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POZ

Confessions of a former ‘gift’ giver…

Patrick King Pascual interviews Paolo, a Filipino living with HIV, who used to hang out with others who touted sharing the “gift”. “If I could only turn back time, I would not have done all those things,” Paolo now says. But he now also believes in one’s responsibility over oneself. “Even if you’re having a fun time, never let your guard down. You should never completely trust anyone when it comes to sex, especially when you are at your most gullible and vulnerable self.”

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This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”. More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

(THIS IS PART OF A SERIES, WITH THE STORY OF PAOLO SHARED IN PARTS – ED)

“I felt a sudden jolt after I came/orgasmed inside the person that I was having sex with bareback,” Paolo said. He didn’t look particularly happy; he even had a blank stare.

But he was open about sharing his sexual experiences with me.

Particularly that part in his life, when he used to be a “participant of a small group of HIV-positive straight-acting gays who frequent different places in the metro and engage in different sexual activities.”

Paolo, by the way, was diagnosed with HIV in 2007. After he registered and submitted his medical documents in San Lazaro Hospital, he didn’t go back until early 2011.

LIVING LIFE TO THE FULLEST

“Maybe I’m the type who doesn’t dwell much on problems. I was aware that I will be battling a lifelong endeavor (being HIV-positive), but I didn’t want to think about it to the point that my life would be hindered,” he said.

When his boyfriend at the time broke up with him, right after he regained his strength from the ARV trial period he had to endure, he lived each day as if it was his last.

“I revealed my condition to some friends and they have been very supportive,” Paolo said. His friends were so supportive, in fact, that “we were going out almost every night.”

It was during one of those night outs that he met Red*.

Red is also HIV-positive; he was diagnosed a year later than Paolo. They became fast friends after their first meeting. “There was nothing sexual nor intimate between us. We were just really good friends,” said Paolo, who found solace in the company of Red.

READ:  Chance of HIV-positive person with undetectable viral load transmitting the virus to a sex partner is scientifically zero

Partying for Paolo meant frequenting the likes of gay bars, including Bed Bar and O Bar. “I was living my life to the fullest; like I’m HIV-free,” Paolo said.

Bar-hopping – according to Paolo – also happened in the likes of Fahrenheit, Palawan, Blue Fairies, and others.

Though Paolo admitted that he was a regular in those establishments, for a while, he went there solely to party.  Picking up was not in his mind, as he was “still afraid and very cautious to have sex with another person. I was only doing oral sex that time.”

Soon, though, everything changed.

NEWFOUND INDEPENDENCE

As shared by Paolo, during one of their “crazy nights” in a bar in Quezon City, “Red and I met a group of good looking and gym-toned straight-acting gays. We had drinks at (this) bar. And after an hour of laughter, we left the club and went to (a bar) in Ortigas,” Paolo recalled.

The night went by like their “regular night outs”. They watched the performances, ordered several bottles of beer, and flirted with different people.

Little did Paolo know that he actually signed up for a different type of fun that night.

“I think it was around 3:00 AM and we were all very tipsy, when one of our newfound friends, Marvin*, started kissing someone he just met on the dance floor,” Paolo narrated. “And then he pulled me closer to them and started rubbing my crotch.”

Tara, sama ka sa amin (Come join us),” Paolo remembered Marvin saying with a smile.

The three of them left that bar and went to Marvin’s apartment.

“While I was getting head from the guy we picked up from the bar, Marvin positioned himself behind him. He started penetrating him without a condom,” Paolo recounted. “After several minutes, he held the bottom guy closer to him, holding his waist tightly, and shot his load.”

After their encounter, the guy they picked up just got dressed and then immediately left. And while Paolo was fixing himself, Marvin asked if he wanted to grab an early breakfast. He agreed.

READ:  LoVeChild: ‘Always protect and love yourself first’

Their conversation while eating turned from recounting what happened at Marvin’s apartment to being confrontational.

“’I saw what you took when we were at O Bar, and it wasn’t a party pill!’, Marvin told me. I was silent at first, and then he continued: “It’s okay, don’t worry, pareho lang tayo (we’re the same),” Paolo said.

SHARING “THE GIFT”

From then on, Paolo and Marvin’s group became this close-knit circle that frequented the bars, flirting and picking up random people, and inviting them to go with them for sex.

“It became my routine. I went to those places three to four times a week to meet different people. And I always performed unprotected sex with them. At that time, I thought I was satisfying my ego, that I had the upper hand and in control,” Paolo said, shaking his head.

He also thought “I was sharing the ‘gift’.”

It reached a point where he no longer joined Marvin’s group and just went out to party and pick up on his own.

“Last year was really the height of my inappropriate routine. As people flocked O Bar, for instance, my choices widened. Every time I went there, I always made it a point that I will be bringing someone home. It became very addicting,” he admitted.

And there were times that “after finishing someone, I would go back to bars to pick up someone again.”

Red*, who ended up knowing about Paolo’s “addiction”, tried talking him out of it.  Paolo just “refused to respond to his calls and text messages.”

TURNING POINT

Last March, according to Paolo, when he went to a bar in Ortigas, “I met this really cute guy. He was about the same height as I am, and he had a really good built,” Paolo said.

They shared drinks together and danced to several songs. And like usual, he invited this guy back to his place.

Paolo had unprotected sex with him. But unlike most of the his one-night encounters, this new guy chose to spend the night at his place.

“We had sex three times that night – at all times, I came inside him. The following day, he gave me a call saying that he wanted to have lunch with me,” Paolo recalled.

READ:  HIV stigma and discrimination and official indifference?

They met and had lunch together. It was also then that he found out that this new guy really likes him.

“He also confessed to me that he was only 16 years old,” Paolo added.

Paolo paused and lit another cigarette. Suddenly, his phone rang; he excused himself.

He returned, looking apologetic.  “Sorry about that. It was the 16-year-old guy I was telling you about,” he said.  He lit another cigarette.

And then sitting across me again, he continued: “We started dating after that unfortunate night. I really like him. But at the same time I feel guilty. He is still young and I (may have given) him the disease. I was awakened. I wanted to die after learning that he was only 16 years old. I felt really sorry for myself… that I had to do those things.”

Paolo was misty-eyed while talking; he even rubbed his eye, looking more like wiping his tears. He cleared his throat, and then continued smoking, finishing his cigarette.

“I know that I’m a bad person because I did all those things and it took me a long time to realize that,” Paolo said. “If I could only turn back time, I would not have done all those things.”

He also added that if he would be given a chance, he would talk to all the people that he had unprotected sex with and ask for their forgiveness.

“Some people living with HIV do really go around to spread the ‘gift’,” Paolo said. There are those who “are out there victimizing HIV-negative members of the community.”

Being more aware, Paolo also believes in one’s responsibility over oneself – helped, obviously, with further education that empowers people to protect themselves.  “Even if you’re having a fun time, never let your guard down. You should never completely trust anyone when it comes to sex, especially when you are at your most gullible and vulnerable self,” Paolo ended.

*FOR PRIVACY, NAMES WERE CHANGED AS REQUESTED BY THE INTERVIEWEE

Living life a day at a time – and writing about it, is what Patrick King believes in. A media man, he does not only write (for print) and produce (for a credible show of a local giant network), but – on occasion – goes behind the camera for pride-worthy shots (hey, he helped make Bahaghari Center’s "I dare to care about equality" campaign happen!). He is the senior associate editor of OutrageMag, with his column, "Suspension of Disbelief", covering anything and everything. Whoever said business and pleasure couldn’t mix (that is, partying and working) has yet to meet Patrick King, that’s for sure! Patrick.King.Pascual@outragemag.com

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POZ

Alternative PrEP forms needed for better uptake

Low uptake of daily oral PrEP since US Food and Drug Administration approval and low medication adherence among users have stimulated the investigation of other modalities for delivery, such as injectable PrEP and on-demand PrEP.

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Pre-exposure prophylaxis (PrEP) is widely accepted as an effective strategy to prevent HIV. However, low uptake of daily oral PrEP since US Food and Drug Administration approval and low medication adherence among users have stimulated the investigation of other modalities for delivery, such as injectable PrEP and on-demand PrEP.

A study – titled “Acceptability of Injectable and On-Demand Pre-Exposure Prophylaxis Among an Online Sample of Young Men Who Have Sex with Men in California”, written by Matthew R. Beymer, Jennifer L. Gildner, Ian W. Holloway and Raphael J. Landovitz – attempted to determine the demographic and behavioral predictors of willingness to try alternative PrEP delivery mechanisms among young men who have sex with men (YMSM) who stated that they were unwilling to try daily oral PrEP.

The study particularly recruited 265 YMSM in California through geosocial networking applications; and then analyzed a subsample who stated that they were either ambivalent about trying or unwilling to try daily oral PrEP. The researchers used chi-square and Fisher’s exact tests to determine characteristics associated with willingness to try injectable PrEP, willingness to try on-demand PrEP, and willingness to try either alternative form.

The study found that for individuals who stated that they would not be willing to try daily oral PrEP, ∼85% were willing to try on-demand and/or injectable PrEP. Individuals who reported some college or more reported greater willingness to try injectable PrEP (adjusted odds ratio [aOR]: 2.92; 95% confidence interval [CI]: 1.32–6.46), on-demand PrEP (aOR: 2.28; 95% CI: 1.06–4.90), or either method (aOR: 5.54; 95% CI: 1.78–17.22).

Confusion about PrEP still common, according to study

According to the researchers, “future research should determine how to enhance uptake of emerging forms of PrEP among the individuals most at risk for HIV.”

READ:  NCCP launches #PreventionNOTCondemnation on WAD 2014

It is worth noting that – while other countries are already discussing alternative PrEP forms – countries like the Philippines continue to have limited access to PrEP. With this, it remains a (sadly) very elitist approach to deal with HIV, with only those who have contacts to pilot project implementers able to access the same.

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From the Editor

3 Terms you need to know in HIV advocacy in the Philippines

HIV advocacy in the Philippines has evolved – and in many ways, devolved – to highlight erroneous practices. Here are at least three terms in use locally that highlight how BROKEN HIV advocacy is in the Philippines.

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Photo by Samantha Sophia from Unsplash.com

I was in Northern Mindanao when I first heard of a term used to refer to a service “provider” who – in a word (and there really is no going around this) – ALLEGEDLY “molested” masseurs who had to be tested for HIV as required by their line of work.

When interviewed, some of these masseurs alleged that a certain medical practitioner who – during testing – would “dulaan ang among itlog ug utin (fondle our testicles and our penises).” And then – as if to show them who’s the boss – “mu-ngisi pa jud siya, unya mu-schedule sa uban sa amo-a ug booking (this person would smirk at us, and would even schedule trysts with some of us).”

That was the first time I heard of a term that is apparently used to refer to people like this person: “advoKATI”, a play on “advocacy” and “makati (literally, itchy; and contextually, a slut)”, because they supposedly use advocacy as a cover for their itch/desire to pick up or sleep around.

Through the years, other terms being used related to HIV advocacy also came to my attention. And here are at least three of them; all of them highlighting how BROKEN HIV advocacy is in the Philippines.

***

1. advoKATI
n. Refers to a person who uses the advocacy as a front to get sexual partners.

The medical practitioner mentioned above is an example; though – by no means – is his case unique. Other examples include: giving (donated) vacc in exchange for sex with a PLHIV; providing after-testing services only to good-looking newly-diagnosed persons with HIV, while the not-so-good-looking are left to fend for themselves; and “counselors” using the confused state of mind of newly-diagnosed PLHIVs to sleep with them.

2. advoCASHy
n. Profiting from HIV advocacy; or people who profit from the same.

Let’s get this straight: Profiting from HIV is not exactly new; nor is this exclusive to the Philippines.

Globally – and perhaps even more apparent – is the profiteering done by pharma companies that produce the life-saving ARVs for PLHIVs. There is also the issue with accessing “good” drugs by developed countries (e.g. PrEP) versus “dumping” of those not already used by the developed countries in the poorer countries (e.g. phase out of Nevirapine and Efavirenz).

READ:  3 Reasons why TasP and U=U won’t happen soon in the Philippines…

Perhaps Peter Mugyenyi said it best when he tackled in “Genocide by Denial: How Profiteering from HIV/AIDS Killed Millions” the “incredible self-indulgence of the pharmaceutical companies and the cold-heartedness of the rich world that turned a blind eye until it was far too late, and then responded too slowly with too little.”

Now not just the big “bodies”, but even the other players in responding to HIV are mimicking this. And yes, this includes HIV “advocacy” in the Philippines, which is emulating this, too.

Here, we continue hearing that “there is no money in advocacy”, much more for those affected by HIV. This is supposedly why it’s difficult accessing existing treatment, care and support (TCS) – because, as always stressed – “there just isn’t enough money to go around”.

And then you hear about HIV “advocates” who can afford to buy numerous stuff (from a number of cars to a number of properties to luxury items to high-end gadgets to getting cosmetic surgery, and so on) from their “small” salary as NGO workers.

Or “advocates” who have drivers. WITH UNIFORM.

Or “advocates” who can tour the world using only their “meager” earnings from their “small” salary.

This is NOT to begrudge people their salaries.

BUT when you couple these with:

  • Inability of newly-diagnosed PLHIVs to go to treatment hubs because they don’t have money to pay for their fare.
  • Complaints from PLHIVs about inability to access to treatment because they can’t pay PhilHealth.
  • Non-access to other meds for opportunistic infections (or the need to beg the likes of DSWD or PCSO to fund these meds).

I am starting to sound like a “sirang plaka (broken record)”, repeatedly writing about issues I’ve already written about.

READ:  Nathaniel David: Finding voice as a poz

BUT there’s this disconnect that is too painful to just ignore.

All because there are “advocates” who see HIV as a cash cow.

3. advoKATKAT
v. The use of HIV advocacy for social climbing. “Katkat” is a Bisayan word meaning “to climb”. This is often related to advoCASHy as it emphasizes only the glam in “helping” even sans the actual helping.

There are NGOs paying PR firms to promote HIV “advocacy”. Ask them how many people got tested because of the “campaigns”, and they’d tell you: Our indicator is the number of Facebook likes. “Likes” derived from the money paid to celebs, bars, photographers/videographers, alcohol consumed, et cetera. Partying in the guise of advocating.

There’s an “award” for people who “helped” HIV advocacy in the Philippines – even if grassroots HIV workers question the “winners” (e.g. who these people are, how they were chosen, what they’ve really done for the HIV community). What’s seemingly important is the hype created; particularly since celebs “joined” the “cause”. More photo ops mean more exposure means more (possible) funds.

There’s the funding of a photo campaign because the one disbursing the fund are “models” in the campaign, themselves.

There’s a well-funded beauty pageant even if we have (often denied) ARV shortage (not to mention hubs that still do not offer all tests included in the OHAT package, from CD4 count to viral load count).

As already noted in the past, there’s this focus on the glam/social climbing (e.g. get celebs to promote testing), perhaps forgetting that real advocacy goes beyond that.

Too much focus on the glitzy fibs, less emphasis on the grimy truth

And so here we are now, with 31 new HIV cases reported every month in the Philippines. Ten years ago, we only had one case EVERY DAY.

We are fucked. But we’re not only fucked because of lack of sex education, non-promotion of condom use, antiquated practices (e.g. we have yet to teach U=U in the country, or make PrEP and PEP widely accessible), and so on.

READ:  @JJhumantorch: Positive and paying it forward

We’re also in deep shit because the people who should be serving us want us to be there so they can benefit from it.

This is the new(er) world of “advocacy”…

It’s called advoCASHy to promote advoKATI and advoKATKAT.

***

Back in Northern Mindanao, I asked those who alleged to have been victimized if they complained – officially.

I was told: “Na, kinsa ra ba mi (Yeah, right! Who do we think we are)? Kolboy kontra sa medical practitioner, paminawun ba mi (Sex workers versus a medical practitioner, who would listen to us)?”

Despite recognizing power structures and all that, I admit I still initially found the “excuse” inexcusable. Lodging a complaint against an abusive service “provider” seems like a good first step to remedy this situation. Letting things as they are only allows the erroneous system to continue.

And then – much later – the person they alleged did them harm formed a new NGO, and this NGO was funded by a bigger NGO based in Metro Manila. I mentioned the allegations to one of the heads of the Metro Manila-based NGO, hoping – perhaps – for them to closely look at the allegations since, and after all, they were “enabling” the person involved by funding this person.

Let me get this straight: These are all allegations, of course, and they need to be investigated to be validated/invalidated. Everyone involved ought to be heard – from those who accused, and the accused. But that they exist at all should already be cause for concern.

Alas, the allegations were ignored.

So this “provider” continues to be coddled – and enabled – so long as this person’s NGO churns out reports that the bigger NGO can use to get even more big bucks.

All too apparent, people choose to turn the blind eye so long as money keeps flowing in…

No wonder HIV advocacy is in the Philippines remains broken…

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NEWSMAKERS

Address causes that put young people at risk of HIV – Pia Wurtzbach

Pia Alonzo Wurtzbach urged decision makers to address the causes that put young people at risk of HIV.

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UNAIDS Goodwill Ambassador for Asia and the Pacific Pia Alonzo Wurtzbach urged decision makers to address the causes that put young people at risk of HIV, speaking at the International Youth Day Conference organized by the United Nations Youth Association of the Philippines in collaboration with the United Nations Association of the Philippines.

“We live in a world where adolescents and young people, especially from key populations, are still left behind. We cannot fail to address their needs. I challenge the indifference and I call for action now,” said Wurtzbach.

Every day, approximately 230 young people are newly infected with HIV in Asia and the Pacific. In 2017, almost half a million young people between the ages of 15 to 24 years were living with HIV in the region.  In the Philippines, young people account for 69% of new HIV infections and data indicates that there is a growing HIV epidemic among young men having sex with men. Young key populations (including gay men and other men who have sex with men, bisexual people, transgender people, sex workers and people who use drugs) are at a high risk of HIV acquisition due to rights violations, discrimination, exclusion, criminalization and violence.

This year’s theme for International Youth Day was Safe Spaces for Youth, highlighting the need of young people for safe spaces to come together, hang out and participate in decision making processes. This includes in healthcare settings, which should be places of safety, free from stigma, discrimination and violence. This is not always the case in Asia and the Pacific, where policies and attitudes remain barriers to youth-friendly HIV and sexual and reproductive health services. In the region, available data indicates that more than half of the countries requires parental consent for HIV testing for adolescents younger than 16 years old.

READ:  Nathaniel David: Finding voice as a poz

‘‘We need a critical change to respond to the dynamic shift of the HIV epidemic among young key populations, not only in the Philippines, but in Asia and the Pacific,” stressed Eamonn Murphy, UNAIDS Regional Director for Asia and the Pacific. “We need the innovation and creativity of young people in designing HIV interventions that work for them and, at the same time, support their leadership in challenging structural barriers in accessing health services, including parental consent requirements for adolescents and the lack of comprehensive sexuality education,” he added.

Wurtzbach encouraged people to advocate for young people’s participation in the AIDS response as leaders and agents of change and build strategic partnerships to end the AIDS epidemic.

“We have miles to go to end AIDS in the Philippines and we need to equip young people with the right information and enable them to access services that are safe and responsive to their needs,” Wurtzbach concluded.

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POZ

993 new HIV cases in Phl in June; 77 AIDS-related deaths reported

There were 77 reported deaths due to any cause among people with HIV last June in the Philippines, more than double the 30 deaths in May. 19% were 15-24 years old, and 51% were 25-34 years old. Also, 90% of the cases acquired HIV from sex.

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The HIV situation remains bad in the Philippines.

There were 77 reported deaths due to any cause among people with HIV last June in the Philippines. This is according to the HIV/AIDS & ART Registry of the Philippines (HARP), which reported that – among those who passed away – 72 were males and five were females.

This is more than double the May figure, when 30 deaths were reported.

For June’s 77 deaths, 15 (19%) were 15-24 years old, 39 (51%) cases were from 25-34 years old, 16 (21%) cases were from 35-49 years old age group, and seven (9%) case were 50 years and older. Ninety percent of the cases were reported to have acquired the infection through sexual contact (12 through male-female sex, 36 through male-to-male sex, and 21 through sex with both males and females), and 10% (8) of the cases were infected through sharing of needles.

The number of deaths may actually be higher because of under-reporting.

But to date, the HIV situation in the country continues to be bad, with 31 new HIV cases reported every day.

In June 2018, there were 993 new HIV cases reported to HARP. This is higher than the number reported in May, with the newly infected reaching 950. In April, it was “only” 924.

Among the new HIV cases, 18% (174 of the total) had clinical manifestations of advanced HIV infection (WHO clinical stage 3 or 4) at the time of diagnosis. Ninety-four percent (934) of the newly diagnosed were male. The median age was 27 years old (range: 3-73 years old). More than half (52%, 512) were 25-34 years old and 29% (287) were 15-24 years old at the time of testing.

READ:  #AIDS2016 opens with calls for reinvigorated force to fight HIV, and inclusion of still-neglected populations

As noted – and worth highlighting – is the age of those getting infected with HIV in the Philippines, with the affected populations getting younger.

In June 2018, 287 (29%) cases were among youth 15-24 years old; 95% were male. Almost all (99%, 285) were infected through sexual contact (23 male-female sex, 187 male-male sex, 75 sex with both males & females). Two cases had no data on mode of transmission.

There were 31 newly diagnosed adolescents 10-19 years old in June 2018. All were infected through sexual contact (5 male-female sex, 20 male-male sex, and six had sex with both males and females). There were two newly diagnosed child less than 10 years old and was infected through vertical/mother-to-child transmission.

One third (33%, 324) of the new HIV cases were from the National Capital Region (NCR). Region 4A (17%, 167 cases), Region 3 (12%, 123), Region 6 (7%, 66), Region 12 (6%, 58) and Region 7 (6%, 55) round off the top six regions with the most number of newly diagnosed cases for June, together accounting for 80% of the total.

Also, sexual contact remains the predominant mode of transmission (98%, 977). Among this, 88% were from males who have sex with males (MSM).

Other modes of transmission were needle sharing among injecting drug users (1%, 7) and vertical (formerly mother-to-child) transmission (<1%, 2).

There were seven cases that had no data on mode of transmission.

Among the newly diagnosed females for June, four were pregnant at the time of diagnosis, three of the cases were from NCR and one case from Region 7.

READ:  'Why haven't we beaten AIDS? Because we value some lives more than others' - Charlize Theron

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POZ

Let science inform application of law in criminal cases related to HIV, according to experts

Prosecutions of people living with HIV for acts that pose no risk of HIV exposure or transmission prompt scientists to issue a statement urging the criminal justice system to use science when considering prosecution of HIV non-disclosure, exposure or transmission.

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A group of 20 leading HIV scientists from around the world have issued a scientific consensus statement urging governments and people working in the legal and justice systems to pay close attention to the significant advances in HIV science to ensure that science informs the application of criminal law in cases related to HIV.

“Science has greatly advanced in recent years which has been critical in allowing countries to make evidence informed decisions in their HIV programming,” said Michel Sidibé, executive director of UNAIDS. “With all the new scientific advances now available we need to continue to use science as evidence to deliver justice. No one should face criminalization because of a lack of information or understanding by the justice system about the risks of HIV transmission.”

The expert group of scientists, convened by UNAIDS, the International Association of Providers of Care (IAPAC) and the International AIDS Society, warn that an overly broad and inappropriate application of criminal law against people living with HIV remains a serious concern across the globe. Around 73 countries have laws that criminalize HIV non-disclosure, exposure or transmission, and 39 countries have applied other criminal law provisions in similar cases.

“Many of these laws do not take into account measures that reduce HIV transmissibility, including condom use, and were enacted well before the preventive benefit of antiretroviral therapy or pre-exposure prophylaxis was fully characterized,” said José M. Zuniga, IAPAC President and Chief Executive Officer. “Most people living with HIV who know their status take steps to prevent transmitting HIV to others. Laws that specifically criminalize HIV non-disclosure, exposure, or transmission thus primarily exacerbate HIV-related stigma and decrease HIV service uptake.”

READ:  Sun exposure and being poz

Most prosecutions have occurred based on perceived risk of HIV transmission through sexual activity. Some have also occurred for biting, spitting or even scratching. Prosecutions, and convictions, have often been influenced by a lack of knowledge or appreciation of scientific evidence regarding the possibility of transmission of the virus. In many instances, they have been influenced by deep-rooted stigma and fear associated with HIV, which still exists despite the huge advances in HIV treatment and prevention.

“We support this globally relevant expert consensus statement, for which we have been long-time advocates,” said HIV Justice Network’s Senior Policy Analyst Sally Cameron, on behalf of the Steering Committee of HIV Justice Worldwide, a global civil society coalition campaigning to end unjust prosecutions. “HIV criminalization is a growing global phenomenon that unfairly targets people living with HIV through criminal prosecutions and harsh penalties. This welcome statement makes the case that our current understanding of HIV science, alongside key human rights and legal principles, does not support this miscarriage of justice.”

The peer-reviewed consensus statement, endorsed by 70 additional scientists from around the world, was released today in the Journal of the International AIDS Society. It describes scientific evidence on the possibility of HIV transmission under various circumstances, the long-term impact of HIV infection and the means of proving HIV transmission so that it is better understood in criminal law contexts.

Based on a detailed analysis of the best available scientific evidence on HIV transmission and treatment effectiveness, the statement notes that there is no possibility of HIV transmission through saliva as a result of biting or spitting, even where saliva contains small quantities of blood. There is no to negligible possibility of HIV transmission where a condom is used correctly during sex, or where a partner living with HIV has an undetectable viral load.

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In addition, effective antiretroviral therapy, low viral load, the use of pre-exposure prophylaxis (antiretroviral drugs taken by an HIV-negative person before a possible exposure), or post-exposure prophylaxis (antiretroviral medicines taken after a possible exposure) all significantly reduce the possibility of HIV transmission.

International guidance on HIV in the context of the criminal law recommends that “proof of causation, in relation to HIV transmission, should always be based on evidence derived from a number of relevant sources, including medical records, rigorous scientific methods and sexual history” (Ending overly broad criminalization of HIV non-disclosure, exposure and transmission: critical scientific, medical and legal considerations).

The experts recommend strongly that more caution be exercised when considering criminal prosecution, including careful appraisal of current scientific evidence on HIV risk and harms. The consensus statement is expected to help policymakers, prosecutors and courts be guided by the best available science and thereby avoid the misuse of the criminal law, as is currently happening in many countries worldwide.

Read the full Expert Consensus Statement on the Science of HIV in the Context of Criminal Law.

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From the Editor

3 Reasons why TasP and U=U won’t happen soon in the Philippines…

Treatment is available for people with HIV. And if a PLHIV gets treatment, he does not need to die from AIDS-related complications, and he’ll reduce his viral load so he can’t transmit HIV to others. But in the Philippines, among the common reasons why TasP is NOT working is because of the failures of the service providers themselves.

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Fact: Treatment is available for people living with HIV.
And if someone with HIV gets treatment, he/she does not need to die from AIDS-related complications.
And if someone also gets treatment, the antiretroviral treatment (ART) he/she uses reduces the HIV viral load in his/her blood, semen, vaginal fluid and rectal fluid to “undetectable level”. And get this: Evidence shows that individuals on effective antiretroviral treatment (ART) with an undetectable viral load cannot transmit HIV to others.

“Lor”, one of the HIV-positive people Outrage Magazine met in Mindanao, who lamented how he was not informed of “what to now do after I tested HIV-positive”.
Eventually, without being able to access treatment, he passed away from AIDS-related complications.

This is why treatment as prevention (TasP) is important.
So important, in fact, that the World Health Organization (WHO) guidelines call for “test and treat” strategies to “initiate all people diagnosed with HIV on ART as soon as possible after diagnosis as a way to decrease community viral load and reduce the rate of new HIV infections”.

But in the Philippines, among the common reasons why TasP is NOT working is because of the failures of the service providers themselves.
Testing is picking up, yes. But even now, not even half of PLHIVs access ART.
But so many of the after-test services continue to be lacking.

Here are three (of the many) reasons why I think TasP and U=U won’t happen soon in the Philippines:

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1. After people get tested, no one really knows what to do next.
In the past three days, I have been speaking with three people whose HIV rapid test results were “reactive”. Soon after the tests, they were basically “dumped” by their “counselors”/service providers. These three were basically left on their own – and, as two of them said, “ni walang flyer na binigay para sana alam ko man lang ano na ang gagawin ko (no flyer was even given so I would at least be guided on what to do next).”
You’d expect more from the center where they got tested, too – both are satellite treatment hubs of one of the country’s major treatment hubs; and one is (in)famous for its extremely well-funded “efforts” to supposedly stop the spread of HIV in the Philippines.
The way I see it: Centers without after-testing support should NOT exist.
Because I said this before, and let me say this again: “You can’t just test people and then – after finding out they’re reactive/positive – ‘dump’ them to become somebody else’s problem. Because if/when you do, your concept of service provision is too limited, and as such, you’re actually part of the problem you claim to be dealing with…”

2. Baseline tests are NOT covered by PhilHealth.
In the Philippines, the treatment, care and support (TCS) received by most people living with HIV (PLHIVs) are covered by the Philippine Health Insurance Corporation’s (PhilHealth) Outpatient HIV/AIDS Treatment (OHAT) Package. Specifically, to those who are enrolled in PhilHealth, P30,000 is allocated per PLHIV per year, or P7,500 every quarter.
The 2010 circular that guided the implementation of the OHAT specifically stated that “covered items under this benefit are drugs and medicines, laboratory examinations including Cluster Difference 4 (CD4) level determination test and test for monitoring of anti-retroviral drugs (ARV) toxicity and professional fees of providers.”
The revised OHAT Package released last June 2015 stated that “covered items under this benefit are drugs and medications, laboratory examinations based on the specific treatment guideline including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), and test for monitoring anti-retroviral (ARV) drugs toxicity and professional fees of providers.”
Meaning: baseline tests are NOT covered by the OHAT package.
In 2015, Outrage Magazine interviewed Dr. Rosanna Ditangco, research chief at The Research Institute for Tropical-AIDS Research Group (RITM-ARG), a treatment hub located in Alabang. She lamented that management issues come to play in the delivery of treatment, care and support (TCS) services to PLHIVs.
For instance, “the OHAT Package does NOT cover baseline tests yet”, including such baseline laboratory tests as CBC, chest x-ray, PPD and blood chemistry (i.e. lipid profile, BUN, Creatinine, FBS), and CD4 count.
Let’s call this out already: This policy is – in a word – idiotic.
You need ARVs to treat HIV. You can ONLY get ARVs if you get your baseline tests done. If you have no money to pay for these baseline tests, then say goodbye to ARVs. Sans ARVs, you’re as good as dead.

3. Many medical practitioners in HIV advocacy continue to not know much about… HIV. Or even if they do, they continue to be sources of HIV-related discrimination.
One of the (aforementioned) guys who only recently got tested for HIV told me that – when the attending doctor was informed that his CD4 count is 60 – he was sarcastically told: “Ha, good luck!”.
I saw for myself how one nurse told a PLHIV “not to have sex anymore, ever. Para di na kayo dumami (So your number won’t grow).”
Try bringing up U=U in the country, and among the staunchest deniers are those working in HIV advocacy. I remember one of them tell me before: “Magkakalat pa (You’re giving them excuse to spread HIV)!”.
I also know of doctors who won’t even touch people they suspect to have HIV – due to disgust or fear or whatever, I can only surmise…

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There are other issues, of course (from slow government response to wrong priorities to fund mismanagement to profiteering).

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

And so here’s another fact: Unless these are dealt with, expect for the worst to come.

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