III. National Response to the HIV and AIDS epidemic

The Third (2000-2004) and Fourth (2005-2010) AIDS Medium Term Plans

The period being assessed in this country report (2003-2005) covers part of two (2) medium-term plans: the last two years of the 2000-2004 Medium Term Plan (AMTP III), and the first year of the 2005-2010 AIDS Medium Term Plan (AMTP IV).

The AMTP III recommended the acceleration of the Philippine response ahead of the potential acceleration of the epidemic. AMTP III focused the national response on an integrated package of five complementary strategies:

1. Management and advocacy: Creating an enabling environment for sustained HIV prevention;

2. Research and surveillance: Understanding the HIV epidemic, risky behavior, and factors affecting vulnerability to infection;

3. Small-scale trials in prevention and support: Demonstrating effective approaches to reduce risks from HIV infection and manage its impact;

4. Large-scale preventive interventions: Expanding implementation of effective approaches to reduce risks of HIV infection associated with the most prevalent risky behavior; and

5. Care and support: Managing the impact to those infected and affected.¹

In its review of the past national response, the AMTP III noted that,

• strong foundations have been put in place that have helped advance the country's capability to confront the issues posed by HIV and AIDS;

• while the current response has adequate scope, it does not have adequate scale in terms of their coverage and output; response has been diffused and diluted;

• there is a clear danger of losing ground if the past pattern of response continues: the epidemic may continue to spread ahead of the country's ability to prevent it; and

• the country's response needs to scale up, accelerate and expand ahead of the spread of the infection.²

Building from the gains and as well as learning from the lessons of the AMTP III, the current AMTP IV envisions that the national response for the five year period 2005-2010 must:

1. intensify prevention interventions among highly vulnerable groups identified in AMTP III PIP, MSM, IDU, and clients of PIP; and scale-up prevention efforts towards other vulnerable groups such as OFW, youth and children;

2. expand coverage and integrate HIV/AIDS in the development priorities at the local level, giving priority to identified risk zones;

3. improve the coverage and quality of care and support for people living with HIV/AIDS; and

4. strengthen management support systems for the national response.³

The AMTP IV likewise emphasized that "priority must be given to the infected and affected as well as the existing and emergent highly-vulnerable groups, especially those not covered in the AMTP III, which include OFW, youth, infected and affected children."⁴

Active and Passive Surveillance Systems in Place

Since 1987, the Department of Health (DOH) has put in place both passive and active surveillance systems in order to keep track of how the epidemic progresses.

The four (4) types of surveillance systems in place are the following:

1. HIV/AIDS Registry - a passive surveillance system established in 1987, it continuously logs Western Blot-confirmed HIV cases reported by DOH-accredited hospitals, laboratories, blood banks and clinics.

2. HIV Serologic Surveillance (HSS) - started in 1993 to serve as early warning for increases in HIV seroprevalence. HSS consistently monitored what it considered as High Risk Groups (HRG) for HIV - Registered Female Sex Workers (RFSW), Freelance Female Sex Workers (FFSW), Men Having Sex with Men (MSM), and Injecting Drug Users (IDU).

3. Behavioral Sentinel Surveillance (BSS) - established in the ten (10) HSS sentinel sites to monitor the level of risk behaviors among HRG. Local Research Institutions recommended by the health officers implemented BSS in eight (8) sites from 1997 to 2001. In 2002, ten local government units (LGUs) institutionalized the HIV BSS, thus expanding the surveillance sites to ten. The same HRG as in the HSS were monitored but research teams were given the opportunity to include other special groups that they considered at risk in their respective sites.

4. Sentinel STI Etiologic Surveillance System (SSESS) - set up in December 2001 and made operational in 2003. Since sexually transmitted infections (STI) have been identified as co-factors for HIV transmission, monitoring STI trend could guide program intervention to prevent transmission of HIV.

The 2002 HIV/AIDS Country Profile Philippines cites that "[a]ccording to behavioral and special STI prevalence studies conducted by the NHSS and Family Health International (FHI), there seems to be a potential for the rapid transmission of HIV… due to unsafe sexual practices and high STI rates."⁵

In 2003, there were ten (10) sentinel sites included in these surveys. However, in 2004, no HSS was conducted due to logistical constraints.

For 2005, there are ten (10) sentinel surveillance sites in the country where HIV serological surveillance and behavioral sentinel surveillance are conducted. Funding for surveillance surveys in the ten sites are provided by the United States Agency for International Development (USAID).

Sentinel sites were chosen based on the following criteria: degree of urbanization, the presence of known commercial sex trade, geographical representativeness and the willingness of their LGU executives to collaborate with DOH.⁶

These ten (10) surveillance sites are as follow:

NCR: Pasay City, Quezon City
Luzon: Angeles, Baguio
Visayas: Cebu City, Iloilo City
Mindanao: Davao, Cagayan de Oro, General Santos, Zamboanga

A. National Commitment and Action

National Commitment at a glance Government funds spent on HIV and AIDS: 2003: Phil. Pesos 35,850,000 (USD 661,448) 2004: Phil. Pesos 33,308,000 (USD 594,454) 2005: Phil. Pesos 33,308,000 National Composite Policy Index: 2003: 85.00 %   2005: 91.66 % Sources: Philippine National AIDS Council-Department of Health (PNAC-DOH) and National Economic and Development Authority (NEDA)

At the center of the country response to HIV/AIDS, a strong framework for multi-sectoral coordination of multi-level activities has been formally established in the Philippine National AIDS Council (PNAC). The Council has the broad representation, legal mandate and official policy instructions to lead the country's efforts.7

In 1992, the country was among the first in the region to set up a national council that focused on policymaking to address the HIV/AIDS situation in the Philippines. The Philippine National AIDS Council (PNAC) was established through Executive Order No. 39 as advisory body to the President. PNAC is a multi-sectoral body composed of members representing key government agencies and several non-government organizations (NGOs). PNAC meetings are also attended by invited observers from private agencies, professional associations, and donor agencies.

The Council is scheduled to have regular quarterly meetings and also to convene special meetings to deliberate and decide on key issues and recommendations for policy and program that are then forwarded to the President for approval and implementation.

In 1998, through Senate initiative and with strong advocacy and support from PNAC, NGOs and many other groups, the Philippines became one of the first few countries in the region to enact a landmark legislation that sought to put in place a comprehensive response to address the AIDS epidemic. Republic Act 8504 or "The Philippine AIDS Prevention and Control Act of 1998" sought to:

1. promulgate policies and prescribe measures for the prevention and control of HIV/AIDS in the Philippines;

2. institute a nationwide HIV/AIDS information and educational program;

3. establish a comprehensive HIV/AIDS monitoring system; and

4. strengthen the Philippine National AIDS Council (PNAC).

RA 8504 contains provisions on education and information, safe practices and procedures, health and support services, monitoring, confidentiality, and discriminatory acts and policies. It prohibits compulsory HIV testing.

A Note on Governmental Structures and Functions in the Philippines

The Philippines has a centralized national government based in the capital city Manila. It follows a presidential form of government with three (3) separate and co-equal branches of government: executive, legislative, and judiciary. The President directs the country's health policy through the Department of Health (DOH).⁸

While policy is set at the national level, enforcement and implementation of these policies, rest on the local government units (LGUs). However, different political dynamics exist at each government level.⁹

The LGUs, being autonomous from the central government, and guided by their own political and economic interests, determine their own priority programs and make their own budget allocations. Moreover, LGUs are not required to report their activities and provide local data to the national-level agencies. Thus, there is no assurance that national policies will always be followed and that data from the local levels will be received by the national agencies.

The UNGASS National Composite Policy Index (NCPI)

The UNGASS National Composite Policy Index (NCPI) is an instrument that measures the second UNGASS national commitment and action indicator. It is designed to "assess progress in the development and implementation of national level HIV/AIDS policies and strategies" and to "estimate the amount of effort put into national HIV/AIDS programmes by national level government, NGOs, and by international organizations."¹⁰

The NCPI is divided into two parts: Part A pertains to the assessment of national efforts by government agencies and is to be administered to governments' officials. Part B provides civil society with a tool to assess national efforts and is to be administered to representatives of governments' primary partners including non-governmental organizations.

The NCPI looks into the following policy areas:

1. Strategic Plan - pertains to the presence of an action framework to combat HIV and AIDS; to be answered by government agencies;

2. Prevention - whether the country has policies/strategies that promote IEC on HIV and AIDS;

3. Human Rights - presence of policies, laws and regulations and its implementation to protect PLWA against discrimination;

4. Care and Treatment - presence of policies and its implementation to promote HIV and AIDS care and support with attention to barriers for women, children and most-at-risk populations¹¹

NGO Assessment of the National Response:
Narrative of NGO inputs to NCPI Part B

A. Processes followed to obtain the NGO inputs

To generate NGO inputs for the NCPI Part B for civil society, the following processes were undertaken:

1. Selection of NGOs that will be invited to participate and contribute to the processes

Selection was done in consultation with Pinoy UNGASS, the Philippine National AIDS Council (PNAC), the Global Fund Project, and UNAIDS. Pinoy UNGASS is a national network of NGOs that monitors the implementation of UNGASS commitments. NGOs selected must have existing programs on HIV and AIDS and must have been working on these issues for at least three (3) years.

It will be emphasized at this point that the process does not claim to have included all NGOs working on HIV and AIDS in the country. Due to logistical and time constraints, the number of those that could be invited was limited. Over 40 NGOs were invited coming from the following: member NGOs of Pinoy UNGASS, PNAC member NGOs, and some of the major networks of HIV/AIDS NGOs in the regions.

2. Fielding of NCPI Part B Questionnaire

The NCPI Part B Questionnaire was fielded to over 40 key NGOs and NGO networks with existing programs on HIV/AIDS for their representatives to fill-up.

3. NGO Consultation Meetings for the NCPI Part B

Two separate NGO consultation meetings were held in 2005: the first one in September 27 and the second in October 28. For these consultations, a combined total of about 35 NGOs and NGO networks from Luzon, Visayas, Mindanao and the National Capital Region (NCR) with programs on HIV and AIDS were invited to attend; of this number, 24 were able to participate. Some of those who were not able to participate sent their filled-up questionnaires (by email, facsimile; some were picked up from their offices as requested) while representatives of one NGO with programs in Luzon were interviewed.

4. Multi-sectoral Validation Meeting with NGOs and government agencies

A Multi-sectoral Validation Meeting was convened on November 14, 2005 to validate the data obtained as well as the draft of the Country Report. For this validation meeting, over 40 NGOs and NGO networks as well as key government agencies were invited. A total of 30 NGOs and government agencies were able to participate. All participants were given copies of the draft 2005 Country Report for them to review and comment on.

B. NGO inputs

During the two consultation meetings, the multi-sectoral validation meeting, and the interview with one NGO, some of the following observations were shared:

B.1 Human Rights

1. Information on provisions of RA 8504 not widely circulated

While NGOs were aware of the existence of a law on HIV and AIDS, information on and specific provisions of RA 8504 are not widely circulated nor popularized. Some NGOs also said that some of the law's provisions were not clear. Many NGO representatives, government officials, and local government officials were not familiar with specific provisions.

2. Advocacy for more specific provisions on equal access to prevention and care services

There was strong advocacy from NGOs for certain provisions of the law to be made more specific (e.g., to include specific provisions ensuring equal access of most-at-risk populations, and of women and men, to prevention and care services). The participants cited that while the law states that it applies to all individuals, it also does not explicitly state that it ensures equal access of most-at-risk populations, and of women and men, to prevention and care services.

3. Role of Human Rights Commission

NGO participants noted that while a Human Rights Commission exists, it is not pro-active but rather reactive towards HIV- and AIDS-related cases.

B.2 Civil Society Participation

1. NGOs invited to planning meetings but not to budget meetings

While some NGOs are invited to participate in planning meetings to develop strategic plans, these same groups are not invited to meetings beyond the planning stage (e.g., they are not involved in meetings that discuss budget matters).

2. NGOs not involved in technical review meetings

Many NGOs are not aware of - and are not involved - in the technical review meeting(s) convened by government agencies.

3. NGOs and PLWHA are not involved in ethical review committees for research on HIV and AIDS

B.3 Prevention

HIV and AIDS education in the schools still very limited; teachers not yet trained in life skills education on HIV and AIDS

Some NGOs shared that while there are attempts by local schools in their areas to integrate teaching HIV and AIDS into their curriculum, most of the time, it is still the NGO personnel who are asked to teach. The teachers themselves have not yet been trained to teach HIV and AIDS to their students.

B.4 Care and Support

1. Programs addressing needs of orphaned and vulnerable children still very limited

Some NGO participants, especially those from the regions, were not aware whether there were programs addressing the needs of orphaned and vulnerable children. The participants noted that the needs of children affected by HIV and AIDS are not adequately being addressed by government agencies, LGUs, private agencies, and by NGOs themselves. They cited that very few NGOs and private agencies are working in this area.

2. Programs addressing needs of orphaned and vulnerable children not reflected in government reports

An NGO that has been providing care and support for children affected by HIV and AIDS for more than a decade indicated that their programs and activities are often not reflected nor acknowledged in government reports (e.g., the AMTP IV writes on page 12 that "There is no care and support program focusing on children").

B.5 Other observations, experiences and concerns expressed by the participating NGOs

1. Positive and negative experiences working with LGUs

NGOs have varied experiences working with local government units (LGUs) and local government officials (LGOs). Some NGOs have positive experiences working with supportive LGUs/LGOs. Others, however, encounter difficulties trying to work with LGUs and with LGOs who are indifferent or are even hostile to programs on HIV and AIDS, especially those that have discriminatory attitudes towards specific groups.

2. NGO perceptions regarding decreases and increases in programs and efforts on HIV and AIDS

Decreased number and scope of programs and efforts: Some NGOs indicated that there are less programs and efforts in 2005 compared to 2003 due to the following reasons: decreased funding from donor agencies; phasing out of the USAID-funded AIDS Surveillance and Education Project (ASEP); efforts of NGOs, government agencies and LGUs were not sustained due to inadequate funding and high turnover of staff (e.g., trained personnel have left to work in other agencies or abroad).

Increased advocacy efforts: Some NGOs, on the other hand, indicated that advocacy efforts in their areas have increased in 2005 compared to 2003.

The NGOs were optimistic that the multi-year Global Fund project will help provide much needed resource inputs to enable NGOs and government agencies to continue doing their work on HIV and AIDS.

3. National government commitment and support not felt by NGOs in the regions

NGOs from the regions indicated that they do not feel the support and commitment of the national government.

There is consensus among participating NGOs - particularly those coming from the regions - that not enough is being done by national agencies to address the problems and needs resulting from the AIDS epidemic.

The NGOs all agreed that while there are already many programs and activities being conducted all over the country, more efforts still need to be undertaken, coordinated and sustained at the national and local levels by the national government, the local government units, civil society and other stakeholders. They emphasized that the national government has to demonstrate firmer commitment and support to HIV and AIDS programs and allocate resources for such.

B. Budgetary allocations: Domestic and External Sources

Aside from policy and program, budgetary allocations are seen as indicators of commitment by government agencies, local government units, NGOs, private agencies, bilateral and multilateral agencies.

The National Economic and Development Authority (NEDA) has compiled the following figures for allocations from domestic (from national and LGU budgets) and external sources (from donor agency contributions):

For the period 2003, total allocation for HIV and AIDS and STI prevention and control programs from domestic sources was Pesos 35,850,000 (USD661,448). This includes Pesos 27,753,000 (USD512,047) from the National Government (NG), and Pesos 8,097,000 (USD149,391) from the Local Government Units (LGUs). Another Pesos 229,982,000 (USD 4,243,202) came from external sources.

For 2004, the total figures from domestic sources was Pesos 33,308,000 (USD594,454), with Pesos 8,148,000 (USD502,373) coming from the National Government and Pesos 5,160,000 (USD92,093) from the LGUs. A total of Pesos 125,005,000 (USD2,231,028) came from external sources.

For 2005, the total figure (as of December 21, 2005) is Pesos 33,308,000 from domestic sources, and Pesos 145,954,000 (USD2,653,927) from external sources.

For domestic figures, there was a decrease in allocation from 2003 to 2004 from 35,850,000 pesos to 33,308,000 pesos. There was same level of spending for 2004 and 2005 (33,308,000 pesos per year).

For funds coming from external sources, it can be noted that there was a big decrease in the amounts from 229,982,000 in 2003 to 125,005,000 in 2004. While the figures for 2005 (145,954,000 pesos) are slightly higher compared to 2004 figures (125,005,000), it still did not match the amounts posted in 2003 (229,982,000).

Allocations for HIV and AIDS Programmes:
Domestic and External Sources

Table 2. Domestic Sources

Name of Agency	Main Programs	Budget (in Phil. Peso and US Dollar)
		2003 USD1=PhP54.20	2004 USD1=PhP56.03	2005 USD1=PhP55.00
Philippine National AIDS Council (PNAC)	Advocacy, Training, management	9,543,000 (176,70)	9,445,000 (168,570)	9,445,000
Department of Health: - National AIDS and STD Control Program	Prevention, Surveillance	3,093,000 (57.084)	2,851,000 (50.883)	2,851,000
- DOH-CHDs(estimates only)	Prevention, Surveillance	2,308,000 (42,580)	2,191,000 (39.10)	2,191,000
- RITM & San Lazaro(estimates only)	Treatment, Care and support	2,315,000 (42,710)	2,610,000 (46.580)	2,610,000
- SACCL	Testing	1,469,000 (27,103)	1,198,000 (21,810)	1,198,000
- NEC	Surveillance	6,881,000 (126,550)	300,000 (5,3540)	300,000
- Others			6,173,000 (110,173)	6,173,000
Department of Education (DepEd)	School-based AIDS Education Program	2,058,000 (37,970)	2,058,000 (36,730)	2,058,000
Department of Labor and Employment - Occupational Safety and Health Center (DOLE-OSHC)	Workplace-based advocacy and training	86,000 (1,586)	36,000 (642)	36,000
Commission on Higher Education (CHED)	Prevention		1,286,000 (22,951)	1,286,000
LGUs	Advocacy and Prevention	8,097,000 (149,390)	5,160,000 (92,090)	5,160,000
TOTAL		P 35,850,000 ($661,448)	P 33,308,000 ($594,454)	P 33,308,000

Source: National Economic Development Authority (NEDA), Philippine National AIDS Spending Assessment (NASA) Report *same level of spending as in 2004 Note: Only a few LGUs provided expenditure data. This does not include expenditure of other public health facilities.

Table 3. External Sources

Name of Agency	Main Programs	Budget (in Phil. Peso and US Dollar)
		2003 USD1=PhP54.20	2004 USD1=PhP56.03	2005 USD1=PhP55.00
USAID	Prevention, Surveillance	83,080,000 (1,532,841)	6,594,000 (117,686)	82,500,000 (1,500)
KfW	Prevention, Social Marketing	48,904,000 (902,287)	49,442,000 (882,420)
Packard	Prevention	30,794,000 (568,154)	1,220,000 (21,774)
PSI-DFID	Prevention	4,689,000 (86,512)
AMKOR	Advocacy, Training	111,000 (2,047)	141,000 (2,516)
JICA	Prevention	1,247,000 (23,007)	286,000 (5,104)
PHANSuP UK	Advocacy, Training	287,000 (5,295)	998,000 (17,811)
CAFOD UK	Advocacy, Research	1,019,000 (18,800)	756,000 (13,492)
British Embassy	Prevention	59,000 (1,088)
Save the Children (UK)	Prevention related activities	820,000 (15,129)	600,000 (10,708)
Save the Children (US)	Prevention, Advocacy, Monitoring and Evaluation		200,000 (3,569)
Ford Foundation	Prevention, Advocacy, Monitoring and Evaluation	2,157,000 (39,797)	1,990,000 (35,516)
Global Fund	Prevention, Treatment and Care		13,465,000 (240,317)
EU	Prevention	42,835,000 (790,313)
PSI-DFID	Prevention	4,689,000 (86,512)
UNICEF	Prevention, Advocacy, Training	1,200,00 (22,140)	35,490,00 (633,410)
UNFPA		4,282,000 (79,003)	5,022,000 (89,630)	22,766,000 (413,927)
Christian AID	Training		41,000 (731)
Plan International	Training		300,000 (5,354)
WHO	Training		616,000 (10,994)
UNAIDS	Prevention, Advocacy, Monitoring and Evaluation	8,498,000 (156,789)	7,844,000 (139,996)	7,688,000 (140,000)
UNDP	Advocacy, Prevention			5,500,00 (100,000)
TOTAL		229,982,000 (4,243,202)	125,005,000 (2,231,028)	145,954,000 (2,653,927)

Source: National Economic Development Authority (NEDA,) Philippine National AIDS Spending Assessment (NASA) Report

Table 4. Summary of Figures for Domestic Sources and External Sources

Name of Agency	Main Programs	Budget (in Phil. Peso and US Dollar)
		2003 USD1=PhP54.20	2004 USD1=PhP56.03	2005 USD1=PhP55.00
1. Domestic Sources	Advocacy, training, Prevention, Surveillance, Treatment, Care	35,850,000 (USD661,448)	33,308,000 (USD594,454)	33,308,000*
2. External Sources	Advocacy, Training, Prevention, Surveillance, Treatment and Care, Social Marketing, Monitoring and Evaluation	229,982,000 (USD4,243,202)	125,005,000 (USD2,231,028)	145,954,000 (USD2,653,927)
TOTAL		265,832,000 (USD4,904,649)	158,313,000 (USD2,825,482)	179,620,000

Source: National Economic Development Authority (NEDA), Philippine National AIDS Spending Assessment (NASA) Report *same level of spending as in 2004

Prevention activities include: IEC, condom social marketing, STI management and treatment
Treatment includes: treatment of opportunistic infections (OI), prophylaxis for OI
Program Support includes: advocacy, training, surveillance, monitoring and evaluation

C. National Programmes

National programmes at a glance HIV Testing and Prevention 1. HIV testing % of most-at-risk populations who receive HIV testing in the last 12 months and who know the results PIP: 3,300 PIP tested for Syphilis and HIV from June to July 2005 (data from GFATM project) MSM: 1,400 MSM tested for Syphilis and HIV from June to July 2005 (data from GFATM project)   15 MSM out of 15 MSM tested (data from Remedios AIDS Foundation) IDU: no data obtained as of writing of this Country Report % of OFW who receive HIV testing and who know their test results   no data obtained as of writing of this Country Report 2. Prevention % of most-at-risk populations who have accessed HIV/AIDS programs during the last 12 months PIP: no final percentage figures available since there is no official estimate of PIP population for 2003, 2004, 20051   4% (4,431 number of PIP [new contacts] out of 115,000 total estimated population of PIP); for female freelance sex workers; data covers the period from February to September 20052 (data from LEAD Project)   4,224 PIP reached by prevention programs between August 2004 to August 2005 (data from Global Fund project) MSM: no final percentage figures available since there is no official estimate of MSM population for 2003, 2004, 2005   3% (6,014 number of MSM who have accessed HIV/AIDS programs during the last 12 months out of 200,000 total estimated population of MSM); data covers the period from February to September 20053 (data from LEAD Project)   2,558 MSM reached by prevention programs between August 2004 to August 2005 (data from Global Fund project) IDU: no percentage figures available since there is no official estimate of IDU population for 2003, 2004 and 2005   441 IDU who have accessed HIV/AIDS programs during the last 12 months [no size estimate due to lack of data]; data covers the period from February to September 20054 (data from LEAD Project)   800 IDU reached by prevention programs between August 2004 to August 2005 (data from Global Fund project) % of vulnerable populations who have accessed HIV/AIDS programs during the last 12 months OFW: no percentage figures available since there is no official estimate of OFW population for 2003, 2004, 2005   3,084 OFW (data from Global Fund project)   12,780 out of targeted 15,000 OFW for Oct 2004 to June 2005 (data from PAFPI project) OSY: no percentage figures obtained since there is no official estimate of OSY population available as of writing of this Country Report street children: no percentage figures obtained since there is no official estimate of street children population available as of writing of this Country Report % of primary, secondary, tertiary and technical/vocational school teachers trained on HIV/AIDS Primary and Secondary Levels (c/o DepEd): 111 officers and personnel trained in 2003 on the "Integration of AIDS Education in the Basic Education Curriculum" Technical/Vocational Level (c/o TESDA): 37 teachers trained in October 2003; no further trainings were held in 2004 and 2005 % of large, medium and small-scale enterprises that have HIV/AIDS workplace policies and programs Large-scale enterprises: 11% in 2004; 32% as of June 2005 Medium-scale enterprises: 9% in 2004; (no figures provided for 2005) Small-scale enterprises: 27% in 2004; 16% as of June 2005

1. HIV Testing

There are hundreds of public and private clinics and laboratory facilities all over the country accredited to do HIV testing. The STD/AIDS Cooperative Central Laboratory (SACCL) reports that there are around 500 HIV laboratories and 2,000 clinical laboratories nationwide.

However, getting percentage figures on HIV testing among most-at-risk populations as well as among vulnerable groups is difficult since not all of these clinics and laboratories report their data to national level agencies.

For this indicator, no percentage figures were obtained. However, actual figures were available from projects currently being implemented.

Below is a listing of actual numbers obtained from the Global Fund Project as well as from Remedios AIDS Foundation regarding most-at-risk populations who receive HIV testing in the last 12 months and who know the results.

PIP:	3,300 PIP tested for Syphilis and HIV from June to July 2005 (data from GFATM project)
MSM:	1,400 MSM tested for Syphilis and HIV from June to July 2005 (data from GFATM project)
	15 MSM out of 15 MSM tested (data from Remedios AIDS Foundation)
IDU:	no data obtained as of writing of this Country Report

No percentage data was obtained for OFW who have received HIV testing and who know their test results.

Meanwhile, voluntary counseling and testing among males aged 15-49 is very low. Moreover, of those ever tested, only 2.7% received their test results. Percentage who tested for HIV and who received their results in the past 12 months is only 0.6%.

Table 5. Voluntary counseling and testing among men aged 15-49 (in percentage)

	Percent
Ever Tested   Received results   No results	2.7 0.9
Never Tested	92.0
Don't know/missing	4.4
Percentage tested for HIV and received results in past 12 months	0.6

Source: Philippines National Demographic and Health Survey 2003, as cited in the 2005 Philippine HIV and AIDS Country Profile

2. Prevention Programmes

Percentage of most-at-risk populations accessing
HIV/AIDS programs during the last 12 months

PIP: No final percentage figures were available for Persons in Prostitution (PIP) since there are no official estimates of PIP population for 2003, 2004 and 2005 coming from the Department of Health.¹ Actual figures are available from two (2) major projects currently being implemented. These are:

4% (4,431 number of PIP [new contacts] who have accessed HIV/AIDS programs out of 115,000 total estimated population of PIP); for female freelance sex workers; data covers the period from February to September 20052 (data from LEAD Project)

4,224 PIP reached by prevention programs between August 2004 to August 2005 (data from Global Fund project)

MSM: No final percentage figures were available for Men Having Sex with Men (MSM) since there are no official estimates of MSM population for 2003, 2004 and 2005 coming from the Department of Health. Actual figures are available from two (2) major projects currently being implemented. These are:

3% (6,014 number of MSM who have accessed HIV/AIDS programs during the last 12 months out of 200,000 total estimated population of MSM]; data covers the period from February to September 20053 (data from LEAD Project)

2,558 MSM reached by prevention programs between August 2004 to August 2005 (data from Global Fund project)

IDU: No final percentage figures were available for Injecting Drug Users (IDU) since there are no official estimates of IDU population for 2003, 2004 and 2005 coming from the Department of Health.⁴ Actual figures are available from two (2) major projects currently being implemented. These are:

441 IDU who have accessed HIV/AIDS programs during the last 12 months (no size estimate due to lack of data); data covers the period from February to September 20055 (data from LEAD Project)

800 IDU reached by prevention programs between August 2004 to August 2005 (data from Global Fund project)

As for percentage figures for OFW who have accessed HIV/AIDS programs during the last 12 months, these were also not available since there were no official estimates for OFW for 2003, 2004 and 2005. Nevertheless, actual figures were obtained from the following:

3,084 OFW (data from Global Fund project)

12,780 out of targeted 15,000 OFW for Oct 2004 to June 2005 (data from PAFPI project)

No percentage figures were likewise obtained for OSY and street children since there are no official estimates of OSY and street children population available as of writing of this Country Report

Life Skills Based Approach to HIV and AIDS Education:
Percentage of primary, secondary, tertiary and technical/
vocational school teachers trained on HIV/AIDS

1. Training of teachers at the primary and secondary levels (c/o the Department of Education)

HIV and AIDS topics and issues had been integrated into the curriculum for primary and secondary levels in 2002. IEC materials have been revised and printing of these materials is scheduled in 2006.

In 2003, a total of 111 officers and personnel underwent the "Training of Trainors on the Integration of AIDS Education in the Basic Education Curriculum." Three batches of participants composed of teachers, administrators, coordinators of programs, medical officers, supervisors, principals and district supervisors attended the three-day training activities. Participants came from the following areas:

First batch (April 21-23, 2003): 30 participants from Regions 1 and 3

Second batch (May 5-7, 2003): 31 participants from Regions 4, 5 and the National Capital Region NCR

Third batch (May 12-14, 2003): 50 participants from Regions 7, 8, 9 and CARAGA

2. Training of teachers at the technical/vocational school levels (c/o the Technical Education and Skills Development Authority - TESDA)

Two trainings were held in 2003 attended by a combined total of 37 teachers from Regions 1, 3, 5, 9, Cordillera Administrative Region (CAR) and the NCR. No other trainings were held in 2004 and 2005. An official training manual has been developed but printing has been put on hold due to budgetary limitations.

3. Training of teachers at the tertiary levels (c/o the Commission on Higher Education, or CHED): no information obtained from CHED.

Workplace HIV/AIDS Control:
HIV/AIDS workplace policies and programs

1. Enterprises with HIV/AIDS workplace policies and programs

Data from the Department of Labor-Occupational Safety and Health Center (DOLE-OSHC) Survey on Workplace-based STD/HIV Activities (two surveys: one in 2004, and one covering January to June 2005) showed the following percentages (%) of large, medium and small-scale enterprises that have HIV/AIDS workplace policies and programs:

Large-scale enterprises: 11% in 2004; 32% for January to June 2005

Medium-scale enterprises: 9% in 2004; (no figures provided for 2005)

Small-scale enterprises: 27% in 2004; 16% for January to June 2005

Table 6. % of Employers with HIV/AIDS Workplace Policies and Programs

Type	2004	Jan-Jun 2005
	%	%
Large-scale	11	32
Medium-scale	9	--
Small-scale	27	16

Source: DOLE-OSHC 2004 and 2005 Surveys Note: based on surveyed employers/companies only: N=87 in 2004; N=35 for Jan-June 2005

2. Employers with accepting attitudes towards PLWHA employees

The DOLE-OSHC Survey also cited percentages (%) of employers with accepting attitudes towards PLWHA employees: nine percent (9%) in 2004 specified in their company policy their commitment to employment of persons regardless of HIV status. The figure for 2005 (January to June) is 40%.

When disaggregated according to urban and rural areas, the data showed that 38% of employers in urban areas had accepting attitudes towards PLWHA employees. The figure was 50% for rural areas.

3. Employers with accepting attitudes towards PLWHA

The same DOLE-OSHC Surveys revealed that 56% of employers surveyed in 2004 had accepting attitudes towards PLWHA. The figure is 40% for January to June 2005.

When disaggregated according to urban and rural areas, the 2005 data showed that 38% of employers in urban areas had accepting attitudes towards PLWHA while the figure was 50% for rural areas. The 2004 data did not include disaggregated figures for urban and rural areas.

Table 7. % of Employers with Accepting Attitudes towards PLWHA Employees and PLWHA in general; in rural and urban areas

Description	2004	Jan-Jun 2005
	%	%
With accepting attitudes towards PLWHA employees	9	40
Urban	no data	38
Rural	no data	50
With accepting attitudes towards PLWHA	56	40
Urban	no data	38
Rural	no data	50

Source: DOLE-OSHC 2004 and 2005 Surveys Note: based on surveyed employers/companies only: N=87 in 2004; N=35 for Jan-June 2005

D. National Knowledge and Behaviour

National knowledge and behaviours at a glance 1. Knowledge: Most-at-Risk Populations % of most-at-risk populations (PIP, MSM, IDU) who can correctly identify ways of preventing sexual transmission of HIV and who reject major misconceptions about HIV transmission1 PIP: RFSW: 66%, FLSW: 55% MSM: 61% IDU: 49% 2. Behaviour: Most-at-Risk Populations % of most-at-risk populations (PIP, MSM, IDU) reporting use of condom with their most recent client PIP: female sex workers: 67% (2,894 respondents who reported that a condom was used with their most recent client out of 4,322 who reported having commercial sex in the last 12 months) Location: 100% urban2 (data from LEAD Project citing 2005 IHBSS) PIP: male sex workers: 45% (138 reported that condom was used with their most recent client out of 304 who reported having commercial sex in the last 12 months) Location: 100% urban3 PIP: 70% (1,679 PIP who reported that a condom was used with their most recent client out of 2,400 who have reported having commercial sex in the last 12 months) (data from BSS 2003 - supplied by NEC) MSM: 20% (170 respondents reported that a condom was used with their last male partner in the last 6 months out of 840 respondents who reported having had anal sex with a male partner in the last 6 months (data from NEC - citing 2003 BSS) % of PIP who consistently used a condom in the last month Female sex workers: 57% reported consistent condom use (1937 out of the 3,402) - time frame is the past week Male sex workers: 27% reported consistent condom use (82 out of 304) - time frame is past week (data from LEAD Project) % of IDU who have adopted behaviours which reduce the transmission of HIV 7% (8 respondents who report having never shared injecting equipment during the last month and who reported that a condom was used the last time they had sex, out of 120 respondents who report injecting drugs and having sexual intercourse in the last month) (data from NEC - citing 2003 BSS) 0.2% (24 IDU who used a condom during last sexual encounter, out of 120 IDU who reported having had sex during the last three (3) months) (data from NEC - citing 2003 BSS; note: the question asked "last 3 months" and not last month) 3. Knowledge: Young People % of people 15-24 years of age who can correctly identify ways of preventing sexual transmission of HIV and who reject major misconceptions about HIV transmission4: 76.8% of young people agreed that condoms can prevent STI/AIDS if used properly 35% of young females and 28.5% of young males correctly rejected the two misconceptions that AIDS can be transmitted by mosquito bites and by sharing food with persons with AIDS. 39.4% of young females and 51.7% of young males correctly answered that condoms and limiting sex to one uninfected partner can reduce the risk of HIV transmission 4. Behaviour: Young People % of people 15-24 years of age reporting use of condom during sexual intercourse with non-regular partner: 12.6% of young people who had experience with sex reported use of a condom during sexual intercourse with a non-regular partner (the term "casual partner" was used in the 2002 YAFS) 26.8% among those who reported having had a sexual encounter with a PIP said they used condom every time they paid for sex 10.4% said they used condom when paid for sex

1. Knowledge among Most-At-Risk Populations: PIP, MSM, IDU

To determine level of knowledge on HIV and AIDS, the UNAIDS provided a criteria that respondents should "correctly identify five ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission." While the surveillance surveys did not include all the five questions prescribed in the UNAIDS Guidelines for Construction of Core Indicators, the available data can still give valuable insights about the level of knowledge on STI, HIV and AIDS among most-at-risk populations.

As knowledge indicator for most-at-risk populations, the 2003 NHSSS obtained the proportion of HRGs who knew of three correct ways to prevent HIV transmission. These three are: 1) being faithful to one faithful partner; 2) consistent and correct condom use; and 3) non-sharing of injecting equipment.

The 2003 NEC Technical Report cited that "per site analysis, [the] 2003 BSS showed that the proportion of study participants who knew of three correct ways of preventing HIV transmission in all cities decreased. Exemptions would include Angeles, Iloilo and Zamboanga for RFSW, Angeles, Baguio and Iloilo for FLSW and Zamboanga for MSM."⁵

The figures for each group are as follow:

Table 8. Proportion of Most-at-Risk Populations Knowledgeable on HIV

High Risk Group (HRG)	Proportion Knowledgeable* on HIV
	2002	2003
PIP: RFSW	74%	66%
PIP: FLSW	61%	55%
MSM	64%	61%
IDU	54%	49%

Source: 2003 NEC Technical Report *Knowledgeable on HIV - those who can correctly identify ways of preventing sexual transmission of HIV and who reject major misconceptions about HIV transmission

Figures from the 2005 IBHSS are not yet available as of the time of writing of this Country Report.

2. Sexual Behaviour: Number of Sex Partners
and Reported Consistent Condom Use among
Most-At-Risk Populations

Consistent condom use was generally low (<30%) among the HRG in 2003. The only improvement was posted among MSM from 2002-2003.²

The 2003 NEC Technical report cites that the number of sex partners of female sex workers vary from one to 80 per week; median was two (2) per week for RFSW and four (4) per week for FLSW.

The 2003 BSS showed that condom use by female sex workers with their non-regular partners was higher compared to condom use with their regular-paying and regular non-paying partners.³ However, the percentages for RFSW fell from 30% in 2002 to 28% in 2003. For FLSW, the percentages were 30% in 2002 and 26% in 2003.

Data from LEAD Project:

Female sex workers: 57% reported consistent condom use (1937 out of the 3,402) - time frame is the past week

Male sex workers: 27% reported consistent condom use (82 out of 304) - time frame is past week

Data from LEAD Project (citing 2005 IHBSS):

PIP - female sex workers: 67% (2,894 respondents who reported that a condom was used with their most recent client out of 4,322 who have reported having commercial sex in the last 12 months). Location: 100% urban4

PIP - male sex workers: 45% [138 reported that condom was used with their most recent client out of 304 who reported having commercial sex in the last 12 months]. Location: 100% urban

Data from BSS 2003 (supplied by NEC):

70% (1,679 PIP who reported that a condom was used with their most recent client out of 2,400 who have reported having commercial sex in the last 12 months).

The 2003 NEC data showed that some MSM reported as many as 55 sex partners per month. The norm however, is two (2) per month.

Data show that MSM practiced anal sex more with their regular non-paying partners (51%) while they practiced oral sex more with their non-regular partners (53%) and regular paying partners (40%). As for condom use, the 2003 BSS revealed that among HRG, only MSM posted improvement from 12% in 2002 to 19% in 2003.

Figures from the 2005 IBHSS are not yet available as of the time of writing of this Country Report

The median number of sex partners per month for IDU was one according to the 2003 NEC data.

The 2004 NHSSS indicated that while most surveillance sites reported use of prohibited drugs by HRG, few are cases of injecting drug use. However, although the proportion of IDU sharing injecting equipment has been decreasing, the use of bleach and water in cleansing equipment has been decreasing since 2002.

For IDU, consistent condom use decreased from 3% in 2002 to 2% in 2003.

For the indicator on percentage of injecting drug users who have adopted behaviors which reduce the transmission of HIV, the NEC (citing 2003 BSS) had the following figures: 7% (8 respondents who report having never shared injecting equipment during the last month and who reported that a condom was used the last time they had sex, out of 120 respondents who report injecting drugs and having sexual intercourse in the last month)

Data from NEC (citing 2003 BSS; note: the question asked "last 3 months" and not last month) reflected the following figures: 0.2% (24 IDU who used a condom during last sexual encounter, out of 120 IDU who reported having had sex during the last three (3) months)

Figures from the 2005 IBHSS are not yet available as of the time of writing of this Country Report

Table 9. Summary of Number of Sex Partners and Reported Consistent Condom Use among Most-at-Risk Populations (High Risk Groups)

High-risk Group (HRG)	Median Number of Sex Partners Per Month		Reported Consistent Condom Use
	2002*	2003	2002	2003
PIP: RFSW	-	2	30%	28%
PIP: FLSW	-	4	30%	26%
MSM	-	2	12%	19%
IDU	-	1	3%	2%

Source: 2003 NEC Technical Report *Data not supplied

STI Incidence among Most-At-Risk Populations

Proportion of Most-At-Risk Populations Who Reported Signs and Symptoms of STI

The 2003 NEC technical report revealed that female sex workers (RFSW and FLSW) reported signs and symptoms of STI more often than MSM. There was a 50% increase of IDU reporting signs and symptoms of STI in 2003 compared to 2002. Breakdown of the figures is as follow:

Table 10. STI Incidence among Most-At-RiskPopulations (High Risk Groups)

	Reported Signs and Symptoms of STI
	2002	2003
PIP: RFSW	24%	22%
PIP: FLSW	18%	24%
MSM	7%	8%
IDU	5%	10%

Source: 2003 NEC Technical Report

Table 11. Summary Table for Knowledge and Behaviour and STI Incidence among Most-at-Risk Populations

High-risk Group	Proportion Knowledgeable* on HIV		Reported Consistent Condom Use		Median No. of Sexual Partners per Month		STI Incidence
	2002	2003	2002	2003	2002	2003	2002	2003
PIP: RFSW	74%	66%	30%	28%	-	2	24%	22%
PIP: FLSW	61%	55%	30%	26%	-	4	18%	24%
MSM	64%	61%	12%	19%	-	2	7%	8%
IDU	54%	49%	3%	2%	-	1	5%	10%

Source: 2003 NEC Technical Report *Knowledgeable on HIV - those who can correctly identify ways of preventing sexual transmission of HIV and who reject major misconceptions about HIV transmission

Reported STI Cases among Male and Female Consultations

Data cited in the 2005 Philippine HIV and AIDS Country profile show that nine percent (9%) of 213,864 females and eight percent (8%) of 15,284 males consulting for STI signs and symptoms were diagnosed as STI cases.

Table 12. Reported STI cases among male and female consultations SSESS 2003

	Number of consultations	STI cases (number)	STI cases (in percent)
Female	213,864	19,829	9
Male	15,284	1,154	8

Source: 2003 HIV/AIDS Technical Report, as cited in 2005 Philippine HIV and AIDS Country Profile

3. Young People's and the General Population's Knowledge about STI, HIV and AIDS

The 2003 NDHS figures on Table 13 below indicate high levels of awareness about AIDS, e.g., who have heard of AIDS and who believe there is a way to avoid HIV/AIDS, across the age groups from 15-54 years, among those residing in urban and rural areas.

Table 13. Knowledge of AIDS: Percentage of women and men who have heard of AIDS and who believe there is a way to avoid HIV/AIDS, by background characteristics. Philippines 2003

Background characteristic	Women			Men
	Has heard of AIDS	Believes there is a way to avoid HIV/AIDS	Number of women	Has heard of AIDS	Believes there is a way to avoid HIV/AIDS	Number of men
Age
15-19	93.1	83.6	2,648	93.3	84.7	918
20-24	95.3	90.0	2,209	96.4	90.9	785
25-29	95.6	90.5	2,034	96.6	91.9	647
30-39	96.5	90.0	3,827	96.3	91.0	1,179
40-49	95.1	87.3	2,915	96.0	88.6	899
50-54	na	na	0	95.2	88.6	338
Residency
Urban	96.6	90.8	7,877	96.9	92.7	2,553
Rural	93.3	84.8	5,756	94.2	85.4	2,213

Source: Philippines National Demographic and Health Survey 2003

However, this high level of awareness does not necessarily translate to high levels of knowledge as misconceptions still abound as shown by the 2003 NDHS figures on Tables 14.

Table 14. Beliefs about AIDS: Percentage of women and men aged 15-49 who, in response to a prompted question, correctly rejected local misconceptions about AIDS transmission or prevention, by background characteristics, Philippines 2003

Background characteristic (Age)	Percentage of respondents who know that:
	AIDS cannot be transmitted by mosquito bites		AIDS cannot be transmitted by supernatural means		A person cannot become infected by sharing food with PWA		Percentage who correctly rejected the two* most common misconceptions		Number of women and men
	Women	Men	Women	Men	Women	Men	Women	Men	Women	Men
15-19	58.1	55.3	75.4	76.2	45.6	39.8	33.7	26.0	2,648	918
20-24	62.2	60.9	83.0	84.4	56.8	46.2	36.8	31.5	2,209	785
25-29	62.6	62.1	84.0	85.7	57.6	47.5	39.6	34.0	2,034	647
30-39	59.3	56.0	81.1	81.2	55.8	45.6	37.6	30.0	3,827	1,179
40-49