One of Nafis Sadik's visit as Special Envoy on HIV/AIDS in Asia in the Pacific is a dialogue with the NGOS working on HIV/AIDS in the Philippines. A total of 40 participants have attended and the following is the summary of the meeting held at United Nations Building Carlos P Romulo Hall Makati City Philippines.
Key Presentations were made on the following topics : treatment and care, HIV and migration, Global Funds for TB AIDS Malaria , Fund sourcing and resource generation and Greater involvement of people living with HIV/AIDS (GIPA). A dialogue were then made during the open forum to discuss and clarify issues/challenges on HIV/AIDS in the Philippines. Dr Sadik ended with her responses for such matters.
The following shows the proceedings of the said meeting that has taken place:
On Treatment and Care issues...
Mr Mar Liwanag of Pinoy Plus Association described the situation in the Philippines as follows:
low priority given by government to health, in general, and HIV/AIDS in particular
inadequate HIV/AIDS case management by hospitals, e.g. treatment is delayed until sometimes it is too late
initiatives in home-based and community-based care are being implemented but inadequate in scope and reach
inaccessibility not only of ARVs, but also drugs for opportunistic infections, pain, management, and supplementary medicines
"Treatment" refers not just to drugs, but also services such as:
counseling
monitoring of health status of PHAs
training for health professionals on HIV case management
The recommendations are:
National system should provide affordable, accessible and quality care
UN to lobby at highest level of government for the provision of Minimum Requirements on HIV/AIDS treatment and care, which includes:
1. Access to functioning and affordable health services and support networks into which ARV treatment can be integrated so that treatments are provided effectively.
2. Information and training on safe and effective use of ARVs for health professionals qualified to prescribe ARVs.
3. Capacity to diagnose HIV infection and to diagnose and treat related illness.
4. Assurance of adequate supply of quality drugs.
5. Sufficient resources should be identified to pay for treatment on along term basis; patient must be aware that treatment is "for life".
6. Functioning laboratory services for monitoring, including routine haematological and
biochemical test to detect toxicities, must be available.
7. Access to voluntary HIV counseling and testing (VCT) and follow-up counseling services must be assured, including counseling of PHAs on the necessity of adherence to treatment.
ON HIV and Migration issues....
Ms. Ma. Lourdes Marin of ACHIEVE described the migration patterns in the Philippines. She noted that even inthe home country, there are already predisposing factors for HIV, while conditions in the hoist
countries further increase the workers' vulnerability. She also noted the feminization of migration, as more women workers leave the country for jobs overseas. Some issues and concerns which need to be looked into are:hostile migration policies; mandatory testing of overseas workers; lack of access to treatment and care.
Ms. Marin called upon the Special Envoy of the UN Secretary General for HIV/AIDS in Asia to support the community's call for governments of both sending and receiving countries to:
Forge bilateral or multilateral agreements that guarantee the protection of migrant workers, especially at the job site. Such agreements must address the various conditions that make migrant
workers vulnerable to abuse, exploitation, violence and ill-health.
Review the requirement of mandatory HIV Antibody testing of migrant workers towards better health and immigration policies that do not discriminate against PHAs.
Provide available, accessible and affordable health services for migrant workers and their families, especially those infected with HIV.
Address specific vulnerabilities faced by undocumented migrant workers.
Ratify the 1990 International Convention on the Protection of All Migrant Workers and Members of their Families.
On Funding and Resource Generation issues....
Ms. Ruthy Libatique of PHANSUP noted the low prevalence of HIV/AIDS in the Philippines, which was largely due to early prevention efforts of government and the medical and NGO communities.
However, the low prevalence status has to led to a low prioritization of the Philippines by donor agencies. She notes the presence of factors which could drive the epidemic, if efforts in education and prevention are not given adequate financial support.
While the opportunity to prevent an explosion of the epidemic is still present, Ms. Libatique urged the UN to:
Lobby donor countries and organizations to increase priority to low prevalence countries in the funding scenario.
Bridge the gap between its declared global priority and actual country level support by re-focusing its funding to HIV/AIDS
Intensify its advocacy for the participation of the highly vulnerable populations.
On Greater Involvement of PHAs (GIPA) ....
Mr. Joshua Formentera of PAFPI noted that for people who are already infected, HIV/AIDS is a matter of life and death, and thus involvement is essential. Involvement is also self-affirming and empowering. Some factors which impede involvement are: fear and denial discrimination, double stigmatization - being HIV positive and at the same time coming from a "socially unacceptable" group such as sex workers, drugusers, etc.
He also noted that PHAs must first have self-acceptance to become involved. Family members, as well as successful programs, also foster greater involvement.
The recommendations were the following:
more funding to support programs and services
Encourage participation of PHAs in international conferences
Increase access to generic drugs and ARVs
Better coordination between UN and key partners
The Dialogue....
The following concerns regarding treatment and care were raised:
the need for early detection and treatment of opportunistic infections, in particular tuberculosis
Inadequate laboratory facilities for health monitoring
Lack of attention given to pediatric AIDS cases
While education/prevention is important,treatment for PHAs should also be given priority
Some PHAs have feeling of being "used" - they serve as health educators and contribute to the solution of the problem, but they are not being given adequate care despite their efforts
In procuring ARVs, various strategies are being explored such as a "buyers' club" to purchase medicines from Thailand, and a donation scheme which did not succeed due to a policy of the National Economic and Development Authority (NEDA) regarding taxation.
Clinical trials are a very sensitive matter, as these raise ethical issues as well as questions on validity and efficacy.
The need to remove the stigma associated with HIV/AIDS, to enhance education efforts and to improve care for PHAs.
The need to strengthen programs and services for adolescents, sex workers, and MSM (men who have sex with men)
In regard to migration, the following were noted:
In-country migration (from rural to urban areas) is part of the cycle of migration
There is also the migration of students who relocate to cities for education purposes
The corporate sector needs to be involved in HIV/AIDS. It was noted that efforts are on-going to invite the former CEO of Shell Philippines to be a UN ambassador, which would strengthen linkages with the corporate sector. A set of proposals, called the Partnership Options will be submitted to the private sector for possible funding. Linkages are also being forged with the Bankers' Association and other business groups to increase involvement in the response to HIV/AIDS.
It was suggested that Dr. Sadik include the private sector in her advocacy efforts, and if
possible to meet with representatives of the private sector while in the Philippines.
There is also a need to develop a national HIV/AIDS workplace program that ensures
tripartism. The ILO Code of Practice on HIV/AIDS is a good framework in the development and implementation of the workplace program.
There is a need to provide employment for PHAs who are still capable of working.
It was also suggested that D. Sadik meet with thePresident of the Philippines to advocate for the prioritization of HIV/AIDS
Regarding the Global Fund, Dr. Sadik was informed that the Philippines submitted proposals, but these were not approved for funding. Also, the proposal on the provision of ARVs was blocked.
The matter would be further looked into by Dr.Sadik.
NGOs and other sectors can raise issues and provide updates to Dr. Sadik through the UN
country program.
Response from Dr. Sadik:...
She will raise the above issues with President of the Philippines Gloria M. Arroyo and Minister of Health Secretary .Manuel Dayrit when she meets with them this week.
she will raise the above issues with Dr. Peter Piot and SG Kofi Annan for follow-up action
she asked UNAIDS Philippines to serve as her link with the NGOs and update her on what is happening in the country so that she can act onsome of these issues as may be necessary and appropriate.
she directed UNAIDS Philippines to act on the issues that can be addressed at the country level (e.g., corporate advocacy)
