Local Government Academy
Department of the Interior and Local Government
Practices that Work:
HIV and AIDS Local Response in the Philippines
Published by: Local Government Academy
All rights reserved.
Parts of this publication may be reproduced with proper acknowledgement.
Writers:
Elyzabeth F. Cureg
Raphael N. Montes, Jr.
Substance Editors: Institutional Partnership Unit – LGA
Patrick Omar B. Erestain
Karl Abalos
Sly Z. Barrameda
Copy Editor:
Layout and Design:
All rights reserved. Copyright 2014
Local Government Academy
8/F Agustin 1 Building. F. Ortigas Jr. Road (formerly Emerald Avenue)
Ortigas Center, Pasig City, 1605 Philippines
Tel. no.: (632) 634 8430 / 634 8436
www.lga.gov.ph/hiv
List of Acronyms
v
Introduction
viii
Chronicles of Success Foretold
1
BAGUIO CITY
For Many are Called
12
SANTIAGO CITY
From Troubled Teens to Power Peers
21
PARAÑAQUE CITY
Guarding the Backdoor
30
ZAMBOANGA CITY
Everybody’s Business
42
PROVINCE OF AKLAN
A Different Battlefield
PROVINCE OF NORTH COTABATO
56
AAI
AIDS
AFRHS
ALS
AOP
APAC
APAFZ
APEC
AWAC
BALUTI
BANS
BARS
BASULTA
BB
BCYA
BHW
BIMP-EAGA
BLAACP
CHAMP
CHD
CHO
CLGOO
COM
CSC
CSO
CSW
DepEd
DILG
DOH
DOJ
DOLE
DRSTMH
EEW
EO
FHI
Abante Aklan, Inc.
acquired immunodeficiency syndrome
Adolescent Friendly Reproductive Health Services
alternative learning system
Annual Operating Plan
Aklan Provincial HIV and AIDS Council
Association of Partners for an AIDS-Free Zamboanga
Asia Pacific Economic Cooperation
(Baguio) AIDS Watch Council
Batang Laging Umiiwas sa Tiyak na Impeksyon
Baguio Association of Night Spots
Bars and Restaurants Association of Baguio City
Basilan, Sulu, Tawi-tawi
Butterfly Brigade
Baguio Center for Young Adults
Barangay Health Worker
Brunei-Indonesia-Malaysia-Philippines East Asia Growth Area
Barangay Legal Action Against Child Prostitution
(Local) Catalytic Actions for HIV and AIDS Mitigation Programme
Center for Health Development
City Health Office
City Local Government Operations Officer
Crossover Mission
Civil Service Commission
civil society organizations
commercial sex workers
Department of Education
Department of the Interior and Local Government
Department of Health
Department of Justice
Department of Labor and Employment
Doctor Rafael S. Tumbokon Memorial Hospital
establishment entertainment workers
Executive Order
Family Health International
FSW
GFATM
GGP
GRO
HDES
HIV
HSO
IDU
IEC
IPHO
IT
KTV
LAC
LEGSC
LGU
LMP
MARP
MIU
MOP
MSM
NASPCP
NEC
NGO
OCSWDO
OFW
PEC
PHO
PIA
PLHIV
PMS
PNP
PPDO
PPP
RA
RAAT
RH
RHWC
SCMS
SEBAS
freelance sex workers; female sex workers
Global Fund to Fight AIDS, Tuberculosis and Malaria
Gawad Galing Pook
guest relations officer
Human Development and Empowerment Services
human immunodeficiency virus
Health Service Office
injecting drug user
information, education and communication
Integrated Provincial Health Office
information technology
karaoke tv
Local AIDS Council
League of Enthusiastic Gays in Santiago City
local government unit
League of Municipalities of the Philippines
most-at-risk populations
Men in Uniform
Manual of Procedures
men having sex with men
National AIDS-STI Prevention and Control Program
National Epidemiology Center
non-government organizations
Office of the City Social Welfare and Development Office
overseas Filipino workers
Peer Educators Council
Provincial Health Office
Philippine Information Agency
People Living with HIV and AIDS
premarital sex
Philippine National Police
Provincial Planning and Development Office
Public-Private Partnership
Republic Act
Regional AIDS Assistance Team
reproductive health
Reproductive Health and Wellness Center
Santiago City Medical Society
Santiago Entertainment Business Association
SEC
SHC
SK
SSOA
STI
SWDO
TESDA
TWG
UN
UNDP
UNICEF
UNFPA
USAID
VAW
VCT
WAD
ZCMSAC
ZEA
Securities and Exchange Commission
Social Hygiene Clinic
Sangguniang Kabataan
Shindig Stall Owners Association
sexually transmitted infections
Social Welfare and Development Office
Technical Education and Skills Development Authority
Technical Working Group
United Nations
United Nations Development Programme
United Nations Children’s Fund
United Nations Population Fund
United States Agency for International Development
Violence against women
voluntary counseling and testing
World AIDS Day
Zamboanga City Multi-Sectoral AIDS Council
Zamboanga Entertainment Association
The rise in the number of HIV and AIDS cases in the Philippines continue to
alarm the world. The country’s epidemic is described as “hidden and
growing”. Commitments to halt this epidemic have launched efforts both at
the national and local levels. Local Government Academy’s Program on
Scaling-up Effective and Sustained Response on HIV and AIDS is one such
effort.
In partnership with the United Nations Development Programme, initiatives
focused on developing the leadership capacities of local governments and
the Regional AIDS Assistance Teams in providing sustainable local AIDS
responses. Aside from capacity building, research and publication and
technical assistance, the Program launched the local C.H.A.M.P. (Catalytic
Actions for HIV and AIDS Mitigation Programme) Award.
Local CHAMP recognizes the good practices of local governments in
addressing the HIV and AIDS problem and in improving services to their
target clientele. The awards started in 2010 and the practices of six LGU
winners are featured in this publication. The stories and experiences in four
cities (Baguio, Santiago, Parañaque, Zamboanga) and 2 provinces (Aklan,
North Cotabato) were captured primarily through document and literature
review and interviews.
BAGUIO CITY. The story outlines the pioneering ideas and actions of the
city since 1987, eleven years before the enactment of RA 8504. Readers would
learn that the city was the first to create a local AIDS Council, first to recruit
the active participation of the private sector, and to practice the STI
Syndromic Case Reporting System. The city’s internationally recognized
Bonjing website and its fun and jam-packed Annual WAD Conference is also
a good practice to discover. Not surprisingly, the City’s RHWC was once
noted as the best and most ideal facility, being able to offer quality and
comprehensive package of services for PLHIVs and the general populace
alike.
SANTIAGO CITY. The city enjoyed a relatively long HIV-free period, until
the first case was recorded in 2011. Their local response nevertheless started
as early as 2008. The city exhibits foresight and astuteness in effectively
building a functional multi-sectoral coalition that jointly works to strengthen
HIV and AIDS advocacy efforts. It also introduced the mobile awareness
booth that roams around the town’s public places, schools and institutional
complexes together with the volunteer peer educators who serve as the
information personnel.
PARAÑAQUE CITY. The city showed that delinquents-to-role model
approach is a risky but fulfilling strategy if applied correctly. Deviating from
the basic peer counseling methodology, the self-help initiative of a dozen
alcoholics/addicts/gang members through the initial support of Save the
Children, grew into what is the Adolescent-Friendly RH Services in
Parañaque City. Officially founded under the B.A.L.U.T.I. program, the
BALUTI together with the City Health Office manages both the communitybased and school-based activities that is grounded on their effective Give Me
5 Communication Approach.
ZAMBOANGA CITY. Recognizing the threats not only locally but also from
the neighboring countries, the City championed the cause when it created
and enriched the membership of the Multi-Sectoral AIDS Council. It also
organized the at-risk groups and customized programs for IDUs. It saw the
need to prepare IEC materials in Chavacano and to beef up the composition
of inspection activities of its Task Force Buenas. All in all, the city welcomed
all possible partners from all walks of life.
AKLAN PROVINCE. The province led in the formation of a multi-sectoral
collaboration that capitalizes on the expertise of member-partners in fighting
the HIV and AIDS problem in Aklan. It reached out to the youth, gay
community, CSOs, academe and media. This collaboration was instrumental
in the design of creative IEC campaigns and the creation of the Peer
Educators Council. Every December, the WAD celebration is a reflection of
the concerted efforts of all Council/Collaboration members.
NORTH COTABATO PROVINCE. This is an interesting case featuring an
RH/HIV/AIDS awareness program for men in uniform (MIU). In
partnership with development aid agencies, the province managed the
conduct of a series of training activities for selected military battalions. Peer
facilitators were identified from each of the platoons. As a result, rate of
condom use as well as MIU availing vasectomy procedures increased.
These six cases are excellent examples of meaningful and life-changing
undertakings on HIV and AIDS. They show that local governments and
community organizations can make a difference. Size does not matter when
passion, compassion and competence are present. These cases present
practices that work, even against a huge enemy like HIV and AIDS.

Their moment of submission of the awards application document is like a
foretelling. The flow of events would clearly suggest the ending. There is no
doubt in anyone familiar with their story that Baguio City would win the
2011 Local C.H.A.M.P Award.
THE SETTING
Baguio, located in the Province of Benguet and 250 kilometers north of
Manila, is a first class city. Its 129 barangays occupy 57.5 square kilometers
of land. As of 2010, its estimated population is 318,676 representing almost
20% of the regional total. It is a migration destination, with half of its
population aged 25 years and younger. The operation in the city of about 8
tertiary education institutions more or less explains for the population’s
youthfulness.
Aside from being an education center, Baguio city is also a hub of
commercial and trade activities in northern Philippines. This complements
its touristic character. The city is known for its pine forests, elevated
altitude, high value vegetables, flower festival and cool climate. It
consistently gets a place in the top 10 favorite tourism destinations in the
Philippines. This is most probably because it is considered the summer
capital of the country, given its temperate weather. Annual visitor arrival
averages at 709,020 (2006-2012), 94.5% of which are domestic travelers.
Baguio city, being a migration, education and tourism magnet, makes it a
hot area for the spread of HIV and AIDS. As of 2013, 18 lives of local
residents have been lost to this dreadful disease since its first case was
reported two decades past. The total number of recorded cases has reach

apologies to Gabriel Garcia Marquez for the title inspiration.
59 (1992-2013). From new case droplets of 1 to 2 HIV infections in 1992 to
2003, broken only by 3 new cases in 1997, the number of new infections
jumped to 6 in 2004. The number positively declined in 2005(3), 2006(4)
and 2007-08(1-2). The year 2009 with 5 new reported cases seemed to
signal a new phase. This was the year when the surveillance team
discovered their youngest infected MSM. This also marked the continuing
period of increasing number of case reports. Only 2012 offered a let up
with just 2 new case reports. But figures for 2010(6), 2011(8) and 2013(8)
seemed to suggest an imminent battle against the 2-digit mark.
The 59 total registered cases come from 17 to 45 age range, more than a
majority of which are males (44). Half of these males are men having sex
with men (MSM). Note that 18 of the patients are overseas Filipino
workers. The trend gives the impression of higher risk from young MSMs,
seeing that 10 of the 24 cases since 2010 are young people and 6 of the 8
new cases for 2013 are MSM.
CHRONOLOGY OF EVENTS AND INITIATIVES
The scenario is bleak but it would most likely be worse if Baguio City did not
act fast enough. Alarmed of the first recorded HIV infection in the
Philippines in 1984, the city government through the Health Department
(now called Health Service Office or HSO) actively recruited the support of
about 500 entertainers to voluntary undergo HIV tests.
By 1987, the city through HSO’s Social Hygiene Clinic (SHC) felt the need to
form a local AIDS Council which they called the Baguio AIDS Watch Council
(AWAC). This is the first of its kind in the country. In fact, it would take 11
more years before Congress would enact RA 8504 or the AIDS Prevention
and Control Act. The council’s basic goal is to raise awareness to prevent
any infection, envisioning an AIDS-free Baguio City. SHC of HSO served as
the Secretariat and Dr. Charles Cheng, then Director of Baguio FilipinoChinese General Hospital, served as the founding President. Even at the
onset, AWAC officers mostly came from the private sector.
In 1992, the first reported case was registered. Three years after, the
program Public-Private-Partnership (PPP) versus HIV/AIDS was
conceptualized and introduced. It became the general approach to AWAC’s
ensuing initiatives. The program rests on three principles:
(1) collaboration of AWAC members and its networks is necessary. Local
government divisions like on social welfare (OCSWDO) and population
office, national agencies like DOH, DOLE and DepEd, private sector
partners like Baguio Center for Young Adults (BCYA) and Bars and
Restaurants Association of Baguio City (BARS) have to learn to work
together;
(2) complementation is important for the provision of optimum care and
support. The weakness of a lean SHC with its 4-6 personnel complement
and its limited resources and services will no longer be a weakness if
supplemented with the commitment and support of partners and AWAC
members;
(3) aggressive and massive information campaign is key to prevention.
DOH identified Baguio as the 10th sentinel site in 1996. SHC thus composed
and led the Baguio HIV sentinel surveillance team to undertake the task.
The other team members include the HSO staff, private practitioners, BCYA,
and laboratory staff of the Baguio City General Hospital and Medical Center
of DOH.
Two years after, SHC drafted a local legislation that seeks to institutionalize
the HIV surveillance system in the city. The proposal was sponsored by
Councilor Elmer Datuin of the Health and Sanitation Committee and it was
enacted by 1998. This is another first for Baguio City.
Come 2000, AWAC registered itself as a non-government organization
under the name Baguio AIDS Watch Council, Inc. It is a non-profit and multisectoral group composed of various representatives of both government
and non-government institutions in Baguio. From the initial 2 partners in
1987, AWAC members grew to 15. It maintained SHC as its Secretariat.
Year 2000 was a busy one. The Baguio SHC pioneered the implementation
of the STI Syndromic Case Reporting System in its different health districts.
Participation of private doctors was critical with 75% of syndromic case
reports coming from them. The system is basically about the reporting of
STI diagnoses, based primarily from flowcharts and independent of
laboratory results. To install the system, almost all health center health
workers and select private physicians were asked to attend a short training
on the subject. This reporting system was supposedly later adopted by
DOH.
Another milestone in 2000 is the first UNDP-AWAC project. The Council got
the support of the development agency for its intensive education
campaign. The project revolved around the promotion and orientation of
schools and city government employees on the provisions of the RA 8504.
Guidance counselors from select public and private schools and even
government offices were asked to attend. As for the city government
employees, the orientation was participated by the different departments.
By December of the same year, AWAC through SHC led the organization of
the Baguio Association of Night Spots (BANS). AWAC wanted to establish
rapport with night workers and bar owners and get their support for
awareness-raising and risk-reduction activities. The organization (BANS)
later became BARS (Bars and Restaurants Association of Baguio City) which
formed a corporate identity of its own. Together with the BANS and the HIV
surveillance team, AWAC started the annual seminar series on HIV and
AIDS. This was the precursor to what later would be converted into an
Annual December Conference (beginning 2006). The focus of the first
seminar was the no condom, no sex policy. It was also an opportunity for
the AWAC to introduce the 3-condom policy; night workers should have in
possession at least 3 condoms at any time during their service hours.
Jump four years after, 2004 was another busy and memorable year for the
AWAC. It was able to forge stronger linkages with two non-government
partners and introduce an IT-based peer education program. BCYA, an
AWAC member, was given the challenge of leading the MSM intervention
track. BCYA helped the SHC to carry out STI screening, HIV pre- and posttest counseling and testing, syphilis testing and further counseling of
MSMs. To do this, HSO gave BCYA a designated room at the 4th floor of HSO
building.
Another partner, a ministry called Crossover Mission (COM) looked into the
spiritual side of the HIV and AIDS problem. COM came over and reached
out to what it considered as the “beloveds” of Baguio, primarily referring to
night workers. COM, the latest AWAC member, is an NGO that provides
spiritual growth, some livelihood assistance and even subscription in the
alternative learning system (ALS) (since 2009). COM was allowed to use the
AWAC room for its outreach programs to SHC clients. Basically, SHC refers
to COM further interventions related to the spiritual, mental, social,
cultural and even economic needs of SHC clients. COM also refers to SHC
clients who may need STI/HIV services. COM ensures that all referred
clients get to attend personality development and personality awakening
sessions.
Another landmark engagement in 2004 to 2005 is the launching of the
award-winning Bonjing e-inquiry (www.bonjing.org.ph). Conceptualized by
Dr. Brillantes of SHC in 2004, it is a website where young people can seek
information and counsel on RH, sex and HIV and AIDS concerns. The name
is drawn from a Filipino term referring to a grown youngster who acts
immature. The ultimate goal of the website is to develop health-seeking
behavior among the youth. The idea is for young people to seek Bonjing as
a friend, get them to reach out and share their sex and RH problems and
needs, convince them to seek professional help and to eventually be able to
bring them physically to a youth-friendly clinic in the city. It is akin to an
online peer educator especially designed for the youth, which they can
access any time at their convenience. SHC can also maximize Bonjing as a
means of determining the knowledge, attitude and RH practices of Baguio
city’s youth and assess their vulnerabilities to HIV.
Bonjing would respond within 24 hours of a client’s inquiry. Some of the
common questions asked were on premarital sex (PMS) and its adverse
consequences, sexually transmitted infections, contraceptives and
substance abuse that lead to PMS and abortion. Three HSO divisions (SHC,
Population Office, Health Education Promotion Office) with technical
assistance from Management Information Technical division of the City
Budget Office, comprise the Team Bonjing.
AWAC first provided for the website registration. Later, as part of
counterpart initiatives to the Global Fund to Fight AIDS, Tuberculosis and
Malaria (GFATMR6) (2007-2009) through the Tropical Disease Foundation,
AWAC secured the domain until 2013. Another partner which actively
endorsed the site is the DepEd. Promoting it to both elementary and high
school students and informing them of Bonjing drop boxes available in their
schools. SHC was also able to get the support of the Rotary Club of Baguio
for it to include Bonjing in its new generation program.
Bonjing was launch on May 2005, as part of the annual candlelight
memorial. It is the city’s first interactive website and first for such a
purpose in the Philippines. It won an international award from APEC (Asia
Pacific Economic Cooperation) in Taipei in August 2005. DOH likewise
recognized it as a best practice of the city government in preventing AIDS in
2008.
Back to 2005 though and even before the APEC award was given, it is
supposedly a research team from the University of the Philippines who first
acknowledged the HSO-SHC and AWAC’s good practices on STI and HIV
prevention. The SHC staff felt that this is a turning point for them. They
believed that this recognition somehow turned the tide of public
perception, with SHC clients no longer as stigmatized as before. From then
on, SHC has been receiving clients that do not necessarily fall under the
most-at-risk-population (MARPs).
Then again, it was in 2006 when the Baguio SHC was considered as the
‘best’ and ‘most ideal’ facility. The Family Health International (FHI) and the
National AIDS-STI Prevention and Control Program (NASPCP) of the DOH
jointly undertook the monitoring of 10 big SHCs in the country. The
monitoring was undertaken 6 months after the Manual of Procedures
(MOP) for SHCs was introduced. The monitoring team outlined some of the
good practices of Baguio City which received commendations on the
following:
(1) location, ambiance, space, supplies of clinic consultation room as
most ideal;
(2) use of new and modern fixtures as well as of disposable examination
table sheets (duplicated later by other SHCs);
(3) dedicated furnished and discrete counseling room;
(4) adequate store room;
(5) availability of all SHC services;
(6) cleanliness, lighting and ventilation;
(7) referral system feedback form;
(8) well-maintained, accurate, complete records system.
The monitoring team likewise noted that the imposition of a dress code and
proper client hygiene prior to consultation is a good practice. The dress
code requires that women should not be in shorts, mini-skirts, pajamas,
slippers and revealing tops while men must refrain from wearing shorts,
sleeveless undershirts and slippers during consultation. This is to lessen
stigma and discrimination.
Finally, before 2006 ended, HSO, SHC and AWAC organized the first of the
annual HIV and AIDS Conference during the World AIDS Day. The
conference took the place of the HIV seminar series started 6 years ago.
The conference brought all the night workers together in one event to
establish camaraderie among them and for them to have a common
knowledge on HIV and AIDS, in the hope of persuading them to translate
what they learn from the conference into practice.
The years 2007 to 2009 marked the city’s participation in the Global Fund
project through the Tropical Disease Foundation. Among the activities
AWAC through the SHC led, are the training of and peer educator outreach,
enhancement of the STI referral network, and IEC engagement with BARS
for the ABCs of STI/HIV prevention among moonlighters and entertainers.
The year 2007 also witnessed the passage of the SHC-drafted resolution
providing for financial (livelihood) assistance to persons with HIV. Three
patients were given Php10,000 worth support for the three types of
livelihood (tamarind candy making, peanut butter jam making, fashion
jewelry making).
It was also in 2007 when SHC decided to change its name to Reproductive
Health and Wellness Center (RHWC) in compliance with the SHC MOP. All
RHWC staff including the volunteers are granted as well the Civil Service
Commission Gantimpala Award under its Mamamayan Muna Program. A
year before, the SHC team was recognized by CSC as a Regional Pag-asa
Awardee (group category).
In 2008, RHWC competently undertook the HIV surveillance without the
assistance of DOH. In 2009, due to the youngest infected MSM discovered
by the surveillance team, the team enlisted MSM partners to join them in
the conduct of the surveillance.
In 2009, AWAC was given a seat in the Local Health Board.
In 2011, Baguio City won Local Government Academy-led Local Catalytic
Actions for HIV and AIDS Mitigation (C.H.A.M.P.) Programme Award.
THE TELLING RESULTS
Baguio City’s initiatives from 1987 to present earned for it a number of
telling results.
One, there is the undeniable rapport established from and among partner
agencies to move as one in their HIV prevention efforts. The AWAC is a
testament that public-private-partnership works and that the private sector
can willingly take the lead. AWAC’s SEC registration is proof of the council
members’ commitment to sustain the cause and offer optimum health
services.
Two, given its advanced initiatives to rally the support of the entertainment
sector, there has been no HIV infection recorded among regular SHC clients
or from the moonlighters since the year 2000. Interestingly, the period
coincided with the introduction of the annual seminar/conference series
and the formation of the BANS.
Three, Bonjing offered another rallying point for all sectors of the city. Since
the website was launched, it has been viewed 20,000 times. Bonjing is a
continuing intervention and has even inspired a congress in November of
2012 with 500 students and school personnel in attendance.
Four, RHWC’s services is at par with private clinics at less the cost. Service
referrals from private doctors is common especially since the FHI and
NASPCP monitoring report was published.
Five, RHWC’s credibility enables it to generate legislative and institutional
support as necessary. Such is the case with the solicitation of financial
assistance for 3 infected patients as well the ordinance providing for the
institutionalization of the local surveillance system. Very unique in Baguio
City as well is AWAC’s membership in the Local Health Board.
Lastly, the most telling result of AWAC and HSO-SHC programs are the
awards it and its members received. The SHC has been commended for
being the best and most ideal. Many of its pioneering good practices have
been shared by DOH to other local governments for replication. Bonjing’s
APEC and DOH awards are not to be forgotten, as with the CSC conferred
Pag-asa and Gantimpala awards.
MORAL OF THE STORY
Some nuggets of wisdom can be outlined from Baguio City’s experience.
Service with compassion. HSO-RHWC and AWAC values the dignity of every
person. The imposition of the dress code during consultations and the
enrollment of COM’s undertaking for the city’s beloveds reflect the need for
the MARP to maintain their dignity. AWAC and RHWC would not have
initiated this if compassion is missing. They would then not have obtained
the support of BANS and the entertainers themselves if the clients felt that
their concern is only feigned.
Too many chefs surprisingly improved the broth. It is critical that AWAC
members are champions who will not falter until the end. It is also critical
that the RHWC’s competency is without question. It would be hard to solicit
external support if the internal core does not have solid foundations. The
well-networked champion like Dr. Cheng and RHWC’s good reputation
inspired others to join their ranks. Unlike other councils though, which
wrestle with the operationalization of teamwork, AWAC members worked
together by capitalizing on their strengths and filling the gaps of each
other’s weaknesses. The lean RHWC staff complement mattered not since
the AWAC members were willing the share the burden from the very start.
Being on guard, always. Baguio City initially thought that the HIV and AIDS
threats would come from the entertainment industry. This explains for its
VCT initiative and the organization of the BARS. As early as 2004 though, it
shifted gear towards MSM-focused interventions because of the profile of
new case reports. The introduction of bonjing is also a response to the
trend towards younger infections.
Small steps to bigger gains. It has been 26 years since the local AIDS Council
was first formed. Across the years various interventions and programs have
been introduced, all following the PPP versus HIV approach. What is vital is
that small, new, good and practicable initiatives are implemented time and
again so that team fatigue would be avoided. Small successes may translate
to greater trusts, additional accomplishments to deeper commitments.
Sustainable solutions. It is not commonplace for a local AIDS council to
create an identity separate from the local government. In Baguio City this
is possible. AWAC also showed that PPP is a viable option even to local
health service provision.
Not resting on laurels. RHWC can be considered a pioneer in a lot of good
practices. This is because it did not stop seeking better ways of providing
services and responding to what it recognized as the HIV and AIDS threats
in the city.
Everything that happened, every engagement and commitment that RHWC
and Baguio AWAC undertook for the past 26 years, led them to this state. A
state of success foretold, only made possible through combined efforts,
steely determination and hard work of partners. It would be a sin not to
recommend that Baguio City’s RHWC be visited by all practitioners in this
sector as soon as possible.
A story is told of a certain city in northern Luzon which lived the dictum -prevention is better than cure. Unlike other towns which react instead of
proactively respond to the HIV and AIDS challenge, this city solidified the
efforts of its various sectors to form a coalition that furthers collaboration
to address the concern. This is despite the fact that the city has no known
HIV infection yet. In 2010, this place called Santiago City was granted the
Emerging C.H.A.M.P. Award by the Local Government Academy.
Ironically nine months after receiving the award, their first confirmed case
was recorded.
THE CITY WITH A SENSE OF URGENCY
Santiago City is a first class city in Cagayan Valley, the first in fact in the
region to acquire cityhood. It is located in the Province of Isabela, about
eight to ten hour drive from Metro Manila. In 2010, its population is pegged
at 132,804, distributed in 37 barangays covering 27,406 hectares.
The city’s strategic geographic location makes it an investment magnet for
big companies intending to gain a foothold in the regional market. It serves
as a converging point for traders coming as far as Bayombong and Aparri.
The economy is still based on agriculture, with corn and palay as its main
produce. The commercial and shopping activity in the center is made
busier by the 223 industrial establishments operating in its territory. These
make it imminent that urbanization stalks just around the corner.
Home to 135 various levels of educational institutions, 13 of which offer
higher education, the city can be described as an education hub as well.
Seven hospitals operate in the area, with only one being public. It is thus
surprising that Santiago City does not appear to be a migration magnet,
though it attracts some laborers and workers from neighboring towns.
Up until 2010, there were no registered HIV cases in Santiago City. Even
with the presence of the then 32 (now 36) entertainment establishments,
the city enjoyed twenty six years of zero prevalence rates since the first
Philippine case was recorded in 1984. But even with zero, the city
government felt that it has to ready the town in the eventuality that might
come any time. Indeed, it did less than a year after.
The first positively diagnosed case was registered in 2011. By 2013, the
Social Hygiene Clinic (SHC) of the City Health Office (CHO) is aware of 2
more new cases. Per National Epidemiology Center’s record though, the
tally is already at 5.
UNITED WE STAND: THE COALITION FOR PREVENTION
Beginning 2008, through Executive Order (EO) 65 inked by three-termer
Mayor Amelita Navarro, the local government sought to establish and
strengthen a local “coalition” against HIV and AIDS. This coalition will
engage in collaborative information and education campaigns aimed at
preventing future infections and the possible spread of HIV and AIDS in
Santiago City. Propitiously, the city became part of the beneficiaries of the
Global Fund to Fight AIDS, Tuberculosis and Malaria Round 6 (GFATMR6)
which should have ran from 2007 to 2012.
EO 65 which calls for the creation of the Local AIDS Council (LAC) was
amended in 2009 through another EO (83) providing for the expansion of
the original 18 members to 23. Among the original members are 11 local
government offices like Office of the Mayor, Vice Mayor, Registrar, Social
Welfare, Health and Legal ; representatives of 2 national government
agencies (DepEd, PNP); and 5 civil society / private sector representatives,
specifically from the Philippine Academy of Family Physicians, Santiago City
Medical Society (SCMS), Isabela-Quirino Dental Society, Knight of Columbus
and SEBAS or the Santiago Entertainment Business Association. The
amended EO introduced the following new members: SK Chairperson, City
Local Government Operations Officer (CLGOO), media and two executive
assistants (Mayor’s Office).
The EO amendment introduced the idea of an expanding membership,
encouraging partnerships from the academe, business, NGOs, hospitals,
professional associations and even private clinics to take part in the
coalition. Never in the EOs was there a mention of a creation of a
“Coalition” but the LAC members symbolically signed a Coalition Covenant
sometime in 2008 and 2009 to signify their united goal of maintaining an
HIV-free city.
The coalition members also fundamentally agree to participate in IEC and
capacity building efforts; develop comprehensive strategic plan especially
for primary health care clinic service; and ensure availability of early
treatment and proper management and referrals.
Upon signing the amended EO, the CHO and the SHC did all the legwork in
identifying and formally inviting additional coalition members. Many were
called and many calls were made. Fortunately, GFATMR6 provided the
mobilization budget to start the ball rolling.
Eventually, a beautiful spider
web-like coalition came to
form (see image at right). In
2010, the city government
depicted that the web has 8
outstretched thread pillars,
weaving together 3 rows of
agency networks
representing 30 offices
separate from the 8
institutional pillars and with
Insert WEB image from awards
application document HERE (better if
acronyms are spelled out)
CHO-SHC-LAC at the core.
The pillars represented by the city government, DILG-RAAT, Positive Action
Foundation Philippines, Inc., DOH, DSWD-RAAT, CHD-RAAT, AIDS Society of
the Philippines and the GFATMR6 strengthen and support the web. Many
of the organizations at the web’s interwoven inner rows are local-based like
the Nagkakaisang Kabataan ng Santiago, League of Enthusiastic Gays in
Santiago City (LEGSC), SEBAS and Infant Jesus Montessori School, which
boosts the inner strength of the coalition. At the web’s center is its inner
strength, the CHO-SHC-LAC which provides the coordinative and secretariat
services to the coalition. The competent CHO and its compact 5-member
SHC accomplishes this role with a smile.
Any break in the web connection may impair the coalition. The strong
linkages built on the other hand, will create a supportive environment that
brings about cooperation and unity among members consistently looking at
the same direction against HIV and AIDS.
NITTY-GRITTY OF THE COALITION’S MOVING CAMPAIGN
The Coalition’s membership was enriched to rally information and
prevention efforts at all fronts and from all sectors. Continued vigilance is
the operative word. The intent is to provide right and accurate information
on STI/HIV/AIDS to the general populace and to targeted audiences to
promote positive behavior especially among the population at risk, as well
as increase access to HIV counseling and testing, particularly to the SHC as
the referral unit.
Yearly, activities of the LAC and the coalition kicks off on May, during the
AIDS candlelight memorial celebration. IEC initiatives and rounds of what
the city introduced as the “mobile awareness booth” (mob-booth) would
then be scheduled for the rest of the year. Normally, the mob-booth would
hop from one high school or college to another. Each year ends with a
highlight through the 4-5 day December World AIDS Day celebration.
Initiatives temporarily wane at the start of each year but had to start-up
again in time for the Gay Pride held every March.
In this cycle of activity highs and lows, coalition members basically inform
the CHO-SHC-LAC of their preferred schedule of mob-booth display in their
institutional grounds, with some even providing for volunteer peer
educators (e.g. from school partners) who would explain the contents of
the mob-booth. Coalition partners have volunteered to shoulder the
reproduction of some of the IEC materials like posters, tarpaulins and fliers.
The local government through the CHO and SHC remains as the coalition’s
focal institution for capacity building on HIV and AIDS. At times, sponsoring
NGOs and private sector partners share some financial support for the
conduct of training activities. The city government endeavors to
mainstream HIV/AIDS response initiatives through its other services like the
HIV 101 to pregnant mothers, joint activities with the local blood council
and mandatory vaginal smearing.
Since the coalition is primarily formed to raise Santiagueños level of
awareness, much thinking went on the contents of the education campaign
materials and the presentation approach. The LAC members scoured for
available online materials to carefully design their IEC materials. They then
decided to put all the information in an easily movable but engaging
platform. This is how the mobile awareness booth (referred here as mobbooth) came to life.
As the name implies, mob-booth is an easily transferrable two-dimensional
poster display booth that stays for 1 to 3 days in one designated location at
a time. It always comes with a package of 2 to 4 volunteer peer educators
who are adept in deepening the understanding of bystanders and
reading/listening audience on the nature, preventive actions for, voluntary
testing and referral services for HIV and AIDS. These peer educators are
required to attend a 3-day course before they could be certified as such.
Mob-booth is usually displayed in schools, thickly populated areas like
market and bus stations and in community meet-up areas. Oftentimes,
school displays ran parallel with organized lectures or workshops for
secondary and tertiary students on HIV and AIDS. The apparent strategy to
target schools with information on HIV and AIDS stems from the Coalition’s
acceptance that the youth, as young as secondary students are nowadays
experimenting with risky behaviors.
For mob-booth displays at more public places like markets and terminals,
peer educators mainly come from the ranks of the SEBAS and LEGSC. They
are therefore mostly establishment entertainment workers (EEWs) and/or
men having sex with men (MSM), who can better relate with their peers
and potential partners the dangers of engaging in risky sexual behavior.
This is complemented by weekly lectures to EEWs and their weekly vaginal
smearing, condom distribution and offer of participation in city
government-led livelihood programs.
As part of the May 2009 candlelight memorial, the coalition launched a
signature campaign that aimed to collect 10,000 signatures of Santiago City
residents to get their support and involvement in the cause. Santiago City
responded and they hit the 10,000 signature target.
SMALL GAINS
A program can only be truly measured through its results. How has the
coalition and its moving campaign strengthened the local HIV and AIDS
response in Santiago City?
One, partnerships and networks have been established and maintained.
Non-government coalition members are still willing to share or invest if you
may, on the reproduction of the IEC materials. Participation of coalition
members on key annual events (May; December) remains high. Requests
for the mob-booth from schools like Patria Sable Corpus College, Southern
Isabel College of Arts and Trade, North Eastern College of Nursing and
private sector partners have continued and even intensified. The working
relationship in the coalition has reached a healthy state where
service/client referrals is now possible. Meaning, some EEWs clients have
been referred to private dermatologists for complementary skin services.
Two, magnitude of population reached. The ‘Be Counted to the 10,000’
signature campaign is proof that the IEC has reached close to a tenth of the
city’s population. More importantly, the strategic targeting scheme
required that ‘vulnerable younger’ residents are the audience of the mobbooth. It therefore comes as no surprise that the P50,000 award money
from the Local Government Academy was used to further reach more of
the populace. The CHO in 2011 conducted 4 batches of courses for BHWs
and even barangay captains and council representatives not only to deepen
their knowledge on HIV and AIDS but also to recruit possible partner
advocates at the community level. They used the remaining amount for a 1
day seminar-workshop for 45 youth student government leaders and
school guidance counselors with the hope of developing a cadre of
advocates for the fight against STI/HIV/AIDS and drafting key youth leaders
in organizing HIV/AIDS youth councils.
Three, Dr. Genaro Manalo of the CHO successfully facilitated the formation
and induction of the first set of officials of the HIV Youth Council in October
2011, representing 8 school of government presidents who themselves
formulated their council action plan.
FOR MANY ARE CALLED, AND MANY WERE CHOSEN.
The Santiago City local HIV and AIDS response is a good case in networking
and coalition building. It may have benefitted from the presence of the
GFATMR6 then, the continued functional existence of the coalition now is
proof that it works. There may remain a couple of challenges such as on
changing of the guards, improving the mob-booth, better targeting of
audience, profiling the vulnerable, maintaining a big pool of volunteer
(honoraria-based) peer educators and convincing catholic schools to
partner with the IEC, but there are 3 major lessons that only the Santiago
City experience can impart.
The value of foresight. Even when the coalition is yet unaware from where
specifically their HIV/AIDS challenge lies, they are united in their belief that
prevention is the best solution. And prevention is only possible if the
community is informed and educated. The coalition thus applied the
country scenario and designed IEC strategies that cater to the 15-29 age
bracket who comprise at least 20% of the city’s population. They decided to
bring the HIV and AIDS message to the schools.
Knowing as well the growing MSM trend in the Philippines, the city
government hopes to initiate an MSM friendly clinic and expand the access
to VCT by putting up a clinic in the public market area. To further lessen the
infection threats among EEWs, CHO feels that provision for alternative
livelihood projects for them should continue to be included in the annual
city budget.
Follow the Herd. The idea of putting up the mob-booth in densely
populated areas in the city and raising a huge number of signatures is a
good way to make noise for the HIV and AIDS campaign and make the
populace notice the cause at the same time. Indeed the coalition is right in
thinking that if the people do not come to you, you can always go to them.
Hold Hands. Due to the numerous requirements of Philippine laws on local
governments to create such and such councils, it is normal for LGUs to just
form the council and expect a lackluster performance. This is as
pronounced in the case of the creation of LACs since HIV and AIDS is not
viewed even by hotspot cities as an urgent problem they are ready to deal
with. Santiago City is thus noteworthy since even with just an Executive
Order and the zealous efforts of the CHO-SHC and the coalition partners,
they have made gains in increasing the level of awareness of their populace
on the concern.
Though the coalition members do not meet as frequently, the active
participation and strong support is evident. They may have to learn more
about direction setting, planning, institution building and local legislation so
they can properly formalize their coalition through an ordinance.
Santiago City can no longer return to the time when they were still ‘zero’
but they can surely do something to ensure that the present figure (5) no
longer increases. Deviating from the biblical words that follow the phrase
“for many are called”, in Santiago City, many were chosen. These chosen
ones, working together, will make that possible.
Ñ
Adolescence is characterized by adventure and curiosity. For Alexis Sarza
and a group of friends, their curiosity about a youth outreach program
which offered an out-of-town five-day seminar would take them on the
path away from alcohol, drugs, sex and crime and into a life of rescuing
teenagers from risky behaviour that will adversely affect their future.
Local government best practices and development plans have been known
to incorporate standards like child-friendliness or business-friendliness. It is
less familiar for local governments to strive towards being adolescentfriendly. Adolescence is a stage in a child’s life where self-discovery,
independence, and individual personality are important developmental
issues. Adolescence is a period of transformation and adventure which also
provides a wide opportunity for exposure to risky behaviour like vices,
sexual activity, and even social deviance. Whether a child successfully
transitions to adulthood largely depends on the adolescent’s family
situation and dynamics, the realities and stimuli in the immediate social
environment and access to support systems (government or nongovernment).
The City Government of Parañaque in partnership with civil society,
especially a self-help organization of at-risk teenagers, set out to provide a
more adolescent-friendly community for all teenagers. Their strategy would
involve even the most unlikely ally and open up opportunities for the city’s
youth to lead peers in living safer lives towards adulthood.
PARAÑAQUE CITY
Parañaque is one of the cities of Metro Manila (National Capital Region)
and is the first city that welcomes travellers who come through the Ninoy
Aquino International Airport. It is located in the southern part of the region
and bounded by Pasay and Taguig to the north and by Las Piñas and
Muntinlupa to the south. It is the sixth most populous city in Metro Manila
with a population of 586,322. Nineteen percent of the population is
between the ages of 10 to 19.
The city is mainly residential. It is where the country’s largest subdivision is
located. There are commercial and industrial activities along the South
Superhighway and major thoroughfares like Sucat Road/Dr. A. Santos
Avenue. The entertainment belt along Roxas Boulevard in Manila and Pasay
peters off on the stretch around Paranaque. There are also informal
settlements located around the residential developments and the
commercial corridors.
While Paranaque does not belong to the top 10 hotspots of HIV infection, it
is very close to hotspots like Manila and Pasay City. With the high mobility
within in Metro Manila, STI and HIV infections cannot be limited by political
boundaries.
BALUTI PROGRAM
Parañaque, together with Las Piñas and Taguig, is a pioneer of the
Adolescent Friendly Reproductive Health Services (AFRHS) Network in the
Philippines. AFRHS is an international network lodged at the Department of
Health which in turn had developed national standards on health services
for adolescents. The standards include making basic health services
accessible to adolescents, reduce teenage pregnancies and its
complications and reduce STI infections and its effects. There are also
interventions to reduce risky behaviour among adolescents like substance
abuse, violence, injury and mental health. Local health stations are the
principal implementers of this program while NGO partners are involved
mainly in capacity building.
Save the Children is an international network of NGOs which support and
implement programs that enable young people to adopt healthy attitudes
and behaviour regarding their health and development. In 2003, it reached
out to a group of teenagers in Barangay San Dionisio who were into risky
behaviour like substance abuse, drug pushing, and sexual promiscuity.
These 12 young people were invited to a 10-day out-of-town seminar. Their
motivation was just to have a change of scenery as one of their youthful
adventures. These twelve would eventually realize that they are being
offered the opportunity to change the course of their future.
The twelve trainees established BALUTI or Batang Laging Umiiwas sa Tiyak
na Impeksyon as a youth peer support group with Alexis Sarza as its first
president. The acronym also means “shield or armor” in Filipino—
reassuring the protective nature of the organization. BALUTI set out to
address early sexual debut, teen-age pregnancy, risky sexual practices,
sexually transmitted infections, HIV and AIDS. The organization uses various
strategies such as peer education, film showing, one-on-one counseling,
provision of free condoms, voluntary counseling and testing, and facilitating
community support for HIV and AIDS. A BALUTI outreach is conducted with
precise procedure but with a lot of first hand points of view from peer
counselors who were themselves at-risk teenagers. Since BALUTI’s outreach
aims to proactively affect the behaviour of at-risk youth, they monitor the
change in reproductive health attitudes and behaviour of each batch of kids
taken into its program.
BALUTI has a two-pronged approach to peer education. They both reach
out to youth in the community as well as youth in the schools. The peer
educators plan for interventions every six months. Youth who are taken
into the program within this period are considered as a batch. Target
communities are chosen due to severe poverty in the area (depressed
communities), a large youth population, and a large number of most at-risk
population (MARPs).
The BALUTI program has two levels. BALUTI Part I is a training program that
focuses on strategies for the general population of adolescents. This
includes topics on the UN Convention on the Rights of the Child, sexuality,
life skills and since 2010, also a spirituality module which is conducted by
speakers from the Parish of St. Andrew. This is normally a three-day
seminar-workshop. It is from Part I that the BALUTI peer educators can
scout for new peer educators who they can recruit to join their ranks.
Particularly for the outreach to MARPS in communities, one would likely be
invited to be a peer educator if he or she exhibited interest on BALUTI
activities; also a youth at-risk; and someone who exhibits leadership skills.
That is why some peer educators used to be gang leaders. On the other
hand, school-based peer educators tend to be sophomores or juniors, as
they still have more time to spend in school.
BALUTI Part II focuses on interventions for adolescents at-risk. This part
uses the “Give Me Five Communication Approach.” This covers five core
topics on substance abuse, teenage pregnancy, STI and HIV/AIDS, safer sex,
and voluntary counselling and confidential testing. This also involves five
action statements asked by peer counsellors in small group discussions or
even on a one-on-one basis which enables the participants to reflect on the
topics discussed. The five action statements are:
1.
2.
3.
4.
5.
Kumusta ka? (How are you?)
Alam mo ba? (Do you know?)
Ganito kasi yun (It’s actually like this…)
Ano sa tingin mo? (What do you think?)
Kita tayo ulit (Let’s meet again)
Part II normally takes two days. Afterwards, peer educators conduct
monitoring and reinforcement of positive behaviour through one-on-one
counselling, regular house visits and the use of a diary. The peer counsellors
would check the diaries at least once a week to ensure that the participants
are recording their behaviour.
Typically, even before the two-stages, peer counsellors and some
participants would undertake a “reality mapping” of their area. It is
composed of two workshops. Workshop 1, the at-risk adolescents are
asked what risky behaviour they have as well as the reasons for engaging or
not-engaging in these risky behaviours. Workshop 2 involves identification
of hotspots in the community map where these risky behaviour occur.
The program also seeks to have the communities provide a supportive
environment for the at-risk adolescents to reform themselves. The results
of the reality mapping are presented to barangay and homeowners’
association officials for appropriate action. Parents in the target areas are
also organized and undergo a three-day training on children’s rights,
technical support from health authorities, as well as dealing with their
children’s risky behaviour and being good role models.
FROM BASELINES TO VOLUNTEERS
In 2004, with support from the City Government of Parañaque, Save the
Children and Lunduyan Foundation, 50 peer educators were trained. They
focused on four sitios of Barangay San Dionisio working among gang
members, drug users, out of school youth and youth in prostitution.
Currently, BALUTI is operating in five adjacent barangays (San Dionisio,
Baclaran, San Isidro, Sto. Niño and La Huerta) and in five schools:
Parañaque National High School (PNHS), Baclaran High School, PNHS-La
Huerta Annex, Don Galo High School and St. Andrew’s Parish Alternative
Learning School.With additional support from the city government, BALUTI
was able to expand training for peer educators to six more barangays: San
Martin, Merville, Sun Valley, Moonwalk, BF Homes, and Vitalez. Peer
educators there have also set-up similar self-help organizations. The World
Health Organization and the AFRHS Network also invited BALUTI peer
educators to train new peer educators in the cities of Caloocan, Malabon,
Navotas and Valenzuela. With UNICEF’s support through funding and
workshops, BALUTI was able to use “The Power of You” video during school
and community outreach. From 2008 to 2012, BALUTI activities have been
supported by the MTV Staying Alive Foundation.
Shocking Back Stories to the Baselines
Each time an adolescent is admitted into the BALUTI program, he or she is
asked to accomplish two forms that serve as part of the baseline data for
their batch: the Adolescent Health Assessment Form and the BALUTI Intake
Form. The baseline survey points to smoking, alcohol drinking, drug use and
pre-marital sex as the main risky behaviour that adolescents engage in.
Gang wars, gambling and watching pornographic films are also constantly
identified. These may no longer be surprising realities in urban life.
However, according to Dr. Ma. Dolores Matias, BALUTI Mentor and doctor
at the San Dionisio Health Station, the stories behind these risky behaviour
tend to be more shocking realities. She recalled that one girl repeatedly
gave sexual favors to have coffee. She clarified that this was not expensive
coffee from famous coffee chains, but just plain instant coffee. Data from
the schools seemed more disturbing as there was one class that had half of
its students absent in one afternoon. Apparently, the absent students had
“bookings” as sex workers.
In one reality mapping exercise, the clean streets of a private subdivision
belie the drug use of some of its teenage residents. With the procedure of
reality mapping the peer educators were able to identify that there is a
particular roof top which is used for drug use sessions. Outputs from reality
mapping workshops are also presented by BALUTI to barangay officials and
homeowners’ association officers for their appropriate action. Even Msgr.
Manuel Gabriel, the former parish priest of St. Andrews, commends
BALUTI’s reality mapping outputs as an ingenious way of knowing the
community. The parish would eventually craft and jointly implement the
Spirituality Module for BALUTI Part I in 2010.
Volunteerism and indigenous development
BALUTI remains a volunteer organization. Its peer educators stay in posts at
health stations and have a permanent working room at the San Dionisio
health station. They are available for counseling or any health related
assistance that adolescents may need. Their presence in the health stations
reassures teenagers that there are peers in government health facilities
who will help them navigate the health services. This also makes health
services less intimidating compared to a system where they have to deal
with adults first. STI and HIV testing and even condom distribution is no
longer awkward. BALUTI also involves the youth under its programs in
community projects like community cleaning as part of an effort to reach
out to the community which often considers at-risk youth as nuisance. With
the help of the internet, peer educators continue to incorporate new tools
that will help them better communicate the aims of BALUTI. Some BALUTItrained peer educators who have formed separate organizations have been
involved in advocacies for reproductive health and other adolescent issues.
BALUTI’S SUCCESSES
From 2008 to 2012, BALUTI has reached 68,883 adolescents of Parañaque.
The end-line surveys and the monitoring (home visit and one-on-one
counseling) conducted towards the end of each intervention shows
significant results in behaviour modification. The consolidated data point to
a 138% increase in protected sex. There even seems to be a high incidence
of abstinence. Gang fights were reduced by 96% and drug use by 87%.
There was a 77% reduction in gambling, 68% in smoking and 61% in alcohol
drinking.
These results did not go unnoticed. In 2009, the Paranaque City
Government was awarded the Gawad Galing Pook for its adolescentfriendly health services much of which could be attributed to the initiatives
of BALUTI in cooperation with the LGU. In 2010, Paranaque and BALUTI
were given the CHAMP Award (Catalytic HIV and AIDS Mitigation Program).
This gave more prominence and attributed successes directly to BALUTI’s
response to STI and HIV/AIDS by proactively addressing risky behaviour and
building life-skills.
With the spotlight on its successes, BALUTI peer educators have become an
important resource for the outreach to teenagers on preventing HIV/AIDS
infections in the Philippines. BALUTI provides a speaker’s pool for the
AFRHS network which has taken some peer educators to trainings for
AFRHS implementers from Borongan, Eastern Samar; Tandag City,
Surigaodel Sur; Mountain Province and Ifugao; and Manila. Some BALUTI
peer educators also spoke at an AFRHS network conference in India. They
have also participated in the public consultations on the Implementing
Rules and Regulations of R.A. 10354 or the Reproductive Health Law and
the RH and Sexual Education program.
LEARNING FROM THE YOUNG
BALUTI has been engaged in an urban warfare against HIV/AIDS. Their
strategy is “winning the hearts and minds of adolescents” for them to leave
their risky behaviour and be more conscious of their health. The BALUTI
formula relies on the peer educator and his/her convincing power. Being a
former adolescent practicing risky behaviour, the BALUTI peer educator has
“street credibility” who can show a teenager that it is possible to change for
the better. A peer educator in this sense, is not just someone who comes
from the same age cohort, but is someone who has experienced risky
behaviour and can empathize with the emotional, social and family issues.
The BALUTI peer educator is a relatable person, but also someone who
cannot be easily fooled by manipulation or ruses. The “delinquents-to-role
models” approach has proven effective as the data showed that significant
behavioural changes were observed. In the baseline data, a reason
common to all risky behaviour was “peer pressure.” In this sense, this is
peer education versus peer pressure, with peer education winning.
Having a first person point of view, BALUTI counselors also devised ways to
battle with the stigma on at-risk adolescents. The choice of the term “baby
colognes” instead of a rather technical and impersonal “MARPs” shows this
concern for addressing that stigma. Baby colognes imply that these
teenagers need “tender loving care” which was a tag-line in a cologne’s TV
commercial. Forming the support mechanisms within the community is also
very important as the baby colognes make the difficult transition back to
healthy living. The capacity building for the Parent Adolescent Lifeline also
enables parents to sufficiently respond to the needs of their children. Even
the Church’s acceptance of and participation in the project, lends a lot of
credibility to BALUTI. In a certain sense, the stigma is wearing off with the
election of six BALUTI members during the most recent Sangguniang
Kabataan elections.
Volunteerism has both its advantages and pitfalls. While BALUTI relies on
the energy and commitment of its volunteers, there are other factors that
impede the volunteers’ full participation in the program. Peer
educators/facilitators who are still in school are unable to join some
activities of BALUTI. Volunteers have to balance personal/family life with
work or study as well as volunteer work.
It truly takes a village to raise a child. Adolescence is not the end of
childhood, it is its culmination and the crucial transition to a healthy and
meaningful adult life. For BALUTI pioneer, Alexis Sarza the AFRHS outreach
made him feel that someone trusted him again. He and his friends set out
to save the youth on which society has almost given up and transform them
as very relatable role models. It is this same empowerment that BALUTI
wants to impart to at-risk adolescents in Parañaque and beyond.
Port cities are one of the most vulnerable to exposure to HIV infections
because of the high traffic of arriving and transiting humans. Risky
behaviour between transients and the local population provide a ripe
situation for the spread of anything contagious or infectious. While the
Philippines admittedly has very porous borders, Zamboanga holds a unique
situation as the only major urban center that is close to the country’s only
near-land border. This makes it an important city in the Philippines’ quest
for economic integration with the rest of Southeast Asia. This also makes it
the Philippines’ backdoor, which adds more complex variables to its nature
as a port city.
Every city has its own red light district. Whether sex is being traded in its
entertainment establishments, it has always been a cat-and-mouse game
between law enforcement and the sex traders. While local governments
are expected to enforce laws against prostitution they also have to look
after the over-all health status of the population in its jurisdiction. This is
thin line that implementers of local HIV/AIDS response have to walk in
order to protect everybody in the city—transient, refugee or local.
Local governments hardly play any role in defending the nation’s borders.
However, HIV/AIDS do not know any international borders. Local
governments like Zamboanga face the challenge of a global epidemic with
local strategies and local means while facing the realities of a shrinking and
highly globalized world.
ZAMBOANGA’S CHALLENGE
Zamboanga is a highly urbanized city located at the south-western part of
the Philippines. It is the Philippines’ sixth most populous city and the third
largest in terms of land area. Its total population in 2010 is 859,595 living in
1,483.4 square kilometres of land. Thirty of its barangays are urban and 68
are rural—10 of which are island barangays.
Zamboanga City is bordered by the territories of the provinces of
Zamboanga del Norte and Zamboanga Sibugay to the north and Basilan to
the south. The city is also located on a narrow channel that connects the
Moro Gulf and the West Philippine Sea (South China Sea). Zamboanga is the
Philippine’s main urban center for the Brunei-Indonesia-MalaysiaPhilippines East Asia Growth Area (BIMP-EAGA). Zamboanga is considered
the “backdoor of the Philippines” as this is the main transit point to
Southeast Asia after Manila. Migrants (legal or undocumented) often enter
Zamboanga as they island hop through the Sulu archipelago into Malaysia.
Zamboanga is also the reception area for deported Filipino workers from
Malaysia’s Sabah state. The city also lies at the cultural boundaries of
Christians and Muslims in Mindanao. Christians comprise 73% of the
population while around 27% are mainly Muslim and from other faiths.
Zamboanga City is also the regional education centerof Region IX –
Zamboanga Peninsula (including the BASULTA sub-region of the
Autonomous Region in Muslim Mindanao). This increases the youth
migrant population as college-age cohorts flock to the city for tertiary
education.
Furthermore, there are three large military installations in the city: the
Southern Command, Edwin Andrews Air Base and the Naval Station Romulo
Espaldon. Zamboanga is also host to American troops participating in the
Balikatan exercises under the Visiting Forces Agreement. Military
installations tend to attract multiple sexual partner practices of uniformed
personnel who often go off-base for recreation purposes.
Its geographic location close to neighboring countries with high HIV
infections, the region’s porous borders and the high transient population
combine to increase the city’s vulnerability to exposure. In fact, the first
two cases of HIV infection was detected from two Filipino immigrants
returning from Malaysia.
Being a highly urbanized city, Zamboanga has its sizeable number of adult
entertainment establishments which become hotspots for possible
infection. Because of these hotspots, high risk groups can be found in these
establishments most especially male and female sex workers and clients of
sex workers. However, the most at risk section of society are the “Men
having sex with men” (MSM) which comprise 73% of HIV cases in the city.
Seventy percent (70%) of infections happen among those aged below 35.
THE PARTNERSHIP PROGRAM
In 1996, Zamboanga City was chosen by DOH as one of the sentinel sites in
the Philippines for the USAID’s HIV surveillance project. After some
surveillance in the interim years, the “Effective Partnership for an AIDS-Free
Zamboanga was begun by the City Health Office (CHO) of Zamboanga City
during the term of former Mayor Maria Clara Lobregat and the Human
Development and Empowerment Services (HDES), an NGO.
Established in 1998, HDES is the Zamboanga implementer of USAIDsupported health projects focusing on high risk groups (i.e. female sex
workers, men having sex with men, male and female sex workers,
customers and injecting drug users). It began with a community outreach
and peer counselling program for street children and urban working
children. HDES covered most of the HIV prevention component which
included conducting lectures, learning sessions, information and education
campaigns, etc. On the other hand, the CHO took charge of behavioural
surveillance and testing. The organization also implemented components
on Barangay Legal Action Against Child Prostitution (BLAACP) which paved
the way for the creation of Barangay AIDS Councils in 10 barangays. This
became the impetus for the establishment of the Zamboanga City MultiSectoral AIDS Council (ZCMSAC). Being the only active NGO on the issue of
HIV/AIDS, HDES became the NGO representative in the ZCMSAC.
The program aims to (1) heighten the awareness and knowledge on STIHIV/AIDS through IEC and advocacy; (2) intensify disease detection, early
diagnosis, treatment, counselling and referral; (3) develop responsive local
policies, plans and programs to help prevent the spread of STI-HIV/AIDS; (4)
conduct surveillance of target groups; and (5) strengthen linkages between
different sectors and continue to seek additional resources.
ZCMSAC AT WORK
Formalizing the multi-sectoral approach. The HIV-AIDS response in
Zamboanga City began as a collaborative program between the city
government and a specialized NGO. However, HDES also pushed for a
multi-sectoral approach by involving more stakeholders by establishing the
Zamboanga City Multi-Sectoral AIDS Council (ZCMSAC).
The ZCMSAC was created under City Ordinance 234. The members include
the City Mayor (or his/her representative as chair); Chair of the City
Council’s Committee on Health and Sanitation Committee and Committee
on Women and Family Welfare; and representatives from various sectors
(Government; NGOs; Civic clubs; Education; Media; Medical Profession;
Youth; Business and labor; Gay; and Religious sector).
Among the members of the ZCMSAC include representatives from the
Zamboanga Entertainment Association (ZEA)—later named as the
Association of Partners for an AIDS-Free Zamboanga or APAFZ. ZEA or
APAFZ is the umbrella organization of entertainments establishments in the
city. Members include individual proprietors of entertainment stalls as well
as members from the 22 KTVs from the Shindig Stall Owners’ Association
and 15 KTVs from the Parklane Plaza Stall Owners’ Association. In 2001, this
sector only had one representative in the council. Starting 2003 there have
been two or three representatives who sit in the council.
The cooperation from these entertainment business owners is key to
preventing infections in one of the hotspots of sexual contact. Owners,
managers and entertainers are required by ordinance to attend accredited
seminars on STI/HIV/AIDS every six months. The permit/license to operate
is tied to this requirement and no establishment will be allowed to operate
without the verification of compliance to this requirement. Each
establishment is further required to have at least one trained peer educator
and register entertainers and employees under its employ at the CHO. The
ordinance also pushes for the 100% use of condoms and mandates weekly
medical examinations of entertainers and others in similar occupations.The
ordinance also enumerates prohibited acts in entertainments
establishments (Article IV) which includes prostitution, exclusive spaces,
lewd shows, child labor, and trafficking.
Clear complementarity. Junpicar Daluz, former Project Manager at HDES,
said that the City Government of Zamboanga acknowledges the
complementary role of HDES in responding to STI/HIV/AIDS. While the local
government is focused on implementing the provisions of City Ordinance
234, HDES continued to work on its projects while working with the LGU
and ZCMSAC. From January 2006 to October 2007, HDES implemented
donor-funded projects that targeted high risk groups, injecting drug users
(IDU), and street and urban working children. HDES also played key roles in
crafting IEC/advocacy materials and activities which included versions in
Chavacano which were distributed to target populations, entertainment
establishment owners and the general public (through the barangay health
centers). HDES’ main role in the program is training peer educators through
the Indigenous Leader and Outreach Model. Peer educators are members
of at-risk populations who can empathize with peers and also help as
models of reformed behaviour that leads to preventive health practices.
HDES and the CHO both operate outreach centers in the entertainment
districts. The spaces were provided by the ZEA/APAFZ.
According to Dr. Kibtiya Uddin, Physician at the Zamboanga City
Reproductive Health and Wellness Center, HDES was crucial in reaching out
to injecting drug users (IDUs). This group perceived the City Health Office as
a spy for law enforcement which impeded the CHO to directly engage
them. HDES stepped in through its peer educators and was eventually able
to teach IDUs how to avoid infection through sharing of needles.
As a consequence, the City Health Office’s resources were geared towards
more resource-intensive, free laboratory testing and analysis, STI
treatment, monitoring and evaluation, and the maintenance of outreach
posts (including maintenance of facilities and salaries of employees).
Acting together, the LGU has involved HDES as a member of ZCMSAC’s
monitoring, surveillance and rescue arm, “Task Force Buenas”—a body that
conducts inspections of all night spots to monitor the compliance of the
necessary business permits, sanitary and health laws, and safety and
security measures under the Building Code and other relevant laws and
ordinances. The inspection team is composed of the City Administrator
(Chair), City Health Officer (Vice Chair), and the City Treasurer’s Office, City
Police Office and HDES as members. The CHO issues a “Pink Card” which
reflects the history of a sex worker’s mandatory weekly health checks.
HDES is also a member of another team of Task Force Buenas that conducts
rescue operations for minors employed in entertainment establishments,
testing for registered female sex workers and freelance sex workers. This
group is composed of the CHO’s Social Hygiene Clinic, Commission on
Human Rights and the city’s City Police Office, and Social Welfare and
Development Office.
APAFZ’s duties were clear and simple. They were expected to constantly
remind members of the LGU’s policy. Establishments were reminded to
comply with three main policies: (1) no minors working in the
establishment; (2) condoms should be available in the establishment; and
(3) no infected worker should be on duty. Violation of any these three may
lead to the closure of the establishment. Having an umbrella organization
do the legwork of the advocacy, enables the LGU to focus on enforcement
and treatment.
Organizing at-risk groups. Several organizations were organized since the
program began. These organizations were the conduits for projects that are
specific to the needs of their particular group. Aside from ZEA/APAFZ,
among those organized were the:
1. Barangay Council for the Protection of Children – aims to help
combat child prostitution, child trafficking, and STI/HIV-AIDS
infection
2. Asosasyon ng mga Batang Lansangan sa Zamboanga – an
association of sexually exploited street children under sixteen
3. Asosacion de las Estrellas de Zamboanga – a group from the gay
sector which produced the “Gay batu?” localized IEC support
material.
4. Mariposa de Zamboanga – a group of gay, bisexual and
transgendered who conduct school advocacy activities and a
beauty contest, “Ms. Mariposa,” as part of the ZCMSAC’s advocacy
program for MSMs.
5. Shindig Stall Owners Association (SSOA) – later integrated with ZEA
to form APAFZ.
6. Vida Vivo Zamboanga – support group of Persons Living with HIV
Targeted interventions included the organization of the annual Señorito y
Señorita de Salud as part of activities for World AIDS Day. Participants come
from different colleges and universities in Zamboanga. In 2010, 500 social
media users were on-board an online group that leads the cause for “Take
the Test, Take Control (HIV).”
OPENING DOORS TO GOOD PRACTICES
Surveillance database. Since the detection of the first HIV infections in the
city in 1995, data on HIV infections in Zamboanga became more accurate
with the establishment of ZCMSAC. From 2003 to 2013, the Reproductive
Health and Wellness Center or RHWC (formerly called the Social Hygiene
Clinic) had registered 68 new infections at an increasing rate. According to
Dr. Uddin, this may be attributed to more at-risk people coming for testing
and better detection due to close monitoring. The analysis of the registry
points to the most at-risk sector in the city.
HIV Cases by Client Groups
Men having Sex with Men (MSM)
Client of Sex Worker (CLSW)
Female Sex Worker (FSW)
Partner of Injecting Drug User (IDU)
Others
Total
Number of Cases by Age
(at time of diagnosis)
15-24
25-34
35-44
45-54
Total
No.
51
5
3
1
10
70
No.
24
25
19
2
70
%
72.9
7.1
4.3
1.4
14.3
100
%
34
36
27
3
100
Source: RHWC, City Government of Zamboanga (2013)
Forty-four (44) of those infected were residents of Zamboanga City while 26
were transients. Twenty-five (25) cases are returning migrants (17 of which
came from Malaysia). Unfortunately, 16 cases ended in 16 AIDS deaths.
In general, there is less than one percent HIV prevalence among MARPs and
the general population. Among MSM the HIV prevalence is at 1.33%. STI
prevalence is at 12%.
Enforcement. Task Force Buenas has recommended the closure of at least
17 entertainment establishments which were caught violating provisions of
City Ordinance 234. Beginning in 2006, the task force’s operations rescued
the following number of persons.
Year
2006
2007
2009
Number of
rescued persons
140
5
41
9
Sector
Sex workers
Trafficked women and minors
Female sex workers and MSM
Minors from videoke bars
Source: RHWC, City Government of Zamboanga
Awards and recognitions. Probably the highest recognitions that the City
Government of Zamboanga has received are from the Gawad GalingPook
(GGP) Foundation. In 2005, the “Effective Partnership towards an AIDS-Free
Zamboanga City” was given the GGP’s Trailblazers Award. The following
year it was given a Special Citation on Local Capacity Innovations for the
Millenium Development Goals #6: Combat HIV/AIDS. These recognitions
have paved the way for the city government to access donor funding like
the USAID’s Health Governance Project, UNICEF project for prevention of
STI/HIV-AIDS infection for pregnant women and children, and the Global
Fund Rounds 5 and 6 for MARPs, migrant workers and Persons Living with
HIV (PLHIV). In 2010, the DILG awarded Zamboanga City with the HIV
CHAMP Award.
The city government has hosted delegations from other local governments
as well as international groups from Thailand, Sri Lanka, Iran, Indonesia and
Malaysia who would like to learn from their experience.
Continuing challenges to implementation. According to the CHO, there are
hard to reach at-risk groups—specifically freelance sex workers (FSWs). The
program is able to reach out to FSWs in the streets but FSWs in schools are
hard to reach. The solution was to conduct IEC/advocacy activities in
schools. However, direct contact may be hard to come by as voluntary
disclosure of their status as an FSW may not happen while the outreach
personnel are still in campus. In addition, closeted gays are also difficult to
reach. While closeted peer educators have been trained, engagement
depends largely on an awkward secret disclosure that one is gay.
Dr. Uddin adds that the protocols for sex workers in Zamboanga tend to
drive sex workers who lack documentation (as simple as birth certificates
which are required before registering at the CHO-RHWC), to leave
Zamboanga for a third location. Because such a sex worker has not been
profiled or checked by the CHO for infection, their mobility may aid in
spreading STI/HIV/AIDS to neighboring provinces.
The returning migrant workers and deportations from Sabah, Malaysia still
pose a threat that the LGU can address only at a limited scale. Many of the
returnees are local residents and easily integrate back to city life. The
ZCMSAC has no control over preventive action, or the lack thereof, in
Malaysia.
Finally, because the program also relies on non-government initiatives and
actions, the nature of HDES’ project-based funding poses a slightly
annoying disruption of HDES’ services. However, the city government is
more than willing to adopt HDES’ peer counselors as voluntary health
workers during periods of funding gaps.
LESSONS FROM THE BACKDOOR
Champions are key. The Zamboanga City Government had to come to
terms with the fact that it was one of the 11 most at-risk cities in the
Philippines. The confluence of realities pointed to the need to respond to
the problem of HIV/AIDS from abroad which puts the local population at
risk. The detection of the first two cases from Malaysia yanked the city
government to act with some persistent prodding from a non-government
organization.
Since Mayor, Maria Clara Lobregat began the program, her successors Celso
Lobregat and Isabel Climaco have fully supported the anti-STI/HIV/AIDS
activities in the city. Incumbent Mayor Climaco began as the program’s
champion during her term as city councilor. HDES’ lobbying for formal
intervention from the local government paved the way for policies and
strategies that have institutionalized the roles and expectations from the
various sectors in jointly combating STI/HIV/AIDS. While the CHO and
ZCMSAC will remain as permanent champions for the program, they are
continuously building champions from among the at-risk groups.
Navigating moral and legal dilemmas. Prostitution remains illegal in the
Philippines. However, local governments and local health policy has to
tread carefully between acknowledging the reality that legal business
establishments (entertainment stalls, massage parlors, even movie
theaters) hosts sex workers and risky sexual encounters and the fact that a
sexual profession cannot be given any legal recognition. Conditions on
sexual protocols imposed on business establishments acknowledge a de
facto existence of sex-for-pay in these establishments. But in an effort to
stop a more urgent problem of an HIV epidemic, law enforcement gives
way to the practicalities of a public health intervention. Moreover, even
religious leaders come to an accommodation of these interventions in
order to stem the spread of a disease. Catholic, Christian and Muslim
representatives sit in the ZCMSAC and lead ecumenical prayers during
World AIDS Day activities.
Sharing the legwork. The PNAC template for HIV/AIDS response includes a
multi-sectoral approach through the establishment of a local AIDS council.
However, as an additional special body, the LAC may be doomed to suffer a
similar fate as other local special bodies—officially constituted but hardly
functional. Operating by committee is always a challenging task because
one has to manage the different perspectives on tackling a problem even if
members are all like-minded or are driven by a singular cause. In the case
of Zamboanga, the CHO and other LGU departments gave the NGO and
community partners a bigger role in reaching out to at-risk groups for the
preventative component of the program. Because the LGU is still
considered as a law enforcer, the non-government partners were able to
engage the target groups and pave the way for government to reach out.
Faced with a daunting task of HIV/AIDS infection that has an international
dimension, the multi-sectoral approach employed by Zamboanga City
offers a model that emphasizes complementarity not only in planned
situations but also in situations that arise from unexpected circumstances
like engaging hard to reach at-risk groups or providing stable funding or
resources. This enabled the efficient use of scarce resources which led to
the promising achievements so far. The continued expansion of the
network of peer educators and the organizing at-risk groups ensures a wide
base for institutional memory and develops a new set of champions who
can continue to advocate for more responsive policies and interventions as
well as provide a pool of collaborators and community mobilizers.
All good managers are familiar with the story of anybody, everybody,
somebody and nobody. As the story implies, if everybody could do it, most
of the time nobody does it. This fortunately does not apply in the case of
the Province of Aklan. In Aklan, it is everybody’s business. Everybody
worked to respond to the growing threat of HIV and AIDS in the locality.
AKLAN, TOURISM, HIV AND AIDS
Aklan, a province with about half million population (2010), is the heart of
tourism in Western Visayas. It is composed of 17 municipalities with Kalibo
as its capital. It is best known for Boracay Island, with its world renowned 7
kilometer white sand beach. In 2012 alone, it welcomed in its shores more
than 1.2 million tourists, earning for it Php 26 billion in receipts. For the
past twelve years, the average annual growth rate of tourist arrivals is at a
minimum 15%.
It was in 2001 when the province learned about the first recorded case of
an Aklanon infected with HIV/AIDS. In the span of 13 years, there have
been 36 registered cases, 8 of whom have passed on. Compared with the
numbers for the region, Aklan’s cases represent only about 11% of the
Western Visayas total. But the stealthy and undeniable sex trade concealed
in the entertainment establishments and the changing lifestyle choices of
homosexual members of the community, makes the province a hotspot for
HIV and AIDS.
The virus transmission is primarily thru sexual activity. Some are from men
having sex with men (MSM), others from those practicing multi-partner sex
or even ‘trip’ sex. Some infections originated from OFWs.
Areas in the province with a busy night life are considered the critical spots.
More or less these are in 3 municipalities where the number of night
establishments is maintained, if not on the rise. These are in Kalibo, Malay
and Nabas.
If the rate of STI infections were to be the measure of the eventual picture
of HIV and AIDS cases in the province, the scenario would be a bleaker one.
For the past 3 years, of the annual average number of clients availing the
tests (1,900), an average of 31% are found to be positive from STI. The
infection range levels can go from 27% to 38%.
It is advantageous then for Aklanons that they have 9 government and 4
private hospitals. However, only 1 public hospital is level II while the rest
are level I. Nevertheless, among the privately owned ones are 2 level II and
1 level III hospitals.
COLLABORATION, BY THE DOZEN
APAC Formation. Aklan’s Provincial HIV and AIDS Council (APAC) has 20
member institutions which have been working on HIV and AIDS for the past
12 years. The formalization of these organizations’ membership to the
council came only in 2006. Their own HIV advocacy and prevention efforts
have started as early as 2001 though, and oftentimes in partnership with
the provincial government.
Sometime in 2001, the Provincial Health Office (PHO) and the Butterfly
Brigade (BB), a peer educators’ organization, began toiling on IEC and
advocacy. It took five more years before Governor Carlito Marquez penned
Executive Order 16 that created the APAC and defined its membership. The
formal pronouncement may partly be attributed to the presence of UNFPA
in the province then, as it was a partner in a Reproductive Health program.
Expanding Membership. So by 2006, national government agencies like
DepEd, DOH, PNP, TESDA, DOLE, DILG, DOJ, PIA and even the President of
the LMP Aklan became council members. Others institutions not yet
mentioned but are represented in the technical working groups are the Dr.
Rafael S. Tumbokon Memorial Hospital (DRSTMH), League of Midwives in
the Philippines (President), and representatives of health offices of two
municipalities (Makato; Malay). Of course, relevant offices in the provincial
government were likewise included in the membership like the SWDO,
PPDO, Tourism Office, and Sangguniang Panlungsod (Health Committee).
In 2009, a non-stock, non profit, non-sectarian and humanitarian
organization working on children’s rights was added as a new member
(Abante Aklan, Inc.). A year after, local media (Aklan United Media
Association) and an Iloilo-based youth organization (Kabataang Gabay sa
Positibong Pamumuhay) were the new additions. By 2011, two more joined
APAC (Aklan Chapter of the Philippine National Red Cross; Youth Aklan).
The Aklan State University and Aklan Medical Society are also active council
partners.
Motivations for Membership. Many of the APAC members come from
agencies mandated by law. But many from the civil society organizations
(CSO) volunteered. Unlike in other areas where membership in the local
AIDS council is considered a ceremonial task, APAC membership has its
incentives. CSO members (e.g. Abante Aklan, Butterfly Brigade, Youth
Aklan) joined APAC for four reasons. One, membership is a way to show
their concern for the plight of PLHIVs. Two, the council offers avenues to
forge partnership and to network with other organizations based in Aklan.
Three, as a result of partnerships, these organizations have widened their
reach not only in the populace but with other municipal governments. Four,
the council is a way for the CSO community targets to understand that they
can be active partners and not just passive beneficiaries of STI/HIV/AIDS/TH
programs.
Expectations from Members. The multi-sectoral members of APAC have
committed themselves to contribute to IEC and advocacy, capability
building, outreach and organizing, and mentoring and referral services.
Concretely, this means that they would initiate awareness-raising activities
within their organizations/communities and partner in the APAC program
implementation. They are also expected to look out for potential peer
educators in their own organizations and actively engage in information
dissemination and referral. If workable, they are expected to share some of
their resources say for the production and reproduction of IEC materials
should these be distributed to their own organization members. Finally,
they are expected to participate in the annual World AIDS Day (WAD)
celebration.
The Collaboration. From 2001 up to 2006, APAC has focused its efforts on
awareness raising, advocacy and the development of info-materials for
dissemination. It has also been the period of council membership
expansion, formalization and competency building (especially on
collaborative project management, documentation, capacity building).
From then on, APAC has worked towards mainstreaming of services and
integration of efforts. It has also lobbied for important policies like the
100% condom use policy.
In terms of project management, PHO convenes APAC quarterly. Council
members undertake program planning, project reporting and work
consolidation during these meetings. Once the plans are set, council
members understand that task assignment follows. Members therefore
make commitments as to what their institutions can contribute.
Partnership in program implementation is explored. The meetings do not
only serve as a venue for sharing of responsibilities but as an opportunity
for the council members to bond.
Shared Leadership for Concerted Action. The quarterly meeting is an
important practice. Without it, APAC members would not be able to tie
their individual initiatives and convert them into a concerted program.
Without it, redundancy and inefficiency would be unavoidable. The WAD
celebration can illustrate this. During the WAD, each organization has its
own plan for the celebration. These plans are presented at the APAC and
are woven together as one integrated plan. At the end of the celebration
preparatory meeting, the weeklong schedule that ties all the organizations’
activities together is finalized.
In APAC, consultation is practiced. Ideas are solicited. Decisions are based
on majority rule. Work assignments are not imposed. Rather, APAC
members are free to accept or decline task assignments or activity support
requirements.
SNAPSHOT OF 3 CSO MEMBERS
Among the APAC members, three stands out. Abante Aklan, Inc; Aklanon
Butterfly Brigade; Youth Aklan.
Abante Aklan, Inc. (AAI) is a child-focused non-sectarian organization that
was organized in 1999 and registered with SEC in 2000. As of 2012, it has
6,400 members from 62 covered communities in 6 municipalities in Aklan
(Altavas, Batan, Madalag, Malinao, Navas, Tangalan). In 2002, it signed a
stewardship agreement with World Vision to become its local partner in
the province. In 2009, it was accepted as a member of APAC when it
signified its interest to become a council member through a letter
addressed to the Governor. AAI works on stigma reduction and awarenessraising on HIV and AIDS on its served communities.
Aklanon Butterfly Brigade, now known as the Peer Educators Council (PEC),
was tapped in 2001 by PHO to be its partner for STI/HIV/AIDS prevention
for the gay community. It strongly advocates for Reproductive Health,
gender awareness and STI/HIV/AIDS prevention and control. The Butterfly
Brigade originated from another organization, SUBEAK, which means to
shine through. SUBEAK with its 75 members was formed to advance gay
men’s rights in Aklan. The members of the Butterfly Brigade can initially be
treated as the RH/health arm of SUBEAK. The two eventually formed two
organizations, with SUBEAK currently working on expanding its
membership to accommodate lesbians and the Butterfly Brigade
metamorphosing as the PEC of the APAC. The peer educators compared
themselves to butterflies because they feel that they had overcome the
cocoon/forming stage and are already unfurling their wings to attract
people to the message they spread about STI/HIV/AIDS.
Youth Aklan is primarily composed of 13 organizations from secondary and
tertiary schools. They represent the 10-24 year old population and are
expected to mobilize the young people of Aklan. Through their advocacy,
peer counseling, blood donation drives and other outreach activities, the
organization intends to reach young Aklanons and inform them about the
HIV issue. They were tapped by the PHO because the city government felt
the need to involve the youth sector given the general trend of young HIV
infections across the country. Specifically, Youth Aklan is expected to
mobilize youth volunteers during yearly school–based orientations and HIVAIDS awareness activities including WAD.
HIGLIGHTS OF SELECT PRACTICES
Information Generation and Campaigns. APAC members see the
importance of getting the right information and delivering correct
messages across. This is why kapihan for the Media (on HIV and AIDS) is a
regular activity, IEC and advocacy engagements with the respective
community targets of Aklan Youth and Butterfly Brigade is undertaken
annually, and the conduct of relevant studies are encouraged (see boxed
discussion at next page).
APAC regularly sends available PHO staff to the council member
organizations to present the HIV and AIDS situationer in Aklan and to raise
employee awareness. Orientation activities in secondary and tertiary
schools are also regularly offered, with Youth Aklan, Peer Educators Council
and PHO serving as resource persons. These kinds of information drive are
undertaken year-round. PEC and Youth Aklan likewise maintains facebook
accounts, specifically set-up to further disseminate information and as a
venue for interaction.
WAD, a December main event. WAD is APAC’s peak activity. Given the
numerous activities of the members for the WAD, the one-day celebration
was transformed into a weeklong event. This results then in heightened
awareness in the province
and is already an
Aklan State University encourages its nursing students to
undertake HIV/AIDS-related research for their undergraduate
anticipated activity every
thesis.
year.
In 2012, WAD activities
include school-based
orientation tours, a youth
camp, quiz bee and
poster slogan contest,
MDG best practices fair
and info-tainment among
other things. This 2013,
the highlight is the WAD
beauty pageant aside
from the red ribbon
campus tour of 21 tertiary
and secondary schools.
One study looked into the risky sexual behaviors among
selected college students (16-22 years old). The study found
that the factors that influence students’ engagement in risky
sexual behaviors are peers, lover, curiosity, intoxication with
drugs and alcohol, personal problems and media. What the
students consider as risky behaviors are non use of condoms,
one-night stands and multiple sex partners.
Another study revolved around the reproductive tract infection
commonly experienced by male teachers in the province. The
study examined the socio-demographic characteristics of 23
teachers and the factors influencing their perception on STI.
Some of the interesting findings are (1) half of respondents are
within 30-39 year old range; (2) half are married; (3) 60% earn
Php14,000-20,000 per month; and (4)almost all Catholics. As to
their perception, the teachers shared that having multiple sex
partners and improper genital care may lead to infections.
Clearly targeted
programs. The initial reaction when the local government learned of the
first infected case was to pay attention to the regulation of entertainment
establishments. PHO thus monitored the health of the establishment
employees/night workers in 4 towns (Kalibo, Boracay, Ibajay, Nabas). The
No Pink card, No duty Policy was imposed. For massage and
bar/entertainment establishments, night workers are asked to undergo
weekly STI check-ups and testing. Pink cards are issued to them once found
negative but if infected, treatment is required by the Social Hygiene Clinic.
A related institutional policy is on permit requirements. For new
entertainment establishments, the owner or floor manager must attend an
orientation at the SHC. New employees (called CSWs or commercial sex
workers) on the other hand are asked to submit pictures, NBI clearance,
birth certificate, resident certificate and relevant laboratory results before
they are given their pink cards.
Gram staining services is scheduled on Mondays and Tuesdays (2013), with
specific establishments clearly scheduled on which days. The clinic also
keeps a tally of the number of GROs (guest relations officer) in each
establishment and the corresponding number of employees with positive
smearing.
The other clearly targeted program is for the MSM. From a 2002 behavior
study among MSM, the Butterfly Brigade and PHO proposed to DKT
Philippine’s NGO/LGU Support Program the conduct of a capacity building
program and the design and reproduction of customized IEC materials on
HIV and AIDS. The program ran for 10 months. It was followed by a 2003
UNFPA-funded training for MSM.
These proposals to raise the level of awareness of MSM on HIV and AIDS
received immediate action given the dismal picture painted by the 2002
behavioral study. Interviewing 70 respondents, the study found that less
than 1 in 3 have heard of HIV and AIDS, 7 out of 10 have misconceptions on
condom use and safe sex, and more than 7 out of 10 only have limited
access to RH information and services.
The creation of the Provincial
Peer Educators’ Council (better
known as Butterfly Brigade) in
2001 continues to be one of the
most promising initiatives the
provincial government has
undertaken to address the HIV
vulnerabilities among the gay
community. Through the council,
Butterfly Brigade organized the first Ms. World AIDS Day
(Ms. WAD) Pageant this 2013. The 15 candidates were
asked to participate in HIV and AIDS advocacy pictorials
in public areas like terminals, gasoline station, market,
shops and shopping center, talipapa and park. The
candidates also visited schools as part of the school
caravan. During the pageant night, the audience were
asked to pay P15 as entrance fee and were given red
ribbons. Pageant proceeds will be used to fund BB’s HIV
and AIDS related programs for 2014.
APAC is able to maintain a pool of peer educators. Through PPEC or PEC,
the gay community has been able to harness their energies and creativity
for a good cause, e.g. through peer education mobile theater; interactive
multi-media presentations , production numbers, WAD beauty pageant. All
the initiatives of the PPEC on IEC fall under what they coined as InfoTainment.
PopShop Franchise. In 2005, the province through its health officer entered
an agreement with one inter-local health zone (I-B) in Makato Municipality
to acquire a DKT Popshop franchise. A PopShop is a small, easily identifiable
vending machine that releases RH products (condoms, pills, depot) of
specific brands. It was acquired through UNFPA support and is set up at the
Social Hygiene Clinic.
Seven municipalities eventually accommodated a PopShop franchise, with
an initial capital requirement of P10,000. Though it made population
control commodities accessible and available, it was thought to support
commodity/brand reliance and was later discontinued.
Two-way Referral System. Referral slips are available at the barangay
health centers and municipal health offices. The slip is to be filled at the
origin health office and submitted by the client to the provincial hospital in
availing services and medicines. The hospital returns a portion of the slip to
the client, which he/she should return to the origin health office. Based on
the 2012 AOP though, PHO is still targeting at least 50% facility
implementation of the system and the manual is already made available to
the health offices.
Butterfly Brigade has its own contact tracing, two-way follow through
referral system through a partner notification card.
Increasing Accessibility. APAC provides technical assistance to municipal
health offices to facilitate the creation of municipal AIDS Council.
Complementing this is the conduct of orientation for local chief executives
so they can be recruited as advocates and partners of the cause. In this
way, the provincial government is bringing the program down at the
municipal level and is a way of increasing access to services of PLHIVs who
may be living in the outskirts of the capital town.
Another way of increasing access is the installation of a satellite treatment
hub at DRSTMH manned by HIV and AIDS Core Team at the hospital. A
satellite clinic is also available in Boracay island.
On a different access point, the PHO published in 2011 a collection of best
practices guidebook. It compiled the good health practices of the local
governments in Aklan to serve as reference material for other local
governments intending to replicate these practices or for those interested
to seek technical assistance.
RETURNS FOR AKLAN
If the collaborative engagement were paralleled to a business venture, how
would the business fare in terms of returns? Here are some of the gains of
the province of Aklan for all its efforts since 2001.
One, APAC’s organizational growth. The Council reached a wider audience
due to its more diverse and wider membership that keeps on getting bigger
across the years.
Two, regular reporting. The multi-sectoral and strategic partnerships
formed as an offshoot of APAC membership contributes to referrals and
regular reporting to SHC of discovered cases.
Three, continuing commitment. Attendance to quarterly meetings of APAC
members are still at a high 80% average. Plus, though each organization
takes the lead in their own HIV and AIDS programs, they find it necessary to
collaborate with the PHO and integrate their plans with the rest of the
plans of the other APAC members.
Four, presence of peer educators in all municipalities. As of 2011, there are
165 gay peer educators distributed in the 17 municipalities. The pool is
maintained even with the turnover of previously trained educators since
about 30-35 new ones are recruited each year.
Five, only 4 remaining municipalities are without local AIDS councils - in
Libacao, Balete, Banga, New Washington. Twelve finished setting up their
councils, with the technical assistance of the province.
Six, higher service demand. There’s a ripple effect on the demand for
orientation from schools, barangay legislators, law enforces and even some
religious organizations. This is reflected in the annual school tours during
the WAD celebration. The same is the trend for services from testing
centers. Perhaps because more people are reached by the advocacy
activities and info-tainment, the number of visits in the satellite clinics is
increasing.
Seven, small budget but big activities. The annual budget of APAC from the
provincial government is more or less around P365,000. Compared with the
scale of APAC’s programs, this amount would not be able to finance the
concerted action if not for the commitment of council members.
Lastly, full service package. Prevention to embalming services are made
available.
These returns and the stories behind them are what the local governments
of Nueva Vizcaya, Ifugao and CARAGA are interested in when they visited
the province as a lakbay-aral site on HIV and AIDS programs.
CHALLENGES AND LESSONS
Challenges. Outlined here are some of the remaining concerns to be
resolved.
Stigma. Even among hospital staff, this is a concern. There seem to be a
lack of understanding on the issue even among medical practitioners. They
need to be oriented and re-oriented on the guidelines and standard
precautions. For potential clients, SHC felt that there is a stigma in taking
the test. People are discouraged from getting tested since people
automatically assume that one is HIV positive just because one wants to get
tested. Others resist getting tested due to the fear of getting exposed as a
freelance sex worker. Stigma reduction efforts should also start at the SHC
level. PHO staff should stop using CSWs, GROs and FSWs as client labels and
should start using more sensitive terms like night or entertainment workers
instead.
Resource constraint. Budget for medicines for opportunistic infections is
hard to come by. Fortunately, DOH usually augments APAC resources
through grants. Some APAC members are likewise willing to provide
resources for certain activities. Also, the province lacks equipment to
undertake complete HIV tests and therefore have to send a sample to the
nearest testing center for confirmation of infection status.
Value of own space. Butterfly Brigade still does not have a physical base.
PLHIVs also do not have a half-way house in Aklan. A half-way house is for
those who are rejected at home or by their community once they learned
that they are infected.
Institutional memory. APAC members are changed time and again. New
representatives are unfamiliar with previous commitments have no
institutional memory of APAC’s initiatives. Each new representative has to
therefore be oriented by the Secretariat.
Reality of sex trade. Though prostitution is illegal, it is a widely accepted
practice in touristic areas. The Social Hygiene Clinic can only impose so
much on the enforcement of the pink card requirement and condom policy.
Still, it is up to the entertainment worker whether to risk getting infected.
Catholic stance. The condom policy runs counter with the position of the
church. This institution would have been a strong partner if only APAC gets
to enlist it as an ally.
Municipal inaction. There is a need to push some municipalities to initiate
their local response on HIV and AIDS.
Lessons from the 12-year APAC Experience.
On collaboration. APAC ensures that Council members are given equal
importance. Regular and open communication is maintained. The
Secretariat always makes the Council members feel welcome and their
comments and suggestions on program activities are consistently sought.
Also, integration of initiatives is the goal and attention is not focused on
who takes the credit. APAC showed that LACs should create a conducive
environment for the different sectors to work together. Mutual respect and
recognition should always be exercised.
Membership expansion. Local governments should not limit themselves to
what is provided by law. They should happily accommodate other members
of the society to take part in the council activities. Such is the case in APAC,
which entertained the youth, gay, children, academe and even media. It is
the local government’s role to reach out and generate more champions and
gatekeepers.
Appreciate diversity. Real partnership means making room for others’
opinions. This can only be forged when partners feel that their voices are
reflected in key decisions and that they are involved in the council
programs from conceptualization to execution and monitoring.
Go down to the community level. Make testing available not only in the
capital but in other hotspots as well. Prevention education should be
brought to schools. Community leaders should be tapped as well.
Inspire volunteers. A local HIV and AIDS response would falter without the
volunteers; peer educators specifically. It is important that volunteers are
given positive experiences during program activities as these memories
would convince them to participate again and again.
Intensive year–round education campaign and well-publicized WAD
celebration. In the last three years, supposedly more clients get tested
during December. This can be an indication that the IECs are taking effect
making people more aware and prompting them to take positive action
during the WAD month.
Partner not beneficiary-driven. The Aklan experience has shown that
program beneficiaries can be engaged as active partners.
Aklanons multi-sectoral approach to HIV and AIDS has consistently shown
that since this is everybody’s business, it should elicit everyone’s support as
well.
Military men tend to have a negative reputation when it comes to sexual
behaviour. They are often disparaged as having sexual partners in every
place to which they are assigned. However, it is true that localities that
surround military bases and camps often have booming entertainment and
recreational areas where off-duty military personnel can visit. This situation
lends itself to risky behaviour that may end up in sexually transmitted
infections including HIV/AIDS. In addition, the fast turn-over of military
personnel due to cycles of re-assignments may result in spreading an
infection to the next place of assignment.
THE STAGING GROUND
North Cotabato is a landlocked province in the center of Mindanao island. It
is the northernmost province of the SOCCSKSARGEN region. To its north are
the provinces of Bukidnon and Lanao del Sur, to the west by Maguindanao,
to the east by Davao City and Davao del Sur, and to the south by Sultan
Kudarat. Its 17 municipalities and one city occupy a 6,565.9 square
kilometre land area.
Seventy-one percent of the population is composed of Christian immigrants
from Luzon and the Visayas. About 16% are Muslim Maguindanao and the
rest are indigenous peoples. Certain parts of the province are affected by
the conflict in Mindanao. The province is the staging ground and sometimes
the site of military operations. There are four brigades deployed in the
province.
At the start of the MIU project, there were no recorded cases of HIV
infections in North Cotabato. However, there were two suspected cases
though was never confirmed. Nevertheless, the very low condom use in the
province—only 2%--was cause enough to proactively introduce preventive
practices to avoid the spread of infections. In addition, among the 40,000
military personnel in North Cotabato only 10 percent were practicing family
planning.
MEN IN UNIFORM PROGRAM
The Integrated Provincial Health Office (IPHO) decided to have a twopronged approach in addressing potential STI and HIV/AIDS problems. In
2005, the Men In Uniform (M.I.U.) Project was instituted by the IPHO which
intended to reach out to military personnel assigned in North Cotabato.
MIU aimed to capacitate military personnel and influence them to have
responsible sexual practices. This intervention aims to increase male
participation in family planning and increase the use of contraceptive
methods. Modules on violence against women (VAW) and gender
sensitivity were also included. The military personnel were later on
expected to reach out to conflict-affected communities that may not be
easily reached by local health personnel and train them on family planning
methods. Rural health units were also involved as centers for testing and
counselling.
The IPHO prepared IEC materials and a training program on the 10
elements of reproductive health including STI and HIV/AIDS, violence
against women, and male participation in reproductive health.
MIU IMPLEMENTATION
The MIU Project was began in 2005 with support from the United Nations
Population Fund (UNFPA). As the first phase of the project, a technical
working group was formed at the IPHO to coordinate the preparatory
activities for the project. Afterwards, the focal persons from the
municipalities were identified. The TWG members and LGU focal persons
were trained on the modules of the MIU Project. The composite team then
selected the target battalions and lobbied with the commanding officers to
engage their personnel.
The second phase involved the roll-out of the training program in the
selected battalions. The pilot training program was implemented at the 39th
Infantry Battalion in Poblacion, Municipality of Makilala. The training was a
five-day seminar-workshop on the modules on reproductive health and
family planning. The MIU Project would proceed to three other units: the
40th Infantry Battalion in Aleosan, 7th Infantry Battalion in Ladtingan, Pikit,
57th Infantry Battalion in Makilala, and the 68th Infantry Battalion in TawanTawan, Mlang.
Two hundred peer facilitators were trained and were expected to be the RH
champions in their platoons and military camps and 1,500 soldiers
underwent the orientation seminars. After the training, the soldiers were
asked to select the MIU focal persons for each battalion. A symposium for
all four battalions and some units of the Philippine Marines was held at Fort
Pikit in the Municipality of Pikit.
The IPHO TWG met with focal persons from the battalions and the focal
persons from the RHUs for planning and feedbacking on RH responses in
the military units and the communities.
THE HEALTH BATTLE
Almost 2,000 military personnel were trained on reproductive health and
preventive practices to avoid STI and HIV/AIDS. Condom use was raised
from 5,000 to 8,000. There were even 272 vasectomy procedures
performed—a stark increase from zero in 2002. The soldiers formed Task
Force Magdalena which was tasked to lower the incidence of STI in camps.
The LGU of Alamada also undertook training for its police officers, barangay
officials, barangay tanods, tricycle drivers and high school students. The
National Defense College took notice of the MIU Project and also plans to
integrate RH and family planning into existing curriculum and training
programs. The MIU experience was also shared in the First Asian
Conference for Behavior Change for Male Participation in Reproductive
Health in Yangon, Myanmar and at the 10th International Congress for
Reproductive Health and Population in Manila.
UNIFORMED LESSONS?
Initially, the soldiers were lukewarm to the concept of MIU—considered a
“soft” project as compared to the business of anti-insurgency or
engineering. It was necessary to gain the support of the commanding
officer who can cascade the buy-in through trusted personnel who can then
become focal persons for the project. Regular dialogues and lobbying with
the officers was a key step to gain project support. The aspects of the
safety of their families and reaching out to conflict-affected communities
also became an additional motivation for the soldiers’ buy-in.
Condom use needs a more intensive encouragement from the brass as
condom use remains quite low.
Motivation, religious beliefs and reinforcement from religious leaders
continue to affect the implementation of RH and family planning related
interventions. Funding became shaky when the UNFPA exited from the
project. The former head of the IPHO had to spend some personal money in
order to provide food during the trainings. Sustainability is heightened
when the municipal governments claim ownership of the project and
implement their own initiatives to replicate the MIU model.
FIGHTING AN INVISIBLE WAR
Military personnel are exposed to many dangers in the battlefield. Dodging
bullets and artillery means a life or death situation. But the Philippines is
opening another front in a war which has no visible frontlines, only
manifestations of the infection here and there. But the infections of
HIV/AIDS are growing and even the toughest military personnel are not
immune from infection if they do not practice safe sex. The MIU is an
exemplary strategy that is an initiative of the local government. Taking care
of military personnel is also local business. It means that possible infections
are avoided in the military camps, host communities, and in future host
communities when the military units have to move on to a new assignment.