention programs for persons at most risk, vulnerable and living with HIV
To improve coverage and quality of treatment, care and support programs for people living with HIV (including those who remain at risk and vulnerable) and their families
To enhance policies for scaling up implementation, effective management and coordination of HIV programs at all levels
To strengthen capacities of the PNAC and its members to oversee the implementation of the 5th AMTP
To strengthen partnerships and develop capacities for the 5th AMTP implementation of LGUs, private sector, civil society, including communities of at-risk, vulnerable, and living with HIV
KEY STRATEGIES
•
Provide an enabling environment for evidencebased policies, standards and guidelines at the local and national levels among government units and agencies
Expand, build and strengthen management systems and supports, partnerships and collaboration in the implementation of the national response
Develop capacity of partners in the national response to include local governments, the private sector and communities at-risk, vulnerable and living with HIV in the implementation of the 5th AMTP
•
•
•
Develop evidence-based targeted and comprehensive programs and services Capacitate service providers in the delivery of quality and comprehensive package of programs and services Provide equitable access to comprehensive programs and services through health promotion Enhance decentralized implementation of the 5th AMTP
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5th AMTP...from page 17 Profiles of the Epidemic and Responses From 2005 to 2010, the national response managed to maintain an HIV prevalence of below one percent of the general population. But the last three years also saw an exponential increase in new cases. Year 2010 showed this epidemiological profile: •
• • •
More are infected. The 5th AMTP shall commence with one HIV case every five hours or five cases every day, an alarming contrast to the 4th AMTP, which commenced with one case every two days. Those infected are young, their median age is 27 years. People infected are in their productive years or between ages 20 and 34. More males are infected or principally infected through male-to-male sexual contact.
The 5th AMTP builds on both gains and gaps of the previous plan’s implementation: it is focused on addressing high-risk behavior and epidemic drivers such as in the context of MSM and PWID. It recognizes emerging opportunities for more tailored interventions, intended to be more responsive to varying sub-cultures within these populations.
For the 5th AMTP to be realistic and sustainable, it will have to balance population-level measures with targeted interventions. It strongly enjoins local governments to assess respective epidemic levels and formulate local responses accordingly. The 5th AMTP Target Groups and Sectors The 5th AMTP considers different population groups and sectors in advancing the six-year response. It will focus on scaling up HIV prevention among groups such as MSM and PWID through improvement of coverage and quality of interventions. Persons living with HIV and their families shall benefit from improved coverage of comprehensive and more sustainable treatment, care and support services. Formulation of enabling policies and guidelines shall be ensured, including setting up of mechanisms for HIV and AIDS in public and private facilities and workplaces, national and local levels of implementation. Programs include reduction of HIVrelated stigma and discrimination and mitigation of the epidemic’s impact. Distinctly manifest too is the critical, strategic role of local governments, where successes on inter-agency collaboration and multi-sector approaches were more evident during the 4th AMTP’s implementation.
ACKNOWLEDGMENTS The Secretary of Health and Chairperson of the Philippine National AIDS Council would like to thank the agencies and organizations for their participation in the HIV Summit. DEPARTMENT OF HEALTH including Bureau of International Health Cooperation, Bureau of Local Health Development, Dangerous Drugs Abuse Prevention and Treatment Program, Health Emergency Management Service, Field Implementation and Coordination Office, Global Fund Round 6 HIV Project, Health Policy Development and Planning Bureau, Infectious Diseases Office, Internal Management Support Team, National AIDS and STI Prevention and Control Program, National Center for Disease Prevention and Control, National Center for Health Facilities and Development, National Center for Health Promotion, National Council for Blood Services and Philippine Blood Coordinating Council, National Epidemiology Center, National Voluntary Blood Service Program, Office of Policy Standards Development for Service Delivery, Office of the Secretary and Philippine National AIDS Council Secretariat; Commission on Population; Food and
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Drug Administration; Philippine Health Insurance Corporation; Research Institute of Tropical Medicine; San Lazaro Hospital; Centers for Health Development in Ilocos, CAR, Cagayan, Central Luzon, CALABARZON, MIMAROPA, Bicol, Western Visayas, Eastern Visayas, Northern Mindanao, Davao, SOCCSKSARGEN, Caraga and NCR. OTHER NATIONAL GOVERNMENT AGENCIES including Armed Forces of the Philippines; Commission on Higher Education; Commission on Information and Communications Technology; Department of Justice and Bureau of Immigration; Department of Labor and Employment, Institute for Labor Studies, Occupational Safety and Health Center, Philippine Overseas Employment Administration and Technical Education and Skills Development Authority; Department of National Defense; Department of Social Welfare and Development and its field offices in Regions IV-B and NCR; Department of the Interior and Local Government,
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its offices in Regions IV-A, VI and VII, Local Government Academy and Philippine National Police; Department of Tourism; National Academy for Science and Technology; National Youth Commission; Philippine Information Agency; Presidential Management Staff; and Philippine Commission on Women. OFFICES OF LOCAL GOVERNMENT UNITS including Angeles City AIDS Council and City Health Office; Davao City Health Office and Social Hygiene Clinic; Las Pinas City Health Office and Social Hygiene Clinic; Makati City Planning Office and Social Hygiene Clinic; Malabon City Health Office and Social Hygiene Clinic; Mandaluyong City Health Department; Manila Health Department; Marikina City Health Office; Muntinlupa City Health and Planning and Development Offices; Parañaque City Health Office and Social Hygiene Clinic; Pasay City Health Office; Pateros Health Office; Quezon City Health Department and Planning and Development Office; Santiago City Health Office; Taguig City Health and Planning and Development Offices; Valenzuela City Health Office; Zamboanga City Health Office; and the Department of Health of the Autonomous Region of Muslim Mindanao. THE ACADEME AND RESEARCH INSTITUTIONS including Ateneo De Manila University; Polytechnic University of the Philippines; University of the Philippines’ College of Public Health, Center for Women, College of Nursing, National Institutes of Health, Population Institute and Reproductive Health, Rights and Ethics Center for Studies and Training. PROFESSIONAL AND INDUSTRY ASSOCIATIONS including Advertising Board of the Philippines; AIDS Society of the Philippines; Business Processing Association of the Philippines; Philippine Hospital Association; Philippine Medical Association; Philippine Obstetrical and Gynecological Society; Philippine Socety for Venereologists; Philippine Society for Microbiology and Infectious Diseases. OTHER NON-GOVERNMENT ORGANIZATIONS, SOCIO-CIVIC GROUPS, FAITH-BASED GROUPS, COMMUNITY ORGANIZATIONS, FOUNDATIONS, NETWORKS including Action for Health Initiatives; Ang Ladlad; Babae Plus; Bangon Pilipinas; Catholic Bishops Conference of the Philippines, its Commission on Public Affairs and National Secretariat for Social Action, Justice and Peace; Center for Health and Rights of Migrants; Creative Collective Center Inc.; Daughters of Charity; Democratic Socialist Women of the Philippines; Filipino Free Thinkers; Family Planning Organization of the Philippines; Health Action Information Network; Health and Development Initiatives Institute; Institute for Social Studies and Action; International Maritime Organization; International Organization for Migration; Kapisanan ng mga Kamag-anak ng Migranteng Manggagawang
Pilipino; League of Angeles City Entertainers and Managers; Lunduyan Para sa Pagpapalaganap, Pagtataguyod at Pagtatanggol ng Karapatang Pambata; Medecins Sans Frontieres; National Federation of Filipinos Living with HIV and AIDS; Order of the Ministers of the Infirm; Philippine Legislators Committee on Population and Development; Philippine Federation for Natural Family Planning – Filtao; Philippine Red Cross; Philippine NGO Council on Population, Health and Welfare; Philippine NGO Support Program; Pilipinas Shell Foundation Inc.; Pinagsamang Lakas ng Kababaihan at Kabataan; Pinoy Plus Association; Plan International; Positive Action Foundation of the Philippines Inc.; Precious Jewels Ministry; PRISM/ Philippines (Chemonics International); Remedios AIDS Foundation; Reproductive Health Alliance Network; Research Institute for Tuberculosis – Japan AntiTuberculosis Association; RockEd Philippines; Samahan ng Mamamayan-Zone One Tondo Organization; Save the Children; Southeast Asian Ministers of Education Tropical Medicine and Public Health Network; Sentro ng Alternatibong Lingap Panligal; Support Service Institute for Women; The Forum for Family Planning and Development; TLF Sexuality, Health and Rights Educators Collective; Trade Union Congress of the Philippines; TRIDEV Specialists Foundation; True Love Waits Philippines; Women’s Health Care Foundation; World Vision Development Foundation; and Young Women’s Choice. BILATERAL, MULTILATERAL, INTERGOVERNMENTAL AGENCIES including Asian Development Bank; Delegation of the European Commission; Deutsche Geselschaft Fur Technische Zusammenarbeit; Joint United Nations Programme on HIV/AIDS; Resident Coordinator of the United Nations; UN Habitat; UN High Commissioner for Refugees; UN Educational, Scientific and Cultural Organization; UN Children’s Fund; UN Development Programme; UN Population Fund; United States Agency for International Development; World Food Programme; and World Health Organization. OTHER PRIVATE ORGANIZATIONS AND INDIVIDUALS (such as private commercial and mass media enterprises and individual content producers) including Associated Press, Boehringer Ingelheim, Bombo Radyo Philippines, Buhay OFW News Express, Business World, Countryside Associated Television, DKT Philippines, Durex Philippines, European Press Association, Glaxosmithkline Philippines Inc., GMA 7 News, IBC 13, Immunotec Research Canada, Inter Press Service Asia Pacific, The Journal Group, Kyodo News, Radyo ng Bayan, Red Pixel Studios, RPN 9, SexandSensibilities.com, Toro, U Life Corporation, ZT Express News, affiliates of National Press Club, freelance journalists, bloggers and photographers.
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PNAC at a Glance
The Philippine National AIDS Council, created by virtue of Executive Order No. 39, reconstituted, and strengthened by Republic Act 8504 or the Philippine AIDS Prevention and Control Act of 1998 is the central advisory, planning, and policy-making body for the country’s comprehensive and integrated HIV and AIDS prevention and control program. PNAC is chaired by the Secretary of Health, is attached to, and its secretariat housed in the DoH.
PNAC envisions a fully empowered nation, where different individuals and sectors work in partnership to prevent HIV transmission and to lessen its impact on affected persons in particular and the society in general. It is PNAC’s mission to lead in developing and sustaining an enabling environment where individuals and sectors can appropriately, effectively and expeditiously respond to the many challenges of HIV and AIDS. Ferchito Avelino, MD, MPH, Director III of the PNAC Secretariat (sixth from left), on behalf of the PNAC Chair, was at the helm in the organizing of the HIV Summit. He was supported by (left to right) Glenn Cruz, Media Reproduction Specialist; Efren Chanliongco Jr., Project Evaluation Officer; Susan Gregorio, MD, MPH, Medical Specialist IV; Ronald Valino and Emily Jane Concepcion, Administrative Aides; Virginia Evangelista, Administrative Officer; Ma. Joane Ann Corbe, Heath Education and Promotion Officer; and Joselito Feliciano, MD, Medical Specialist III.
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EDITORIAL ADVISERS: Enrique T. Ona, MD, FACS, FPCS, DOH Secretary and PNAC Chair; Austere A. Panadero, DILG Undersecretary and PNAC Vice-Chair; and Alicia R. Bala, DSWD Undersecretary and PNAC Member EDITORIAL MANAGEMENT: The PNAC Advocacy Committee oversees the content development, publication and circulation of the AIDS Gazette. It is composed of technical representatives from PIA (Chair), TLF SHARE Collective (CoChair), CHED, DepEd, DILG, DOH, DOJ, DOLE-OSHC, DOT, DSWD, Senate Committee on Health and Demography, ASP, Lunduyan Foundation, TUCP, WHCF and a representative from the PLHIV Community. PUBLICATION AND CIRCULATION MANAGEMENT: The PNAC Secretariat facilitates activities to produce content, process presswork and distribute the AIDS Gazette, co-managed by Susan P. Gregorio, MD, MPH, Medical Specialist IV and Officer-in-Charge and Glenn A. Cruz, Media Reproduction Specialist. Technical assistance provided by Ross Mayor, copy development, and Jansen Mayor, layout design development. THIS ISSUE’S PHOTOS AND GRAPHICS CONTRIBUTORS: DOH Media Relations Unit and National Center for Health Promotion, Pitt Pugahan (cover photo), Samuel Genita Jr. (Red Pixel Studios) AIDS GAZETTE Volume 1, Issue Number 1 (March 2011). Copyright 2011. All rights reserved. AIDS Gazette by Philippine National AIDS Council is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Philippines License (http://creativecommons.org/licenses/by-nc-sa/3.0/ph/). For feedback, requests and other concerns, contact PNAC Secretariat, Third Floor, Building 15, Department of Health, Rizal Avenue, Sta. Cruz, Manila 1003 Philippines; PHONE +632-651-8000 Ext. 2550 or 2551; FAX +632-743-0512; E-MAIL aidsgazette@pnac.org.ph.
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