INNOVATIVE APPROACHES TO HIV PROGRAMMING

“The speed at which the HIV virus travels must be equaled with a response that is rapid as it is novel.”


In 2001, the first HIV/AIDS case in Aklan came out. His name was Peter and he was the very first HIV positive person in Aklan to disclose his status to us. Peter had earlier sought treatment in Iloilo City, preferring the anonymity of a strange place several miles away from his hometown. The Department of Health-Region VI in Iloilo City notified us about Peter. Efforts were made to trace him immediately but by then, Peter was already in advanced stage of the disease. Because of the absence of HIV/AIDS services in Aklan, we had to bring him to Iloilo. As Peter’s health declined, he decided to stay at a half-way home in Iloilo City. Because of limited resources at the facility, Peter had to go home to his family. In 2003, Peter died without having access to antiretroviral medicines that could have prolonged his life.

During this period, the HIV/AIDS services under the reproductive health program in Aklan had not gotten beyond information and education. Peter’s death painfully underscored the need to put up a comprehensive program on HIV/AIDS that would include care and treatment. We could not allow one more HIV positive person to die unattended when resources are just within reach. Spurred by this realization, Aklan’s initiatives in HIV/AIDS programming took a sharper focus. Thus in 2006, it finally established the first community-based comprehensive HIV/AIDS program in Aklan which provides prevention education, counseling, testing, care and treatment, and antiretroviral medicines.

Aklan’s initiatives in HIV/AIDS programming have been marked by constant search for innovative practices. The speed at which the virus travels must be equaled by a response that is rapid as it is novel. This is the only way we can immediately and sufficiently mobilize people and resources to prevent the virus from spreading further. In sharing our experiences through this manual, we hope to contribute to the enrichment of HIV/AIDS program practices among groups and sectors working for people living with HIV/AIDS.

THE AKLAN HIV/AIDS PROGRAM


The Aklan HIV/AIDS Program is a comprehensive response against HIV/AIDS combining advocacy and concrete medical services. It was launched in 2005, but the program foundations were laid much earlier when Aklan began its Reproductive Health Program under the UNFPA 5th Country Programme of Assistance in 2001-2004. During its “formative” stage, Aklan’s HIV/AIDS Program focused on extensive information and education work among adolescents, health workers, and the communities. It gradually evolved into a broader initiative when the threat of HIV/AIDS became more urgent and real when Aklan was confronted with its first HIV case in the later part of this period.

Aklan’s lack of capability to respond concretely to its first HIV case was a sobering experience. The alarm and bewilderment which attended its response to this case was a painful reminder of the program’s failings. The death of Peter, Aklan’s first PLHAS (People Living with HIV/AIDS), was a strong wake up call for provincial health program stakeholders to take a more concrete step. A parallel development also unfolded during this period which provided added impetus for Aklan to take a more decisive response to HIV/AIDS. UNFPA-Aklan commissioned a study in 2002 on MSM (Men Having Sex with Men) in the resort island of Boracay, Aklan. The study showed high prevalence of risky sexual behavior among male sex workers and homosexuals. It also indicated the probable outbreak of sexually transmitted diseases (STD) because of this factor, worsened by the absence of treatment facilities in the island. The study pointed out the need for a program response that would reverse the potential spread of STD cases and arrest the incursion of HIV in the area. These findings and the subsequent consultations with health program managers all over Aklan pointed out the need to take heed before the threat of HIV/AIDS approaches epidemic proportions. The social and economic cost of HIV/AIDS to Aklan, considering that Boracay is a leading tourist destination and major income earner, compelled the province to take decisive action. Thus in 2005, the first comprehensive, community-based HIV/AIDS Program in Aklan was launched.


Establishing the Need

Does the need for HIV/AIDS services exist? The answers which held true for Aklan then, and even until now were:

There was a need because

· There was Peter. There could be many more Peters who are in hiding. After Peter’s case in 2002, Aklan monitored its second HIV case two years later. He is now being assisted through counseling and antiretroviral medicine. In 2005, another Aklanon was monitored to be in advanced stage of AIDS, but has chosen not to reveal his condition and to forego assistance from the PHO.

· There are vulnerabilities due to exposure. There are vulnerable sectors in our society who, because of their work and lifestyles, are at greater risk. There are some one hundred registered sex workers in Kalibo alone (the number fluctuates since the sex trade is seasonal). The sex trade in Boracay is prevalent and peaks during the summer season, coinciding with the arrival of tourists. In most instances, tourists bring sex workers with them.

· There is a culture and subculture that puts people at risk. As in most rural areas in the country, people do not talk about sex openly. The topic is generally taboo and most practices are consequently either harmful or unhealthful. There is a need to further intensify 100% condom use for protection and family planning among male Aklanons. Pretests among students and out-of-school youths indicate surfaced considerable myths and misconceptions about sexually transmitted diseases, including AIDS.

· It is our right to be provided health care if we have sexually transmitted infections or if we are infected with HIV. It s our right to be provided the same services as anyone, without stigma and discrimination