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Data Collection in MARA –

Integration in national IHBSS

Example: Philippines

Gudrun Nadoll, HIV Specialist, UNICEF Philippines

September 3, 2009, MARA Consultation, Geneva

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Background

Low HIV prevalence, high rates of STIs HIV reported cases increasing; profile getting

younger Expansive sex industry Sub-groups of MSM practice unsafe sex /

many partners Needle sharing; overlap IDU/sex work Estimated 10-30% of MARP below 18 years of age Low level of awareness, low condom use

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Background

While national response focuses on MARP, young MARP receive less intervention than older MARP

Studies on OSY and street children ongoing; but not specifically for most-at-risk adolescents

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Know the epidemic: Evidence through IHBSS

Evaluation of 2007 HIV Surveillance

Evaluation of 2007 HIV Surveillance

• Unclear eligibility criteria regarding age

• Study teams not trained in enrolling minors

IHBSS: Integrated HIV Behavior and Serological Surveillance

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Know the epidemic: Evidence through IHBSS

Evaluation of 2007 HIV Surveillance

Evaluation of 2007 HIV Surveillance

• Council for the Welfare of Children HIV Committee

• Chaired by DoH, with members from DSWD, DILG, DepEd, PNAC, Youth Representatives, PLHIV, NGOs, UNICEF

• Development of draft policy guide on children’s access to HIV counseling and testing

• Draft strategy framework

• Additional CWC Stakeholder Consultation

• To discuss legal perspective, perspective of service providers, perspective of young people most-at-risk regarding children’s access to counseling and testing

2008/2009: Consultations regarding children and HIV strategy and policies

2008/2009: Consultations regarding children and HIV strategy and policies

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Know the epidemic: Evidence through IHBSS

Evaluation of 2007 HIV Surveillance

Evaluation of 2007 HIV Surveillance

• Conclusion for IHBSS:

• Recognized importance of data on young MARP for policies and programs for young MARP.

• Can the 15-17 be included in IHBSS?

• If informed consent is ensured, adolescents can give own consent under AIDS law

• Steps in policy guide to be followed

• Below 15 to be excluded since this would require different set-up

• Should the 15-17 be included in IHBSS (as compared to special study)?

• IHBSS is the official, comprehensive surveillance; linked with related m&e efforts

• Considered cost-effective

2008/2009: Consultations regarding children and HIV strategy and policies

2008/2009: Consultations regarding children and HIV strategy and policies

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Know the epidemic: Evidence through IHBSS

Evaluation of 2007 HIV Surveillance

Evaluation of 2007 HIV Surveillance

Approval by DoH Ethical Review Board

Approval by DoH Ethical Review Board

2008/2009: Consultations regarding children and HIV strategy and policies

2008/2009: Consultations regarding children and HIV strategy and policies

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Know the epidemic: Evidence through IHBSS

Evaluation of 2007 HIV Surveillance

Evaluation of 2007 HIV Surveillance

APPROVAL

APPROVAL

Training Interviewers on Child’s Rights

Training Interviewers on Child’s Rights

Referral directory for <18

Referral directory for <18

• Ensuring consent in minors

• Involvement of Regional and City Social Welfare Departments, “stand-by” for referral

2008/2009: Consultations regarding children and HIV strategy and policies

2008/2009: Consultations regarding children and HIV strategy and policies

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Know the epidemic: Evidence through IHBSS

Evaluation of 2007 HIV Surveillance

Evaluation of 2007 HIV Surveillance

APPROVAL

APPROVAL

Training Interviewers on Child’s Rights

Training Interviewers on Child’s Rights

Referral directory for <18

Referral directory for <18

Pilot Sampling Methodology (RDS)

Pilot Sampling Methodology (RDS)

2008/2009: Consultations regarding children and HIV strategy and policies

2008/2009: Consultations regarding children and HIV strategy and policies

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Know the epidemic: Evidence through IHBSS

Evaluation of 2007 HIV Surveillance

Evaluation of 2007 HIV Surveillance

APPROVAL

APPROVAL

Training Interviewers on Child’s Rights

Training Interviewers on Child’s Rights

Referral directory for <18

Referral directory for <18

Pilot Sampling Methodology (RDS)

Pilot Sampling Methodology (RDS)

‘Traditional’ Sampling Methodologies

‘Traditional’ Sampling Methodologies

2008/2009: Consultations regarding children and HIV strategy and policies

2008/2009: Consultations regarding children and HIV strategy and policies

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Use of the data

• Baseline for programming; monitoring progress in programming for young MARP

• Base to discuss/advocate for MARA policies and programs

• IHBSS process goes hand in hand with MARP size estimation workshops

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Challenges and lessons learnt

Still bias in terms of enrolment of <18

Follow-through on child-protection issues Monitor quality of ‘informed

consent’ procedure

Monitor quality of referral to social services

Large number of logistical issues absorb attention

WHO: documentation of 2009 IHBSS

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Thank you!