United Nations Development Programme A Referral System for Care and Support Services for Persons Living with HIV and their Families in the Community Referral System for Care and Support Services for Persons Living with HIV in the Community 1 A Referral System for Care and Support Services for Persons Department of Social Living with HIV and Welfare & Development Social Technology Bureau their Families in the with assistance from the Community United Nations Development Programme A Referral System for Care and Support Services for Persons Living with HIV and their Families in the Community Department of Social Welfare & Development Social Technology Bureau with assistance from the United Nations Development Programme 1 December 2010 Referral System for Care and Support Services for Persons Living with HIV in the Community 2 Message from the Department of Social Welfare and Development There are a total 4,817 reported cases of AIDS from 1984-2010. The current statistics manifest that the situation is alarming and something needs to be done immediately. HIV/AIDS often poses a devastating effect on families, communities, and societies as a whole. PLHIV are confronted with multiple burdens, ranging from psychosocial to economic, and it is the prime duty of the DSWD with the support of the United Nations Development Programme, to develop a referral system that will equip LGUs with the necessary mechanisms to deliver community- based services to PLHIV. The Referral System for the Care and Support Services for Persons Living with HIV is a significant tool that facilitates the collaboration of service providers and local government agencies to provide care, and support for PLHIV. With this tool, HIV/AIDS can be prevented with the harmonization of information given to people and institution of values that are against discrimination and stigmatization. Furthermore, this Referral System will also ensure that social workers and other service providers will be guided by the principles of confidential HIV counseling and working towards empowerment of PLHIV, promoting accountability on the part of local officials, and safeguarding the future and life of children involved in cases of HIV/AIDS. Through the Republic Act 8504 ―Philippine AIDS Prevention and Control Act of 1998‖ and the AIDS Medium Term Strategic Plan IV (2005-2010), which is geared towards helping the country meet the MDG targets by 2015, the Department have recognized the importance of ensuring that PLHIV will have access to an environment that is caring, supportive, and sensitive to their varying needs and conditions. I am glad that this Referral System has been crafted because it stresses that in case of HIV/AIDS something has to be done beginning from the city/municipal level up to the national level. The contents of this manual also promotes a framework that showcase a holistic response to the immediate and long term needs of the PLHIV, their families, and communities. Together as a compassionate society, we can prevent the spread of HIV/AIDS in our nation and eventually the rest of the world. Let us stand up to this challenge and work together for a better future for the next generation. Corazon Juliano-Soliman Secretary Referral System for Care and Support Services for Persons Living with HIV in the Community 3 Message from United Nations Development Programme The Philippines is at a critical moment in its response to HIV and AIDS with the rapidly accelerating rate of HIV infection in the past years. While one of the biggest challenges is scaling up effective HIV prevention strategies, equally important is improving care and support services for the increasing number of people infected and affected by HIV and AIDS. To help mitigate the negative impact of HIV and AIDS, UNDP supported the establishment of the referral system for care and support services for people infected and affected by the disease and the development of its accompanying program manual. These manuals are products of the strategic partnership between the Department of Social Welfare and Development (DSWD) and UNDP towards successful achievement of the outcome of the joint project, ―Mitigating the Economic and Psychosocial Impact of HIV and AIDS‖. The first manual, “A Referral System for Care and Support Services for Persons Living with HIV (PLHIV) and their Families in the Community”, provides a framework through which stakeholders fulfill their obligations to protect and promote the rights of PLHIV, their children and affected families. It presents an effective mechanism to ensure access of PLHIV to a quality and timely delivery of services, including those that will cater the needs of their families. It is intended to facilitate the convergence of various service providers from multi- sectoral agencies to respond to the emerging needs of PLHIV towards full enjoyment of their human rights, and fulfillment of a meaningful and productive life. The accompanying document to the referral system, “Program Manual on Care and Support Services for Persons Living with HIV and AIDS and their Families”, serves as the operations manual to guide implementers in the delivery of care and support services to PLHIV, their children, and their families. It is a tool that supports the prevention and management of problems associated with HIV and AIDS at all levels: individual, family, and community, particularly those that requires psychosocial interventions. I am delighted that the referral system is now in place. In a way, this will help support the fulfillment of DSWD’s mandate of mitigating the impact of HIV and AIDS on individuals, families and communities, and its effort to institutionalize care and support services by strengthening the role and capacities of social workers, community volunteers, and community leaders. I hope that this will also facilitate the successful implementation of the country’s Fifth AIDS Medium-Term Plan (AMTP V) particularly in addressing the emerging challenges on HIV treatment, care and support. Moreover, I hope that this would, ultimately, assist the country in attaining its MDG 6 target of halting the spread of HIV and AIDS by 2015. I wish to extend my sincerest appreciation to DSWD for the partnership, dedication, and commitment to develop these important tools. I look forward to the effective use of these tools towards enhanced HIV prevention, care and support services in the Philippines. Renaud Meyer UNDP Country Director Referral System for Care and Support Services for Persons Living with HIV in the Community 4 Acknowledgements The Referral System for the Care and Support for Persons Living with HIV and their Families in the Community was developed in partnership and collaboration with several stakeholders. The Department would like to express its deepest and sincerest gratitude to the United Nations Development Programme (UNDP) for funding the DSWD-UNDP Project entitled Mitigating the Economic and Psychosocial Impacts of HIV and AIDS. This project is under component number three (3) of the five (5) components under Promoting Leadership and Mitigating the Negative Impacts of HIV and AIDS on Human Development Programme of UNDP which supported the publication of this document. The Department commends and recognizes the contributions of the following for the formulation of this significant and unprecedented document: ƒ To DSWD Undersecretary Alicia R. Bala, Assistant Secretary Florita R. Villar, and STB Assistant Bureau Director Gemma B. Gabuya, for their invaluable support, guidance, and inputs; ƒ To Ms. Irene V. Fonacier-Fellizar and former DSWD Undersecretary Lourdes G. Balanon, for being the Resource Persons during the series of regional consultations and validation workshops and the latter for being the Consultant of this publication; ƒ To our partners in this UNDP Project: Positive Action Foundation of the Philippines (PAFPI), and Pinoy Plus, for providing significant inputs and sharing their first hand experiences in working with Persons Living with HIV (PLHIV); ƒ To the DSWD Regional AIDS Focal Persons: Mr. Armont C. Peciña, Ms. Melanie M. Barnachea, Ms. Mylah So Gatchalian, Mr. Benjamin C. Baruc, Ms. Elizabeth Lim Dy, Ms. Hazel T. Militante and Ms. Maria Clara P. De Guzman, who all throughout, tirelessly supported the project; ƒ To the participants of the series of consultations, writeshops, and validation workshops from the national and local government agencies: (PNAC Secretariat - Dr. Ferchito L. Avelino, DOH- National Center for Disease Control and Prevention, Dr. Gerard B. Belimac, DILG, PDEA, DepEd, DOLE, P/C/Municipal Health Offices, Social Hygiene Clinics, P/City/M Social Welfare and Development Offices); the Philippine National Red Cross; the NGOs: The Library Foundation, Remedios AIDS Foundation, TRIDEV, Bidsiliw, Babae Plus, Precious Jewels Ministry; the CBOs: HDES, Cebu Plus, Cavite Support Group, ACAC-Sister Plus Angeles City; the FBOs: Belen sa Batangas); and the Academe (CEDO-South Western University). ƒ To the Social Technology Bureau (STB) staff; Marilyn B. Moral, Ms. Eden C. Mariño and Ms. Elma Solis-Salamat, for their substantial contribution; and ƒ Most especially, to the Persons Living with HIV and their Families who inspired us and contributed to this publication. Referral System for Care and Support Services for Persons Living with HIV in the Community 5 Table of Contents Acronyms Acronyms .....................................................................................................................................9 AIDS - Acquired Immune Deficiency Syndrome Part I. Background ...........................................................................................................10 CBOs - Community Based Organizations Section 1. Introduction ..................................................................................................10 CoC - Continuum of Care Section 2. Rationale .......................................................................................................11 CorA - Coordinating Agency Section 3. Policy Framework .........................................................................................12 CHED - Commission on Higher Education Section 4. Guiding Principles ........................................................................................14 Section 5. Defnition of Terms .......................................................................................15 DepEd - Department of Education Section 6. Conceptual Framework ................................................................................17 DILG - Department of the Interior and Local Government 6.1. Continuum of Care (CoC) ............................................................................17 DFA - Department of Foreign Affairs 6.2. Care and Support Services for PLHIV and their Families ...........................18 DOH - Department of Health 6.3. The National Referral Mechanism ...............................................................18 DOJ - Department of Justice DOLE - Department of Labor and Employment Part II. The Referral System .......................................................................................20 DSWD - Department of Social Welfare and Development Section 7. The Referral System ......................................................................................20 FBOs - Faith Based Organizations 7.1. The advantages of establishing a referral system .......................................20 FP - Focal Person 7.2. Essential Elements of Referral System .........................................................21 HACT - HIV/AIDS Core Teams Section 8. Establishing a Referral System ....................................................................23 HIV - Human Immunodeficiency Virus Section 9. Operationalization of the Referral System ...................................................26 LAC - Local AIDS Council 9.1. Coordinating Agencies at the Regional and City/Municipal Levels ............26 LGU - Local Government Unit 9.2. Provision of Care and Support Services for PLHIV and their Families ......27 NEC - National Epidemiology Center 9.3. Community-Based Referral System ..............................................................30 NGOs - Non - Government Organizations Section 10. Competencies of the Service Providers ......................................................36 OI - Opportunistic Infections 10.1. Knowledge. .................................................................................................36 10.2. Attitudes and Behavior ...............................................................................36 OWWA - Overseas Workers Welfare Administration 10.3. Skills ...........................................................................................................36 PAFPI - Positive Action Foundation Philippines, Inc. P/C/MHO - Provincial/City/Municipal Health Office References ..................................................................................................................................37 P/C/MSWDO - Provincial/City/Municipal Social Welfare and Development Office Appendices .................................................................................................................................38 PLHIV - Persons/People Living with HIV Appendix A: Intake Form (Form 1) ................................................................................39 PNAC - Philippine National AIDS Council Appendix B: Referral for Service Form (Form 2) ..........................................................42 RAATs - Regional AIDS Assistance Teams Appendix C: Referral Feedback Form (Form 3) ............................................................43 RH - Reproductive Health Appendix D: Referral Registry (Form 4) ........................................................................44 RS - Referral System Appendix E: Directory of Resources (Form 5) ...............................................................45 RecA - Receiving Agency Appendix F: Implementing Rules and Regulations Republic Act No. 8504...................49 RefA - Referring Agency Appendix G: DILG Memorandum Circular ....................................................................72 Appendix H: DSWD, DOH, DILG Joint Memorandum Circular ...................................74 STI - Sexually Transmitted Infections on Regional AIDS Assistance Team (RAATs) ....................................................74 TESDA - Technical Education Skills and Development Authority Appendix I: Olongapo City Ordinance on Local AIDS Council ....................................77 VCT - Voluntary Counseling and Testing Appendix J: Directory Of Resources For STI, HIV and AIDS ........................................87 Appendix K: List of Accredited Laboratories for HIV Testing in MetroManila .............94 Appendix L: List of Treatment Hubs ...............................................................................96 Referral System for Care and Support Services for Persons Living with HIV in the Community 7 Acronyms AIDS - Acquired Immune Deficiency Syndrome CBOs - Community Based Organizations CoC - Continuum of Care CorA - Coordinating Agency CHED - Commission on Higher Education DepEd - Department of Education DILG - Department of the Interior and Local Government DFA - Department of Foreign Affairs DOH - Department of Health DOJ - Department of Justice DOLE - Department of Labor and Employment DSWD - Department of Social Welfare and Development FBOs - Faith Based Organizations FP - Focal Person HACT - HIV/AIDS Core Teams HIV - Human Immunodeficiency Virus LAC - Local AIDS Council LGU - Local Government Unit NEC - National Epidemiology Center NGOs - Non - Government Organizations OI - Opportunistic Infections OWWA - Overseas Workers Welfare Administration PAFPI - Positive Action Foundation Philippines, Inc. P/C/MHO - Provincial/City/Municipal Health Office P/C/MSWDO - Provincial/City/Municipal Social Welfare and Development Office PLHIV - Persons/People Living with HIV PNAC - Philippine National AIDS Council RAATs - Regional AIDS Assistance Teams RH - Reproductive Health RS - Referral System RecA - Receiving Agency RefA - Referring Agency STI - Sexually Transmitted Infections TESDA - Technical Education Skills and Development Authority VCT - Voluntary Counseling and Testing Referral System for Care and Support Services for Persons Living with HIV in the Community 9 Referral System for Care and Support Services for Persons Living with HIV in the Community 7 Part I. Background Section 1. Introduction The first AIDS case in the Philippines was reported in 1984. From January 1984 to March 2010, there were a total of 4,817 HIV Ab seropositive (HIV positive) cases reported (Table 1), of which 3,979 (83%) were asymptomatic and 838 (17%) were AIDS cases. In March 2010 alone, there were 120 new HIV Ab sero-positive individuals confirmed by the STD/AIDS Cooperative Central Laboratory (SACCL) and reported to the HIV and AIDS Registry (Table 1). This was a 103% increase compared to the same period last year (n=59 in 2009) [Figure 1]. 1 Table 1. HIV Cases from 1984-2010 Quick Facts Demographic Data Mach 2010 Jan-Mar 2010 Cumulative Data: 1984—2010 Total Reported Cases 120 393 4,817 Asymptomatic Cases 117 387 3,979 AIDS Cases 3 6 838 Males 104 349 3,581 Females 16 44 1,225 Youth 15-24yo 35 126 850 Children <15yo 0 1 53 Reported Deaths due to AIDS 0 0 318 With the current statistics, the country’s HIV and AIDS situation has reached alarming proportions as it is now described as ―expanding and growing‖, from the previous ―low and 2 slow‖ and ―hidden and growing‖ phases. 1 DOH, National Epidemiology Center, 2009 2 DOH Press Release/26 March 2010 http://portal.doh.gov.ph/node/2628 Referral System for Care and Support Services for Persons Living with HIV in the Community 8 Referral System for Care and Support Services for Persons Living with HIV in the Community 10