Overview of the AIDS Epidemic and the Response in Quezon City

With more than 2.6 million residents, Quezon City is the largest city in the Philippines (by population) and has been classified by PNAC as one of the country’s 22 highest priority areas for accelerated HIV interventions. There are numerous entertainment establishments in the city and it is home to the largest concentrations of key affected populations (KAPs) in Metro Manila. The 2011 IHBSS indicated HIV prevalence in Quezon City among RFSW at 0.33%, among FFSW at 0.34% and among MSM at 5.56%, which is significantly higher than the national HIV prevalence for MSM (2.16%). Prevalence figures are not available for PWID, of whom there are fewer than 300 in Quezon City, according to the most recent population size estimates. The epidemic is currently being driven by male to male sex, which accounted for 52% of HIV cases reported in 2011.^[1] Quezon City has had an active HIV response since the 1990s and was one of the original HIV sentinel sites in the DOH’s AIDS Surveillance and Educational Project (ASEP), supported by USAID.

The AIDS program in Quezon City is fully supported by the City Government through the City Health Department, which has shown a high level of leadership. The incumbent City Health Officer was formerly in charge of the AIDS Program and therefore has an in-depth understanding of the epidemic and is very engaged in the response. As such she has been proactive in seeking additional resources/funding and other support for the program.

Currently, Quezon City Health Department delivers STI and HIV services through three Social Hygiene Clinics that cater mostly to FSW, with one also operating extended hours (‘Sundown clinic’) to cater specifically to MSM. A fourth SHC/Sundown clinic will open in 2014.  SHCs are supported by the LGU, with some support from the central government and Global Fund for HIV test kits.

Quezon City Health Department has pioneered a number of initiatives in the country response. With assistance from FHI, it developed a local Service Delivery Network that facilitates referrals across several hospitals and NGOs; in 2009 it became the first local Health Department in the country to offer provider-initiated HIV testing and counselling in TB-DOTS centers (2009); it was the first LGU to hire peer educators to expedite service delivery to MSM (2010); and the first to set up clinic services specifically to meet the needs of MSM (the Sundown Clinic, established in 2012). It is now in the process of setting up satellite ARV treatment hubs, which will operate through two Sundown clinics. 

The AIDS program has benefited from high-level political commitment from both the executive and legislative branches of the local government (see Box 1). This is demonstrated through their response to requests for funding; willingness to facilitate access to funding from a variety of sources such as the LPRAP[2] and Gender and Development funds, which are available to local authorities up to the Barangay level; the issuance of local ordinances that directly or indirectly support the AIDS response; and the approval of innovative approaches such as the hiring of peer educators, the opening of a Sundown clinic for MSM and allowing NGOs to use SHC facilities.

The LGU’s willingness to engage civil society organisations as partners in the response may have been influenced by the strong tradition of student activism (through the University of the Philippines – Diliman Campus in Quezon City), NGOs and community mobilization in Quezon City. Other examples of the City’s support include the use of Mayor’s Funds to establish the Quezon City Pride Council, which is led by LGBTs. 

The 1998 AIDS Law stipulates that every LGU in the country should have an AIDS council, supported by contributions from each of the member departments. The Quezon City STD and AIDS Council (QCSAC), established in 1999, is tasked with setting the direction of and coordinating AIDS and STD prevention programs in the city that are implemented by the LGU and non-government organizations. Alongside the Quezon City Health Department, the QCSAC formulates policies and guidelines, and coordinates activities and funding for the AIDS response. Members include all departments and offices of the city government, the Philippine Red Cross, CSOs (including organizations serving key affected populations) and others. It is chaired by the Mayor, with the Head of the City Health Department as the co-chair.

The QCSAC aims to be a model AIDS council, with a defined budget from each department, however small. The Council meets every month, and minutes go to the Mayor, department heads, stakeholder organisations, etc. Many, if not all, of the NGO implementers/partners are invited to the monthly QCSAC meetings even if they are not members. All implementers and development partners are invited to an annual HIV/AIDS program implementation review (PIR) to evaluate progress and plan for the next cycle. As of the beginning of 2014, this will take place on a quarterly basis.

Quezon City has issued a number of local ordinances in support of the AIDS response, the first of them predating the 1998 AIDS Law. The key ordinances are: 

•  Ordinance SP-380, S-95 1996: institutionalised Quezon City’s prevention campaign against HIV, AIDS and other sexually transmitted diseases.

•   Ordinance SP-838, S-99 1999: formed the Quezon City STD/AIDS Council (QCSAC), defined its functions and membership, as part of the City’s response to the emerging threat of HIV, AIDS and other STD.

•  Ordinance SP 1053, S-2001, or the Quezon City AIDS Prevention and Control Ordinance: strengthened the QCSAC by giving it a mandate to ensure the comprehensive implementation of five STD/HIV/AIDS Prevention Policies, including the availability of prophylactics and other information materials in all registered entertainment establishments.

•  Ordinance SP-2210, S-2013, “an ordinance prohibiting all forms of discrimination of workers perceived or suspected or even found to be positively infected with HIV in workplaces within the territorial jurisdiction of Quezon City.”

A review of Ordinance 1053 in 2011 by ACHIEVE for the Local Government Academy, with UN support, found several shortcomings in the implementation of its major provisions.^[3] 

Moreover, there may be a need to update the legislation (which focused on HIV prevention among FSW) to better reflect the changing profile of the epidemic in Quezon City.

Following PNAC’s identification of Quezon City in 2012 as one of the areas to be prioritized for an accelerated HIV and AIDS response, the City became a focus for intensified technical assistance and capacity development under the UN Joint Programme on AIDS, facilitated by UNAIDS and a number of its co-sponsors.

In 2012, PNAC nominated Quezon City as the Philippines’ participant in the ASEAN Cities Getting to Zero initiative (based on criteria that included epidemic burden, available epidemiological, programmatic and policy information, and potential for good-neighbor influence among other priority areas), and in 2013 implemented a Rapid Assessment Survey as an initial step in strengthening the localization of AIDS responses among LGUs.

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[1] NEC HIV Registry, as quoted in the Quezon City Investment Plan for HIV and AIDS.

[2] Funding is allocated to selected LGUs specifically to finance their Local Poverty Reduction Action Plans, which are developed through a participatory process involving CSOs and other stakeholders to directly address the needs of poor and marginalized sectors in the LGU. (DBM-DILG-DSWD-NAPC Joint Memorandum Circular No.1/2012)

[3] Policy Review: The AIDS Prevention and Control Ordinances of Quezon City and Pasay City, Local Government Academy/Department of the Interior and Local Government, 2011, as quoted in Looking Back and Taking Stock: Implementation of the ASEAN Cities Getting to Zero Rapid Assessment Tools in Quezon City and 16 Other Sites in Metro Manila, PNAC et al. The review was carried out as part of a project launched by UNDP and the Local Government Academy (LGA), in conjunction with the PNAC and the UN Joint Team on AIDS, to strengthen local AIDS responses through developing the leadership capacities of local governments and establishing Regional AIDS Assistance Teams (RAATs) to provide technical assistance to the LGUs. The review sought to assess local HIV and AIDS ordinances in Quezon City and Pasay City with regard to their alignment with national laws/policies and internationally recognized guidelines and principles, responsiveness to the current epidemiological situation and emerging risks, and implementation, in order to generate recommendations that would contribute to enhancing the policy environment and programme implementation among LGUs.