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IV. Major Challenges Faced and Action Needed to Achieve the Goals/Targets
As results of the Behavioral Sentinel Surveillance (BSS) showed that "consistent condom use among the most-at-risk populations (PIP, MSM, IDU) as well as among the vulnerable populations (OFW, young people) was low, most IDU still shared injecting equipment, only a small proportion of 'sharers' used bleach and water to share injecting equipment, and that health-seeking behavior for STI was still far from ideal, particularly among the MSM,"1 the Philippines faces many challenges that need urgent action if the country is to get a step ahead and gain a foothold in preventing the escalation of the epidemic.
Many of the challenges identified in the 2003 Country Report remain to be challenges identified in this 2005 report. The 2003 NEC Technical Report, AMTP III and AMTP IV Plan have likewise identified major challenges. Participants to the two NGO consultation meetings and the November 2005 validation meeting have also contributed their perspectives and recommendations. Specifically, these combined challenges and recommendations to address these challenges are:
A. Setting-up and Strengthening of Monitoring and Evaluation Systems (M & E)
1. Convincing and training key stakeholders to systematically undertake M&E, collect the necessary data, make data accessible and user-friendly, adopt systems where raw data may be summarized for easier and faster data collection.
2. Getting the cooperation and commitment of government agencies, LGUs, and NGOs to allocate and mobilize resources (financial, human, infrastructure, systems) for HIV and AIDS programs, including for M&E activities.
3. Developing and sustaining support for champions and focal persons for M&E within each government agency, in the LGUs, as well as in the legislative chambers.
B. Strengthening HIV and AIDS Education
4. Implementing School-based HIV and AIDS education by strengthening curriculum development and training of teachers, getting teachers to actually teach the students using life-skills based approach about HIV and AIDS in an age-appropriate, gender sensitive and gender-responsive manner.
5. Strengthening community-based HIV and AIDS education among young people, including out-of-school youth (OSY) and among street children. While these groups have been identified as among the vulnerable members of the population, few interventions are still being undertaken to address their needs.
C. Strengthening Promotion of Correct and Consistent Condom Use and Ensuring Supplies Are Available
6. Increasing and strengthening promotion of correct and consistent condom use since correct and consistent condom use is still low and has been decreasing in recent years. There is a need to increase access to information and resources to enable individuals to consistently and correctly use condoms as a means of protecting themselves and others from HIV transmission as well as from other sexually transmitted infections. Communication campaigns also need to be undertaken and continuously assessed/evaluated to counter existing misconceptions about condom use and HIV prevention.
There is a need to look into factors that have contributed or led to decreases in knowledge of correct ways of preventing HIV transmission.
7. Ensuring access of individuals to reliable and continuous supply of condoms. There is a need to look into factors that have contributed or led to decreases in condom use among most-at-risk populations in the past years. A review of government policies on condom procurement and distribution needs to be undertaken. The impact of non-promotion of condoms for family planning purposes and non-allocation of government resources for condom procurement also need to be looked into.
D. Institutionalizing AIDS in the Workplace Programs
8. Expanding and sustaining AIDS in the workplace programs to cover more areas and individuals.
E. Improving Access to Care, Support and Treatment
9. Improving access to care, support and treatment of PLWHA, including care and treatment of children affected by HIV and AIDS
10. Providing for the needs of children affected by HIV and AIDS (HIV+ children, children orphaned by HIV/AIDS, children living with HIV+ parent(s) and/or HIV+ family member(s): psycho-social support, family or other alternate parental care (whichever is appropriate), pediatric ARV therapy, support to help affected children stay in school, other needs, utilizing the Convention on the Rights of the Child and the Child 21 framework.
F. Developing and Maintaining Databases for Most-at-Risk and Vulnerable Populations for More Effective Policymaking and Programming on HIV and AIDS
11. Developing a database for PIP, MSM and IDU for improved programming for most-at-risk populations. Currently it is difficult to get percentage figures for some of the indicators due to the lack of official and updated estimates regarding population sizes of the above groups. According to the National Epidemiology Center (NEC), they are now in the process of updating previous estimates of population sizes for the said groups. Official estimates are hoped to be released in 2006.
12. Developing a database for children affected by HIV and AIDS. Currently, there is no existing database for children affected by HIV and AIDS. A project called "Crossing Borders" is being developed by Precious Jewels Ministry in cooperation with the Department of Health and three hospitals (Philippine General Hospital, San Lazaro Hospital and the Research Institute for Tropical Medicine). This joint initiative will include building a comprehensive database for children affected by HIV and AIDS as a major output, the first results of which will be available by December 2006, and thereafter. This database is expected to help provide critical data for improved programming for children affected by HIV and AIDS.
G. Increasing Civil Society Involvement and Participation
13. Increasing involvement and participation of civil society, including NGOs, private agencies, professional organizations, and faith-based organizations, in:
reviewing existing laws and policies, formulation of new ones, and repealing certain discriminatory provisions of existing laws and policies, towards making laws and policies more sensitive and responsive to the current as well as the changing needs; and planning, implementation, monitoring and evaluation of national and local level programs.
H. Strengthening Monitoring of Human Rights Issues
14. Strengthening monitoring of human rights issues in HIV and AIDS by establishing enforcement mechanisms for the promotion and protection of human rights, and providing legal assistance and access to justice mechanisms for PLWHA, most-at-risk populations, and vulnerable populations.
I. Ensuring Quality Assurance in HIV Testing
15. Ensuring quality assurance for all clinical laboratories providing HIV testing. The Department of Health has issued an Administrative Order (series 2005) titled, "Guidelines of the National Reference Laboratory on the Quality Assurance Program (QAP) for All HIV Clinical Laboratories in the Philippines." This is being implemented by the NRL-SACCL and involves providing measures "to improve laboratory efficiency and effectiveness, for maximum benefit of the people with minimal risk to laboratory personnel." It seeks to "ensure that test results provided are accurate and reliable as possible for all persons being tested." The QAP will regulate and monitor all accredited HIV testing laboratories nationwide (about 500 HIV laboratory facilities and 2,000 clinical laboratories).
J. Sustaining PNAC and the PNAC Secretariat
16. Sustaining the work of the PNAC. The PNAC Secretariat itself lacks technical staff. Many of those that had been trained in the past had left. Moreover, staffing complement was also trimmed down and while RA 8504 provides for budget allocation for PNAC each year, the full and legislated budget amount for PNAC operations and activities has not been allocated by the national government in recent years. This trend in reduced funding will likely continue as the national government tightens its belt and cuts down on spending due to its huge fiscal deficit.
It is asserted, however, that if government is intent on and committed to addressing the HIV and AIDS epidemic, it needs to invest more resources (financial, human, infrastructure and systems) to prevention, care and treatment programs. At this juncture in the nation's history, critical efforts to afford the Philippines the opportunity to avert an explosive HIV epidemic cannot be sacrificed by belt-tightening measures. For the meantime, this low budget allocation may be supplemented by resource inputs from donor agencies and by private agencies.
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