Philippines: Initiatives on Improving Migrants’ Health and HIV/AIDS Services

1. Philippines: Initiatives on Improving Migrants’ Health and HIV/AIDS Services Ma. Lourdes Marin, ACHIEVE Susan Gregorio MD, PNAC – DOH Lilibeth David, MD, DOH Ivy Fatima Ferrer, DFA Ma. Teresita S. Cucueco MD, DOLE-OSHC

2. Outline of Presentation: • Philippines Statistics on HIV/AIDS • National prevalence including OFW (1984-Sept 2011) • Government initiatives on HIV and Migration • Department of Health • Department of Labor and Employment • Department of Foreign Affairs • Civil Society Initiatives • Challenges in Implementation and Improving Migrant workers health and access to HIV

3. HIV/AIDS Cases (1984- Sept 2011)

4. No. of New HIV/AIDS cases per month (2009- Sept 2011)

5. No. of HIV/AIDS cases Reported by Year

6. Comparison of Male/Female HIV/AIDS cases by age group

7. Reported Mode of HIV Transmission

8. Reported Mode of HIV Transmission among OFWs

9. No. of OFWs compared to non-OFWs by Year

10. Profile of HIV+ OFWs • 1,729 HIV+ OFWs (1984-2011) • 76% Males (1,317) • Age range from 18 to 69 years (median 35 years) • Predominant mode of transmission - Sexual contact (96%) • Asymptomatic cases: 84% (1,454) • AIDS cases: 16% (275)

11. Government Initiatives • Millennium Development Goals- MDG 6: Combat HIV and AIDS • Republic Act 8504: Philippine AIDS Prevention and Control Act • Republic Act 10022: Migrant Workers and Overseas Filipinos Act of 1995 as amended

12. Department of Health • AIDS Medium Term Plan 2011-2016 • Philhealth Package for OFWs • Department Order 01-04 s. 2006: Guidelines on the Referral System of Repatriated OFWs Diagnosed with HIV Abroad • NDHS Survey on KAP • Treatment Service

13. Department of Foreign Affairs • Integration of HIV in the pre-departure orientation seminar/training curriculum of all departing foreign service personnel and officers (since 2004) • Development of a guidebook on Handling HIV cases among OFWs Onsite • Conduct of HIV awareness seminars for personnel of DFA (OUMWA, OCA, FSI)

14. Department of Labor and Employment • Labor Offices in-charge of Migration: • Philippine Overseas Employment Authority (POEA) • Overseas Workers Welfare Administration (OWWA) • Education and Information Dissemination • Integration of HIV Modules in: • Pre-employment and Pre-Departure Orientation Seminar (PEOS and PDOS) • Capability Enhancement of Public Employment Service Office (PESO) Managers in Local Government Units • Continuing Education for Recruitment Agency Personnel and Applicants • Training of Overseas Labor Officers (POLOs) to provide needed services onsite

15. Department of Labor and Employment and Department of Foreign Affairs • Assistance On-site: Assistance to Nationals • Migrant Workers and Other Overseas Filipinos Resource Centers (24 hour information and assistance center established in Phil. Embassies and Consulates with large number of OFWs) • HIV/AIDS Counselling, IEC material dissemination • Legal and Consular Services (for OFWs with problems of deportation, arrest and dismissal from work) • Welfare Assistance (medical and hospitalization) • Monitor daily situation affecting migrant workers

16. Department of Labor and Employment and Partners • 24 Hour information Center (OWWA) • Facilitates communications of OFWs with their Families • Credit and Livelihood Training and Related Services (OWWA and NGOs/CSOs) • Insurance (Social Security System) • Health Care (OWWA and NGOs/CSOs)

17. Department of Labor and Employment and Partners • Return and Reintegration • Referral for Loans and Livelihood training from the National Reintegration Center for OFWs (NRCO) • Skills training and upgrading by TESDA (Technical Education and Skills Development Authority)

18. CSO Initiatives • Conduct of pre-departure seminars on HIV and AIDS for OFWs (among seafarers, domestic workers, other land-based workers) • Care and support (counseling, referrals) for HIV+ OFWs • Community-based programmes for female spouses of seafarers • Advocacy for recognition of migrant workers human rights, including right to health • Action-researches to inform HIV and other health related programmes (sexual reproductive health and mental health) of migrant workers

19. Walk- in HIV+ OFW Provide all possible support within bounds of law. Advice to return to work Assists OFW NO Facilitates repatriation; Coordinates with Repatriation Assistance Office in Head Office; Informs next of kin For repatria-tion? Needs medical interven-tion? NO YES Assess case; Provide counseling and, accommodation YES Refers to health facility for care & treatment (abroad) Coordinates with DFA Turns over OFW to Repatriation Officer Monitors status until stabilizes DFA to alert Philippine Department of Health through the Bureau of Quarantine OFW returns to the Philippines Flow Chart For Overseas Welfare Officers in Managing HIV (+) OFWs

20. OFW arrives at airport • Repatriation Officer • endorses OFW to Case Officer in Home Office • coordinates with next of kin Local Case Officer to refer to Bureau of Quarantine at port of entry NRCO to assist OFW in employment or livelihood activities Refer to National Reintegration Center for OFWs Disagree Refer to VCCT * ? Refer for counseling Agree Refer Laboratory facility for Pre-Counseling and Confirmation Refer to health facility for care and support? Refer to physician for post-test counseling and physical assessment Positive Test ? OWWA to facilitate transport to preferred facility Agree YES Disagree NO Provide list of facilities to OFW for future access when ready Refer to trained counsellor for post-test counselling * Voluntary Confidential Counselling and Testing or its equivalent; Procedure based on DOH Department Memorandum 2006-0104 Flow Chart for Management of Repartriated HIV (+) OFW Cases

21. Issues and Challenges on Assistance to OFWs and other Filipino Nationals • Reports from Phil. Overseas Labor Officers (POLOs) • Fear of Stigma • Fear of Disclosure of Disease by Embassy POLO staff • Lack of Trust and Confidence on Foreign service personnel • Recommendation: • Enhance and strengthen capacities of Philippine Embassy staff: DFA consular officers and Phil. Overseas Labor Officers and OWWA Representatives • Training on Counseling • Strengthen referral systems

22. Maraming Salamat po!