Country AIDS Situation
Amidst the global downtrend in the AIDS epidemic, the Philippines continues to see accelerated increase in new HIV infection. Data from the National HIV and AIDS Registry of the Department of Health reveals an exponential increase in new reported HIV cases in the country with more than half of the cumulative infections reported in the last three years alone. From one new case detected every three days in 2000, the reported HIV incidence increased to one every three hours in 2012. This has well positioned the country to be among the nine countries globally with more than 25 percent increase in HIV incidence since 2001 (2012 UNAIDS Report on the Global AIDS Epidemic).
The uptrend in the epidemic is not surprising considering the less than optimal programme coverage for most-at-risk populations. With a national universal access target for prevention coverage set at 80 percent, the country fell below the mark with rates ranging from 5 percent to 63 percent depending on the population, with injecting drug users and men having sex with men at the bottom end of the scale (Philippine Country Progress Report, 2012 Global AIDS Response Progress Report). Similarly, the 2009 Integrated HIV Behavioral and Serologic Surveillance revealed dismal rate on knowledge on HIV and AIDS among most-at-risk populations at 32 percent, which is far from the national target of 80 percent.
Moreover, stigma and discrimination against people living with HIV (PLHIV) remain a major problem in the country. Although protection of human rights of people living with HIV is protected in the Philippine AIDS Law, the PLHIV Stigma Index Report (2010) revealed widespread discrimination among the population further confounding the AIDS response.
In addition, discrimination related to sexual orientation and gender identity still persists, driving members of the gay, lesbian, bisexual and transgender community to situations that place their physical, mental and social well-being at greater risk. This cannot be more than illustrated by the escalating epidemic of HIV among men having sex with men (MSM) and transgender people in the country, with the population making up more than eight of ten reported new cases of HIV. Stigma and discrimination leave many of the population in the shadows, unable to access life-saving prevention and treatment.
In addition, review of the country’s AIDS response and challenges reveal gaps in the quality of information and services delivered. Therefore, the lack of knowledge on and access to services, the continued stigma attached to AIDS and the discrimination actually experienced by PLHIV have resulted to a low uptake of services by people most-at-risk, vulnerable and living with HIV.
Republic Act 8504 or “The Philippine AIDS Prevention and Control Act of 1998” served as the legal framework of the national AIDS response in the country. It was signed into law in 1998 when evidences of some of the most effective prevention interventions for HIV were only being studied or disseminated. RA 8504 is supportive of measures to protect human rights, end stigma and discrimination, and provide access to services and commodities needed for prevention and treatment, care and support. However, the national AIDS response, which has been primarily health-sector led, has been constrained by the current policy environment, hindering implementation and scale-up of evidence-based effective strategies (such as harm reduction strategies among PWID). Moreover, the law does not include provisions to address the needs of KPHR, and may no longer be responsive to current AIDS situation. Furthermore, a large segment of society – including personnel of key national and local agencies who are supposed to implement it – is still largely unaware of the law’s existence. More so, even some of those who may be aware of the law are unsure of how to operationalize it. As a result, the law is hardly enforced. The capacities of key institutions to carry out their mandates remain weak; programmes are unfunded or under-funded, and programme implementation, monitoring and coordination has been largely at the “project” level.
A major constraint to implementing proven HIV prevention interventions are linked either to absence and/or non-harmonized national policies that impact negatively on the AIDS response. Although there is no law criminalizing male-to-male sex in the country, MSM and transgender people do experience police harassment. Laws being used by the police to harass MSM and transgender people include the anti-vagrancy and anti-sex work laws (Revised Penal Code Article 202), anti-public scandal law (Revised Penal Code Article 200), the Anti-Trafficking in Persons Act and laws that pertain to moral turpitude (UNDP, 2010). The vagueness of some of these laws enables some law enforcement personnel to threaten prosecution for sexual conduct, and to harass or extort money from MSM and transgender people. These laws are also used to apprehend and harass female sex workers.
Moreover, certain provisions of the Dangerous Drugs Act, which prohibit the distribution of clean needles and injecting equipment, and restrict the provision of information and services to people who need them are inconsistent with the AIDS Law, which promotes the right of KPHR and people living with HIV to prevention services. Other laws are discriminatory or either applied selectively, such as anti-vagrancy ordinances, anti-loitering, anti-trafficking, or other ordinances intended to promote “public order” but which seem to specifically target female sex workers and MSM. Evidence has shown that such barriers inadvertently fuel the further spread of HIV, or drive KPHR underground where they cannot be reached by health service providers. In some cases, possession of condoms is also cause for harassment by law enforcers.
New policy and legislation addressing stigma and discrimination against KPHR and PLHIV, and harmonization of some provisions of the AIDS Law with other laws (e.g., the Comprehensive Dangerous Drugs Act, Anti-Trafficking in Persons Act, etc.) needs to be crafted.
The Philippine National AIDS Council (PNAC), created “to oversee an integrated and comprehensive approach to HIV/AIDS prevention and control in the Philippines” has been weak in carrying out its mandate. As a policy-making body, it has yet to define the country’s prevention strategy, and set standards of quality. Involvement of PNAC members is largely at the technical level only. Decision-making has been very slow and any action needs to be mandated.
Past UNDP Support
UNDP has contributed in developing leadership capacities of government institutions and community groups to strengthen sustainable local AIDS responses for the most-at-risk groups. UNDP helped establish and train 17 Regional AIDS Assistance Teams (RAATs) – technical groups with key actors from the Departments of Health, Interior and Local Government, and Social Welfare Development – that show the promise of multi-sectoral teams in bridging national and local policies and facilitating coordinated responses.
UNDP also worked on enabling those affected to contribute to fighting HIV. UNDP has trained over 250 Local AIDS Champions, drawing on members from affected communities and providing training and support to help them campaign for the needs of those most-at-risk. Particularly, UNDP worked with MSM and transgender community groups, providing training on advocacy, health issues, and supporting better organizational development. To date, UNDP has trained over 200 members from 19 MSM and transgender community groups.
HIV and AIDS Programme 2012-2016
The UNDP HIV and AIDS Programme for 2012-2016 is aligned with the United Nations Development Assistance Framework (UNDAF) for 2012-2018, which articulates the collective, coherent and integrated response of the UN system in the Philippines in support of national development priorities. Particularly, it contributes to the first UNDAF outcome which states, “The poor and vulnerable have improved access to and utilization of quality social services, with focus on the MDGs least likely to be achieved.” More specifically, it directly contributes to UNDAF sub-outcome on AIDS (1.6), which states, “By 2018, more people at-most-risk, living with and affected by HIV have access to quality HIV prevention, treatment, care and support services.”
Overall, it will contribute to the achievement of the goal of the 5th AIDS Medium Term Plan (AMTP) for 2012-2016, which is to “prevent the further spread of HIV and reduce its impact on individuals, families, sectors and communities.”
In line with the UNDAF and AMTP, the Programme harnesses UNDPs special mandate and comparative strengths. Its overall approach will be to strengthen capacities of national and local governments and communities to plan and implement sustained, comprehensive and effective responses to HIV and AIDS. The Programme’s potential areas of interest include the following:
- Development and resource mobilization for the implementation of gender-responsive, age-sensitive and context-specific normative guidelines for targeted HIV prevention, treatment, care and support programmes;
- Policy reforms at the national and local levels;
- Institutional capacity enhancement of the national and local AIDS coordinating bodies; and
- Capacity development of national government agencies, Regional AIDS Assistance Teams, local government units and civil society organizations, including empowerment of community groups, particularly MSM and TG groups, to participate in the country response to AIDS.
In addition, UNDP, as one of the agencies leading the implementation of the UN Joint Programme on KPRHR, which aims to improve the quality of HIV prevention services and increase the coverage of these services towards universal access in sites with the highest number of new HIV infections (i.e., Metro Manila, Metro Cebu and Davao). Particularly, UNDP is tasked to coordinate the overall actions of participating UN agencies under Component 3 on Governance. The Joint Programme will address the key barriers to the country’s achieving its MDG and universal access targets, specifically:
- Conflicting provisions of laws and policies at the national and local level that limit comprehensive and effective interventions, and address gaps (such as the lack of a clear policy on national government budgeting for AIDS).
- Inadequate institutional capacity of the Philippine National AIDS Council (PNAC) and Local AIDS Councils (LACs) to lead, coordinate and monitor the AIDS response at the national and local levels, respectively, in the light of the changing trends in transmission and rapid acceleration in some sites.
- Lack of normative guidelines and human-rights based standards for comprehensive HIV prevention packages for persons most-at-risk, vulnerable and living with HIV.
- The lack of technical capacity of national government agencies (NGAs), local government units (LGUs) and civil society organizations (CSOs) in sites with highest HIV burden to implement the 5th AMTP, sectoral strategic plans, and laws and policies related to HIV prevention.