Friday, September 14, 2012

A local approach to HIV and AIDS

published August 29, 2012, MST page A5

In 2010, UNAIDS published a report saying that new infections of HIV and AIDS have been declining globally. There are, however, seven countries which are an aberration. They observed an incidence increase of more than 25 percent compared to their 2001 levels. These seven countries are Armenia, Bangladesh, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan—and the Philippines.

Data from the Philippine National AIDS Council support this. In fact, in the month of June 2012 alone, there were 295 new HIV cases recorded, a 66-percent increase from the number recorded in June 2011. This brings to 1,600 the number of new cases reported in the first six months of this year.

Ninety-six percent of those infected this year were male, with a median age of 28 years.

Since the first case was documented here in the Philippines in 1984, there have been 9,964 individuals diagnosed with HIV. Ninety-two percent were infected through sexual contact, 4 percent through needle-sharing among injecting drug users. The balance stands for mother-to-child transmissions and absence of information.

The PNAC report adds that from 2007, there has been a shift in the predominant trend of sexual transmission from heterosexual contact (20 percent) to males having sex with other males, or MSM (80 percent).

Some may argue that the number of HIV-infected Filipinos comprises a very small portion of the total population, and that there are many other pressing health problems—or other problems for that matter—that must first be addressed before this.

But anything that spreads this fast is cause for alarm. In 2000, the Philippines along with 192 other nations, signed up for the Millennium Development Goals, a set of eight time-bound goals that sought to eradicate poverty. MDG 6 deals with the reversal of the spread of HIV and AIDS and the achievement of universal access to treatment by the year 2015 (the other aspect is the containment of malaria).

That reckoning date is three years away and there has been evidence that the Philippines has been making progress in the other goals. For MDG 6, however, performance has been bad. Not only has the country not been able to decrease the number of new cases, or slow the growth of new ones. The number of new cases has been getting bigger than ever, with certain at-risk populations becoming more vulnerable than before.

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How, then, to respond?

Philip Castro, programme officer for HIV and AIDS of the United Nations Development Programme, says his agency has teamed up with the Local Government Academy of the Department of the Interior and Local Government to localize the government’s response to the menace.

There are of course laws that mandate a national effort especially for education and information for prevention of HIV and AIDS. The AIDS Law of 1998, which also established the PNAC, highlighted that issue needed to be seen as a multi-sectoral issue.

Practically speaking, however, the central government is hardly in a position to oversee initiatives at the grassroots level in all parts of the country. No less than the late Secretary of the Interior and Local Government, Jesse Robredo, in his Message for the publication “Localizing the HIV and AIDS response,” acknowledged the “explosion of the epidemic in recent years” and said that the problems were made worse by competing priorities and lack of capacity.

Capacity is built, and that is exactly what the program is all about: Capacity to treat, and capacity to prevent.

To this day, there is no cure for HIV-AIDS. Once diagnosed with the virus, especially if the CD4 level dips below acceptable limits, a patient must take anti-retroviral medicines every day for the rest of his or her life. Treatment, according to Castro, costs anywhere between P30,000 and P70,000 per person per year—a costly exercise, and given the increasing number of infected Filipinos, treatment funds may sooner than later dry up. Treatment is mainly provided to patients through international aid.

A good, parallel approach addresses prevention, not just as an issue of health but one of behavior and governance. Communities need to get past the denial and discriminatory stage—believing that only the promiscuous are at risk and that the disease is a punishment for their lifestyle. Prevention also does not begin and end with making condoms available, for instance. A more crucial component is education for behavioral change, because it is a person’s behavior that allows him or her to place himself or herself in risky situations.

To effectively respond, Castro elaborates, an LGU has to have a local policy (an ordinance), a coordinating body, a local AIDS plan, a budget, and active partnership with other government agencies, civil society organizations and the community itself.

It would be good to find out how seriously different local government units are taking up the challenge to build capacity in improving their communities’ fighting chance by keeping their citizens informed. HIV-AIDS threatens the most productive and most promising sectors of our population. We must not allow faux conservatism, or plain apathy, to lead our people to make choices with irreversible consequences.

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