April 13, 1999

PNAC RESOLUTION NO. 1

IMPLEMENTING RULES AND REGULATIONS FOR REPUBLIC ACT NO. 8504 "PHILIPPINE AIDS PREVENTION AND CONTROL LAW OF 1998"

WHEREAS, Republic Act 8504 otherwise known as "the Philippine AIDS Prevention and Control Act of 1998" was signed into Law by the President of the Republic of the Philippines on February 13, 1998; SAHEIc

WHEREAS, The Philippine National AIDS Council, a multi-sectoral, central advisory, planning and policy making body is mandated by Law to oversee a comprehensive and integrated HIV/AIDS prevention and control program in the Philippines whose members were sworn into office by the President of the Republic of the Philippines on April 6, 1999;

WHEREAS, Article IX, Section 49 of Republic Act 8504 states that within six (6) months after it is fully reconstituted, The Philippine National AIDS Council is mandated to formulate and issue the appropriate rules and regulations necessary for the implementation of Republic Act 8504;

BE IT RESOLVED AS IT IS HEREBY RESOLVED, that We, The Members of the Philippine National AIDS Council do hereby order and issue the following Implementing Rules and Regulations.

Pursuant to Section 49 of Republic Act No. 8504, otherwise known as the Philippine AIDS Prevention and Control Act of 1998, the following Implementing Rules and Regulations are hereby adopted. DHCSTa

RULE 1

Title and Application

SECTION 1. Title. —

This Administrative Order shall be known as the "Rules and Regulations Implementing the PHILIPPINE AIDS PREVENTION AND CONTROL ACT OF 1998 (RA 8504)".

SECTION 2. Purpose. —

These Implementing Rules and Regulations (IRR) are adopted to disseminate the principles of RA 8504 and prescribe guidelines, procedures and standards for its implementation, to facilitate compliance to and achieve the objectives of the law.

SECTION 3. Declaration of Policies. —

Acquired Immune Deficiency Syndrome (AIDS) is a disease that recognizes no territorial, social, political and economic boundaries for which a cure has yet to be discovered. However, even if a cure is discovered, the Act shall continue to serve as an important guide in sustaining prevention and control efforts and caring for people of all ages already infected. The gravity of the AIDS threat demands strong State action today and in the future, thus:

a. The State shall promote public awareness about the causes, modes of transmission, consequences, and means of prevention and control of the Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) through a comprehensive nationwide education and information campaign organized and conducted by the State. Such campaigns shall promote value formation and employ scientifically proven approaches, focus on the family as a basic social unit, and be carried out in all schools and training centers, workplaces, and communities. This program shall involve affected individuals and groups, including people living with HIV/AIDS. SDITAC

b. The State shall extend to every person suspected or known to be infected with HIV/AIDS full protection of his/her human rights and civil liberties. Towards this end,

1) compulsory HIV testing shall be considered unlawful unless otherwise provided in this Act;

2) the right to privacy of individuals with HIV/AIDS shall be guaranteed;

3) discrimination, in all its forms and subtleties, against individuals with HIV/AIDS or persons perceived or suspected of having HIV/AIDS shall be considered inimical to individual and national interest; and

4) provision of basic health and social services for individuals with HIV/AIDS shall be assured.

c. The State shall promote utmost safety and universal precautions in practices and procedures that carry the risk of HIV transmission.

d. The State shall positively address and seek to eradicate conditions that aggravate the spread of HIV infection, including but not limited to poverty, gender inequality, prostitution, marginalization, drug abuse and ignorance. In seeking to eradicate these conditions, there is no intent to undermine other HIV/AIDS prevention activities. For example, this Act does not advocate eradicating prostitution through actions which drive the sex industry out of sight where it is more difficult to conduct HIV/AIDS prevention activities. DcSTaC

e. The State shall recognize the potential role of affected individuals in propagating vital information and education messages about HIV/AIDS and shall utilize their experience to warn the public about the disease.

f. Consistent with the above mentioned policies and in consonance with the Philippine National HIV/AIDS Strategy, the State, further, recognizes that:

1) Multi-sectoral involvement is essential to national and local responses to HIV infection;

2) People should be empowered to prevent further HIV transmission. Empowerment for all Filipinos will come through access to appropriate information and resources for prevention;

3) The formulation of socio-economic development policies and programs should include the consideration of the impact of HIV infection/AIDS;

4) Resources should be allocated taking into consideration the unique vulnerabilities of various population groups, including children, affected by HIV/AIDS and its impact; and

5) Continued efforts should be made to constantly improve the performance and assure the quality of HIV/AIDS related programs.

SECTION 4. Definition of Terms. —

As used in this IRR, the definitions of terms are as follows:

1. Acquired Immune Deficiency Syndrome (AIDS) — A condition characterized by a combination of signs and symptoms, caused by HIV contracted from another which attacks and weakens the body's immune system, making the afflicted individual susceptible to other life-threatening infections.

2. AIDS Registry — The official record of the number of reported HIV positive and AIDS cases and deaths confirmed by either the Bureau of Research and Laboratories (BRL) or the Research Institute for Tropical Medicine (RITM), and reported to the National HIV Sentinel Surveillance System (NHSSS).

3. Anonymous Testing — An HIV test procedure whereby the identity of the individual being tested is protected or not known. The unlinked anonymous method tests blood drawn for other purposes for HIV antibodies without the subjects knowledge and with all identifying data removed, while the voluntary anonymous method tests blood drawn from volunteers who have no identifying information, except a code number which is matched with a similar code of a given test result. AHSaTI

4. Behavioral Surveillance System (BSS) — A systematic and regular collection of information on risk behaviors and co-factors of the transmission of HIV infection among selected population groups.

5. Community — A group of persons with something in common.

6. Compulsory HIV Testing — An HIV testing of a person attended by the lack of consent; lack of consent of the parent when said person is a minor or the legal guardian when the same is insane; or use of physical force, intimidation or any other form of compulsion.

7. Condom — Is a thin protective barrier or sheath worn over the male or female external reproductive organ.

8. Contact Tracing — A method of finding and counseling the sexual partner(s) of a person who has been diagnosed as having a sexually transmitted disease or diseases.

9. Discrimination — A prejudicial act of making distinctions or showing partiality in the granting of privileges, benefits or services to a person on the basis of his/her actual, perceived or suspected HIV status.

10. Government Agency — Any of the various units of government, including a department, bureau, office, instrumentality or government-owned or -controlled corporation or a local government or a distinct unit therein.

11. Government Office — Any major functional unit of a department or bureau, including regional offices, within the framework of the governmental organization. It also refers to any position held or occupied by individual persons, whose functions are defined by law or regulation. All establishments or offices outside this definition are considered private offices.

12. Health Worker — A person engaged in health or health-related work in hospitals, sanitaria, health infirmaries, health centers, rural health units, barangay health stations, clinics and other health-related establishments.

13. High-Risk Behavior — A behavior or activity which when done increases the risk of acquiring or transmitting HIV. Examples are unprotected sex with multiple partners, low condom use and sharing of intravenous needles. TaCDcE

14. Hiring — The process of selecting an individual for a specific position or job.

15. HIV/AIDS Education — The provision of information on the causes, prevention and consequences of HIV/AIDS and activities designed to assist individuals to develop the confidence and skills needed to avoid HIV/AIDS transmission and to develop more positive attitudes towards people living with HIV/AIDS (PLWHA).

16. HIV/AIDS Monitoring — The documentation and analysis of the number and the pattern of spread and transmission of the HIV/AIDS infection and the prevention and control measures directed against it.

17. HIV/AIDS Prevention and Control — The program, strategies and measures aimed at protecting non-infected persons from contracting HIV and minimizing the impact of the condition on PLWHAs.

18. HIV-negative — Denotes the absence of HIV or HIV antibodies upon HIV testing.

19. HIV-positive — Denotes the presence of HIV infection as demonstrated by the presence of HIV or HIV antibodies upon HIV testing.

20. HIV Status — Denotes whether a person who has undergone an HIV test is HIV-positive or HIV-negative.

21. HIV Testing — A laboratory procedure done on an individual to determine the presence or absence of HIV infection.

22. HIV Transmission — The transfer of HIV from an infected person to an uninfected one, more commonly through sexual intercourse, blood transfusion, sharing of intravenous needles, or from the mother to the fetus or infant. aSCHcA

23. Human Immunodeficiency Virus (HIV) — The virus which causes AIDS.

24. Indigenous Learning Systems — Culturally rooted, formalized, and codified beliefs, knowledge and skills from recognized alternative systems of instruction which parallel modern private and public schooling. Classic examples of indigenous learning systems include the tent schools in Ifugao, Islamic or Quranic schools in Muslim societies, and child socialization practices in cultural communities. TIcEDC

25. Informed Consent — The voluntary verbal or written agreement of a person to undergo or be subjected to a procedure based on full information.

26. Injecting Drug Users (IDUs) — Individuals who inject prohibited or regulated drugs.

27. Medical Confidentiality — The expectation or situation of protecting and upholding the right to privacy of a person who had an HIV test or was diagnosed to have HIV. Confidentiality encompasses all information that directly or indirectly lead to the disclosure of the identity and HIV status of said person. This information includes, but is not limited to, the name, address, picture, physical characteristic or any other similar identifying characteristic.

28. Minor — A person who is below 18 years of age.

29. Non-formal Education — An organized non-school, community-based educational activity undertaken by the Department of Education, Culture and Sports or by other agencies, including private schools, aimed at attaining specific learning objectives for a target clientele, such as the illiterate, children who do not go to school, and adults who cannot avail of formal education. It is distinct from and outside of the regular offering of the formal school system.

30. Non-Government Organization (NGO) — A private, non-profit voluntary organization that is committed to the task of socio-economic development and established primarily for service.

31. Perceived or suspected HIV status — A judgment or suspicion about the HIV status of a person which may or may not correspond with the actual HIV status.

32. Person with HIV — An individual whose HIV test indicates, directly or indirectly, that he/she is infected with HIV.

33. Pre-employment to Post-employment — The continuity of employment starting from the hiring process, through employment, resignation, retirement and after retirement or resignation of an employee.

34. Pre-Test Counseling — The process of providing information on the biomedical aspects of HIV/AIDS and the possible results of the HIV test; and providing emotional support for any psychological implication of undergoing HIV testing to an individual before he or she undergoes the HIV test. CacEID

35. Post-Test Counseling — The process of providing risk-reduction information and emotional support to a person who submitted to HIV testing at the time that the test result is released.

36. Private Sector — The sector composed of non-government organizations, people's organizations, private schools and universities, business enterprises owned and operated by private individuals or groups, and other organizations and establishments which are not part of the government.

37. Prophylactic — A medical agent or device used to prevent the transmission of a disease. It does not include antibiotics and vitamins.

38. Sexually Transmitted Disease (STD) — Any disease that is acquired or transmitted through sexual contact.

39. Standardized Basic Information — The amount of knowledge on HIV/AIDS deemed sufficient by the Department of Health, the Department of Labor and Employment, the Department of National Defense and the Civil Service Commission, that enables individuals to take action for their own protection. It includes information on the nature of HIV/AIDS, its mode of transmission and causes. It discusses the issues of medical confidentiality, the dignity of the person afflicted with HIV/AIDS, the rights and obligations of employers and employees towards persons with HIV/AIDS, and the particular vulnerability of women.

40. Subpoena ad testificandum — A procedure of a competent court inviting a person to testify as a witness during a court trial or any investigation conducted under the laws of the Philippines. It is commonly referred to as subpoena.

41. Subpoena duces tecum — A procedure whereby a competent court requires a person to appear in court to present or provide specified documents and/or materials under her/his control which may be used as evidence.

42. Termination from work — Dismissal from work or the end of an employer-employee relationship.

43. Tourist — A temporary visitor staying at least 24 hours in the country for a purpose classified as either holiday (recreation, leisure, sport and visit to family, friends or relatives), business, official mission, convention or health reasons.

44. Transient — A temporary visitor who stays less than 24 hours in the country visited.

45. Treatment or Care — A health, psychological, spiritual or social intervention extended to a person with HIV/AIDS.

46. Voluntary HIV Testing — HIV testing done on an individual who, after having undergone pre-test counseling, willingly submits himself/herself to said test. CAaSHI

47. Window Period — Period of time, usually lasting from two (2) weeks to six (6) months during which an HIV/AIDS infected individual will test "negative" for HIV antibodies but, since the HIV is present, he or she is capable of transmitting the same.

RULE 2

Education and Information

SECTION 5. Nature and Scope. —

HIV/AIDS education and information shall consist of knowledge, skills and attitude competencies, accessible and available to all Filipinos, and targeted for the following groups:

a. Students and teachers in the primary, secondary, tertiary and vocational schools; HTASIa

b. Health workers and their clients in the government and private sectors;

c. Employers and employees in government and private offices;

d. Filipinos going abroad;

e. Tourists and transients;

f. Communities; and

g. Population groups with relatively higher risk of acquiring or transmitting HIV/AIDS.

SECTION 6. Purpose. —

Provision of timely, accurate, adequate, appropriate and relevant HIV education and information shall empower persons and communities to think and act in ways that protect themselves from HIV infection, minimize the risk of HIV transmission and decrease the socio-economic impact of HIV/AIDS.

SECTION 7. Content. —

The standardized basic information on HIV/AIDS shall be the minimum content of an HIV/AIDS education and information offering. Additional content shall vary with the target audience.

Selection of content or topic shall be guided by the following criteria:

a. Accurate — Biomedical and technical information is consistent with empirical evidence of the World Health Organization, the DOH, or other recognized scientific bodies. Published research may be cited to establish the accuracy of the information presented.

b. Clear — The target audience readily understands the content and message.

c. Concise — The content is short and simple.

d. Appropriate — Content is suitable or acceptable to the target audience.

e. Gender-sensitive — Content portrays a positive image or message of the male and female sex; it is neither anti-women nor anti-homosexual.

f. Culture-sensitive — Content recognizes differences in folk beliefs and practices, respects these differences and integrates, as much as possible, folkways and traditions that are conducive to health. cACHSE

g. Affirmative — Alarmist, fear-arousing and coercive messages are avoided as these do not contribute to an atmosphere conducive to a thorough discussion of HIV/AIDS.

h. Non-moralistic and non condemnatory — Education and information materials or activities do not impose a particular moral code on the target audience and do not condemn the attitudes or behaviors of any individual or population group.

i. Non-pornographic — Content or activity informs and educates and do not titillate or arouse sexual desire.

SECTION 8. Approaches. —

A prototype module or instructional design shall be developed on the standardized basic information on HIV/AIDS. Additional content suitable to a selected target audience may be added on the prototype.

This HIV/AIDS education and information prototype shall include the following:

a. instructional objectives;

b. content or topics and recommended time allocation;

c. teaching methods and activities;

d. evaluation methods and tools; and

e. recommended qualifications of resource persons.

Partnership and consultation shall be used in the development of the HIV/AIDS education and information prototype. The Department of Health (DOH), through the Special HIV/AIDS Prevention and Control Service (SHAPCS) shall develop the prototype, within six (6) months from the effectivity date of this IRR, in partnership and consultation with the:

a. Department of Education, Culture and Sports (DECS), Commission on Higher Education (CHED) and Technical Education and Skills Development Authority (TESDA);

b. Philippine Information Agency (PIA); HTSAEa

c. Department of Labor and Employment (DOLE);

d. Department of National Defense (DND);

e. Department of Foreign Affairs (DFA);

f. Department of Tourism (DOT);

g. Department of Transportation and Communication (DOTC);

h. Civil Service Commission (CSC); and

i. Representatives of private offices and NGOs

Suitability and flexibility shall be the basis for the adoption and modification of the prototype. The specific needs of each target audience for HIV/AIDS education and information shall be addressed by add-ons to the prototype.

DOH, in collaboration with its partners, shall assure the quality of the prototype through an annual review or as often as the need arises.

SECTION 9. Types of HIV/AIDS Education and Information Offerings. —

The HIV/AIDS education and information offerings shall make appropriate use of the multi-media, namely:

a. Face-to-face instruction as in tutorials, classes, seminars, workshops and discussion groups;

b. Print materials as in modules and other self-instructional materials, brochures, flyers, comic books, and magazines;

c. Audio and audio-visual activities and materials as in jingles, cassette tapes, radio broadcast, radio programs, film strips, VHS and beta tapes, and TV programs; and

d. HIV/AIDS distance education where self-instructional materials are sent to the target audience in accordance with adult learning principles. HTAIcD

SECTION 10. Levels of HIV/AIDS Education and Information. —

HIV/AIDS education and information shall be conducted at the following levels:

a. Individual;

b. Group;

c. Organization or institution;

d. Community;

e. Barangay;

f. Municipal;

g. Provincial;

h. Regional; and

i. National

SECTION 11. Structural Modes. —

HIV/AIDS education and information shall have the following structural modes:

a. Formal — HIV/AIDS education and information is integrated in existing or planned subjects or courses at the primary, secondary or tertiary levels of education;

b. Non-formal — HIV/AIDS education and information is part of non-degree continuing professional education programs; orientation, on-the-job training and in-service training; and extension programs for adult education; and

c. Indigenous learning systems.

SECTION 12. Training of HIV/AIDS Education and Information Trainors and Educators. —

The DOH, through the SHAPCS, in collaboration with its partners in the government and private sectors, shall undertake a national and regional training program of trainers for the HIV/AIDS education and information campaign, at least once a year.

Qualifications of the participants for the training for trainers shall include:

a. A health worker, teacher or individual working in the area of human resource development;

b. A representative of a government or private office or agency, school, NGO, community or local government unit (LGU) that will offer HIV/AIDS education and information training; and

c. Commitment to offer an HIV/AIDS education and information training for educators. THCSEA

Trainers, in turn, shall conduct the HIV/AIDS education and information training for educators at the group, organization, school, and community or LGU levels.

Educators shall conduct the HIV/AIDS education and information offerings at the individual, group, course, organization, community or LGU levels.

Other existing venues for the HIV/AIDS trainers and educator's training that may be considered by SHAPCS are the courses of the various health profession education programs, continuing professional education programs of the 42 nationally accredited professional organizations and the human resource development programs of the NGOs, academe and private agencies.

SECTION 13. HIV/AIDS Education in Schools. —

DECS, CHED and TESDA shall develop a school-based HIV/AIDS education and information program which shall include the HIV/AIDS education and information prototype, add-on content, and the development and provision of multi-media information and instructional materials to schools under their respective jurisdictions.

HIV/AIDS education shall be integrated into but not limited to science and health, edukasyon pantahanan at pangkabuhayan (EPP), sibika at kultura, good manners and right conduct (GMRC), and Filipino at the elementary level; in science and technology, social studies, physical education, health and music (PEHM) and values education at the secondary and tertiary levels. HIV/AIDS education shall also be integrated by DECS into its non-formal education program and in the indigenous learning systems. Instructional materials shall be provided for such purposes.

DECS shall further strengthen its own school-based AIDS education project through the development and printing of audio-visual materials such as posters, comics, flipcharts, modules, tapes and film strips.

Flexibility in the formulation and adoption of appropriate course content, scope and methodology in each educational level or group shall be allowed after consultations with the Parents-Teachers-Community-Association, association of private schools, school officials and other interest groups.

SECTION 14. HIV/AIDS Information as a Health Service. —

All efforts shall be exerted to provide inpatients with HIV/AIDS education, individually or in groups, during their period of confinement in a clinic, hospital or medical center, both government and private. The HIV/AIDS education prototype, as adopted and modified to suit the needs of this target audience, shall be used for this purpose. TSEAaD

Outpatient clients of barangay health stations, rural health units; district, provincial and regional hospitals; private clinics and hospitals; and government medical centers shall be given HIV/AIDS education seminars or tutorials to the extent possible.

Self-instructional HIV/AIDS materials shall be made available and accessible to inpatients and outpatients alike by the respective health agencies.

Government and private health facilities and private clinics shall be encouraged by the SHAPCS to play HIV/AIDS education and information audio and video tapes in the waiting, lounging and/or common rooms for their clients.

HIV/AIDS education and information shall be an integral part of the work of the health workers and they shall be trained for this purpose in accordance with Section 12 of this IRR.

Government agency members of the Philippine National AIDS Council (PNAC) shall ensure that all public health workers are trained on HIV/AIDS. In the private sector, it shall be the responsibility of the head of the health institution or agency to qualify the health workers under his or her jurisdiction as trainers and educators for the HIV/AIDS education and information program.

SECTION 15. HIV/AIDS Education in the Workplace. —

HIV/AIDS education shall be integrated in the orientation, training, continuing education and other human resource development programs of employees and employers in all government and private offices.

Each employer shall develop, implement, evaluate and fund a workplace HIV/AIDS education and information program for all their workers. The program shall include the following elements:

a. The HIV/AIDS education prototype and the modifications therein, that are suited to the target audience;

b. List of trainers and other resource persons from the same or other workplace(s);

c. Training schedule;

d. Self-learning information materials such as booklets, brochures, flyers and tapes;

e. Dissemination and distribution schedule of self-learning materials; and

f. A monitoring and reporting scheme

Monitoring and assessment of the workplace HIV/AIDS education program in the private sector shall be the responsibility of the DOLE, in collaboration with the DOH. The DOLE agencies in charge shall be the Inter-Agency Committee on STD/HIV/AIDS, chaired by the Occupational Safety and Health Center (OSHC) of DOLE, as well as the Department's Regional Offices. The Labor Inspectorate under the DOLE Bureau of Working Conditions, shall be responsible for enforcing compliance to the HIV/AIDS Workplace Program. AaSHED

For members of the AFP and the PNP, this shall be the responsibility of the Armed Forces Chief of Staff and the Director General of PNP, respectively. The Civil Service Commission (CSC) shall assist in the monitoring and assessment efforts for all other groups in the public sector.

Upon inspection, employers shall present records and materials of the HIV/AIDS education and information program and related activities undertaken.

The quality of the HIV/AIDS education and information program shall be under the Collective Bargaining Agreement, the human resource development unit or its equivalent in the agency or establishment.

SECTION 16. HIV/AIDS Education for Filipinos Going Abroad. —

Filipinos going abroad, consisting of all overseas Filipino workers (OFWs), as well as diplomatic, military, trade and labor officials and staff who will be assigned overseas, shall attend an HIV/AIDS education seminar prior to departure.

For OFWs, the HIV/AIDS education seminar shall be part of the Pre-Employment and Pre-Departure Orientation Seminars supervised by the DOLE. For the diplomatic, military, trade and labor officials and staff and their families, the appropriate agencies shall integrate the HIV/AIDS education into their existing training programs.

The HIV/AIDS education prototype and the modifications made therein, in partnership with various agencies and sectors of government and non-government organizations, to meet the specific needs of the target audience shall be used for the seminar or training program. Additional self-learning materials such as brochure, flyers and/or tapes shall be available to each participant. aCATSI

SECTION 17. Information Campaign for Tourists and Transients. —

HIV/AIDS information materials such as brochures, flyers, posters, audio and video tapes shall be prominently displayed or played, easily accessible and available at places where there are tourists and transients. These include:

a. commonly-used modes of land, sea and air transport such as buses, ferries and ships, and airplanes;

b. international and domestic ports of entry and exit;

c. passenger departure and waiting rooms of bus, ship and airport terminals;

d. travel agencies, resorts and other tourist spots;

e. restaurants and hotels; and

f. information center booths of the DOT.

The DOT and the DOTC shall produce, distribute and disseminate the appropriate multi-media HIV/AIDS information materials using the HIV/AIDS education prototype as basis. The DOT and DOTC Regional Offices shall be adequately provided with these information materials for distribution in their respective areas of jurisdiction.

The DOT, DFA and the Department of Justice (DOJ) through the Bureau of Immigration (BI), in collaboration with the DOH, shall monitor, coordinate and assess the HIV/AIDS information campaign for tourists and transients.

SECTION 18. HIV/AIDS Education in Communities. —

Local government units (LGUs) through their health, social welfare and population officers shall undertake an HIV/AIDS education and information program in the community and shall observe the following guidelines:

a. coordinate closely with concerned government agencies, NGOs, PLWHAs and other community-based organizations;

b. cover the provincial, city, municipal, barangay and household levels;

c. use the HIV/AIDS education prototype as basis and modify the same to meet the needs of a specific target audience;

d. utilize multi-media materials and sources; and

e. integrate the HIV/AIDS education and information program into existing community-based HIV/AIDS prevention and control programs and other health education programs of the LGUs. cATDIH

The provincial governor, city mayor, municipal mayor and barangay captain, through their respective local development councils shall produce the HIV/AIDS education and information campaign materials; and monitor, coordinate, assess and fund the implementation of the HIV/AIDS education and information campaign in communities.

SECTION 19. Information on Prophylactics. —

A labeling material shall be attached to or provided with every prophylactic offered for sale or given as donation and shall meet the following specifications:

a. Printed information is in English and any locally used Filipino dialect;

b. Size of the labeling material is at least 60 square cms;

c. Text is in font size six (6) or bigger; and

d. One labeling material is provided for each pack of prophylactic.

Each labeling material shall include the following information:

a. Date of expiry and date of manufacture;

b. Statement that "sexual abstinence and mutual fidelity are effective strategies for the prevention of HIV/AIDS and STDs"; TSEAaD

c. The statement "When used properly, the use of a condom is a highly effective method of preventing most sexually transmitted diseases";

d. Instructions on the proper use of a condom;

e. Simple illustration that shows clearly the steps in the correct use of a condom; SCaTAc

f. Advice against the use of non-water-based lubricants like baby oil or petroleum jelly; and

g. Advice that each condom is used only once.

The requirements in this Section shall apply one year after the date of effectivity of this IRR. In the case of condoms supplied by donors, the receiving agency shall be responsible for meeting the said requirements.

SECTION 20. Forms of Misleading Information. —

Misleading information may take the form of false or deceptive advertisements. Further, it is misleading information when the presentation fails to reveal facts material to such presentation or the possible outcomes of using the products and/or services being advertised. aSCHcA

Information shall be deemed misleading if:

a. Advertisement of the benefits or use of non-prescription drugs, devices and treatments does not comply with the specifications on indications and labeling as approved by the Bureau of Food and Drugs (BFAD);

b. Advertisement offers false hopes in the form of a temporary or permanent cure or relief; and

c. Reference to laboratory data, statistics and/or scientific terms used in the advertisement or packaging comes from doubtful sources or is not quoted accurately.

Violations of this specific Section shall be punishable with a penalty of imprisonment for two (2) months to two (2) years. The same shall be without prejudice to the imposition of administrative sanctions or the suspension or revocation of the professional or business license.

RULE 3

Safe Practices and Procedures

SECTION 21. Universal Precautions. —

Universal Precautions is the basic standard of infection control. The underlying principle is to assume that all patients and staff are potentially infected with blood-borne pathogens such as HIV and hepatitis B virus. Universal Precautions is intended to prevent transmission of infection from patient to staff, staff to patient, staff to staff, and patient to patient. ISDCaT

The procedures for Universal Precautions shall include:

a. Standard hygienic procedures, especially handwashing, should be followed at all times.

b. Hospital or medical center guidelines for disinfection and sterilization should be consulted and followed faithfully.

c. Any skin disease or injury should be adequately protected with gloves or impermeable dressing to avoid contamination with a patient's body fluids.

d. Any spills of blood or other potentially contaminated material should be liberally covered with household bleach (dilution of 1 to 10), left for 30 minutes then carefully wiped off by personnel wearing gloves.

e. Gown, gloves, mask and protective eyewear should be worn, if possible, during surgery, childbirth and other procedures where contact with blood or body fluids is likely.

f. Needles and sharp objects should be discarded immediately after use in puncture-proof containers marked BIOHAZARD. Do not bend or break needles by hand. Do not recap used disposable needles.

g. Reusable needles and syringes should be handled with extreme care and safely stored prior to cleaning and sterilization or disinfection.

h. Linen soiled with blood or other body fluids should be handled as little as possible. Gloves and a protective apron should be worn while handling soiled linen.

i. Specimens of blood and body substances should be handled as potentially infectious.

SECTION 22. HIV/AIDS Core Teams. —

All hospitals and other appropriate health care facilities shall establish an HIV/AIDS Core Team (HACT).

HACT is multi-disciplinary group of health workers with policy-making, implementing, coordinating, assessing, training, research and other project development functions on matters related to the diagnosis, management and care of HIV/AIDS patients and the prevention and control of HIV/AIDS infection in the hospital. Its primary objectives are to facilitate the provision of safe, comprehensive and compassionate care to HIV/AIDS patients by properly trained personnel; to mobilize hospital and community resources towards minimizing the impact of HIV/AIDS infection on the patient and his family; and to coordinate all efforts to prevent and control the transmission of HIV/AIDS infection. cHaICD

The functions of HACT include:

a. Implement hospital guidelines on the comprehensive care and management of HIV/AIDS patients;

b. Provide care and counseling to HIV/AIDS patients;

c. Promote prevention and control measures/strategies such as health education and hospital infection control;

d. Facilitate inter- and intra- departmental/agency coordination including referral system and networking;

e. Perform training and research activities on HIV/AIDS;

f. Provide recommendations on hospital planning and development related to HIV/AIDS;

g. Monitor compliance of ethico-moral guidelines for HIV/AIDS including confidentiality of records and reports and release of information;

h. Update records and submit reports to concerned offices; and

i. Conduct monitoring and evaluation activities.

HACT shall be composed of five (5) to seven (7) members, which may include, but is not limited to, the following:

a. Doctors;

b. Nurses;

c. Medical social workers; and

d. Medical technologists

The criteria for selecting HACT members include:

a. Commitment to accept responsibilities and perform the tasks of HACT members;

b. With permanent position, resident physician or specialist;

c. Willingness to undergo training in clinical management and care of HIV/AIDS patients; and

d. High respect for medical confidentiality.

In addition to the criteria for a HACT member, the criteria for the selection of a HACT leader include:

a. Commitment to accept responsibilities and perform the tasks of a HACT leader;

b. High level of knowledge of the program, including positive attitudes for the clients of the program;

c. Preferably an infections disease consultant or an internist with a permanent specialist position in the hospital; and

d. Preferably has a direct involvement in the care and management of patients in the hospital.

SECTION 23. Requirements on the Donation, Acceptance and Disposition of Blood, Tissue, or Organ. —

Only blood, tissue or organ testing negative (-) for HIV shall be accepted by any laboratory or institution for transfusion or transplantation.

Before transfusion or transplantation, the recipient or his/her immediate relative may demand, as a matter of right, a second HIV test; except in an emergency case, as determined by the physician, when testing is not practical, feasible or available: Provided, That said recipient or immediate relative consents, in writing, to the HIV test waiver. DTaAHS

Donations of blood, tissue or organ testing positive (+) for HIV shall be disposed of properly and immediately; or accepted for research purposes only by qualified medical research organizations, and subject to strict sanitary disposal requirements as contained in the DOH Manual of Nosocomial Infections and Hospital Waste Management.

Medical research organizations qualified to accept HIV-positive (+) blood, tissue or organ are those research institutions that have an ethics review board that reviews the process by which the donation of said blood, tissue or organ was done and have the facilities to properly handle and dispose of HIV-positive (+) blood, tissue or organ donations.

Procedures and standards regarding donation, transport, handling and disposal of blood, tissue or organs as contained in the DOH Manual on Nosocomial Infections and Hospital Waste Management which are not in conflict with this IRR shall continue to be in effect. Revisions in said procedures and standards shall be made known to all concerned personnel.

SECTION 24. Guidelines on Surgical and Similar Procedures. —

Standards for the prevention of HIV transmission enumerated in the procedures for Universal Precautions found in Section 21 of this IRR shall be observed during the following procedures:

a. Surgical;

b. Dental;

c. Embalming;

d. Handling and disposition of cadavers, blood, organs or wastes of HIV (+) persons;

e. Tattooing; and

f. Other similar procedures

A separate manual for each procedure shall be developed and printed by the DOH within one (1) year from the effectivity date of this IRR. cSaCDT

The development of the said manuals shall be in consultation and coordination with:

a. Hospital associations;

b. Accredited professional organizations;

c. NGOs; and

d. Experts from the academe

The manuals shall be formally signed and dated by the Secretary of Health and shall be incorporated as an integral part of this IRR.

The manuals shall be distributed to the national, regional and local agencies regulating the establishments where surgical, dental, embalming, tattooing or similar procedures are performed, to be used for the following:

a. Issuance of sanitary permits,

b. Accreditation, or

c. Renewal of permits

The regulatory agencies issuing permits or accreditation shall be responsible for the monitoring of the compliance to these guidelines.

Each manual shall be reviewed and revised periodically. Every revision or updated edition shall be distributed to the regulatory agencies for enforcement.

Pending the official issuance of the manuals by the DOH, the following issuances, provided they are not in conflict with this IRR, shall continue to be in effect:

a. Administrative Order No. 18, s. 1995 "Guidelines for the Management of HIV/AIDS in Hospitals" (DOH, 21 November 1995);

b. IRR of Chapter XXI of the Code of Sanitation of the Philippines (1997);

c. Guidelines for Infectious Disease Control in Hospitals by the Committee Members for Hospital Policies on HIV/AIDS (DOH, July 1997); and

d. Chapter 8, pages 39 to 44 of the Manual on Nosocomial Infections (DOH, December 1993).

SECTION 25. Penalties for Unsafe Practices and Procedures. —

Unsafe practices and procedures shall refer to the non-compliance with the recommended universal precautions in Section 21 of this IRR. AaECSH

The penalties of an individual committing unsafe practices and procedures shall be imprisonment for six (6) to twelve (12) years, without prejudice to the imposition of administrative sanctions such as, but not limited to the following:

a. Fines; and/or

b. Suspension or revocation of license to practice the profession.

Failure of the institution or agency to maintain safe practices and procedures as may be required by the guidelines to be formulated in compliance with Section 13 of RA 8504, and Section 24 of this IRR shall suffer the:

a. Cancellation of the permit or license of the institution or agency; or

b. Withdrawal of the accreditation of the hospital, laboratory or clinic.

RULE 4

Testing, Screening and Counseling

SECTION 26. Consent as a Requisite for HIV Testing. —

A written informed consent shall be obtained before HIV testing. Said consent shall be made by the:

a. Individual to be tested;

b. Parent of a minor; or

c. Legal guardian of a mentally incapacitated person.

except for unlinked and voluntary anonymous testing as provided for in Section 29 of this IRR.

It is acceptable for a person being tested to use an assumed name or code name instead of the real name and written informed consent using said assumed or code name shall constitute lawful consent. aCITEH

In case the person is unable to write, a thumbprint shall substitute for the signature on said consent.

A written consent of a person to act as a volunteer or donor of his/her blood, organ or tissue for transfusion, transplantation, or research shall be deemed a consent for HIV testing as provided in Section 23 of this IRR.

The DOH, through SHAPCS shall develop a prototype informed consent form in English and any locally used Filipino dialect which may be modified accordingly. The prototype consent form shall include this excerpt from Section 16 of RA 8504: "RA 8504 prohibits the imposition of HIV testing as a precondition for employment, admission to an educational institution, freedom of abode, entry or continued stay in the Philippines, the right to travel or the provision of medical service or any other kind of service".

The duly accomplished informed consent record shall be kept confidential in accordance with Section 41 of this IRR. Except for a valid medical or legal need for this record, no access shall be allowed as provided in Sections 39 and 42 of this IRR.

SECTION 27. Prohibitions on Compulsory HIV Testing. —

HIV Testing shall not be imposed as a precondition for the following:

a. Employment;

b. Admission to an educational institution;

c. Exercise of freedom of abode;

d. Entry or continued stay in the country;

e. Right to travel; TSAHIa

f. Provision of medical service or any kind of service; and

g. The enjoyment of human rights and civil liberties, including the right to enter into marriage and conduct a normal family life.

SECTION 28. Exception to the Prohibition on Compulsory Testing. —

The prohibition on compulsory HIV testing shall be lifted in the following instances:

a. Upon a court order when a person is charged with the crime specified in the following:

1) Act 3815, as amended, or the "Revised Penal Code" specifically the following Articles:

a) Article 264 — Administering injurious substances;

b) Article 335 — Rape;

c) Article 337 — Qualified seduction; and

d) Article 338 — Simple seduction

2) R.A. 7659, or the "Death Penalty Act," specifically Section 11, paragraph 5 — Rape, when the offender knows that he is afflicted with AIDS; and

3) R.A. 8353 or the "Anti-Rape Law of 1997," specifically Section 2 — Rape, when the offender knows that he is afflicted with Human Immuno-Deficiency Virus HIV/AIDS or any other sexually transmitted disease and the virus or disease is transmissible to the victim; TDCaSE

b. Upon order of the court when the determination of the HIV status is necessary to resolve relevant issues under Executive Order No. 209, otherwise known as the "Family Code of the Philippines", particularly:

1) "Art. 45. A marriage may be annulled for any of the following causes, existing at the time of the marriage:

xxx xxx xxx

(3) That the consent of either party was obtained by fraud, unless such party afterwards, with full knowledge of the facts constituting the fraud, freely cohabited with the other as husband and wife; and

xxx xxx xxx

(6) That either party was afflicted with a sexually-transmitted disease found to be serious and appears to be incurable.

xxx xxx xxx

Art. 46. Any of the following circumstances shall constitute fraud referred to in number 3 of the preceding Article:

(3) Concealment of sexually transmissible disease, regardless of its nature, existing at the time of the marriage; or

c) When complying with the provisions of Republic Act No. 7170, otherwise known as the "Organ Donation Act" and the Republic Act No. 7719, otherwise known as the "National Blood Service Act".

SECTION 29. Anonymous HIV Testing. —

Anonymous HIV testing is a procedure whereby the identity of the individual being tested is protected or not known. Two methods of anonymous HIV testing are the unlinked anonymous and the voluntary anonymous.

Any person who submits to anonymous HIV testing shall not be required to provide a name, age, address or any other information that may potentially identify the same. In the case of voluntary anonymous HIV testing an identifying symbol is substituted for the person's true name or identity. The symbol enables the laboratory doing the test and the test person to match the test result with the said symbol. EDATSI

SECTION 30. Accreditation of HIV Testing Centers. —

No person, firm, corporation, center, hospital, clinic, blood bank or laboratory shall perform HIV testing without accreditation by the DOH, through the BRL, in the Office for Health Facilities, Standards and Regulation (OHFSR).

The accreditation standards for performing HIV testing provided in Administrative Order No. 55-A, s. 1989 in ANNEX A shall be an integral part of this IRR, except for Sections 7.1.6 and 9.3 which are amended to read:

Section 7.1.6. Reagents: The laboratory shall utilize reagents, such as HIV kits, which have been registered with the BFAD, and evaluated and recommended by RITM.

Section 9.3. The names, age, sex and addresses of persons confirmed to be seropositive (by Western blot, immunofluorescence and radioimmune precipitation assay) shall be reported to AIDSWATCH as provided in Section 38 of this IRR.

SHAPCS and RITM shall convene a forum for consultation and review of the technical and other related issues concerning HIV testing annually or as needed. Participants of the forum shall include representatives of DOH, Philippine Association of Medical Technologists (PAMET), Philippine Society for Pathologists (PSP), HIV test kit suppliers, clinical laboratories and blood banks, and individuals actively involved in HIV testing.

RITM shall serve as the national reference center for HIV testing.

SECTION 31. Pre-Test and Post-Test Counseling. —

All individuals, centers, clinics, blood banks or laboratories offering HIV testing shall provide, free of charge, pre-test and post-test counseling for persons who avail of their HIV testing services. CIScaA

Pre-test counseling shall include the following:

a. Purpose of HIV testing;

b. Other diseases that should be tested, if applicable;

c. Window period;

d. HIV test procedure;

e. Meaning of a negative and a positive test result;

f. Guarantees of confidentiality and risk-free disclosure;

g. When the result is available and who can receive the result;

h. Basic information on HIV/AIDS infection: nature, modes of transmission, risk behaviors and risk reduction methods; and

i. Informed consent and prohibition of compulsory testing under most circumstances.

Post-test counseling after a negative test result shall include the following:

a. Release of the test result to the test person or legal guardian of minor;

b. Review of the meaning of negative test result;

c. Discussion of the test person's immediate concerns;

d. Review of the basic information on HIV/AIDS infection; and

e. Provision of HIV/AIDS information literature and arrangement for a community referral, if necessary. TSIDaH

Post-test counseling after a positive test result shall include the following:

a. Release of the test result to the test person or legal guardian of minor;

b. Assistance and emotional support to the person in coping with the positive (+) test result;

c. Discussion of the person's immediate concerns;

d. Review of the meaning of a positive test result;

e. Review of HIV/AIDS infection transmission and risk reduction;

f. Explanation of the importance of seeking health care and supervision;

g. Arrangements for referral to health care and other community services and to any organization of people living with HIV/AIDS; and

h. Assistance with the disclosure of HIV status and health condition to the spouse or sexual partner, as soon as possible.

Pre-test and post-test counseling shall be done in a private place away from possible interruptions. It may be done at the bedside of an ill person, in a counseling room or in a person's home, and preferably in a pleasant atmosphere.

When tests are undertaken of OFWs prior to their employment overseas, group pre-test and post-test counseling may be done. However, individual counseling shall be provided for an OFW with an HIV positive (+) result.

Only health workers who had undergone HIV/AIDS counseling training shall provide pre-test and post-test counseling. The DOH, through the SHAPCS shall produce a training kit and a trainer's training kit for HIV/AIDS counseling. The SHAPCS shall conduct national and regional trainer's training and may utilize the expertise of the academe and the NGOs for this activity. In turn, the trainers shall conduct HIV/AIDS counseling training for counselors at the provincial and institutional levels. EHTCAa

SECTION 32. Support for HIV Testing Centers. —

The DOH through the SHAPCS shall coordinate the training of medical technologists, pathologists and other health workers who will staff the testing centers.

The SHAPCS, through RITM, BRL, accredited professional organizations and societies, qualified NGOs and experts from the academe, shall conduct training courses and workshops on HIV testing at least twice a year.

Content of the training course/workshop shall include:

a. HIV biology;

b. Epidemiology;

c. Principles and methods of HIV testing;

d. Laboratory safety and precautions;

e. Counseling; and

f. Quality assurance

SHAPCS, in collaboration with RITM, BRL, PAMET, LGUs, NGOs and the academe, shall form a network of HIV testing centers to facilitate the assessment of support needs and the delivery of support services, including the promotion of continuing professional education and quality assurance. Network members shall meet at least once a year. THaCAI

RULE 5

Health and Support Services

SECTION 33. Hospital-Based Services. —

A manual on the Standard Operating Procedures (SOP Manual) for the provision of a comprehensive and compassionate hospital-based care services for PLWHAs shall be developed by the SHAPCS, through a Committee, within 90 days from the effectivity date of this IRR.

The SOP Manual shall ensure the accessibility of basic hospital services and shall contain the technical, managerial, quality and procedural requirements for the physical, physiologic, psychological, socio-economic and spiritual care in the hospital of the person living with HIV/AIDS (PLWHA) and the family. The services shall include:

a. emergency treatment;

b. laboratory services; and

c. diagnosis and treatment of HIV/AIDS, STD, other infections and complications.

The Committee shall be composed of representatives from the following offices/sectors:

a. OHFSR;

b. Hospital Operations and Management Service (HOMS);

c. San Lazaro Hospital (SLH);

d. RITM;

e. Accredited professional association (APOs);

f. NGOs;

g. Academe; and

h. PLWHAs

Pending the official release and effectivity date of the SOP Manual, the provision of hospital services for PLWHAs in government hospitals shall follow the Guidelines in:

a. Administrative Order No. 18, s. 1995 "Revised Guidelines in the Management of HIV/AIDS Patients in the Hospital" (DOH, 21 November 1995); and

b. Administrative Order No. 9, s. 1997 "Amendment to Administrative Order No. 18, s. 1995 regarding the Guidelines in the Management of HIV/AIDS Patients in the Hospital" (DOH, 10 May 1997). DECcAS

in Annex B1 and Annex B2 of this IRR, which shall continue to be in effect until further notice of revision by the SHAPCS.

The SOP Manual shall be reviewed periodically and revised accordingly by the SHAPCS, through the DOH Committee for Hospital Policies on HIV/AIDS Prevention and Control.

SECTION 34. Community-Based Services. —

The LGUs, through its health, social welfare and population officers, in collaboration, cooperation or partnership with the following:

a. Concerned government agencies;

b. NGOs;

c. Private sector organizations and establishments;

d. People living with HIV/AIDS; and

e. Other vulnerable groups.

shall develop and support services for the prevention and control of HIV/AIDS and care of PLWHAs and their families in the community. These services or programs include, but are not limited to:

a. HIV/AIDS/STD education and information campaign;

b. Counseling;

c. Home-based care;

d. Organizing community-based HIV/AIDS support groups including PLWHAs;

e. Networking of HIV/AIDS support groups; and

f. HIV/AIDS referral system.

Community-based HIV/AIDS prevention, control and care services shall be integrated into the development plans and the existing programs of the province, city, municipality and barangay. DTEAHI

SECTION 35. Livelihood Programs and Training. —

Government agencies such as the Department of Social Welfare and Development (DSWD), DOLE, DECS, TESDA and Department of Trade and Industry (DTI) and private agencies, as well, shall provide opportunities for PLWHAs to participate in skills training, skills enhancement and livelihood programs. No PLWHA shall be deprived of participation by reason of HIV/AIDS status alone.

Skills training and enhancement programs along the interest and capacity of the PLWHAs and livelihood assistance in the form of capital assistance, marketing assistance and job placement shall be rendered.

The DSWD with DOLE, DILG and private agencies, and utilizing existing mechanisms and strategies, shall jointly set up a referral system to assist PLWHAs in accessing skills training and livelihood assistance programs at the regional and provincial levels.

SECTION 36. Control of Sexually Transmitted Diseases. —

To help contain the spread of HIV infection, the DOH, in coordination and cooperation with other concerned government agencies, LGUs and NGOs, shall pursue the prevention and control of sexually transmitted diseases as provided in:

a. Administrative Order No. 2, s. 1997 "National Policy Guidelines for the Prevention and Management of Sexually Transmitted Diseases (STDs)" (DOH, 20 February 1997); and

b. Administrative Order No. 5, s. 1998 "Implementing Guidelines in STD Care Management at the Different Levels of the Health Care System" (DOH, 13 February 1998) IETCAS

c. Administrative Order No. 17-B, s. 1998 "Implementing Guidelines for STD Case Management for Children". (DOH, 17 October 1998)

in Annex C1 and Annex C2 of this IRR, which shall continue to be in effect, until further notice of revision by the SHAPCS.

Further, the DOH shall ensure the periodic conduct of studies on the prevalence of STDs, levels of anti-microbial drug resistance and new treatment modalities for STDs. DOH shall submit a report of the results of these studies to PNAC.

SECTION 37. Insurance for Persons with HIV . —

Within 60 days of the effectivity date of this IRR, the Secretary of Health and the Commissioner of the Insurance Commission shall create a Task Force that shall oversee a study or studies on the feasibility of offering a package of insurance benefits for PLWHAs in accordance with the guiding principles of Sections 26 and 39 of RA 8504.

The composition of the Task Force may include, but not limited to, the representatives of the following offices, agencies, or organizations:

a. DOH;

b. Insurance Commission;

c. Philippine Hospital Association (PHA);

d. Philippine Health Insurance Corporation (PHIC);

e. Association of private insurers;

f. Association of actuaries;

g. Health maintenance organizations (HMOs); and

h. Other groups, as needed

A report of the results of the feasibility study or studies shall be submitted by the DOH to PNAC within one year of the creation of the Task Force.

Should the study or studies find that insurance coverage for the PLWHA is feasible, the program shall be implemented by the concerned agencies. The PHIC shall oversee the implementation of the said insurance program. SEIDAC

RULE 6

Monitoring

SECTION 38. Monitoring Program. —

"AIDSWATCH" shall be established as a comprehensive HIV/AIDS monitoring and review program of the DOH. Upon the effectivity of this IRR, it shall integrate unto itself the National HIV Sentinel Surveillance System (NHSSS) and the AIDS Registry.

AIDSWATCH shall:

a. Monitor the magnitude, distribution and progression, including epidemics, of HIV infection in the country; and

b. Evaluate the adequacy and efficacy of the HIV prevention and control measures employed.

The monitoring role of AIDSWATCH shall be performed through:

a. Passive surveillance; and

b. Active surveillance

Passive surveillance shall report on HIV/AIDS cases through the following process:

a. Identification of positive (+) cases in HIV tests conducted as a pre-screening procedure in blood banks, hospitals, clinics and accredited laboratories; IcDCaS

b. Confirmation of positive (+) cases from government sites by the BRL, and from private sites by the RITM;

c. Processing and analysis of confirmed positive cases by AIDSWATCH; and

d. Information dissemination on the incidence of HIV/AIDS to the public.

The levels of reporting in passive surveillance include.

a. Primary health centers;

b. LGUs;

c. Regional epidemiological surveillance units (RESUs); and

d. Field Health Surveillance and Intelligence Service (FHSIS) at the Central Office.

Active surveillance shall systematically monitor the biomedical and behavioral components of HIV/AIDS/STD among vulnerable groups in selected sentinel sites that are geographically distributed throughout the Philippines. This surveillance shall be conducted annually and the results disseminated to the public after a technical review.

Resources for the institutionalization of the monitoring and review of the HIV/AIDS situation in the country shall be provided as a line item for AIDSWATCH in the DOH budget.

SECTION 39. Reporting Procedures. —

All hospitals, clinics, laboratories, and blood banks shall be required to report all diagnosed HIV infections to AIDSWATCH. cHEATI

The attending physician shall submit to AIDSWATCH a written report at the time of any of the following events: 1) time of diagnosis; 2) progression to AIDS; and 3) death.

These HIV/AIDS-related health reports shall be received, collated, evaluated, and disseminated by AIDSWATCH. Epidemiological data shall be made available always to various HIV/AIDS stakeholders and the public.

To maintain the confidentiality of information regarding HIV cases and AIDS patients, questionnaires and forms to be used by laboratories shall be unlinked anonymous as provided in Section 29 of this IRR. The unlinked anonymous procedure safeguards the identity of the person tested and assures that the result is not traced or linked to him/her.

SECTION 40. Contact Tracing. —

HIV/AIDS contact tracing and all other related health intelligence activities may be pursued by the DOH: Provided, That these do not conflict with the general purpose of RA 8504 or this IRR.

Any information gathered shall remain confidential and classified, and can only be used for statistical and monitoring purposes as provided in Sections 41, 42 and 43 of this IRR.

No information gathered through contact tracing may be used as basis or qualification for any employment, school attendance, freedom of abode, travel, or access to health and other social services as provided in Sections 46 to 52 of this IRR. EHTIDA

RULE 7

Confidentiality

SECTION 41. Medical Confidentiality. —

Medical confidentiality shall protect and uphold the right to privacy of an individual who undergoes HIV testing or is diagnosed to have HIV. It includes safeguarding all medical records obtained by health professionals, health instructors, co-workers, employers, recruitment agencies, insurance companies, data encoders, and other custodians of said record, file, or data.

Confidentiality shall encompass all forms of communication that directly or indirectly lead to the disclosure of information on the identity or health status of any person who undergoes HIV testing or is diagnosed to have HIV. This information may include but is not limited to the name, address, picture, physical description or any other characteristic of a person which may lead to his/her identification. cDTACE

To safeguard the confidentiality of a person's HIV/AIDS record, protocols and policies shall be adopted by concerned officials, agencies and institutions.

SECTION 42. Exceptions to the Mandate of Confidentiality. —

The requirement for medical confidentiality shall be waived in the following instances:

a. When responding to a subpoena duces tecum and subpoena ad testificandum issued by a court with jurisdiction over legal proceedings where the main issue is the HIV status of an individual;

b. When complying with the reporting requirements for AIDSWATCH as provided in Section 39 of this IRR; and

c. When informing other health workers directly involved or about to be involved in the treatment or care of a person with HIV/AIDS and such treatment or care carry the risk of HIV transmission.

Health workers who are exposed to invasive procedures and may potentially be in contact with blood and bodily fluids likely to transmit HIV shall be informed of the HIV status of a person, even without his/her consent. This information is vital to their protection against acquiring and transmitting the HIV infection through safe practices and procedures in accordance with Sections 21 and 24 of this IRR.

Those who are not at risk of transmission, must not be informed of a person's HIV status.

All health workers shall maintain shared medical confidentiality.

SECTION 43. Release of HIV/AIDS Test Results. —

The result of HIV/AIDS testing shall be confidential and shall be released only to the following:

a. Person who was tested;

b. Parent of a minor who was tested;

c. Legal guardian of an insane person or orphan who was tested;

d. Person authorized to receive said result for AIDSWATCH in accordance with Section 39 of this IRR; and/or

e. A Judge of the Lower Court, Justice of the Court of Appeals or Supreme Court Justice. SHIcDT

SECTION 44. Penalties for Violations of Confidentiality. —

Penalties for violating medical confidentiality, as provided in Sections 30 and 32 of RA 8504, include imprisonment for six (6) months to four (4) years. Administrative sanctions may likewise be imposed, such as:

a. Fines;

b. Suspension or revocation of license to practice the profession; or

c. Cancellation or withdrawal of the license to operate of any business entity, and the accreditation of hospitals, laboratories or clinics.

SECTION 45. Disclosure to Sexual Partners. —

Any person with HIV shall be obligated to disclose his/her HIV status and health condition to his/her spouse or sexual partner at the earliest opportune time.

PLWHA may seek the assistance of health workers or counselors providing the post-HIV test counseling on the matter of disclosure of HIV/AIDS and health status to spouse or sexual partner.

As a general policy, post-test counseling of PLWHA shall aim to assist him/her in informing his/her spouse or sexual partner of his/her HIV status and health condition at the earliest possible time. aSACED

RULE 8

Discriminatory Acts and Policies

SECTION 46. Discrimination in the Workplace. —

Discrimination in any form, from pre-employment to post-employment, including hiring, promotion or assignment, based on the actual, perceived or suspected HIV status is prohibited.

All individuals seeking employment shall be treated equally by employers who shall not make any distinction among job applicants on the basis of their actual, perceived or suspected HIV status.

Persons with HIV/AIDS already employed by any public or private company shall be entitled to the same employment rights, benefits and opportunities as other employees, namely:

a) Security of tenure;

b) Reasonable alternative working arrangements, when necessary;

c) Social security, union, credit and other similar benefits; and

d) Protection from stigma, demotion, discrimination and termination by co-workers, unions, employers and clients.

Termination from work on the basis of actual, perceived or suspected HIV status is deemed unlawful.

HIV-infected employees shall act responsibly to protect their own health and prevent HIV transmission. HEcIDa

Acts of discrimination against an individual seeking employment, or in the course of employment, because of his/her actual, perceived or suspected HIV status, shall be reported to the DOLE by those in the private sector and to the CSC by those in the government offices and government-owned corporations. DOLE and CSC shall resolve any such matters brought to their attention, including the implementation of administrative sanctions, as may be appropriate.

SECTION 47. Discrimination in Schools. —

No educational institution shall refuse admission to any prospective student or discipline; segregate; deny participation, benefits or services to; or expel any current student on the basis of his/her actual, perceived or suspected HIV status. This shall include any perception or suspicion of HIV status which may arise from a person being a friend, relative or associate of a PLWHA.

The right to full participation shall include the right to take part in all school activities, including all sports activities.

HIV-infected students shall act responsibly to protect their own health and prevent HIV transmission.

SECTION 48. Restrictions on Travel and Habitation. —

HIV is not among the dangerous, loathsome or contagious diseases referred to in the Immigration Code (Section 29). The freedom of abode, lodging and travel of a person with HIV shall not be abridged. No person shall be quarantined, placed in isolation, or refused lawful entry into or deported from Philippine territory on account of his/her actual, perceived or suspected HIV status. TSEHcA

SECTION 49. Inhibition from Public Service. —

The right to seek an elective or appointive public office shall not be denied to a person with HIV.

SECTION 50. Exclusion from Credit and Insurance Services. —

All credit and loan services, including health, accident and life insurance shall not be denied to a person on the basis of his/her actual, perceived or suspected HIV status: Provided, That the person with HIV shall not conceal or misrepresent his or her HIV status to the insurance company upon application. Extension and continuation of credit and loan shall likewise not be denied solely on the basis of said health condition.

SECTION 51. Discrimination in Hospitals and Health Institutions. —

No hospital or other health institution shall deny access to health care services to a PLWHA or those perceived or suspected to be HIV-infected, nor charge the said persons higher fees. Access to health services must be on an equal basis for all people, regardless of perceived, suspected or actual HIV status.

Refusal to admit a person to a hospital or health care facility and refusal to provide health care or perform health services to a person in a hospital or health care facility on the basis of perceived, suspected or actual HIV status are prohibited acts.

SECTION 52. Denial of Burial Services. —

Subject to the observance of universal precautions as outlined in Section 21 of this IRR, any deceased person who was known, suspected or perceived to be HIV positive shall not be denied any kind of decent burial services. Decent burial services include any ceremonial, burial or cremation practices that conform to culturally acceptable religious beliefs and norms. SEHTAC

Pending the development and implementation of the Guidelines/Manuals/Protocol stipulated in Rule 3, section 24 of this IRR, the following recommendations on undertaking, embalming and cremation of the remains who died with HIV shall apply:

a. The remains of persons who died with HIV shall be buried or cremated within 24 hours after the time of death.

b. No embalming of the remains of persons who died with HIV shall take place except: When the family requests for embalming provided that the procedure will be done by a licensed embalmer, qualified and previously trained by the National AIDS/STD Prevention and Control Service (NASPCP) on HIV/AIDS and the observance of the practice of universal precautions.

c. The HIV status of an individual shall not be a consideration in the issuance of permits for the transfer of such remains.

SECTION 53. Penalties for Discriminatory Acts and Policies. —

All discriminatory acts and policies referred to in Sections 46 to 52 of this IRR and in accordance with RA 8504 shall be punishable with a penalty of:

a. Imprisonment for six (6) months to four (4) years; and

b. A fine not exceeding Ten thousand pesos (P10,000.00).

In addition, licenses or permits of schools, hospitals and other institutions found guilty of committing said discriminatory acts and policies shall be revoked.

RULE 9

The Philippine National AIDS Council

SECTION 54. Establishment. —

The Philippine National AIDS Council or PNAC shall be reconstituted and strengthened to enable the Council to oversee an integrated and comprehensive approach to HIV/AIDS prevention and control in the Philippines. For all intents and purposes, PNAC shall be attached to DOH. DICSaH

SECTION 55. Functions. —

The Council shall be the central advisory, planning and policy-making body on the prevention and control of HIV/AIDS in the Philippines. The Council shall have the following functions:

a. Secure from government agencies concerned recommendations on how their respective agencies could operationalize specific provisions of RA 8504. The Council shall likewise ensure that there is adequate coverage of the following:

1) The institution of a nationwide HIV/AIDS information and education program;

2) The establishment of a comprehensive HIV/AIDS monitoring system;

3) The issuance of guidelines on medical and other practices and procedures that carry the risk of HIV transmission;

4) The provision of accessible and affordable HIV testing and counseling services to those who are in need of it;

5) The provision of acceptable health and support services for persons with HIV/AIDS in hospitals and in communities;

6) The protection and promotion of the rights of individuals with HIV; and

7) The strict observance of medical confidentiality.

b. Monitor the implementation of these rules and regulations, issue or cause the issuance of orders or make recommendations to the implementing agencies as the Council considers appropriate;

c. Develop a Strategic Plan and update regularly, through a process of multisectoral consultation, that details a comprehensive national HIV/AIDS prevention and control program. The Plan shall be integrated into the Medium-Term Development Plan. Said Plan shall include indicators and benchmarks against which PNAC shall monitor its implementation;

d. Coordinate the activities of, and strengthen working relationships between all partners in the response including GO, NGOs, private sectors, academe, media, vulnerable communities and people with HIV;

e. Coordinate and cooperate with foreign and international organizations regarding data collection, research and treatment modalities concerning HIV/AIDS; and

f. Evaluate the adequacy of and make recommendations regarding the utilization of national resources for the prevention and control of HIV/AIDS. The Council shall facilitate and advocate the provision as well as mobilization and use of technical, financial and logistical support to government agencies and NGOs for the development and implementation of plans, programs and projects for the prevention and control of HIV/AIDS in the Philippines.

SECTION 56. Membership and Composition. —

The Council shall be composed of the following:

a. The Secretary of the DOH;

b. The Secretary of the DECS or his/her representative;

c. The Chairperson of the CHED or his/her representative;

d. The Director-General of the TESDA or his/her representative;

e. The Secretary of the DOLE or his/her representative;

f. The Secretary of the DSWD or his/her representative;

g. The Secretary of the DILG or his/her representative;

h. The Secretary of the DOJ or his/her representative;

i. The Director-General of the NEDA or his/her representative; STCDaI

j. The Secretary of the DOT or his/her representative;

k. The Secretary of the DBM or his/her representative;

l. The Secretary of the DFA or his/her representative;

m. The Head of the PIA or his/her representative;

n. The President of the League of Governors or his/her representative;

o. The President of the League of City Mayors or his/her representative,

p. The Chairperson of the Committee on Health of the Senate of the Philippines or his/her representative;

q. The Chairperson of the Committee on Health of the House of Representatives or his/her representative;

r. Two (2) representatives from organizations of medical/health professionals;

s. Six (6) representatives from non-government organizations involved in HIV/AIDS prevention and control efforts or activities; and

t. A representative of an organization of persons living with HIV/AIDS.

SECTION 57. Appointment and Tenure. —

To the greatest extent possible, appointment to the Council must ensure sufficient and discernible representation from the fields of medicine, education, health care, law, labor ethics and social services. SDATEc

All members of the Council shall be appointed by the President of the Republic of the Philippines, except for the representatives of the Senate and the House of Representatives, who shall be appointed by the Senate President and the House Speaker respectively.

The members of the Council shall be appointed not later than thirty (30) days after the date of the enactment of RA 8504.

Representatives of heads of government agencies shall at least hold a Director-level position.

NGO membership in PNAC shall consider sectoral representation as a factor in its selection. PNAC shall review the sectors to be represented by NGOs every two years. Selection of sectors shall consider the following information:

a. Epidemiological studies — infections reported by AIDSWATCH and surveillance data;

b. Socio-behavioral studies — vulnerability of particular population groups; and

c. Demographic studies — size of population at risk

NGO representatives appointed to PNAC shall be NGOs from the sectors selected. They shall bring the concerns and issues of the sector they represent to PNAC. Where this is not possible, NGOs working with and advocating the concerns and issues of selected sectors shall be eligible to be NGO members of PNAC, as representatives of said sectors. TAIaHE

NGO members to PNAC shall meet the following qualifications:

a. At least three years experience of working productively for the prevention and control of HIV/AIDS;

b. Registered with the Securities and Exchange Commission;

c. HIV/AIDS-related programs and projects are not limited to one region of the country; and

d. Implement programs/projects that show potential for national replicability.

The members representing the medical/health professional groups, non-government organizations and the representative of an organization of PLWHA shall be appointed initially for a period of two years. Subsequently, the said positions shall be filled via a nomination process as follows:

a. Call for nominations of qualified representatives shall be published by PNAC, allowing a period of one month for the receipt of the nominations;

b. A Nomination Committee composed of the PNAC Chair, Vice-Chair and three other PNAC members shall review the nominations, rank the nominees and submit its recommendations to PNAC for action;

c. PNAC shall recommend two (2) nominees per position to the President.

The Secretary of Health shall be the permanent chairperson of the Council. The vice-chairperson shall be elected by the Council members and shall serve for a term of two (2) years.

SECTION 58. Meetings and Quorum. —

The Council shall hold regular meetings at least once every quarter. Special meetings may be convened by the Chairperson outside of the regular meetings as the need arises. The presence of eleven (11) members shall constitute a quorum. In the absence of the Chairperson and the Vice-Chairperson, a presiding officer shall be elected by the majority of the members present. TaCEHA

SECTION 59. Reports. —

All PNAC member agencies shall submit to the Council quarterly progress reports and annual reports of the programs and projects on the prevention and control of HIV/AIDS of their respective agencies or organizations. The Council, in turn, shall consolidate the reports of its member agencies for submission to the President and to both Houses of Congress on an annual basis.

SECTION 60. Technical Committee. —

A Technical Committee shall be formed by PNAC to be composed of representatives from the different member agencies of the Council. This Committee shall facilitate inter- and intra-agency coordination and monitoring of HIV/AIDS policies and programs and support PNAC in its functions.

SECTION 61. Creation of Special HIV/AIDS Prevention and Control Service. —

There shall be created in the Department of Health a Special HIV/AIDS Prevention and Control Service (SHAPCS) which shall be headed by a Director and staffed by qualified medical specialists and support staff with permanent appointments. It shall implement programs on HIV/AIDS prevention and control. In addition it shall also serve as the Secretariat of the Council.

RULE 10

Miscellaneous Provisions

SECTION 62. Rules of Interpretation. —

These Implementing Rules and Regulations shall be interpreted in the light of the provisions of the Constitution of the Republic of the Philippines and the declaration of policies under Section 2 of the Republic Act 8504.

SECTION 63. Separability Clause. —

In the event that any part or provision of these Implementing Rules and Regulations is declared invalid for any reason, the other parts or provisions thereof not affected thereby shall continue to be in force and effect. CTHDcS

SECTION 64. Repealing Clause. —

All pertinent laws, Presidential Decrees, Executive Orders, Rules and Regulations which are inconsistent with the provisions of these Implementing Rules and Regulations are hereby repealed, amended or modified accordingly.

SECTION 65. Amendments. —

These Implementing Rules and Regulations may be amended, modified or supplemented when necessary for effective implementation and enforcement of RA 8504.

SECTION 66. Effectivity. —

These Implementing Rules and Regulations shall take effect fifteen (15) days after its submission to the Office of the National Administrative Register. DCASEc

SECTION 67. Approved in the City of Manila, this thirteenth day of April in the year of Our Lord, nineteen hundred and ninety-nine.

(SGD.) ALBERTO G. ROMUALDEZ, JR., M.D.Secretary of Health and ChairPhilippine National AIDS Council

DOH ADMINISTRATIVE ORDERS THAT ARE INTEGRAL TO THIS IRR

ANNEX A

Administrative Order No. 55-A, s. 1989. Rules and Regulations Governing the Accreditation of Laboratories Performing HIV Testing. DOH. 02 January 1989.

ANNEX B1

Administrative Order No. 18, s. 1995. Revised Guidelines in the Management of HIVE/AIDS Patients in the Hospital. DOH. 21 November 1995.

ANNEX B2

Administrative Order No. 9, s. 1997. Amendment to Administrative Order No. 18, s. 1995 Regarding the Guidelines in the Management of HIV/AIDS Patients in the Hospital. DOH. 10 May 1997.

ANNEX C1

Administrative Order No. 2, s. 1997. National Policy Guidelines for the Prevention and Management of Sexually Transmitted Diseases (STDs). DOH. 20 February 1997

ANNEX C2

Administrative Order No. 5, s. 1998. Implementing Guidelines in STD Case Management at the Different Levels of the Health Care System. DOH. 13 February 1998.

ANNEX C3

Administrative Order No. 17-B, s. 1998 "Implementing Guidelines for STD Case Management for Children". DOH, 17 October 1998.

RECONSTITUTED PHILIPPINE NATIONAL AIDS COUNCIL
	AGENCY/ORGANIZATIONS	REPRESENTATIVE
1.	Department of Health	HON. ALBERTO DEL GALLEGO,
		ROMUALDEZ JR.
		Secretary of Health and Chair,
		Philippine National AIDS Council
2.	Department of Education, Culture and	DR. ADELFO ABELLA TRINIDAD
	Sports	Director
		Health and Nutrition Center
3.	Commission on Higher Education	HON. KATE CHOLLIPAS-
		BOTENGAN
		Commissioner
4.	Technical Education and Skills	MR. CARLOS GENCIANA
	Development Authority	GELLEKANAO
		Executive Director
		National Institute for
		Technical/Vocational Education
		and Training
5.	Department of Labor and Employment	DR. DULCE ESTRELLA-GUST
		Executive Director
		Occupational Health and Safety
		Center
6.	Department of Social Welfare and	MS. BELINDA CUISIA-
	Development	MANAHAN
		Undersecretary
7.	Department of Interior and Local	MR. AUSTERE ABONG
	Government	PANADERO
		Assistant Secretary
8.	Department of Justice	ATTY. RICARDO VALERA
		PARAS III
		Assistant Secretary
9.	National Economic and Development	MS. ERLINDA MORALES-
	Authority	CAPONES
		Director
10.	Department of Tourism	DR. GENEROSO NAJERA SISON
		Medical Officer
11.	Department of Budget and Management	MR. GIL PARUNGAO MONTALBO
		Director
12.	Department of Foreign Affairs	MR. ALADIN GONZALES
		VILLACORTE
		Executive Director
13.	Philippine Information Agency	MS. EMELYN QUINTOS-LIBUNAO
		Director for Program Development
14.	Leagues of Governors	ATTY. JOMAR MILLORA
		OLEGARIO
		Head, Policy Development Group
15.	League of City Mayors	ATTY. GIL FERNANDO
		CASUPANAN CRUZ
		Executive Director
16.	Senate Committee on Health	HON. JUAN FLAVIER
		Chair, Senate Committee on
		Health and Demography
17.	House Committee on Health	HON. EDITH YOTOKO-
		VILLANUEVA
		Committee on Health
		House of Representatives
18.	Medical/Health Professional Group	DR. RICO MACAN MEDINA, SR.
		President
		Philippines Hospital Association
19.	Medical/Health Professional Group	DR. OFELIA TAGLE MONZON
		President
		AIDS Society of the Philippines
20.	NGO	Representative
		DR. MICHAEL LIM TAN
		Executive Director
		Health Action Information Network
21.	NGO	Representative
		DELMAR SOLIS BARROZO
		(mentor:
		MS. IRENE FONACIER-FELLIZAR
		Executive Director
		Children's Laboratory for Drama
		in Education Foundation)
22.	NGO	Representative
		MS. ROWENA ONG ALVAREZ
		Executive Director
		Institute for Social Studies and Action
23.	NGO	Representative
		MR. ARIEL BONIFACIO CASTRO
		Director for Education
		Trade Union Confess of the
		Philippines
24.	NGO	Representative
		MR. FERDINAND VILLAMOR
		BUENVIAJE
		President
		The Library Foundation
25.	NGO	Representative
		DR. FLORENCE MACAGBA
		TADIAR
		Executive Director
		Women's Health Care Foundation
26.	Organization of People Living with HIV	Representative
		MS. LEA SALES
		President
		Pinoy Plus Association

 

PNAC SECRETARIAT

Dr. LORETO B. ROQUERO, JR. Director III and Head, PNAC Secretariat

Dr. RODERICK POBLETE

Atty. VENER PIMENTEL

Mr. ALEXANDER CONCEPCION

Mr. VOLTAIRE MENDOZA

Mr. PETER LOCKEY, UNV

Ms. LIZA FETALINO, UNV

ANNEX A

January 2, 1989

ADMINISTRATIVE ORDER

No. 55-A Series 1989

RULES AND REGULATIONS GOVERNING THE ACCREDITATION OF LABORATORIES PERFORMING HIV TESTING

Section 1. Title: — These rules and regulations shall be known as the "RULES AND REGULATIONS GOVERNING THE ACCREDITATION OF LABORATORIES PERFORMING HIV TESTING."

Section 2. Authority: — These rules and regulations are issued in accordance to R.A. 4688 (Clinical Laboratory Law) and R.A. 1517 (Blood Bank Law) consistent with E.O. 119 (Reorganization Act of the Ministry of Health).

Section 3. Purpose: — These rules and regulations are promulgated to protect and promote the health of the people by regulating the performance and assuring the quality of HIV testing in laboratories and blood banks licensed according to the implementing Rules and Regulations of R.A. 4688 and R.A. 1517.

Section 4. Scope: —

4.1 The regulations embodied herein shall apply to any person, firms, corporation, laboratory or blood bank performing or seeking to perform HIV testing to the Philippines for the public, for diagnostic or public health purposes. HIV testing shall include the determination of the presence of antibody, antigen/protein, viral particles in a clinical specimen indicating infection by Human Immunodeficiency Virus (HIV).

Section 5. Regulatory Authority: — The accreditation of HIV Testing Laboratories/Blood Banks under these rules and regulations shall be exercised by the Department of Health through the Bureau of Research and Laboratories in the Office for Standards and Regulation.

Section 6. Laboratory Procedures Requiring Accreditation: —

6.1 Any of the following laboratory procedures shall require accreditation as a HIV Testing Laboratory:

1) Screening tests for HIV antibody

1.1 Enzyme Immunoassay (EIA)

1.2 Particle Agglutination (PA)

1.3 Others

2) Supplemental (Confirmatory) Tests for HIV antibody

2.1 Western Blot (WB)

2.2 Immunofluorescence (IF)

2.3 Radioimmuno Precipitation Assay (RIPA)

2.4 Others

3) Other laboratory procedures such as testing for HIV antigen, culture of HIV, etc.

6.2 No laboratory shall be allowed to perform HIV testing without accreditation by the Department of Health through the Bureau of Research and Laboratories.

6.3 No HIV clearance certificate shall be authenticated by the DOH unless the laboratory procedure has been performed by a laboratory accredited in accordance to these rules and regulations.

Section 7. Accreditation Requirements for a HIV Testing Laboratory: — (Technical Standards)

7.1 All clinical laboratories or blood banks shall be required to demonstrate compliance with the following Technical Standards as a requirement to accreditation:

1) The clinical laboratory or blood bank shall be duly licensed by the Bureau of Research and Laboratories.

2) The laboratory shall be headed by and under the direction and supervision of a duly licensed physician who is certified by the Philippine Board of Pathology or Philippine Board of Hematology and Blood Transfusion.

3) The laboratory shall be staffed by medical technologists duly registered with the Board of Medical Technology, who have undergone acceptable training in HIV testing duly certified by a training laboratory.

4) The physical plant shall be housed in well-lighted and ventilated, dust-free areas with an adequate supply of water. The space appropriately furnished, should be sufficient to accommodate the activities needed for HIV Testing.

5) Equipment, glassware and supplies:

The HIV Testing Laboratory shall have the appropriate equipment, glassware and other supplies needed for HIV testing.

6) Reagents:

The laboratory shall utilize reagents, such as HIV kits, which have been registered with the Bureau of Food and Drugs (BFAD) and evaluated and recommended by RITM.

7) Report Forms — The report forms should be clear, objective and indicate the type of HIV.

7.1 The Bureau of Research and Laboratories shall evaluate compliance with such technical standards in accordance to requirements as may be promulgated under these Rules and Regulations.

Section 8. Reporting: —

Each HIV testing laboratory shall report monthly the number of tests done, results and referrals of seroreactive samples in accordance with the format prescribed by the Bureau of Research and Laboratories. The report shall be accompanied by xerox copies of invoices of purchases of HIV kits the previous month. ATDHSC

Section 9. Referral of Seroreactive Serum Samples: —

9.1 All serum samples reactive in screening tests (EIA or PA) by private laboratories shall be referred to the Research Institute of Tropical Medicine for confirmation.

9.2 All serum samples reactive in screening tests (EIA or PA) by government laboratories shall be referred to the Bureau of Research and Laboratories for confirmation.

9.3 The names, age, sex and addresses of persons confirmed to be seropositive (by WB/IF/RIPA) shall be reported to AIDSWATCH, as provided in Section 18 of this IRR.

9.4 Such person shall be informed of the implications of a seropositive test and the requirement of a confidential report to the AIDS Registry.

Section 10. Quality Control Tests: — The Director of the Bureau of Research and Laboratories or his representative is hereby authorized to conduct such quality control tests as he deems appropriate or necessary for the administration of these regulations, for the control of operations and as criteria for the renewal of certificates.

Section 11. Inspection: — HIV testing laboratory facilities and records shall be subject to regular inspections to determine compliance with the above regulations.

11.1 The Director of the Bureau of Research and Laboratories or his duly authorized representative(s) shall be given reasonable time and opportunity to inspect the premises and facilities wherein the HIV testing is being performed.

11.2 Each laboratory shall make available to the Director of the Bureau of Research and Laboratories or his duly authorized representative all records kept pursuant to these regulations for inspection.

11.3 The Director of the Bureau of Research and Laboratories or his representative(s) may be assisted by duly designated experts from professional associations in such inspections.

11.4 Directors of Regional Health Offices, Provincial, City and Municipal Health Officers are hereby directed to report to the Bureau of Research and Laboratories the existence of unaccredited HIV testing laboratories or any private party performing such test without a proper accreditation certificate.

Section 12. Basic Accreditation Requirements: — Any person, firm or corporation desiring to perform HIV testing shall submit to the Bureau of Research and Laboratories, a sworn petition/application on the prescribed firm and containing among others, the following data:

1) Name, citizenship and domicile of the head of the HIV Testing Laboratory;

2) Place, municipality and province where it is to be established;

3) Name of the establishment;

4) Name, citizenship and domicile of the owner;

5) Copy of a valid permit to operate a clinical laboratory or blood bank from the Department of Health, and

6) Scope of the nature of work to be undertaken.

Section 13. Application for Accreditation: —

13.1 An application for accreditation shall be filed in a form "Application for Accreditation of Laboratories performing HIV testing" with the Office of the Bureau of Research and Laboratories for screening and approval.

13.2 Each application shall be signed under oath or affirmation by the applicant or a person duly authorized to act for and on his behalf.

13.3 Within 60 days after receipt of said application together with the accreditation fee, and inspector from the Bureau of Research and Laboratories shall inspect the establishment and verify if the applicant has complied with the requirements prescribed in these regulations.

13.4 Any material false statement in the application or failure to comply with requirements may serve as basis of the Director of the Bureau of Research and Laboratories to refuse recommending the issuance of a certificate of accreditation.

Section 14. Accreditation Fees: —

14.1 A non-refundable fee shall be charged for every application for an accreditation certificate issued for the performance of HIV Testing for government and private laboratories.

14.2 A non-refundable fee is charged on application of renewal if filed at least sixty (60) days before the accreditation expires.

14.3 All fees shall be payable to the Bureau of Research and Laboratories in accordance with the following schedule:

For New Certificates: P500.00

For Renewal of Certificates: P250.00

14.4 A penalty of P200.00 for late renewal shall be charged in addition to the renewal fee when filed within sixty (60) days after expiration of accreditation.

14.5 Sixty (60) days after expiration of accreditation, unrenewed certificates shall be considered lapsed, and a new certificate shall have to be applied for.

Section 15. Issuance and Exhibition of Certificate of Accreditation: —

15.1 The certificate will be issued and signed by the Undersecretary of Health for Standards and Regulation if the application is found to be meritorious and the fees duly paid; otherwise the same shall not be approved.

15.2 The accreditation certificate should be placed in a conspicuous place within the laboratory. A copy of the rules and regulations shall be readily available for the guidance of the staff in the laboratory.

Section 16. Terms and Conditions of Accreditation: —

16.1 The certificate as herein granted or any right under the certificate shall not be assigned or otherwise transferred directly or indirectly to an unauthorized party.

16.2 The owner or manager of any HIV testing laboratory desiring to transfer to another place shall inform the Bureau of Research and Laboratories in writing, stating the new place and site of the establishment within fifteen (15) days after such transfer. The new facilities shall be subject to re-inspection before it can resume operation.

16.3 Any HIV antibody laboratory desiring to stop operation should notify the Bureau of Research and Laboratories stating the said date of termination.

16.4 Any pathologist who decides to terminate services or transfer supervision should inform the Bureau of Research and Laboratories within fifteen (15) days after such termination or transfer.

16.5 Failure to report in writing within 15 days any change in conditions of Accreditation will be cause for suspension or revocation of the certificate of Accreditation of the laboratory.

Section 17. Expiration of Accreditation Certificate: —

Each accreditation certificate shall expire one year after the date of approval of the certificate such date being indicated in the upper right hand corner of the certificate.

Section 18. Renewal: — Application for renewal of certificates shall be filed at least sixty (60) days before the expiration of the certificate accordance to Section 14. The Bureau of Research and Laboratories shall process applications for renewal immediately upon receipt thereof subject to inspection upon the discretion of the Director; provided however, that such HIV testing laboratory may continue operation pending action on their application, unless otherwise advised or ordered by the Director, Bureau of Research and Laboratories or his representative to cease operation.

Section 19. Publication of List of Accredited Laboratories: —

19.1 A list of laboratories and blood banks accredited for HIV testing under these rules and regulations shall be published periodically and be made available to any person, agency or organization for legitimate purposes.

19.2 The results of quality control testing shall likewise be published.

Section 20. Modification and Revocation of Certificates: —

The terms and conditions of each certificate shall be subject to amendment or modification by means of amendments to these regulations as the Secretary of Health may deem necessary. Except in cases of willful, or repeated violations hereof, or where public health interest or safety requires otherwise, no certificate shall be modified, suspended or revoked unless prior notice has been made and the corresponding investigation conducted.

Section 21. Violations: —

21.1 The certificate of accreditation of a laboratory to perform HIV testing shall be suspended or revoked by the Undersecretary of Health for Standards and Regulations for any violation of these Rules and Regulations, which may include among others:

1) Operating an HIV Testing Laboratory without a qualified pathologist or hematologist or medical technologist.

2) Any material false statement in the application.

3) Utilizing unregistered HIV testing kits.

4) Repeated failure to submit a monthly report with accompanying xerox copies of invoices to the Bureau of Research and Laboratories.

5) Failure to submit seroreactive samples for supplemental (confirmatory) testing to the Research Institute of Tropical Medicine or Bureau of Research and Laboratories.

6) Failure to report confirmed seropositive cases to the AIDS Registry, HIS, DOH.

7) Refusal to allow inspection of the laboratory by persons authorized by the Bureau of Research and Laboratories during reasonable hours.

8) Refusal to perform tests on quality control samples required by the Bureau of Research and Laboratories.

9) Failure to correct deficiencies within a reasonable time after due notice from the Bureau of Research and Laboratories.

21.2 Any HIV Testing Laboratory that violates these rules and regulations shall be liable under the Clinical Laboratory Law (R.A. 4688) or Blood Bank Law (R.A. 1517) and suffer penalties provided for in the law and the Revised Rules and Regulations issued pursuant to such law. Such violations shall be basis for sanctions including suspension or revocation of the license to operate the Clinical Laboratory or Blood Bank.

Section 22. Effectivity: — These rules and regulations shall take effect fifteen (15) days after its publication in the Official Gazette or in a newspaper of general circulation.

(SGD.) ALFREDO R.A. BENGZON, M.D.

Secretary of Health

ANNEX B1

21 November 1995

DOH ADMINISTRATIVE ORDER

No. 18 s. 1995

SUBJECT : Revised Guidelines in the Management of HIV/AIDS Patients in the Hospital

I. BACKGROUND

The HIV/AIDS pandemic has been declared a worldwide emergency by the World Health Organization. This situation has serious health, social, economic and political implications for all countries. The Philippines is not spared of the problems brought about by this pandemic as evidenced by the current national statistics on AIDS.

In response to the emerging need for standardized procedures in the OPD consultation and/or hospitalization of HIV/AIDS patients, the Department of Health through the Hospital Operations and Management Service in collaboration with the national AIDS/STD Prevention and Control Program issued Administrative Order No. 27 last March 1994. Since then, the guidelines had been disseminated to concerned hospitals through orientation seminars, and even through other training workshops conducted by the national AIDS program.

More than a year after its issuance, experience in field implementation had gradually accumulated. With lessons learned, the need for the revision of this guidelines became evident.

II. OBJECTIVES

General Objective: To strengthen the capability of the hospital in the prevention and control of HIV infection/AIDS.

Specific Objectives:

1. To organize an HIV/AIDS Core Team.

2. To formulate standardized guidelines in the management of HIV/AIDS.

3. To provide holistic care to HIV-infected/AIDS patients, their families and significant others including referrals and networking with NGOs and GOs.

4. To develop human resources necessary to carry out the provisions of this guidelines.

5. To implement and operationalize HIV/AIDS-related programmes in the hospital.

III. ORGANIZATIONAL STRUCTURE

IV. COMPOSITION AND FUNCTIONS OF THE HACT

Each DOH hospital shall organize an HIV/AIDS Core Team (HACT) which shall directly report to the Chief of Hospital. It shall be composed of, but not limited to the following: doctor(s), dentist(s), nurse(s), medical social worker(s), and medical technologist(s) and have the following functions:

1. Formulate hospital guidelines on the comprehensive care and management of HIV/AIDS patients.

2. Provide care and counseling to HIV/AIDS patients.

3. Promote prevention and control measures/strategies such as health education and hospital infection control.

4. Facilitate inter- and intra- departmental/agency coordination including referral system and networking.

5. Performs training and research activities on HIV/AIDS.

6. Provide recommendations in hospital planning and development related to HIV/AIDS.

7. Monitor compliance of ethico-moral guidelines for HIV/AIDS including confidentiality of records and reports and release of information.

8. Update records and submit reports to concerned offices.

9. Conduct monitoring and evaluation of activities.

A. SPECIFIC FUNCTIONS OF EACH HACT MEMBER

1. PHYSICIAN

1.1 Acts as chairpersons of HACT as designated by the Chief of Hospital.

1.2 Coordinate with the Hospital Infection Control Committee in the strict implementation of prevention and infection control measures within the hospital.

1.3 In-charge of the medical management.

1.4 Ensures follow-up of patients and referral to other specialties as necessary.

1.5 Conducts training and research.

1.6 Submits reports of HIV infection/AIDS to the National AIDS Registry.

1.7 Provides post-test counseling.

2. DENTIST

2.1 Coordinates with Hospital Infection Control Committee in the strict implementation of prevention and infection control measures within the dental clinic.

2.2 In-charge of the oral care and management.

2.3 Disseminates oral health information and counseling.

2.4 Ensures follow-up of dental patients and refers them to specialist when necessary.

2.5 Conducts training and research related to dental field.

3. NURSE

3.1 In-charge of the nursing management.

3.2 Coordinates patient referrals within the hospital.

3.3 Promotes health education activities.

3.4 Manages training and research activities for nurses and auxiliaries.

3.5 Ensures implementation of infection control guidelines.

4. MEDICAL SOCIAL WORKER

4.1 Provides psychosocial support services including counseling to HIV-infected/AIDS patients and their families.

4.2 Coordinates and establishes linkages with GOs and NGOs in order to:

4.2.1 identify existing resources for efficient networking

4.2.2 assist in providing alternative source of income

4.2.3 provide continuing psychosocial support

4.3 Provides health education.

4.4 Conducts home visits/follow-ups.

4.5 Conducts training and research related to social work activities.

5. MEDICAL TECHNOLOGIST

5.1 Ensures that pre-test counseling is provided with an oral or written informed consent.

5.2 Performs appropriate laboratory procedures according to set technical standards.

5.3 Ensures proper laboratory waste disposal.

5.4 Implements guidelines on laboratory safety and preparations.

5.5 Ensures that test results are reviewed and duly signed by the laboratory chief before releasing to HACT physician.

V. APPROACH TO MANAGEMENT

1. Suspected or known HIV-infected patients shall be referred to the HACT.

2. Initial assessment shall be done by HACT physician.

3. Suspected HIV cases shall undergo HIV antibody testing with an informed consent after a pre-test counseling. Post-test counseling shall be provided to all patients who underwent HIV antibody testing.

4. The decision to admit known HIV-infected/AIDS case shall be determined by the HACT doctor and shall be admitted to the appropriate ward according to the presenting manifestation.

5. A multidisciplinary approach to the care and counseling of HIV-infected patients shall be carried out by the HACT.

6. All HIV-infected/AIDS patients for discharge shall be provided with written discharge instructions on home care and management.

7. Asymptomatic patients shall be followed-up every 3 months. Symptomatic patients shall be followed-up as necessary.

8. Referrals/networking with other hospitals/agencies shall be done as necessary.

VI. RECORDS AND REPORTS

1. HACT shall observe and monitor implementation of the ethico-moral guidelines in record-keeping and release of information of HIV/AIDS patients.

2. HACT shall ensure that the records of HIV/AIDS patients are complete and regularly updated.

3. HACT shall submit to the Medical Records Office the records of HIV/AIDS patients with coded names. The name should remain with HACT for safekeeping. However, information related to such record shall be released only upon authorization of Chief of Hospital unless otherwise delegated to the HACT chairman.

4. HACT shall submit updated reports to concerned offices for statistical purposes (DOH-National AIDS Registry).

VII. MONITORING AND EVALUATION

1. HACT shall formulate monitoring tools and guidelines for the HIV/AIDS program of the hospital.

2. HACT shall conduct annual evaluation of program implementation and make necessary recommendations.

3. HACT shall submit annual report to NASPCP.

4. HACT shall conduct regular review of HIV/AIDS clinical management protocol.

VIII. GENERAL PROVISIONS

1. Confidentiality

All HACT members shall ensure that all medical data and information of HIV/AIDS patients are maintained with utmost confidentiality. HACT physicians are required to report using the official HIV/AIDS reporting form (See ANNEX 3) any HIV infection/AIDS case the HACT members attend to. In order to protect the fundamental right of privacy of an individual with AIDS or infected with HIV, the reporting must be limited to the number of AIDS cases and other statistics without divulging the identity of the person unless the patient agrees in writing to the disclosure.

2. Counseling

All HACT members should be able to provide counseling to all patients including pre- and post-test counseling.

3. Right to health care services

HIV/AIDS patients have the right to avail of health care services in any health care facility. One who has HIV infection/AIDS shall not be denied his right to medical treatment.

4. Hospital Implementing Procedure

The HACT shall be responsible for formulating the implementing procedure of this guidelines and such procedure shall be in accordance to the objectives and provisions of this Administrative Order. The scope and limitations of the Hospital Implementing Procedure shall be concurrent to the hospital set-up and capacity.

5. Case Definition

Any person with or without overt signs and symptoms of opportunistic infection and gives a confirmed positive HIV antibody test result is diagnosed to be HIV-infected. On the other hand, an AIDS case has one or more of the AIDS-defining conditions (see ANNEX 1).

6. Universal Precautions

Universal precautions assume that blood, blood products and other body fluids of all patients are potential sources of infection independent of diagnosis or perceived risk. It is, therefore, mandatory for all hospital personnel to practice precautionary measures (see ANNEX 2) to prevent transfer of HIV and other infectious agents.

7. Post-Mortem Care

All dead bodies shall be considered potentially infected with HIV. Procedures that would entail physical contact with blood and other body fluids shall be carried out with precautions. Cadavers should be properly placed inside a non-permeable material such as plastic bag before burial or cremation. Physical barriers to prevent exposure of skin and mucous membranes to potentially infected body fluids during post-mortem procedure shall be utilized. Patients who died of AIDS shall be buried unembalmed within 24 hours or cremated.

IX. PENALTY CLAUSE

Any individual who does an act in violation of any of the foregoing provisions or fails to do an act provided thereof, shall be subject to appropriate action by proper authorities after due notice and process.

X. EFFECTIVITY

This order supersedes Administrative Order No. 27, s. 1994 (Subject: Guidelines on OPD Consultation and/or Hospitalization of HIV/AIDS Patients) and shall take effect immediately.

(SGD.) HILARION J. RAMIRO JR., MD, MHASecretary of Health

ANNEX 1 OF ANNEX B1

US Centers for Disease Control (CDC), AIDS Defining Conditions

Opportunistic Infections

Candidiasis of bronchi, trachea or lungs

Candidiasis, esophageal

Coccidioiidomycosis, disseminated or extrapulmonary

Cryptococcosis, extrapulmonary

Cryptosporodiosis, chronic intestinal (> 1 month's duration)

Cytomegalovirus disease (other than liver, spleen or nodes)

Cytomegalovirus retinitis (with loss of vision)

Herpes simplex: chronic ulcer(s) (> 1 month's duration), or bronchitis, pneumonitis, or esophagitis

Histoplasmosis, disseminated or extrapulmonary

Isosporiasis, chronic intestinal (> 1 month's duration)

Mycobacterium avium complex or M. kansasii, disseminated or extrapulmonary

Mycobacterium tuberculosis, any site (pulmonary or extra-pulmonary)

Mycobacterium, other species or unidentified species, disseminated or extrapulmonary

Pneumocystis carinii pneumonia

Pneumonia, recurrent

Progressive multifocal leukoencephalopathy

Salmonella septicaemia, recurrent

Toxoplasmosis of brain

Malignancies

Kaposi's sarcoma

Lymphoma, Burkitt's (or equivalent term)

Lymphoma, immunoblastic (or equivalent term)

Lymphoma, primary of brain

Cervical cancer, invasive

Encephalopathy, HIV-related

Wasting Syndrome due to HIV

Advanced immune deficiency (CD4 cell count <200 /uL)

ANNEX 2 OF ANNEX B1

Universal Precautions

a. Standard hygienic procedures, especially handwashing, should be followed at all times.

b. Hospital or medical center guidelines for disinfection and sterilization should be consulted and followed faithfully.

c. Any skin disease or injury should be adequately protected with gloves or impermeable dressing to avoid contamination with a patient's body fluids.

d. Any spills of blood or other potentially contaminated material should be liberally covered with household bleach (dilution 1 to 10), left for 30 minutes then carefully wiped off by personnel wearing gloves.

e. Gloves, masks and protective eyewear should be worn during surgery, childbirth and other procedures that might cause splashing of blood or body fluids wherever possible.

f. Needles and sharp objects should be discarded in puncture-proof containers. Do not bend or break needles by hand. Do not recap used disposable needles.

g. Reusable needles and syringes should be handled with extreme care and safely stored prior to cleaning and sterilization or disinfection.

h. Linen soiled with blood or other body fluids should be handled as little as possible. Gloves and a protective apron should be worn while handling soiled linen.

Unnumbered Annex of ANNEX B1

Department of Health

National AIDS Prevention and Control Program

San Lazaro Compound, Sta. Cruz, Manila

HIV AIDS Case Reporting Form

The LAW ON REPORTING COMMUNICABLE DISEASES (ACT 3573) require attending physicians to report all diagnosed HIV infections (including both asymptomatic and symptomatic cases) to the AIDS Registrar, Field Epidemiology Training Program (FETP), Department of Health. A written report must be submitted at the time of any of the following events: 1) Time of diagnosis; 2) Progression to AIDS; and 3) Death. Physicians are encouraged to refer all HIV/AIDS patients to either San Lazaro Infectious Disease Hospital, Sta. Cruz, Manila or to the Research Institute for Tropical Medicine, Alabang, Muntinlupa, MM (Tel. No. 842-2245, 842-2194) for long term follow-up.

Patient's Initial Code ________________________

Birthdate (MM/DD/YY) _____________ Age ________ Sex _______

Date of HIV Diagnosis (Month/Year) ____________________

HIV/AIDS Classification:

________ Class 1 (Acute Infection)

________ Class 2 (Asymptomatic HIV Carrier)

________ Class 3 (Persistent Generalized Lymphadenopathy)

________ Class 4A (Constitutional Manifestations, i.e., prolonged fever, chronic diarrhea, weight loss, etc.)

________ Class 4B (Neurological Manifestations)

________ Class 4C (Opportunistic Infections, Specify: __________________ ____________________________________________________

________ Class 4D (Malignancies: Lymphoma, Kaposi's Sarcoma, etc.)

________ Class 4E (Other AIDS Related Condition, Specify: _____________ ____________________________________________________

Mode of Transmission:

________ Sexual intercourse

 Heterosexual ( ) Homosexual( )

________ IV Drug Use (Needle Sharing)

________ Contaminated Blood Transfusion

________ Perinatal (Mother to Infant)

________ Others, Please Specify: _________________________________

________ Unknown

Report Type: ___________ Initial

 _______ Conversion to AIDS, Date (Month/Year): __________

 _______ Death Date (Month/Year): ______________

 HIV Related Death: _____ Yes _____ No

Date of Report: _________________________________________________

Referring Agency: _______________________________________________

 Address/Tel. No. ___________________________________________

Reporting Agency: _______________________________________________

 Address/Tel. No. ___________________________________________

ANNEX B2

May 10, 1997

ADMINISTRATIVE ORDER

No. 9 s. 1997

 

Administrative Order No. 18 s. 1995 is hereby amended to include the following provisions.:

I. CRITERIA IN THE SELECTION OF HIV/AIDS CORE TEAM (HACT) LEADER AND MEMBERS:

A. Team Leader

The HACT leader shall be chosen on the basis of the following criteria:

1. Commitment to accept responsibilities and perform the tasks of a HACT leader;

2. High level of knowledge of the program, including positive attitude particularly towards the program's clients;

3. Preferably an infectious disease consultant or an internist with a permanent medical specialist position in the hospital;

4. Preferably has a direct involvement in the care and management of patients in the hospital; and

5. Willingness to undergo training on the clinical care and management of HIV/AIDS patients.

B. Team Members

The HACT members shall be chosen on the basis of the following criteria:

1. Commitment to accept responsibilities and perform the tasks of HACT members;

2. With permanent position, either resident physicians or specialists from other departments; and

3. Willingness to undergo training on the clinical care and management of HIV/AIDS patients.

II. PERFORMANCE OF HIV/AIDS SCREENING TEST:

1. Suspected HIV/AIDS patient shall undergo HIV antibody testing with a written informed consent after a pre-test counseling. Post-test counseling shall be provided to all patients who underwent the procedure.

1.1 The written informed consent shall be signed by the patient himself.

1.2 The written informed consent may be signed by an immediate member of the family only in the following cases:

a. Patient's incapacity but known to possess a risky behaviour

b. Below 18 years of age.

2. The screening test can be undertaken in the absence of the nearest kin provided that the following conditions are met:

2.1 Test is undertaken for the purpose of managing the opportunistic infection.

2.2 There is a written justification from the attending physician which is duly noted by the medical director of the hospital.

III. REFERRAL/NETWORKING SYSTEM:

1. The referring hospital shall be responsible for the following:

a) The attending physician shall take care of informing the patient or the immediate relatives for the mentally deranged patients, about the patient's HIV serostatus.

b) A clinical abstract shall be prepared and forwarded to the HACT of the receiving hospital. A directory of the HACT leaders and members shall be provided to both private and government hospitals through the Philippine Hospitals Association (PHA). Strict confidentiality shall be observed in the process of referral.

c) If possible, the attending physician shall communicate with the receiving HACT leader for endorsement.

2. The receiving hospital shall be responsible for the following:

a) Confirmation of the HIV serostatus of the referred patient through proper coordination with RITM or BRL.

b) Admission of the patient in the hospital shall be according to presenting clinical problem, regardless of the patient's HIV serostatus.

All other provisions which are not affected by this amendment shall remain in effect.

(SGD.) CARMENCITA NORIEGA-REODICA, MD MPH CESO II

Secretary of Health

ANNEX C1

20 February 1997

ADMINISTRATIVE ORDER

No. 2 s. 1997

 

Rationale:

The Department of Health, taking the lead in preventing the spread of HIV/AIDS in the Philippines has established the National AIDS Prevention and Control Program in August 1988. By virtue of Administrative Order No. 57-A s. 1989, the 12 policy statements for the prevention and control of HIV/AIDS in the Philippines were ratified to become the basis for national strategies in the fight against the AIDS disease in the country.

Recognizing the strong association of STDs in the transmission of HIV, the National STD Control Program was integrated into the National AIDS Prevention and Control Program in 1994. Both programs are now being implemented with complementing strategies and approaches. STD case management is one complementary strategy in preventing HIV transmission and shall always include diagnosis made according to the resources available, effective treatment based on the national recommendations, education and counseling on treatment compliance and risk reduction including condom promotion and encouragement to notify sexual partners.

In consideration of the HIV and STD epidemiological situations in the Philippines and the experiences gained by the Department since the establishment of the National AIDS Prevention and Control Program in 1988, the 12 policy statements were revised. Administrative Order No. 7-C s. 1995 was then issued to revise the policy statements contained in Administrative Order No. 57-A s. 1989. The revised policy guidelines will complement the existing and future strategic planning documents of the National AIDS/STD Prevention and Control Program.

To provide strategic directions for future activities and complement the existing guidelines on the National AIDS/STD Prevention and Control Program, the following policy statements shall form the bases for the prevention and management of STDs at all levels of the health care system nationwide in order to lessen complications and consequences and reduce the spread of HIV. DTEcSa

1. AIDS/STD prevention and control program shall be implemented in all levels of STD service facilities.

2. Acceptable, affordable and effective case management of patients with STD shall be made accessible to all individuals through the general health care system including Maternal and Child Health Services (MCHS), Family Planning (FP) and other medical services, whenever possible.

3. Syndromic management, which includes diagnosis based on recognizable groups of signs and symptoms and provision of treatment against the majority of organisms producing the syndrome, shall be applied when and where reliable laboratory diagnostic support is not consistently available.

4. Designated referral sites with appropriate laboratory support to STD diagnosis shall be made available at least on a regional level.

5. The role of Social Hygiene Clinics shall be expanded to provide STD services not only for special populations but also for the general community, and where appropriate, provide services to referrals from other levels of the health care system.

6. The promotion of STD health-seeking behavior, as a priority, shall be included in the local or national HIV/STD plans.

7. Drugs used for STD management shall be in accordance with the updated STD Treatment Guidelines of the Department.

8. The Department of Health in collaboration with the local government units shall ensure that doctors, nurses, midwives, pharmacists and other health care workers, both hospital and community based, receive appropriate training on STD case management.

9. The existing reporting system for STD surveillance shall be strengthened and be made culturally appropriate in collaboration with the local government units and other health-related agencies.

10. Operational research necessary to the performance of the National AIDS/STD Prevention and Control Program, including microbiological surveys, shall be coordinated by the AIDS/STD Unit. NASPCP shall see to it that significant results shall be disseminated and acted upon appropriately.

11. The program shall encourage case finding in vulnerable populations e.g. unregistered sex workers and asymptomatic patients at increased risk of infection. Routine testing for syphilis among pregnant women shall be encouraged at all health care facilities such as hospital, primary health care centers, etc. and where resources can be made available should be free of charge.

Specific guidelines to implement the above policies shall be formulated and widely disseminated through the AIDS/STD Unit to all programs and services involved in the prevention and control of STD in the Philippines.

This order shall take effect immediately.

(SGD.) CARMENCITA NORIEGA-REODICA, MD MPH CESO IISecretary of Health

Annex C of ANNEX C2

SUMMARY OF SPECIFIC GUIDELINES AND PROCEDURES

 

 

APPENDIX A. ACRONYMS AND CORRESPONDING MEANINGS:

IRR of RA 8504 "PHILIPPINE AIDS PREVENTION and CONTROL ACT of 1998"

As used in this IRR, the following acronyms shall mean:

AFP	- The Armed Forces of the Philippines
AIDS	- Acquired Immune Deficiency Syndrome
APO	- Accredited Professional Organization
BAP	- Bankers Association of the Philippines
BFAD	- Bureau of Food and Drugs
BID	- Bureau of Immigration and Deportation
BRL	- Bureau of Research and Laboratory
BSS	- Behavioral Surveillance System
CHED	- Commission on Higher Education
CSC	- Civil Service Commission
DBM	- Department of Budget and Management
DECS	- Department of Education, Culture and Sports
DFA	- Department of Foreign Affairs
DILG	- Department of Interior and Local Government
DND	- Department of National Defense
DOF	- Department of Finance
DOH	- Department of Health
DOJ	- Department of Justice
DOLE	- Department of Labor and Employment
DOT	- Department of Tourism
DOTC	- Department of Transportation and Communication
DSWD	- Department of Social Welfare and Development
DTI	- Department of Trade and Industry
EPP	- Edukasyon Pantahanan at Pangkabuhayan
FETP	- Field Epidemiology Training Program
FHSIS	- Field Health Surveillance and Intelligence Service
GAA	- General Appropriations Act
GSIS	- Government Service Insurance System
HACT	- HIV/AIDS Core Team
HIV	- Human Immunodeficiency Virus
HMO	- Health Management Organization
HOMS	- Hospital Operations and Management Service
HSS	- HIV Serologic Surveillance System
IDU	- Injecting Drug User
IEC	- Information, education and communication
IRR	- Implementing Rules and Regulations
LGU	- Local Government Unit
NASPCS	- National AIDS and STD Prevention and Control Service
NEDA	- National Economic Development Authority
NGO	- Non-Government Organization
NHSSS	- National HIV Sentinel Surveillance System
OFW	- Overseas Filipino Worker
OHFSR	- Office for Hospital Facilities Standards and Requirements
OHSC	- Occupational Health and Safety Center
OWWA	- Overseas Worker Welfare Association
PAMET	- Philippine Association of Medical Technologists
PDOS	- Pre-Departure Orientation Seminar
PHA	- Philippine Hospital Association
PHIC	- Philippine Health Insurance Corporation
PIA	- Philippine Information Agency
PLWHA	- People Living with HIV/AIDS
PMA	- Philippine Medical Association
PNAC	- Philippine National AIDS Council
PNP	- Philippine National Police
POEA	- Philippine Overseas Employment Administration
PSP	- Philippine Society for Pathologists
PTCA	- Parents-Teachers-Community Association
RESU	- Regional Epidemiological Surveillance Unit
RITM	- Research Institute for Tropical Medicine
SHAPCS	- Special HIV/AIDS Prevention and Control Service
SLH	- San Lazaro Hospital
SOP	- Standard Operating Procedures
SSS	- Social Security System
STD	- Sexually Transmitted Disease
TESDA	- Technical Education and Skills Development Authority

APPENDIX B. List of Administrative Orders and Department Orders of the DOH referred to in this IRR

Department Order No. 93-B s. 1987 "Designation of the Research Institute for Tropical Medicine as National Reference Laboratory for Testing for Human Immunodeficiency Virus (HIV)" (21 May 1987)

Department Order No. 197 s. 1987. "Amendment to Department Order No. 93-B, s. 1987 Designation of the Research Institute for Tropical Medicine as National Reference Laboratory for Testing for Human Immunodeficiency Virus (HIV)" (7 August 1987)

Administrative Order No. 55-A s. 1989 "Rules and Regulations Governing the Accreditation of Laboratories Performing HIV Testing" (2 January 1989)s

Administrative Order No. 18s, 1995, "Revised Guidelines in the Management of HIV/AIDS Patients in the Hospital." (21 November 1995)

Administrative Order No. 27s 1994, "Guidelines on OPD Consultation and/or Hospitalization of HIV/AIDS Patients." (24 March 1994)

Administrative Order No. 9s 1997, "Amendment to Administrative Order No. 18s, 1995 regarding the Management of HIV/AIDS Patients in the Hospital." (10 May 1997)

Administrative Order No. 2s, 1997 "The National Policy Guidelines for the Prevention and Management of Sexually Transmitted Diseases (STD)" contained in A.O. No. 2s, 1997

Administrative Order No. 5s, 1998 "The Implementing Guidelines in STD Case Management at the different levels of the Health Care System" (13 February 1998)

Department Order No. 93-B s. 1987

Department Order No. 197 s. 1987.

Administrative Order No. 55-A s. 1989 (Rules and Regulations Governing the Accreditation of Laboratories Performing HIV Testing)

A.O. 18s, 1995, "Revised Guidelines in the Management of HIV/AIDS Patients in the Hospital."

A.O. 27s 1996, "Guidelines on OPD Consultation on HIV/AIDS Patients."

A.O.9s 1997, "Amendment to A.O 18s, 1995 regarding the Management of HIV/AIDS Patients in the Hospital."

The National Policy Guidelines for the Prevention and Management of Sexually Transmitted Diseases (STD) contained in A.O. No. 2s, 1997

The Implementing Guidelines in STD Case Management at the different levels of the Health Care System contained in A.O. No. 5s, 1998