A total of 21 participants attended the UNGASS In the Philippines Workshop held at the Romulo Hall of the NEDA Sa Makati Building in Makati City, Philippines. Majority of the participants were from non-government organizations (NGOs) involved in HIV/AIDS programs in the Philippines. Five government organizations were represented during the workshop, namely: the Department of Health (Research Institute for Tropical Medicine and San Lazaro Hospital), Philippine National AIDS Council, Office of Senator Flavier and the House of Representatives. The resource persons and facilitators for the workshop were: David Stephens and Susan Chong of APCASO and Joel de Mesa of Library Foundation. The Remedios Foundation and the Philippine NGO Support Program (PHANSuP) were co-organizers of the workshop.

The UNGASS workshop intended to: a) assist the participants to utilize the UNGASS Declaration of Commitment to HIV/AIDS; b) generate NGO/CBO national advocacy platform based on UNGASS Declaration of principles and indicators; and c) facilitate the development of an action plan based on the UNGASS priorities. David Stephens emphasized that the workshop aimed to make UNGASS relevant to current requirements and activities and add value to current local efforts on HIV/AIDS.

The participants were also provided a background and a review of the process on how representatives from about 189 nations came up with the UNGASS Declaration in June 2001. The Declaration came out of a need to reaffirm a common understanding of the epidemic and to arrive at a consensus agreement that could form the basis for a concerted effort to address the epidemic.

The UNGASS Declaration of Commitment comprised a comprehensive set of international and national actions on HIV/AIDS and signatories to this Declaration had, in effect, committed their respective governments to achieve the targets. The reporting process to indicate the achievement of targets was lodged among the national governments that were also responsible for establishing their respective National AIDS Councils and for compiling and submitting the indicators used for monitoring. The civil society organizations were expected to take part in the reporting process. Since the signing of the Declaration, it has been used to strengthen existing advocacy efforts among NGOs, disseminated in symposia for schools and universities and other discussion venues.

Emerging concerns for the workshop scope and process

The following emerged as the concerns of the participants in the conduct of the workshop.

A. Potential for "merging" or "consolidating" current initiatives of civil society, PNAC, national government/local governments, Global Fund and others

The UNGASS could help organizations in the process of measuring achievement of objectives through the indicators that were developed as part of the Declaration. With this, the participants could already identify strategies on the key issues that confront the service organizations.

B. Integrating key issues of UNGASS into the national response

Although many of the participants were not involved in the process of developing the UNGASS Declaration and since many have started working on HIV/AIDS even before UNGASS, the "reality" of UNGASS could already be integrated in many of existing national and organizational concerns. The integration could be made at the policy, programmatic and activity levels.

C. Comparison framework maybe useful to start-up "consolidation" process

The challenge for many organizations would be on how to make HIV/AIDS reporting more meaningful in order for governments to take cognizance of its importance and, eventually, take more action and involvement. The consolidation process could start with the formulation of a "comparison framework" between the provisions of UNGASS Declaration and the existing national responses.

Susan Chong added that this workshop would be the first of its kind for APCASO. She noted that the workshop results could already translate into action the 'work' that governments need to undertake -- including strengthening existing programs of service organizations. The Declaration could be used to strengthen the organizations' advocacy positions both at the policy and program levels.

D. Stake-involvement -- making it real

Susan suggested that national (and local) government support for HIV/AIDS could be anchored on the fact that the Philippines is one of the signatories to the Declaration. The challenge now would be in getting government leaders to be actively involved and support the Declaration.

Remarks and Gaps Identified on the PMTP vis-a-vis the UNGASS Declaration

The group proceeded to review the specific sections of the UNGASS Declaration which were compared to the provisions of RA8504 and the Philippine Natrional AIDS Council (PNAC)-developed Medium Term Plan (MTP)-III. The review intended to validate the gaps identified in the initial assessment made by PNAC. Susan Chong emphasized that the exercise aimed to enhance the participants' recognition of the gaps and the manner with which to address these gaps at the local level.

In summary, the following highlights the gaps identified in the national response to HIV/AIDS based on the UNGASS Declaration and the existing program efforts resulting from Republic Act 8504 and PNAC MTP-III:

1. The need to clarify the meaning of a "true gap"
2. The source of funding for HIV/AIDS always needs to take on a broader perspective because:
   • The basic problems of poverty override AIDS as a priority.
   • The need for multi-sectoral partnerships which also forms a gap in itself in the funding and implementation of programs.
   • Majority of government agencies have not mainstreamed HIV/AIDS.
   • There are gaps in PNAC representation.
   • The leadership of country has not made public statements or shown strong leadership on HIV/AIDS.
   • The Secretary of Health has not chaired UNGASS/PNAC meetings.
3. All three documents do not address concerns specific to the out-of-school-youth.
4. There is need for structural reform and a comprehensive plan for migrant workers; specifically, women in migration that include wives and children of migrant workers.
5. The lack of logistics in enforcing universal precaution and the absence of any follow through training and re-education of health workers to improve attitudes and practices are obvious gaps.
6. There is also a lack of "harm reduction" programs in drug use and the law that penalizes use and users aggravates the condition in this sector.
7. Care and support programs need to be more comprehensive.
   • Not all people with HIV/AIDS (PHAs) are aware of the existence of the HIV/AIDS Core Team (HACT). The patients are being referred to Manila since services are centralized in Manila.
   • The HACT system does not observe basic requirement for service (e.g., confidentiality).
   • There is need for more private sector participation since private hospitals do not prioritize care and support services for HIV/AIDS.
   • There is need to ensure full and genuine participation of PHAs
8. There is an absence of data, monitoring system and policy on orphaned children from HIV/AIDS-affected parents.
9. There are inadequate resources for research and development (R&D).

Audit and Framework for Comparison (UNGASS and the National Response)

For this workshop session, the participants were grouped into three according to their organization's service focus: a) women, youth, children and GO; b) PHA, care, support and treatment; and c) men who have sex with men (MSM), workplace, migrant workers, health care workers, coalitions and GO. The following were the group outputs.

A. Group on Women, Children and Youth:

1. Women and adolescent girls:
   • This was mentioned in Sec. 52, 59, 60 of UNGASS and harmonize with some parts of the MTP in addressing the empowerment of women and girls.
   • The gaps identified were:
     • Women are not specifically identified as a vulnerable sector in the MTP.
     • There had been the absence of a national policy to increase the capacity of women. Hence, the need for policy formulation in the following: multi-sectoral roles, logistics/budget, advocacy/legislation and capacity building.
     • There is need to monitor if HIV/AIDS (quality) services are really integrated within health care settings and a need to address the unique needs of women in indigenous cultures
     • There is a need for policy that protects the rights of minor clients who are PHAs.
2. Role of Men
   • Covered in paragraph 59, but not mentioned in the MTP.
3. Children and Orphaned Children
   • Covered in para 53 of UNGASS, also in the DOH program on Adolescent Youth Health and Development (AYHD) but was not mentioned in the MTP.
   • The need for AYHD to implement programs for out of school youth and in-school youth.
   • ARH services to be made available to this sector and trained services providers (health facilities, etc.) are insufficient/inadequate to provide these.
   • There had been the absence of specific targets of young men/women accessing HIV/AIDS services.
   • There is the need to monitor implementation of integration policy, skills, attitudes and comfort of educators.
   • Orphaned children are covered in para 65 of UNGASS but not in the MTP. There is the absence of special assistance to children affected by HIV/AIDS. In this regard, there may be a need for multi-sectoral partnerships to provide such services to affected children.
   • There is a need for integration of HIV/AIDS issues in orphan care policies - addressing the "territorial issue" among orphan care agencies/organizations and reintegrating the orphan children back to their families
4. Role of the family
   • Covered in para 63 of UNGASS, but was not mentioned in the MTP.
   • There is a need to have more comprehensive context in educating families together (both parents, especially the fathers).
5. Lesbian in sexual health
   • This was not included in both the UNGASS Declaration and the MTP. There is also an absence of lesbian sexual health program.
6. Mother to child transmission
   • Covered in para 54 of UNGASS but not covered in MTP.
   • There is a need for HIV/AIDS education among women/mothers.
7. HIV/AIDS in conflict and disaster-affected regions
   • Covered in para 75 of UNGASS Declaration but there was no mention in the MTP or any national strategy.
   • There is a need to look at mobility issues - sexual networks in disaster-stricken areas, e.g., military people

B. Group on MSM, Workplace, Migrant Workers, Health Care Workers

1. There appeared to be no harmony between the UNGASS Declaration and MTP, between government and the civil society, between UNGASS and the NGOs/CBOs efforts and between and among civil society.
2. There is generally very few discussions and very limited responses targeting MSMs.
3. Initiatives in migration are driven by ASEAN Task Force on AIDS (ATFOA) more than UNGASS. This was not included specifically in MTP and there was no actual response made on migration and HIV/AIDS issues. Government response were centered on pre-departure orientation but there was no post-arrival monitoring and reintegration program.
4. There had been the absence of a comprehensive framework that looks at migration as a structural issue. Existing programs are limited and does not address these structural issues (e.g., violation of human rights). There is an absence of on-site programs for migrant workers and the vulnerability of spouses of migrant workers has not been addressed adequately.
5. There is a need for a condom-friendly policy.
6. There is a need for policy that deals with culture in relation to HIV/AIDS and RH
   • how do we solve the whole issue of religion and its influence over culture?

C. Group on PHA, care support and treatment

1. There is a need for integration of palliative care and communication enhancement in the curriculum for medical/health workers
2. There is a need to include/incorporate with the publication entitled "Ethical Guidelines in AIDS Investigations in the Philippines", the guidelines for psycho-social research as well as treatment management including alternative modalities (e.g., herbal medicine)
3. There is a need to conduct more research on alternative modalities.
4. There is a need for continuing education (e.g., training and retraining) of health workers at all levels.
5. There is a need to highlight the importance of providing a continuum of services that included PHA's nutrition, psycho-social, and other support services.
6. There is a need for a sound policy on trade (and importation) that will allow access to cheap, quality anti-retroviral (ARV) drugs.

Cross-Cutting Themes/ Issues

As a result of the discussions on the gaps between the UNGASS Declaration and the national response based on RA 8504 and MTP III, the following cross-cutting themes and issues were identified by the three workshop groups.

Monitoring
Policy & Program Implementation


Legislative Advocacy/ Lobbying
Condom Use Policy
Policy Level

• Resources (human, monies, logistics)
• Systems and structures (prioritization of public health i.e. budget)
Reproductive Health and rights of PHAs
Lack of resources to implement UNGASS and MTP
AIDS Law cannot be fully enforced


Mechanisms in ensuring partnerships (functional and effective)
Greater Involvement of persons living with HIV/AIDS (GIPA) and involvement of vulnerable sectors not actualized (in principle, it exists)
Multi-sectoral involvement/ participation



Gender
Culture
Catholic influence/ power over state/ individuals



Absence of political will from top to bottom
Involvement of highest GO (government official)



Program level:

• Integration of health services regardless of HIV status
• Mainstreaming HIV/AIDS into their own agencies



Economic realities
Economic priorities
Globalization



International policies
Changing environment
Global economic (dis)order

Action Planning

For this part of the workshop, the intention was to draw up some general strategies and outline the course of action that the participants would take in response to the gaps identified on the first day. The following were the action plan outputs of the three workshop groups.

• Group on Women, Children and Youth:
• Group on PLWH/A, Care Support and Treatment:
• Group on MSM, Workplace, Migrant Workers, Health Care Workers