Abstract
Final evaluation of the AIDS Prevention and Education Project (ASEP), designed to combat HIV/AIDS and sexually transmitted diseases (STDs) in the Philippines. Evaluation covers the period 7/92-5/01. ASEP implementation is led by the World Health Organization/Western Pacific Regional Office (WHO/WPRO) and the Program for Appropriate Technology in Health (PATH) and focuses on eight major cities of the country. Overall, ASEP has been highly successful and has accomplished a great deal at a relatively low cost. The continued slow pace of the HIV/AIDS epidemic is due in part program accomplishments, of which three are major: (1) In 1993, ASEP established the country's first HIV/AIDS sentinel surveillance, a system that now covers 10 cities. Surveillance data show that prevalence continues to remain at very low levels even among high-risk groups (<1%). However, high-risk behaviors among sex workers, male clients, men who have sex with men, and injecting drug users create the potential for a rapid increase in HIV/AIDS infections. The risk of a rapid acceleration remains quite real, requiring continued assistance for HIV/AIDS prevention. (2) ASEP has demonstrated that local NGOs, very few of whom were involved in HIV/AIDS work at project inception, can develop effective education programs targeted on difficult to access high-risk groups. At the same time, PATH's work with NGOs in the eight ASEP focus cities shows that it takes about 4 years for an NGO to become effective at supporting STD/HIV/AIDS prevention work. The NGO must recruit, train, supervise, and retain workers who are willing and able to undertake difficult and potentially dangerous work. They must also establish credibility and rapport with clients before education messages are accepted and believed. Reaching individuals for one-on-one discussions about HIV/AIDS prevention requires workers to do where their clients work -- red-light districts, sex establishment, bars, streets frequented by freelancers, etc. This work is further complicated by the frequent occurrence of police raids in these areas and by the fact that certain high- risk groups -- particularly injecting drug users (IDUs) and men who have sex with men (MSM) -- avoid contact because they do not wish to be known. (3) ASEP has shown that local government units (LGUs) can be actively engaged in supporting and conducting STD/HIV/AIDS prevention programs, particularly surveillance. Thanks to the work of PATH and its NGO partners, ASEP LGUs have progressed from no awareness and no response to actions previously not even contemplated. ASEP has helped develop local government institutional mechanisms that are essential for implementing and sustaining programs against the spread of STDs and HIV/AIDS. ASEP partners are now working with barangay officials and council members to use existing laws and ordinances to thwart sexual exploitation of children and to gain access to available funds for programs that discourage sex work by minors. In fact, although there is a wide range of stakeholders from national to local levels as a result of ASEP, the strongest capacity for future support for HIV/AIDS prevention is in ASEP- assisted cities. Possible elements for a "second generation" HIV/AIDS program include: performance-based incentive grants for LGU STD/HIV/AIDS prevention; applied research for developing STD/HIV/AIDS prevention programs that reach unserved/under-served high risk groups; targeted programs for MSM and IDUs; and applied research for promotion of additional behavioral change associated with STD/HIV/AIDS infection.