Policy breakthrough for a
needle and syringe program
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
Dr Zhao Pengfei, WHO Western Pacific Regional Office, Philippines
www.aids2014.org
Outline
1.
2.
3.
4.
The HIV epidemic in the Philippines
Advocacy and technical assistance
Summary of lessons learned
The way forward
www.aids2014.org
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
www.aids2014.org
As of June 2013, Philippine HIV Registry – NEC/DOH
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)
Manila
• Reported AIDS deaths: 887
89%first
menreported Filipino HIV case in the Philippines
The
InMode
1984ofistransmission
a heterosexual male OFW.
• 93% sexual (73% among MSM)
• 4% needle/syringe sharing among PWID
HIV Data
prevalence
< 1% among general population
HIV
Sources:
Philippine
HIV/AIDS
Registry (asepidemics
of December 2013)
Cities with
concentrated
among MSM, PWID
Philippine
Integrated
HIV City)
Behavioral & Serological Surveillance
and FFSW
(eg. Cebu
Cebu
EPP/Spectrum, UNAIDS Software
MSM = men who have sex with men,
PWID = people who inject drugs,
FFSW = female freelance sex workers
www.aids2014.org
HIV Data Sources: Philippine HIV/AIDS Registry (as of December 2013), and Philippine Integrated
HIV Behavioral & Serological Surveillance EPP/Spectrum, UNAIDS Software
Quick facts about PWID
in Metro Cebu
Metropolitan
Cebu
# of PWID
(2011
estimate)
Cebu city
2,017
Other cities
3,983
Total
6,000
Median age of
respondents (n=767)*
30 yrs
(15-56)
Age of first drug use
(Median)
16 yrs
Age of first Injection
(Median)
19 yrs
% injecting nalbuphine
98%
Average number of
injections/day
3 (1-12)
% PWID tested and
6%
Source:
DOHstatus
NEC IHBSSin
2013
knew their
HIV
last year
www.aids2014.org
PWID = people who inject drugs
* Data source: IHBSS survey 2013
A public health crisis in Cebu,
Philippines (HIV)
60%
53.2% 52.3%
50%
HIV Prevalence
42.3%
40%
30.4%
30%
Cebu (male)
Cebu (female)
Mandaue
20%
10%
0%
0.8%
2005
0.4% 0.6%
2007
2009
Year
3.6%
2011
2013
HIV Data Sources: Philippine HIV/AIDS Registry (as of December 2013), Philippine Integrated HIV Behavioral and
www.aids2014.org
Serological Surveillance EPP/Spectrum, UNAIDS Software
A public health crisis in Cebu,
Philippines (Hepatitis C)
100%
88.0% 95.0%
Hepatitis C prevalence
90%
80%
92.8%
80.8%
70%
60%
GEN
SANTOS
50%
ZAMBOANG
A
40%
30%
20%
10%
0%
6.3%
4.8%
4.1%
3.7%
0.0% 0.0% 0.0%
2007 2009 2011
0.3%
2005
Data Sources: Philippine Integrated HIV Behavioral & Serological Surveillance EPP/Spectrum, UNAIDS Software, 2005-2011
www.aids2014.org
Delay in response
due to conflicting laws
The Philippines AIDS
Prevention and Control Act
of 1998 (RA8504)
Dangerous Drug Act of 2002
(RA9165)
• Support HIV response in
sex workers and people
who inject drugs
• Access to HIV prevention
• Improving quality of life
• 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
www.aids2014.org
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
www.aids2014.org
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
www.aids2014.org
NSP = needle and syringe programme
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
www.aids2014.org
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?
www.aids2014.org
Consensus
among key stakeholders
Finding a local solution
for a local problem
www.aids2014.org
‘One-stop shop’ comprehensive harm
reduction in Cebu social hygiene clinic
1.
2.
3.
4.
5.
6.
7.
8.
9.
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
www.aids2014.org
Number of PWID accessing needles/
syringes in Cebu social hygiene clinic
(2013-2014)
700
Restriction on # of
distribution per visit
650
600
526
Number of PWID
500
460
410
406
400
321
348
372
379
404
2013
2014
331 321
2 per. Mov. Avg. (2013)
300
2 per. Mov. Avg. (2014)
233 234
200
137
100
43
54
62
JAN
FEB
MAR APR
# Needles/syringes per
PWID distributed
2013: 115
2014 (as of Jun) 87
0
MAY
JUN
JUL
AUG SEPT OCT
www.aids2014.org
Source of dada: Cebu social hygiene clinic-progress report, 2014
NOV
DEC
Month
PWID = people who inject drugs
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
www.aids2014.org
DoH = Department of Health
NSP = needle and syringe programme
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)
www.aids2014.org
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
www.aids2014.org
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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