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Alternative budget proposal for HIV and AIDS (2013 GAA)

Alternative budget proposal for HIV and AIDS (2013 GAA)

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Published by Jonas Bagas

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Published by: Jonas Bagas on Sep 12, 2012
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Policy Brief on the 2013 HIV and AIDS budgetPrepared by the Network to Stop AIDS-Philippines (NSAP)
Introduction: A ‘fast and furious’ concentrated HIV epidemic 
The ‘fast and furious’ increase in new HIV cases in the Philippines points to a worseningconcentrated HIV epidemic in the country. While HIV prevalence is still low at .036%, therise in new infections is exponential: the number of new cases has gone up from 1 newinfection a day in 2007 to 8 to 9 new infections daily in 2012, bringing the number of
cases to 10,242 by July 2012. However, based on the projection
done by thePhilippine National AIDS Council, the total HIV cases in the Philippines is
to bearound 22,800 for 2012. The total cases is estimated to reach 35,900 to 46,500 by 2015.
The global HIV pandemic is manifesting signs of a slowdown, yet the Philippines is one ofonly seven countries worldwide with the highest increase in HIV incidence in the last tenyears.The main drivers of new infections are unprotected male-to-male sex (mostly in highlyurbanized centers in NCR, Cebu and Davao) and sharing of needles among injecting drugusers (mostly in Cebu). HIV prevalence among men who have sex with men and
HIV prevalence is the number of total HIV cases versus the total population, while HIV incidence refers tothe number of new HIV cases. The main source of the figures above is the 2011 Philippine Estimates of theMost-at Risk Population and People Living with AIDS of the Philippine National AIDS Council. The highestimate for 2015 is from the presentation of Dr. Eric Tayag during the March 22, 2012 Plenary Meeting ofPNAC.
The Philippines is facing a concentrated HIV epidemic that could lead to an estimated HIV prevalence of 35,900 to 46,500 by 2015. The rapid increase in new HIV cases has made the Philippines one of only seven countries worldwide with the highest increase in HIV cases.Reach of crucial HIV and AIDS services remains low. HIV testing is low among men who have sex with men and transgenders, including among injecting drug users. Risky behavior (unprotected sex or sharing of needles) is also common.Low coverage reflects low investment. Scaling up of treatment in HIV burden sites like NCR, Cebu, and Davao, requires an investment of P1B for this year, but total spending from public and private sources is only P540M.Reliance on external sources of funds is not strategic. Global Fund, the main donor for the Philippines’ HIV programs, has cancelled its next round of grants. The country proposed for a two-year extension but the funding’s approval is not yet guaranteed. Finally, even with Global Fund’s support, the funding gap still needs to be addressed.The P20M budgetary increase for the 2013 GAA is commendable, but it is not enough. The country needs P222M to reach the targets set by the national response.
YearTotal spending
2009573,122,069.902010563,684,723.902011545,365,110.07transgenders (MSM & TGs) is already at 1.68%, while it has reached 13.56% amonginjecting drug users (IDUs).
 Low coverage of crucial HIV prevention, treatment, care and support services amongthese key drivers of the epidemic accounts for the rapid rise in new infections.Among MSM and TGs who engage in anal sex, only 23% have been reached byprevention programs. This is supported by data showing low condom use among MSMand TGs who engage in anal sex (36.2%) and poor reach of HIV testing in said community(5%). Among drug users, risky behavior remains rampant: only one out four uses sterileinjecting equipment, and only 5% have undergone HIV test in the last 12 months.
Low coverage due to low HIV spending 
To arrest and reverse the growing HIV epidemic in the Philippines, key HIV prevention,treatment, care and support services have to reach 60% to 80% of all most-at riskpopulations by 2016, a recommendation contained in the 5th AIDS Medium Term Plan(AMTP V), the country’s roadmap in addressing the HIV epidemic. These interventionsneed to be targeted in high burden areas, especially NCR, Cebu, Davao and Angeles City,and other urban areas that surround these epidemic hotspots where new HIV cases havelikewise increased (Category B).A total of almost P1Bis needed to reach the targets set by the AMTP V for 2013 just forthe Category A areas.
Ironically, despite the rapid increase in HIV incidence in the country, the combined totalHIV spending from public and private sources is slowly declining (see table below). 
(Source: UNAIDS-National AIDS Spending Assessment)While the national government is slowly increasing its role in financing the country’s HIVand AIDS programs, the Philippines remains largely reliant on external sources offunding,mainly from Global Fund for AIDS, TB, and Malaria (GFATM), the largest internationaldonor for HIV and AIDS programs, and the private sector, mainly DKT International.
Source: 2011 Integrated HIV Behavior and Serological Surveillance
Unprotected anal sex is the most risky of all sexual activities, while sharing of needles is an immenselyefficient way of transmitting HIV through blood-to-blood contact. Voluntary HIV testing is an importantprevention intervention because HIV infection is asymptomatic. More data on coverage of existing HIVprograms and other indicators may be found in PNAC’s 2012 Global AIDS Response Progress Report.
Source: HIV and AIDS Investment Plan 2011-2016 (PNAC).
The decline in Global Fund spending can be attributed to the closure of two grants (GFRounds 3 and 5). The remaining grant supported by Global Fund (Round 6) will end thisNovember 30, 2012.Spending for prevention activities declined from 2011 to 2012. In 2011, nationalgovernment spending for prevention accounted for 22% of total spending for prevention,higher than Global Fund’s spending for prevention activities. The private sector spent themost, primarily for behavior change and condom use interventions. (see table below)
 Prevention spening
YearNGGlobal FundOthersTotal200912,950,881.00170,996,996.64135,184,179.18319,132,056.82201074,230,600.0085,028,107.91202,458,028.43361,716,736.33201178,252,300.0058,110,434.27211,063,115.33347,425,849.60Meanwhile, from 2009 to 2011, the national government steadily increased its spending forHIV treatment, care and support interventions. In 2011, it accounted for 80% of allspending for treatment, care and support, while Global Fund, which in previous years hasbeen the main funder of ART in the country, spent only P7 million for treatment.0150300450600
200920102011Share of spending (in million pesos)Natl. GovtGlobal FundOthers

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