Data Collection in MARA – Integration in national IHBSS Example: Philippines

1. Data Collection in MARA – Integration in national IHBSS Example: Philippines Gudrun Nadoll, HIV Specialist, UNICEF Philippines September 3, 2009, MARA Consultation, Geneva

2. Background Low HIV prevalence, high rates of STIs HIV reported cases increasing; profile getting younger Expansive sex industry Sub-groups of MSM practice unsafe sex / many partners Needle sharing; overlap IDU/sex work Estimated 10-30% of MARP below 18 years of age Low level of awareness, low condom use

3. Background While national response focuses on MARP, young MARP receive less intervention than older MARP Studies on OSY and street children ongoing; but not specifically for most-at-risk adolescents

4. Know the epidemic: Evidence through IHBSS IHBSS: Integrated HIV Behavior and Serological Surveillance • Unclear eligibility criteria regarding age • Study teams not trained in enrolling minors Evaluation of 2007 HIV Surveillance

5. Know the epidemic: Evidence through IHBSS • Council for the Welfare of Children HIV Committee • Chaired by DoH, with members from DSWD, DILG, DepEd, PNAC, Youth Representatives, PLHIV, NGOs, UNICEF • Development of draft policy guide on children’s access to HIV counseling and testing • Draft strategy framework • Additional CWC Stakeholder Consultation • To discuss legal perspective, perspective of service providers, perspective of young people most-at-risk regarding children’s access to counseling and testing • 2008/2009: Consultations regarding children and HIV strategy and policies Evaluation of 2007 HIV Surveillance

6. Know the epidemic: Evidence through IHBSS • Conclusion for IHBSS: • Recognized importance of data on young MARP for policies and programs for young MARP. • Can the 15-17 be included in IHBSS? • If informed consent is ensured, adolescents can give own consent under AIDS law • Steps in policy guide to be followed • Below 15 to be excluded since this would require different set-up • Should the 15-17 be included in IHBSS (as compared to special study)? • IHBSS is the official, comprehensive surveillance; linked with related m&e efforts • Considered cost-effective • 2008/2009: Consultations regarding children and HIV strategy and policies Evaluation of 2007 HIV Surveillance

7. Know the epidemic: Evidence through IHBSS • 2008/2009: Consultations regarding children and HIV strategy and policies Evaluation of 2007 HIV Surveillance • Approval by DoH Ethical Review Board

8. Know the epidemic: Evidence through IHBSS • Training Interviewers on Child’s Rights • Ensuring consent in minors • Involvement of Regional and City Social Welfare Departments, “stand-by” for referral • APPROVAL • 2008/2009: Consultations regarding children and HIV strategy and policies Evaluation of 2007 HIV Surveillance • Referral directory for <18

9. Know the epidemic: Evidence through IHBSS • Pilot Sampling Methodology (RDS) • Training Interviewers on Child’s Rights • APPROVAL • 2008/2009: Consultations regarding children and HIV strategy and policies Evaluation of 2007 HIV Surveillance • Referral directory for <18

10. Know the epidemic: Evidence through IHBSS • Pilot Sampling Methodology (RDS) • Training Interviewers on Child’s Rights • APPROVAL • 2008/2009: Consultations regarding children and HIV strategy and policies Evaluation of 2007 HIV Surveillance • Referral directory for <18 • ‘Traditional’ Sampling Methodologies

11. Use of the data Baseline for programming; monitoring progress in programming for young MARP Base to discuss/advocate for MARA policies and programs IHBSS process goes hand in hand with MARP size estimation workshops

12. Challenges and lessons learnt Still bias in terms of enrolment of <18 Follow-through on child-protection issues Monitor quality of ‘informed consent’ procedure Monitor quality of referral to social services Large number of logistical issues absorb attention WHO: documentation of 2009 IHBSS

13. Thank you!