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Dr Ethel Dano , WHO local consultant, Cebu, Philippines

Policy breakthrough for a needle and syringe p rogram for people who inject drugs in Cebu City, Philippines. Dr Ethel Dano , WHO local consultant, Cebu, Philippines Dr Ilya An- Tac , Cebu City Health, Philippines Dr Gerard Balimac , Department of Health, Philippines

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Dr Ethel Dano , WHO local consultant, Cebu, Philippines

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  1. Policy breakthrough for a needle and syringe program for people who inject drugs in Cebu City, Philippines DrEthel Dano, WHO local consultant, Cebu, Philippines DrIlyaAn-Tac, Cebu City Health, Philippines Dr Gerard Balimac, Department of Health, Philippines Dr Zhao Pengfei, WHO Western Pacific Regional Office, Philippines

  2. Outline • The HIV epidemic in the Philippines • Advocacy and technical assistance • Summary of lessons learned • The way forward

  3. Every 2 hrs a Filipino becomes HIV infected… 2000 1 1 new cases in 3 days 2012 9 new cases a day or 1 new case every 3 hours 2013 13 new cases a day As of June 2013, Philippine HIV Registry – NEC/DOH

  4. Quick glance at HIV in the Philippines • Population: 92.34M (NSO 2010) • Projected number of people living with HIV (15-49) by 2014: 32,279 • Reported cases since 1984: 16,516 • HIV cases (15,009) • AIDS cases (1,507) • Reported AIDS deaths: 887 The first reported Filipino HIV case in the Philippines In 1984 is a heterosexual male OFW. HIV Data Sources: Philippine HIV/AIDS Registry (as of December 2013) Philippine Integrated HIV Behavioral & Serological Surveillance EPP/Spectrum, UNAIDS Software Manila • 89% men Mode of transmission • 93% sexual (73% among MSM) • 4% needle/syringe sharing among PWID • HIV prevalence < 1% among general population • Cities with concentrated epidemics among MSM, PWID and FFSW (eg. Cebu City) Cebu MSM = men who have sex with men, PWID = people who inject drugs, FFSW = female freelance sex workers HIV Data Sources: Philippine HIV/AIDS Registry (as of December 2013), and Philippine Integrated HIV Behavioral & Serological Surveillance EPP/Spectrum, UNAIDS Software

  5. Quick facts about PWID in Metro Cebu Source: DOH NEC IHBSS 2013 PWID = people who inject drugs * Data source: IHBSS survey 2013

  6. A public health crisis in Cebu, Philippines (HIV) HIV Data Sources: Philippine HIV/AIDS Registry (as of December 2013), Philippine Integrated HIV Behavioral and Serological Surveillance EPP/Spectrum, UNAIDS Software

  7. A public health crisis in Cebu, Philippines (Hepatitis C) Hepatitis C prevalence Data Sources: Philippine Integrated HIV Behavioral & Serological Surveillance EPP/Spectrum, UNAIDS Software, 2005-2011

  8. Delay in response due to conflicting laws The Philippines AIDS Prevention and Control Act of 1998 (RA8504) Dangerous Drug Act of 2002 (RA9165) Impedes HIV response: Arrest Mere possession of needles as injecting paraphernalia (even without drugs) Caught visiting area known to be drug dens Problem for peer educators bringing clean needles/ syringes to the community • Support HIV response in sex workers and people who inject drugs • Access to HIV prevention • Improving quality of life

  9. Delay in response due to ‘Chicken and Egg’ situation • Central level expects local government to take initiative in harm reduction, and policy making based on local experience • Local government waits for clear health policy guidance from central government, before action is taken

  10. Advocacy & technical assistance to set up NSP in Cebu • Development of advocacy briefing paper • Fact finding • Packaging HIV epi data for stakeholders • Share international harm reduction experiences • Advocacy meetings including training of police • Drafting proposal for community-based pilot of harm reduction programme NSP = needle and syringe programme

  11. Advocacy works… good work continues… • Drug use is a multiple health problem, PWID should NOT be seen as criminals • Access to essential health commodities (condoms, needles/syringes) is a human right • A public health approach (harm reduction) improves public security PWID = people who inject drugs

  12. Quotes from a catholic Brother P.- religious group speaking at police training workshop “Love is above law!” “Asking permission is difficult, but asking forgiveness is easy” If a Catholic Brother can do (distributing needles/syringes and condoms) for the sake of saving lives, who else cannot?

  13. Consensusamong key stakeholders Finding a local solution for a local problem

  14. ‘One-stop shop’ comprehensive harm reduction in Cebu social hygiene clinic • Needle and syringe program • HIV counseling and testing • Antiretroviral therapy • Management of sexually transmitted infections • Condom programme for PWID and their partners • Targeted information, education, communication and psychosocial services for PWID and their partners • Vaccinations, diagnosis and treatment of Viral Hepatitis • Prevention, diagnosis and treatment of TB* • Referral for voluntary rehabilitation

  15. PWID = people who inject drugs Source of dada: Cebu social hygiene clinic-progress report, 2014

  16. Lessons learned… so far • Social hygiene clinic based NSP - a model fits well the Philippines • Dedicated manager/staff essential, and more trained staff in demand to ensure quality of services and use of data • Strong support from DoH, PWID community, NGOs from HIV-positive groups and faith-based organizations • WHO local consultant provides direct support and facilitates additional assistance in time • Working with police possible! Increased police understanding of public health solution to HIV crisis as public security DoH = Department of Health NSP = needle and syringe programme

  17. The way forward • Continue advocacy to enforcement agencies (including city lawyers) to sustain the local enabling environment, with a vision to reform the drug policy/laws • Strengthen and monitor current programme to ensuring the quality of services and use of data • Extend the current facility-based services to community-based • Replicate Cebu model to other cities which have HIV among PWID (e.g. under the GF new funding model)

  18. Acknowledgements • Jerson See, Cebu Plus Association, the Philippines • Mark Arnejo, Cebu Plus Association • Floyd'Maldepena, Cebu Plus Association • Daisy Villa, Cebu City Health Department • Teresita Rodriguez, Cebu City Health Department • Gary Reid, Independent consultant • Nerissa Dominquez, WHO Philippines • Ying-Ru Lo, WHO Western Pacific Regional Office

  19. Thank you! Is there any existing experience on Nalbuphine substitution treatment? What about Buprenorphine? Terumo Insulin Syringes - 29G U-100 1 cc 1/2" - BX 100

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