A total of 65 delegates from government civil society bilateral multilateral agencies from ten (10) participating countries namely Bangladesh, Bhutan, Fiji, Lao People's Democratic Republic, Democratic People's Republic of Korea, Malaysia, Maldives, the Philippines Sri Lanka and the host country Mongolia have met to discuss how to avert HIV epidemics among Asia Pacific Countries. These Asian and the Pacific country delegation have one thing in common -that is, a very low rate of HIV infection - less than 0.1 per cent -.

Key objectives of the conference are to:

	a)	Share and discuss evidence and current approaches to prevention, effective surveillance, treatment, care and support for low prevalence countries;
	b)	Identify the critical obstacles and opportunities that take priority for action in low prevalence countries as they scale up towards universal access to prevention, treatment care and support;
	c)	Develop a road map for the scaling up of comprehensive national AIDS responses and determine concrete actions to overcome identified obstacles;
	d)	Mobilize political leadership, civil society groups and bi-lateral multilateral organizations working in low prevalence countries so scale up join efforts in a coordinated manner under the Three Ones principle.

Philippine delegation is represented by:

	a)	Undersecretary Alexander Padilla Department of Health
	b)	Dr Ferchito Avelino, Head Philippine National AIDS Council Secretariat
	c)	Dr Jose Narciso Melchor C Sescon, Director Remedios AIDS Foundation, Inc
	d)	Ms Maureen Colambo, Coordinator Babae + Support Group

Tuesday 24 October 2006

Registration was started on the second floor Chinggis Khaan Hotel. The Opening Ceremony was held through a welcome dinner at the Great Khural Hall of the Government House. The Prime Minister of Mongolia Mr Miegombo Enkhbold along with Mr Sultan Aziz Director Asia and Pacific Division UNFPA welcomes all participants for the said conference. A mini AIDS concert followed to entertain the delegation.

Wednesday 25 October 2006

Plenary Session 1: "Setting the Context: Evidence and Issues for Low prevalence Countries"

The session's objective is to introduce through current evidence, appropriate strategies for LPC and debates surrounding the different approaches. The session was chaired by the Honorable Dr Gunasagaran Gounder as Minister of Health of Fiji and moderated by DR Bertrand Desmoulins UNICEF Country Representative Mongolia. The Honorable Mr M Enkhsaikhan, Deputy Prime Minister of Mongolia and Chair of the Mongolia National AIDS Committee, represented the Government of Mongolia as the host country.

Dr JVR Rasada Rao, Regional Director of the UNAIDS Regional Support team (RST) spoke on the topic: "Curbing the Epidemic through Intensifying HIV prevention". The "dynamics of the epidemic" center on three points:

	1)	Asia may look lower in prevalence than Africa, but we must look at the actual numbers of HIV cases in Asia , not just the ratio of numbers of cases to size of population;
	2)	Severity of epidemics is determined by extend of male clients of sex workers population; and
	3)	If low prevalence countries approach 1% prevalence, then they are approaching a generalized epidemic.

Opportunities for LPC centered on understanding that LP leads to low visibility and thus low priority setting for responses to HIV and AIDS. In the Asia and Pacific region, there are approximately 8.3 million HIV cases, with nearly 1 million new infections per year.

AP has a choice: 1) to conduct business as usual, which would result in a projected 20 million HIV cases by 2010 or 2) to become assertive by committing more resources for prevention, with a $1 investment in the present preventing $22 economic loss by 2010.
Dr Bertrand Desmoulins summarized the plenary session.

Panel Discussion I

This panel discussion was chaired by Dr A Waheed, National Narcotics Director of Maldives, Ms Delia Barcelona UNFPA Country Representative Mongolia moderated the discussion.

Dr Ross McLeod, a Ph D in economics and Director of eSYS Development Pty Limited, has worked on HIV prevention for 30 countries in Africa and Asia . He focused on five points: 1) Regional need for HIV resources is increasing; 2) There is significant mobilization, but from a low base; 3) There still are gaps, with a need to set priorities; 4) cost effectiveness analysis helps the setting of priorities; and 5) the pay-off is high from targeting and facilitating action. Costs must be weighed against benefits.

Dr Peter Chan, who has a PhD in communication and marketing and an MPH, spoke on "Specific needs of vulnerable populations in different LPC" He pointed out several definitions for vulnerability, focused on young people as the "at-risk population, " and emphasized the need to prioritize interventions for the "most-at-risk populations"- sex workers (SW), men having sex with men (MSM), injecting drug users (IDUs), prisoners, the mobile segment of the population, and migrants. He closed his topic by emphasizing that HIV and AIDS is not just a health sector issue - HIV and AIDS as a cross-sectoral issue. Universal access to HIV prevention/ treatment/ care support requires the involvement and commitment of all sectoral ministries in a country.

Mr Ilias Ben Adam Yee, volunteer from Family Planning Association Malaysia spoke on "Youth Leadership in the response to HIV and AIDS in LPC". He discussed his volunteer work in Malaysia amongst adolescents through RH for Adolescents module (RHAM), developed by young people. He discussed further the UNFPA Mysor Project for reaching marginalized young people. Lessons learned included: 1) knowledge of HIV and AIDS is not enough; 2) Young people need life skills; 3) Young people can design programmes; 4) Leadership comes from youth; and 5) Adults can work effectively with youth.

Dr Ahmed Zouiten, a former Medecins Sans Frontiers (MSF) physician and current WHO medical Officer for STI and HIV and AIDS in Lao PDR spoke on " Coverage and Costing of Services for Prevention, Treatment and Care: Model Delivery for ART in LPC." He presented the model for Lao PDR, in which the stratified health system works in a cost-saving, coverage-focused manner across district, provincial, and regional levels -with referrals between levels.

For diagnosis, he distinguished amongst HIV testing and Counseling (HCT) Voluntary counseling and testing (VCT), and Provider Initiated Testing and Counseling (PITC). For treatment, he discussed anti-retroviral treatment (ART) delivery system, which proceeds in a systematized manner from registration, to medical consultation by physician for first assessment, to hospitalization, to biological assessment, to ART assessment, to pre-ART counseling, to distribution of ARV, to follow-up and side effects management. He also pointed out "task shifting", with nurses taking on traditional tasks of physicians for diagnosis and treatment procedures, which has been effective in Africa Region and which can be effective in the Asia-Pacific region.

Ms Delia Barcelona gave the summary of the panel discussion on cost-effectiveness, vulnerable groups, youth leadership, and the systemization of diagnosis and treatment through referral systems in LPC in the AP region.

It was in the afternoon that the Philippine delegation team arrived for the meeting. Timely, for the official launching of the Global campaign on Children and AIDS " Unite for children unite against AIDS" organized by UNICEF/ UNAIDS Mongolia was held at the lobby area of Chinggis Khaan Hotel.

Towards the afternoon, participants were divided into two workshop groups. The Philippines was part of Group B and was assigned as the rapporteur, while Mongolia assigned as chair Other group B members were Lao PDR, DPRK.

The group was tasked to discuss the issues as a country delegation team and then later, in a group plenary discussion to see common responses. The following were asked:

	a)	factors that drive the epidemic
	b)	current national response
	c)	3 obstacles identified
	d)	3 opportunities to overcome HIV and AIDS

A dinner reception was hosted by the Government of Mongolia at Ikh Tenger Hotel.

Wednesday 26 October 2006

Plenary session II " Regional challenges, Critical Obstacles and Strategic Opportunities in achieving Universal Access by 2010"

The session was chaired the Undersecretary Alexander Padilla of the Department of health Philippines with Dr Hernando Agudelo, UNFPA Representative, Timor Leste acts as the moderator.

Ms Celina De Costa spoke on " Human rights, Stigma and Discrimination". She gave her personal testimony and her struggles, being an HIV for 12 years. She spoke of her stigma obtained from the hospital, her family and her community. She spoke of her involvement with India Network of People living with HIV (INP+) and Project Concern International. She further stressed that PLHA need to be involved at the heart of the response, and community-based organizations should support advocacy on behalf of PLHA, particularly for anti-discrimination laws with proper monitoring systems.

Ms Caitlin Weisen-Antin talked about "Multi-sector Programme and Synergy within UN system and between National and UN response. HIV and AIDS is an unprecedented development crisis which reverses development gains across all sectors and erodes government will to provide services. A result is the decrease in life expectancy for PLHA ---a loss of 5-10 years of life in Cambodia , for example. Within our region, Cambodia , Thailand , Myanmar , and Papua New Guinea (PNG) formerly had low prevalence of HIV but now have generalized epidemics. Nevertheless, hope is exemplified by Cambodia and Thailand , in which the pace of the epidemic has slowed.

For the response to HIV and AIDS, two core frameworks are the United Nations General Assembly Special session (UNGASS) commitments with a target of 2010 and the MDG with a target of 2015. HIV and AIDS has a high cost, with a USD 7.3 billion loss in 2001 and a projected loss of USD 17.5 billion by 2010. For maximizing development impact by generating a sustainable response to HIV, the focus must be on building synergies between the UN system and national governments. Thus, there must be: 1) adherence to the Three Ones Principles (particularly for target-setting in a National AIDS Strategies); 2) acknowledgement of the unified UN HIV response based on the Common Country Assessment (CCA) and the United Nations Development Framework (UNDAF); 3) coordination through the UN Resident Coordination System and the UN Theme Group; and 4) encouragement of national government support for UNGASS and MDG commitments. Ten countries in the region have an MDG-based national strategy; the United Nations Development Program (UNDP) and the Asian Development Bank (ADB) are leading the process. Mongolia leads the way with its costed National MDG plan.

Ms Chee Yoke Ling spoke on "Trade Agreement, TRIPS, and Sustainable Access to Treatment." The General Agreement on Tariffs and Trade (GATT) was adopted during 1945-Headquartered in Geneva , the World Intellectual Property Association (WIPO) is part of the UN family of organizations but receives approximately 95% of its funding from the private sector. It provides a model to shape the laws of developing countries. The Trade-related Aspects of Intellectual Property Standards (TRIPS) was opened for signature in 1994 and came into force in 1995. A staged period was formulated for member states to meet their obligations for implementing TRIPS: 1996 for more developed countries (MDC), 2000 for developing countries, 2005 for less developed countries (LDC), and as a special provision 2016 for LDCs regarding their patenting of pharmaceuticals.

TRIPS Plus allows a country to set higher standards than the original TRIPS agreement. The 2001 Doha Declaration on TRIPS and Public Health addressed patent laws for pharmaceutical companies, with the 20 years of patent protection acting as a barrier to generic manufacturing. India is a special case for exception from pharmaceutical patenting regulations because of its thriving manufacturing industry for generics.

For other countries, the issue of generics manufacturing is confronted by patent regulations for first-line ARV and for opportunistic infection (OI) medications. There are no generic for second-line ARV, and there are no patents for diagnostic kits. The DOHA declaration asserts that TRIPS does not and should not interfere with the public health practices of a country. TRIPS flexibilities include: 1) patentability criteria, parallel importation, compulsory license, and government use.

Dr Gounder spoke on "Political leadership". Reference to government means reference to political leadership, which is central to achieving universal access. Physicians can be politicians. Politicians have an important role for influencing societal, national and global development. Money is scarce commodity in developing countries. As a member of the national budget committee, he shared the difficulties faced by the Ministry of Finance in trying to allocate funds to the Ministry of Health for HIV and AIDS response. There is only so much money to allocate from the "money pie" and hence there is a need to increase eth size of the "money pie". IN his country, Fiji , there are currently 239 HIV cases. The Government of Fiji initially budgeted USD 200,000 for HIV and AIDS prevention, care and treatment, but now allocates USD 500,000. Dr Gounder emphasized that we must work at multiple levels of leadership by forming partnerships with government and civil society.

Mr Mohamed Nasseer spoke on "Political Leadership" South Asia Association for Regional Cooperation (SAARC) has a seven countries ( Bangladesh , Bhutan , India , Maldives , Nepal , Pakistan and Sri Lanka ). Afganistan will become a member state in April 2007. SAARC recognized the urgency of the HIV and AIDS issues by developing the "SAARC Regional Strategy on HIV and AIDS" during the 2005 SAARC meeting in Dhaka , Bangladesh . During the SAARC Expert group meeting, the " SAARC HIV and AIDS Action Plan" for 2006-2007 was drafted.

Dr Prasada Rao shared with the delegation that ASEAN consisting of 10 member countries will have a Special Summit on HIV and AIDS in December 2006. SAARC will have a meeting in New Delhi in 2007 as well as the Pacific Island Forum by 2007 and should discuss the HIV and AIDS responses.

Dr Hernando Agudelo provided a summary of this Plenary session.

Panel Discussion II : Roadmap for Effective responses

There are three (3) main objectives ; 1) to explore an effective surveillance system in low prevalence countries; 2) to critically examine the key elements of what an effective AIDS response is for LPC; and 3) to define priorities and targeted national strategies appropriate for LPC.

This session was chaired by Dr H. A. Perera Kahandaliyangage, Director General of Health services for Ministry of Healthcare and Nutrition in Sri Lanka and moderated by Dr Jean-Marc Olive as the WHO representative Philippines.

Dr Prasada Rao spoke on "Universal Access for Effective Response: The Three Ones Principle and the current implementation status in LPC. From the presentation, the Philippines have been regarded as one of the fast moving country to undertake UA amongst LPC. Aside from Philippines , Cambodia , India Nepal and Thailand have been mentioned. These countries have national governments who are fully committed to UA and have good-in-country consultations. Other LPC are in Group 2 - Bangladesh, Laos PDR, Sri Lanka Group 3- Bhutan , DPRK, Fiji , Maldives and Mongolia . Group 2 and 3 have a window of opportunity for achieving UA. Stigma and Discrimination as internal barriers, and trade-related issues are external barriers to achieving UA.

The next speaker is Dr Barnard Fabre-Teste who spoke on "Universal Access and Effective Surveillance Systems in LPC" He offered a variation on the Three One Principle: one person infected, one person not infected, one risky behavior episode between these two people. Without prevention, there will be a widening of gaps in diagnosis and treatment needs. Dr Fabre Teste pointed out the five strategic directions for WHO response include: 1) expanding counseling and testing 2) maximizing prevention 3) accelerating scale-up of treatment (building on the momentum of the "3 by 5 intiative" for treating 3 million PLHA by 2005 4) strengthening health systems; and 5) developing more strategic and accurate information systems (second generation surveillance" ; surveillance of HIV drug resistance; strengthening of monitoring and evaluation; operational research)

Dr Enkhjin Bavuu spoke on the "100% Condom use Programme experience in Mongolia" He gave a brief overview of HIV AIDS and STI situation in Mongolia to rationalize the need for this program with support from the Global Funds Round 2 in 2002, and for scaling up such intervention under Global Funds Round 5 in 2005.

Dr Saramma T Mathai spoke on "Opportunities and Challenges in Linking HIV/ Sexual reproductive health. (SRH) " This linkage of HIV and AIDS with SRH approaches is supported by International Planned Parenthood Federation (IPPF), UNAIDS, UNFPA and WHO.

Dr Jean - Marc Olive gave the summary of this panel discussion.

Lunch was served and the delegates were divided accordingly: Ministerial group, civil society group, donors group. Each group assigned two representatives tasked to draft the declaration for Action and another representative to give the closing remarks in behalf the group.

In the afternoon, participants proceeded to their workshop 2 having the same groupings. Further discussion was carried out to discuss action points to be undertaken on the following themes: political commitment, human resources, sustainable financing, human rights stigma and discrimination, systems and infrastructures. Towards the end of the discussion, the group decided to prioritize top three (3) actionable points to be undertaken by the following agencies: government, civil society and international multilateral bilateral donors after the meeting.

A dinner reception was hosted by UN Country team Mongolia held in Khaan Palace Hotel.

Friday, 27 October 2006

A special session entitled " Technical support to Country and Strategies for Resource Mobilization and Issues of Sustainable Financing" was conducted and this is participated in by various international donors, multinational bilateral agencies. Mr Romy Garcia Chief of North East clusters, UNDP HQ NY USA chaired the session.

Assigned rapporteurs from the grouping presented their two day proceedings. The Mr Thinlay Dorji Deputy Secretary, Ministry of Health Bhutan presented for Group A while Ms Maureen Colambo Babae + Philippines gave the report for group B.

After lunch, UA Declaration of Action was reviewed with comments obtained from the delegation. Further refinements will be done by the steering committee for approval by the body.

Finally on its third day, closing remarks were given by the following : Mr Purejave Mongolia in behalf of the civil Society, Ms Pratibha Mehta UNDP Resident Representative and UNRC Coordinator Mongolia in behalf of the donor agencies. Ms Mehta acknowledged the Philippines for its interest to host the 2nd Asia Pacific Regional Conference on Universal Access for 2008.

The Honorable Mr M Enkhsaikhan Deputy Prime Minister of Mongolia gave the closing message in behalf of the government. Various ministerial heads of the ten (10) participating countries were likewise given the opportunity to respond thereafter. The final dinner reception for the delegation was conducted Seoul Restaurant

REFLECTIONS:

Having attended this follow through meeting on Universal Access on HIV and AIDS prevention treatment care and support, the Philippine delegation has realized that Philippine National response towards curbing the course of HIV and AIDS epidemic is on the right track. The fact remains that, the Philippines is way forward on schedule with all of its deliverables for these initiative. There is so much to learn and share with all the processes, consultations and undertaking these past months towards achieving UA.

We hope that the spirit of enthusiasm and the vigor to continuously have genuine partnerships amongst PNAC, national and local government and civil society continue deepen towards scale up for UA. The Philippines , will surely be emulated for this undertaking. In the meantime, preparatory consultations and planning has to be made for now, as Philippines host the 2nd Asia Pacific Regional Conference on Universal Access to HIV and AIDS prevention care treatment and support.

Prepared by:

	Head of the Philippine delegation team: Undersecretary Alexander Padilla Department of Health
	Members, Philippine Delegation: Dr Ferchito Avelino, Head Philippine National AIDS Council Secretariat Dr Jose Narciso Melchor C Sescon, Director Remedios AIDS Foundation, Inc and Ms Maureen Colambo, Coordinator Babae + Support Group