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7 B.S. (or at least half-truths) you hear about HIV in the Philippines

For Michael David C. Tan, “a big part of why the Philippines’ HIV situation doesn’t seem to be getting better is because of the continuing use of ‘lies’ (okay, fine, let’s just call them half-truths!) in dealing with HIV.” As such, it’s time to debunk long-held beliefs that aren’t helping deal with this issue.

PHOTO TAKEN DURING AN OUTREACH PROGRAM TO PLHIV OF THE PROJECT RED RIBBON

In 1998, when Shola Luna started her antiretroviral therapy (ART), she had to take 30 tablets in the morning and another 30 tablets at night. It can be said that things are not as “bad” as they were in the early days of HIV. Nowadays, when compared to the early plight of the likes of Shola, many Filipinos living with HIV (for instance) need only take one antiretroviral (ARV) tablet a day.

But this is not to say that everything is now rosy, considering that: the country registers approximately 31 new HIV cases EVERY DAY; less than half of PLHIVs in the Philippines access ART (in June 2017, that’s 21,035 of the 45,023 total reported cases); and those getting infected with HIV are getting younger (again in June, half of 1,013 cases reported were from the 25-34 year age group while 32% were youth aged 15-24 years).

I advance the position that a big part of why the Philippines’ HIV situation doesn’t seem to be getting better is because of the continuing use of “lies” (okay, fine, let’s just call them half-truths!) in dealing with HIV.

1. There’s a law that protects persons living with HIV

Yes, we have RA 8504, which – aside from mandating efforts to stop the spread of HIV in the Philippines – actually offers SOME (that’s in CAPS for emphasis) protection against discrimination of PLHIVs.
BUT (again in CAPS, for emphasis) the law itself is FLAWED, not to mention that having this law doesn’t mean it is actually being properly implemented.

Issues with it being flawed include: not allowing minors to get tested for HIV sans parental/guardian’s consent, even if the age of those getting infected in the Philippines are getting younger; only medical professionals who disclose one’s HIV status is punishable; lack of PLHIV representation in the national body (that’s the Philippine National AIDS Council) that is also supposed to look after their issues; and lack of clarity re bodies responsible re implementation (or non-implementation) of the law’s mandates (for instance, insurance companies still discriminate sans sanctions).

Issues with implementation are numerous, including: abundance of agencies that mandate HIV testing even if this is against the law – e.g. some are government offices and employment companies; absence of bodies PLHIVs can actually approach if/when violations happen; non-formation of Local AIDS Councils in local government units (with the devolving of healthcare to local governments); and so on…
So consider having a law as a good thing; but that it’s largely toothless makes it… largely inadequate.

HIV stigma and discrimination and official indifference?

2. Social media caused the surge of HIV

Eric Tayag of the Department of Health was one of the earliest to stress that easy access to social media networks (online and app-based, like Grindr, PlanetRomeo, Blued and even the likes of Facebook and Twitter) helped cause the surge of HIV infections in the country.

I’d say this is true… BUT only to the extent that technology made hooking up easier (and with more sexual partners, one’s risk of exposing oneself to STIs increases).

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I contend, nonetheless, that this is also a questionable blanket statement because even if you are not into monogamy but practice safer sex, your risk of getting infected may be lower than someone who is in a monogamous relationship but: A) does not know his/her HIV status; B) have had unsafe sex prior to the relationship he/she has now; or – if one is HIV+ – C) has issues with his/her meds so his/her VL is in doubt.

In the end, educating people on how to stay negative (or if positive, how they won’t infect others) is the BETTER approach, instead of the admittedly catchier extensive claim of the Internet as (solely) blame-worthy for the spread of HIV.

3. Most affected by HIV are men who have sex with men (MSM)

Many people will not necessarily agree with me here; and they have every right opposing me. After all, data shows that the population most affected by HIV in the Philippines involves MSM. For instance, in June 2017, of the 1,013 Filipinos who were newly infected with HIV, most (93%) were male.

BUT for those willing to hear me out, my position is largely based on anecdotes we’ve encountered while interviewing (and even attending training) for articles developed for Outrage Magazine.

For instance, I have spoken with HIV counselors in Cagayan de Oro City and in Davao City who alleged that they were blatantly told by agencies implementing HIV-related programs in their localities to “only test MSM.” I personally attended a government-sanctioned training (to give community-based HIV testing) where the participants were told to “only use the rapid test kit to MSM, and NOT women (even if these women wanted to get tested)”. We also heard of populations (e.g. women in prison) who want to get tested, but aren’t tested.

So YES, existing figures show that MSM “drive” the spread of HIV in the Philippines. But I’d argue that THIS DOES NOT SHOW THE WHOLE PICTURE.

On this, note that we refer to the key affected population as “men who have sex with men”. Meaning, these are men who are not necessarily gay or bi, but are hetero-identifying men who just happen to have (had) sex with other men (e.g. DOTA boys, sex workers, masseurs who give extra service). Any other time, they will (also) have sex with women (they’re hetero, after all). So that if they have HIV, they may also infect these women they have sex with. Now, if we don’t test women (particularly those who want to get tested), our efforts are lacking…

4. Antiretroviral medicine is free

You’d often hear NGO workers, and EVEN GOVERNMENT OFFICIALS claim that Filipinos should get tested to know their HIV status because – if they turn out to be positive – meds are given out for free anyway.

Let’s call this a B.S.

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Because the general rule is for a PLHIV to pay PhilHealth (if voluntary, this totals to P2,400 per year) first before he/she can get the ART. Specifically, in the Philippines, the treatment, care and support received by most people living with HIV (PLHIVs) are covered by the Philippine Health Insurance Corporation’s (PhilHealth) Outpatient HIV/AIDS Treatment (OHAT) Package. To those who are enrolled in PhilHealth, P30,000 is allocated per PLHIV per year, or P7,500 every quarter.

There are “exceptions” – e.g. for some, their fees are paid by local governments (say the mayor), NGOs, faith-based organizations, et cetera. But again, as a general rule, payment happened before the service (including the meds) is accessed. Meaning, you have to first cough up the money to access the life-saving meds (and HIV-related services).

This is important to point out here because:

A) Telling people outright that the meds are ALL FREE is a lie; and

B) Many PLHIVs consider themselves “lucky” for being “served” by treatment hubs, when the fact of the matter is that they paid for that “service” and therefore have every right to complain if that same service sucks.

5. PrEP is now available in the Philippines

Here, it’s a yes and no.

YES because it is being piloted, with a very select few chosen for the pilot.

So NO, too, because IT STILL ISN’T AVAILABLE FOR EVERYONE WHO WANTS/NEEDS IT (e.g. opposite sex couple who want to get pregnant, and those in serodifferent relationships). So if you’re a fisherman or a farmer somewhere in Visayas or Mindanao (and yes, there have been reported cases of HIV infection in these populations!), PrEP isn’t available for you (though for that matter, so is ARV).

What’s ironically funny for me is this: PrEP was already proven to be effective, so why the continuing delay in just rolling it out in the Philippines?

As a side note here: Do you know that even post-exposure prophylaxis (PEP) is still not (widely) available in the Philippines?

6. There’s no money for HIV

A common message we hear in HIV advocacy is that there’s not enough money to deal with a burgeoning problem.

I say: Yeah, right!

When we have NGO workers who: A) get to travel the world (for leisure at that!) using (most of) the money supposed to benefit people living with HIV; B) can afford to buy high-end gadgets (e.g. Apple Watch, think of the latest iPhone units, including iPhone X) and luxury goods (e.g. LV, Coach, et cetera) from a “low” salary; C) can afford to pay for cosmetic surgery from the same “low” salary; D) can buy properties (e.g. car/s and condos); and E) have “meetings” in – say – Boracay (and then present the same as an “achievement” to donor agencies), then we know THERE IS MONEY if not FOR, then at least IN HIV.

The emphasis, therefore, is NOT on whether there is money; but on WHERE THE MONEY GOES.
Of course, it’s easy to blame the government’s continuing seeming non-focus on HIV (e.g. remember those ARV procurement issues that happened because of non-payment of taxes?).

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But I’d also argue that part of the problem are some donor agencies that partner only with “big” NGOs, and then solely base indicators of “success” on reports given to them, as if these can’t be (or aren’t) faked.

For instance, there are many (admittedly smaller) HIV-centric NGOs in the Philippines that DO NOT HAVE MONEY to implement their projects, and yet there are many (bigger) non-HIV NGOs that get funds to run HIV-specific projects. The main difference is the “established systems” (e.g. accounting) of the bigger NGOs. A common practice is, therefore, for the bigger NGOs to get the money, and then hire (and pay less) the smaller NGOs to implement the projects for them. In a way, they become the “middleman” who gets “cut” not necessarily because they know what they’re doing, but solely for holding the power of the purse…

If these donor agencies really wanna help, I’d say EMPOWER THE SMALLER NGOs/CBOs by giving them the money (including to train their people to become competitive with the bigger NGOs) and JUST GET RID OF THE (profiteering) “middlemen”…

Another senseless indicator of success, for me, is the “noise” made in social media. For instance, I’ve attended a presscon of a well-funded “effort” to encourage people to get tested for HIV by using celebrities. The budget went to these celebrities (some even had the gall to complain that they were getting “peanuts” from the project), the photographers/videographers, PR firm, et cetera. After the project (and the money was spent), actually counting people who got tested because of the effort was sidelined because, as was said, “that’s not an indicator for success”.

Again, to emphasize, there is money for HIV. It just isn’t necessarily getting spent where it ought to be.

7. The HIV “community” is unified – NOT!

When somebody from the HIV community claims to speak for the entire HIV community, he/she is bullshitting you. This includes “speaking on behalf of the HIV community in amending RA 8504”, or giving citations to very select people who are supposed to have helped HIV advocacy in the Philippines (and even if their roles in HIV advocacy are questionable).

Remember that study about thinking twice before talking about the “LGBT community”? Yes, there would be similarities in the experiences (e.g. the need for ARV). But the same principle holds true here – i.e. this community is so diverse that speaking for it AS A WHOLE is not only erroneous, but ill-advised.

The first step to doing something about anything is acknowledging the truths (and lies, for that matter) about it. And so for me, here are the BASIC truths/half-truths/lies we need to tackle when discussing HIV in the Philippines…

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