While the Philippines is considered as a "low prevalence' for HIV and AIDS the presence of risks and vulnerabilities among Filipinos (like low condom use, liberal view on sexual practices leading to multiple partners, lower sexual debut among youth) made the Philippine civil society and partners to be more vigilant against a "hidden and growing" HIV epidemic that lurks behind this stark reality.

TABLE 1. Philippines HIV AIDS Prevalence January 1984 to September 2006 (N 2,655)

Reported Modes of transmission January 1984- September 2006 N = 2,655 September 2006 N = 25 Sexual transmission     Heterosexual 1659 16 Homosexual 497 7 Bisexual 148 2       Blood/blood products 19 0 Injecting drug use 7 0 Needle prick injuries 3 0 Perinatal 37 0       No exposure reported 285 0

Source: HIV/ AIDS Registry September 2006 For more updated statistics, please visit: www.doh.gov.ph/nec

HIV Prevalence among Filipino adults (15-49 years old) was 0.03%.¹ What is important to note here is that high risk groups only account for 26% of the total HIV prevalence.² Table 2 provides the existing HIV prevalence among them.

TABLE 2. Population Size and Prevalence Rate by Most-at-risk population (MARP), 2005

Injecting Drug users (IDUs) 16,000 30,500 0.10 2.90 Men having sex with men (MSMs) 379,799 804,280 0.00 0.39 Female sex workers (FSWs) 112,354 175,553 0.06 0.34 Male clients of FSWs 280,604 438,444 0.00 0.63 TOTAL 788,757 1,448,777

Such "low and slow" characterization of the HIV and AIDS epidemic in the Philippines has pushed the issue low in the development agenda.

The Philippines enacted Republic Act 8504 otherwise known as "AIDS Law" in 1998, one of the first countries in Asia to do so. But the eight years that passed since then did not show much achievement in terms of enforcement. Low HIV prevalence nothwithstanding, , persistence of stigma and discriminatory practices among persons living with HIV and AIDS and their affected families remains.

A response

Remedios AIDS Foundation, Inc (RAF) was founded in 1991 as a pioneer non-profit, non-governmental organization (NGO) that provides quality information and services on sexual and reproductive health (SRH) primarily to the "most at risk" (sex workers, men having sex with men, drug users) and "vulnerable" (youth, migrant workers, persons living with HIV and AIDS [PHAs] and their families) populations to HIV and AIDS. RAF developed various programs over a decade in pursuit of its mission.

The RAF programs adhere to all international guidelines provided by the 1994 Cairo Consensus of the International Conference on Population and Development (ICPD), the Declaration of Commitment of the 2001 United Nations General Assembly Twenty-sixth Special Session (UNGASS), and the Millennium Development Goals (MDGs). Furthermore, RAF applies rights-based, gender-responsive, and culturally-appropriate principles to its programs, and ensures meaningful participation of PHAs and the civil society at all times.

RAF's capacity-building initiatives among infected PHAs and affected families involve several stages. At the first stage they are provided basic information about HIV and AIDS and the impact of the virus on them and society. PHAs are sensitized to these crucial issues until they eventually recognize that they relate to their inherent human rights.As one PHA said,

Just like anyone, I am also a human being with heart and mind that experiences pain. I don't need sympathy from anyone...As HIV positive, what we need is your understanding and acceptance…What we were in the past and what we are now there is no difference…Being accepted by the society is what matters most…With a few years remaining alive in this world, we hope to experience the love and caring from anyone…always there to support us.) Cynthia 26 years old HIV positive.

The next stage includes provision of information about agencies/networks that provide services for their needs. This proved to be an effective and vital way in advocating for PHAs' needs.

These stages are employed in HIV Counseling, HIV Care and Support, and HIV Treatment Literacy workshops. PHAs and their family members learn about the basic principles, clarify what their needs are, and get to know where to go for HIV services in these workshops. Most PHAs and their affected families have been empowered and honed to become advocates of their rights through various workshops and experiences gained locally and abroad. Having been empowered, Filipino PHAs realized the need to further strengthen their advocacy efforts and thus formed the Pinoy Plus Association, Inc. It is the only national organization of PHAs in the Philippines.

RAF has another program on "follow through" counseling for PHAs and their family members. Counseling has various forms: partner/ couple counseling (how to cope and live productively with HIV), counseling on how to handle HIV status disclosure to their partners, family members and relatives, family counseling (to settle disputes), anti-retroviral (ARV) adherence counseling for PHAs on ARV treatment, and grief loss and bereavement counseling (for cases involving late stages of the disease).

Counseling sessions alleviate fears, guilt, and shame and helps resolve unfinished businesses among PHAs.

Under the HIV care support treatment program, RAF provides voluntary counseling and testing (VCT), home based/ community care and support services, access to ARV, and opportunistic infections (OI) services.

Research on stigma and discrimination against PHAs

RAF, in partnership with Pinoy Plus Association and Deakin University Australia , published in 2003 a report o the situational analysis of HIV/AIDS-related stigma and discrimination in the Philippines . The report focused on institutional forms of discriminatory practices in Metro Manila. One significant finding shows that most of the discriminatory practices occur in the health care setting as compared incidents in the ten areas of social life (housing, welfare, justice system, finance and insurance, livelihood, prison, reproductive health and family , public accommodation ). This is probably due to the fact that most of the PHAs access the health services more than the other areas. The research was very enriching and needed to be followed up to ensure that stigma and discrimination issues related to HIV might be addressed accordingly.

In summary, the current RAF programs are geared toward the empowerment of PHAs and their family members as well as service provision. These programs will continue to evolve and expand according to the current PHA needs. RAF has paved the way towards ensuring that a more enabling and supportive environment for PHA and their families is realizable. Hopefully, other stakeholders - local governments for example will be able emulate these programs and ensure that they are implemented. RAF remains determined in pursuing the tasks at hand as it continues with the journey!

Jose Narciso Melchor C Sescon, MD FPOGS is the Executive Director of Remedios AIDS Foundation, Inc
For further information, please contact: Remedios AIDS Foundation, Inc., 1066 Remedios Street corner Singalong Street, Malate, Manila Philippines 1004; ph (632)524-09-24 (632)524-48-31; fax no (632)522-34-31;
e-mail: reme1066@pldtdlsl.net
website address: www.remedios.com.ph

References:

^{1 2005 HIV Estimates in the Philippines , DOH
2 Ibid}