Philippine Twitter Campaign

5-days, 21-26 July 2013 Rationale: President Noynoy Aquino will deliver his 4th State of the Nation Address (SONA) on 22 July 2013. In the past three SONAs (2010-2012), there was no mention about the HIV problem in the country despite the MDG Report statement that HIV is one of the MDG targets that is least likely to be achieved. Strategy: The following twitter messages will be posted before (Jul 21-22 am), during (Jul 22 pm), and after (Jul 23-26) the SONA. The primary target twitter accounts will be: @noynoyaquino (President Nonoy Aquino) and @govph (Official Gazette of the Philippines). Other accounts will be tagged including the Presidential Communication Group (@dawende, @mlq3, etc), Philippine Legislators (@piacayetano, @bamaquino, @senmiriam, etc), journalists (@GMANewsOnline, @ANCALERTS, @rapplerdotcom, etc), and key partners in the HIV response. Twitter Messages: Message #1: @noynoyaquino #HIV is rapidly expanding in key groups in the #Philippines. Left unaddressed, it will be an #HIVtimebomb #SONA Message #2: @noynoyaquino #HIV is growing in the #Philippines & the current response is inadequate #HIVtimebomb #SONA Message #3: @noynoyaquino Since2006, #HIV infection rate reduced in most countries, it increased 10x in the #Philippines #HIVtimebomb #SONA Message #4: @noynoyaquino #HIV infection among young Filipinos has increased 10x since 2006. Their future is at stake #HIVtimebomb #SONA Message #5: @noynoyaquino Only14% of affected Pinoys in the #Philippines know their #HIV status. More testing is vital #HIVtimebomb #SONA Message #6: @noynoyaquino #HIV is under-reported in the #Philippines. The real rate is likely 3x higher #HIVtimebomb #SONA Message #7: @noynoyaquino In #Philippines, only 8% of HIV+ pregnant women recv #ARV treatment 2 prevent passing it on #HIVtimebomb #SONA Message #8: @noynoyaquino #AIDS spending in the #Philippines is only 14% of whats needed to address the epidemic #HIVtimebomb #SONA Message #9: @noynoyaquino Every 1-Peso investment in prevention will save the #Philippines 4-Pesos on #ARV treatment #HIVtimebomb #SONA

Strategic Information: The following data and analysis on the Philippine HIV epidemic and response will further provide evidence on the twitter messages. This document will be uploaded in websites of key (PLCPD, etc) so that President Noynoy and those who are interested could be provided with additional strategic information on HIV.

Philippine HIV Epidemic 2013 Update

Increasing prevalence in key populations. National HIV prevalence remains under 0.1%, but rapidly expanding among key affected populations (KAP). By 2011, 4-6% among males who have sex with males (MSM) in the cities of Cebu, Quezon and Manila; 53% among people who inject drugs (PWID) and 5% among female sex workers (FSW) in Cebu City. [2011 IHBSS, 2012 Spectrum Projections] More are infected. The number of cases reported has shown a steep increase in the last 6 years - from less than 1 case a day in 2006 to 9 cases a day in 2012. Actual rate of increase was estimated at 12 cases per day in 2012 (or 4,400 new cases for the year) and will likely increase every year. In 2012, the Philippine National AIDS Council (PNAC) has projected that the total number of HIV cases in the Philippines could reach 37,000 [29,00054,000] by 2015. Those infected are young with a median age of 27. HIV infection among 15-24 years old increased ten-fold, from 44 in 2006 to 704 in 2011. The period of initiation to sex and drug use among key affected populations is as early as from 14 years old. Male to male transmission had significantly increased. Sex is still the main mode of transmission with, 85% of new cases were reportedly through male-to-male sex in 2012. More local transmission. HIV cases among Overseas Filipino Workers (OFW) continue to increase (330 cases in 2012 - highest ever) despite the decrease in proportion of OFW to the total cases from 42% in 2006 to 11% in 2011 indicating that local transmission has outpaced infections reportedly contracted overseas. Very Low Prevention Coverage mostly below national targets of 80% since 2005; specifically 63% for establishment-based FSW, 38% for freelance FSW, 23% for MSM and 11% among PWID (2012 GARPR Report). Low number of KAP are tested for HIV (merely 14%) and zero for key affected populations under the age of 18. High-risk practices among KAP continues. Knowledge levels (index of basic HIV knowledge including misconceptions) among KAP was only 32%, with those aged 15 to 17 years, even lower at <25%. While most HIV infections are still primarily through sexual transmission, a strong interplay of risk factors exists particularly between injecting drug use and unprotected sex (paid or otherwise). Condom use at last high-risk sex was only 11% among sex workers who inject drugs, 22% among clients of sex workers who inject drugs, and only 32% among MSM (2011 IHBSS).

AIDS Investments in the Philippines

Selected Data from the National AIDS Spending Assessments (NASA) 2000-2012
The AIDS Funding Scenario Annual resource requirements is $73 million if the country has to provide prevention services to 80% of key populations at risk. This will go as high as $96 million in 2016 when PLHIV on ART is estimated to reach more than 11,000. (AMTP5 2011-2016) AIDS spending never reached more than $15 million in any given year. Annual AIDS expenditure was estimated at around $10 million only per year (NASA 2000-2011). Government spending was only 20% of total expenditures. Up until 2010, more than half of total AIDS spending came from external sources, mainly the Global Fund, USAID, and the UN. Only around 20% ($1-2 million) annually came from the government - the Department of Health (DOH), Phil National AIDS Council (PNAC) Secretariat and selected local government units (LGU). In 2011, the country spent $12.6 million on AIDS - 64% on prevention programmes, 22% on programme support (e.g. M&E, technical support, and capacity building), and 8% on ART. Funds made available for 2012 was estimated to be $10.6 million only. Of this budget, the Global Fund (Round 6) covered the bulk at 42%. The rest of the allocations were from the national programs (22%), local government (19%), and bi/multilateral agencies (17%). Full funding of the AMTP was never considered. Current discussions both by the PNAC and the congress revolved around increasing the current budget into a certain percentage, but never on funding the annual resource need in full. Seventeen (17) of 23 sites of the 2008-2012 GF Round 6 grant were not continued in the 2013-2014 GF-TFM grant. None of these sites had developed plans to sustain earlier investments on AIDS. Actual costs of a prevention package per year was $170 per MSM/PWID (2012 UNAIDS Costing Study). Where AIDS investment should be Drastic efforts should be done to reach 80% or as many MSM and PWID as possible in 70 high burden sites in the country (covering more than 80% of disease burden), noting also the need to improve targeted, rights-based prevention interventions that actively engages the MSM and PWID communities. Coverage in 2011 was almost none among these two target populations, with only <5% of MSM and <5% of PWID received an HIV test and know the results. Poor coverage over the years may account for expanding HIV prevalence reaching 2%-6% among MSM in at least 5 cities and 53% among PWID in one city. Gains in maintaining low prevalence among establishment sex workers should be sustained. 2011 data shows 79% of male and 63% of female Registered SW were reached by programs. None of the sites has reached more than1 % HIV prevalence among these population. However, efforts should also focus on making HIV tests accessible to them as in 2011, still <20% of them were tested. However, there was virtually no package for freelance female sex workers and clients of sex workers - these target population should be included. Ensure more than 90% coverage of ART among PLHIV in need of treatment or around $7 million annually (AMTP5 Investment Plan). Estimated cost per PLHIV per year was $625 for first line and $1,050 for second line (2012 UNAIDS Costing Study).

Who should invest National government to increase investments and cover 50%-75% of national needs (or $20 to $30 million per year). Local governments particularly the 70 priority cities and towns (covering more than 80% of disease burden) to invest on AIDS and cover at least 25% of national needs or each city to invest $200,000 (P10 million) per year. There is a need to aggressively promote enrolment to the Philippine Health Insurance (Philhealth) to help ensure that country-agreed target of 90% coverage of ART is met. Not all PLHIV in need of ART are PhilHealth members. Support the strengthening of the oversight functions of the Philippine Congress. For now the Congress only monitors the budget released but not the expenditure and the results achieved. Reinforce the oversight role of CSO to continue advocacy for funding AIDS response and monitoring government utilization of investments in HIV to deliver results.

Meeting HIV Targets by 2015 2012 Philippine Report to the United Nations
Low Investments, Very Low Service Coverage Only 27% of estimated resource needs was funded. Only $12 million was spent on HIV in 2011 despite the annual resources needs of $45 million per year [AMTP5 Investment Plan]. VERY, very low HIV testing coverage. Those who received an HIV test and got the results: <1% - Filipinos 15-49 years old (2008 NDHS) <20% - all sex workers [37% - male sex workers , 16% - female sex workers] < 5% - men who have sex with men [ almost none among MSM below 18 years old] < 5% - Filipinos who inject drugs AMTP Target: 60% Very low prevention service coverage. Those who reported to have been reached by prevention programs either who received commodities (condoms, clean needles or IEC) or knew where to take a voluntary and confidential HIV test: < 70% - all sex workers [79% - male sex workers , 63% - female sex workers] NONE - clients of female sex workers < 25% - men who have sex with men < 15% - Filipinos who inject drugs [2010 UNGASS] AMTP Target: 80% Very high misconceptions about HIV transmission among Filipinos 15-24 years old. In one national study, only 20% of the 15-24 years old had correct knowledge on HIV transmission and prevention.

Prevalent Risky Behaviors Generally low condom use during last sex among key population at most risk. 65% - all sex workers [84% - male sex workers , 64% - female sex workers] < 40% - men who have sex with men < 20% - Filipinos who inject drugs [14% - male PWID, 24% - female PWID] AMTP Target: 80% Expanding HIV in Key Populations Increasing HIV prevalence among key populations 275 per 100,000 (0.275%) - all sex workers - 120/100,000 - establishment-based sex workers - 430/100,000 - freelance sex workers - 5,000 /100,000 (5%) freelance SW in Cebu City 1,680 per 100,000 (1.68%) - men who have sex with men - 2,000-4,000/100,000 (2%-4%) in the cities of Manila, Pasay, and Davao - 5,000-6,000/100,000 (5%-6%) in Quezon City and Cebu City 13,560 per 100,000 (13.56%) - Filipinos who inject drugs - 12,870/100,000 (13%) among males who inject drugs - 26,980/100,000 (27%) among females who inject drugs - 53,000/100,000 (53%) among PWID in Cebu City Reported HIV cases double per year 250 reported cases per year from 2000 to 2008 835 reported cases in 2009 (2 cases per day) 1,305 cases in 2010 (4 cases per day) 2,349 cases in 2011 (6 cases per day) 3,338 cases in 2012 (10 cases per day) 1,892 cases in Jan-May 2013 (13 cases per day) No way but up Estimates show that there will more than 5,000 new cases per year beginning 2013 or more than 50,000 Filipinos living with HIV by 2015, more than 8,000 of which will be needing HIV treatment.

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