Another month to highlight the worsening HIV situation in the Philippines; and how existing efforts continue to be lacking, if not actually failing.
In March 2017, the HIV/ AIDS & ART Registry of the Philippines (HARP) of the Department of Health reported 968 new HIV cases, which is 32% higher compared to the same period in 2016 (735). According to HARP, this was the “highest number of cases ever reported since 1984.”
The first HIV case in the Philippines was reported in 1984. From January 1984 to March 2017, the number of HIV cases reported to HARP totaled 42,283.
“Let’s be blunt: We are not doing enough to deal with the (worsening) HIV situation in the Philippines,” said Michael David dela Cruz Tan, publishing editor of Outrage Magazine, the only LGBT publication in the Philippines, which also has HIV-related efforts. “Enough of the sugarcoating and patting of the backs of those who are currently in the HIV advocacy; we may risk burnout, but we have to do more and act even faster if we want to see all our efforts make a dent at all in this continuously worsening social problem.”
This development is alarming, according to Roxanne Omega Doron, who helms Bisdak Pride Inc., a Cebu City-based LGBT organization that also has HIV-related efforts, including conducting community-based HIV screening (CBS).
“Thirty (people getting infected with HIV) per day is something we need to worry about – economically, socially and even politically,” Doron said. “While HIV incidence is decreasing in a significant majority of countries around the world, ours is increasing. Demographers even call it demographic anomaly, and rightfully so.”
Most (96%) of the 968 new HIV cases reported by HARP were male. The median age was 27 years old; with half belonging to the 25-34 year age group, while 33% were youth aged 15-24 years.
Region-wise, the most number of reported cases were from the National Capital Region (NCR) with 309 (32%) cases, Region 4A with 135 (14%) cases, Region 3 with 107 (11%) cases, Region 7 with 76 (8%) cases, and Region 11 with 52 (5%) cases. An additional 289 cases (30%) came from the rest of the country.
For Fritzie Estoque, chairperson of the Misamis Oriental-Cagayan de Oro AIDS Network (MOCAN), existing efforts continue to be lacking. “No, we are not doing enough,” she said.
For instance, the Department of Labor and Employment (DOLE) has D.O. No. 102-10 (HIV Workplace Policy) requiring all private companies to conduct HIV education to all employees and officers, while the Civil Service Commission has Memorandum Circular No. 11 s. 2013 that provided guidelines in the implementation of workplace policy and education program on HIV and AIDS. Now, if only these orders were fully implemented… then by this time, we’d be reaping the benefits that these orders ought to have sown,” Estoque said.
Estoque added that there’s always a gap with “the grand plans, and what’s being implemented.”
DOLE Region 10, where MOCAN is directly involved in the awareness aspect of the implementation – may be certain of the need to implement the ordinance there, but “it seems to us that other companies don’t bother to comply because complying isn’t strictly implemented.”
MODES OF TRANSMISSION
Reported modes of transmission (MOT) were sexual contact (942), needle sharing among injecting drug users (IDU, 22) and mother-to-child transmission (4). Eighty-seven percent of infections transmitted through sexual contact were among males who have sex with males (MSM).
It is worth noting that from 1984 to 2009, the predominant MOT was male-female sex. But starting 2010, the trend shifted to male-to-male sex as the main MOT; this has continually increased since then, so that from January 2012 to March 2017, 82% (27,709) of new infections were through sexual contact among MSM.
Different regions also have different predominant MOTs. For instance, almost half (47%) of the MSM ever reported were from NCR; almost all of the IDU were from Region 7; and 39% of females who engaged in transactional sex were from Region 3.
Tan already earlier noted the “inevitable pending return to mainstream population of HIV infection”. While the current trend seems to signify that “the Philippine sis mimicking largely (particularly former) Western trends, where HIV infection seemed to have focused particularly on gay men, we will buck this ‘trend’ because MSM do not necessarily only have homosexual sexual contacts. And when they start having sex with women, the risk for infection is also there.”
For Tan, this is worth highlighting because there were instances when Outrage Magazine made rounds in other parts of the country, where there are actually so-called service providers that refuse to offer HIV testing to women, claiming that their ‘priority’ is only to serve MSM. This is true, for instance, in select (and well-funded) community-based HIV screening (CBS) programs that only target MSM, and “even openly refuse to test women who want to know their HIV status.”
“It’s almost like we recognize that many MSM are at risk for HIV infection due to their unsafe sexual practices, and yet we refuse to acknowledge that they have other sexual partners aside from men,” Tan said. “Again, if left sans proper responses, we’re setting the stage for things to just worsen.”
MOCAN’s Estoque also lamented the “over-emphasis on key affected populations (KAP)/key populations (KP), considering that if people are HIV ignorant, then they won’t know that any one can get infected with HIV.”
This is why she’s pushing for better HIV education, instead of “just focusing on voluntary counseling and testing (VCT) and treatment.” “Why not invest in the education aspect as a prevention measure?”
Four pregnant women were, in fact, diagnosed with HIV in March, with two cases from NCR, one case was from Region 4B, and another one from Region 7.
Perhaps also worth noting is the encumbrance of HIV among the young.
In March, 315 (33%) cases were among youth aged 15-24 years. Most (96%) were male; and almost all (312) were infected through sexual contact (30 male-female sex, 200 male-male sex, 82 sex with both males and females). Three were infected through needle sharing among IDU.
Under-19 adolescent Filipinos also figured in the March data. Forty-five adolescents aged 10-19 years were reported to HARP, and all of them were infected through sexual contact (three male-female sex, 31 male-male sex, 11 sex with both males and females).
Ninety-five people (or 10% of the total number of cases for the month) who engage in transactional sex – or those who report paying for sex, regularly accept payment for sex, or do both – were infected with HIV. Almost all (98%) were male whose ages ranged from 18 to 64 years; the two females were from 20-31 years old.
It was only in December 2012 when HARP started reporting on those who engaged in transactional sex. And since then, a total of 3,788 cases reported in HARP from were people who engaged in transactional sex. Ninety-six percent (3,625) were male and 4% (163) were female.
NO ONE SHOULD DIE FROM AIDS – YEAH, RIGHT!
Twenty-seven Filipinos dies from AIDS-related complications in March; all of them were male. Eighteen (67%) of the reported deaths belonged to 25-34 year age group, eight (30%) were from 35-49 year old age group, and one case from 15-24 year age group. All were infected through sexual contact (three male-female sex, 16 male-male sex, eight sex with both males and females).
Since 1984, when the first HIV case was reported in the Philippines, a total of 2,124 deaths were already reported. The number is believed to be inaccurate, however, due to under-reporting.
For Tan, “internationally, there’s this notion that no one should die from HIV anymore. “In an ideal world, this is all good. But in a setting like the Philippines, this is also a very naïve perspective.”
In the Philippines, there remain many issues that lead to AIDS-related deaths, e.g.:
- Delayed detection (often “blamed” on the PLHIV, with this blaming neglecting that there are still unresolved issues related to stigma and discrimination).
- Bureaucratic deterrent to make new approaches the norm (e.g. rollout of well-funded CBS takes years; ignorance of U=U, thus non-inclusion among existing solutions).
- Lack of information about HIV and AIDS that often lead to stigma and discrimination (e.g. PLHIVs getting kicked out of their homes after their family members discover their status).
- Inability to get tested (e.g. there are fishermen and farmers who have no access to HIV testing facilities; minors who are unable to get tested sans consent from their parents/guardians).
- Inconsistent HIV services offered even by government-owned treatment hubs (e.g. viral load is not available in many of treatment hubs outside of Metro Manila).
- Mismanagement of available resources (e.g. existing projects allocate for some implementers to stay in posh hotels to hobnob with some well-compensated ‘ambassadors’; while some PLHIVs unable to access ARVs because of inability to pay PhilHealth).
On the latter (i.e. access to life-saving antiretroviral medicines), in March, 784 PLHIVs started on ART. Three of them died within the same month.
Over 19,370 PLHIVs were on ART as of March, most (97%) of them males. The number continues to be less than half the 42,283 number of reported PLHIVs in the Philippines. Ninety-five percent were on first line regimen, 4% were on second line regimen, and 1% were on other regimen.
Stephen Christian Quilacio, former head of Cagayan de Oro City-based Northern Mindanao AIDS Advocates, believes there’s a “continuing effort to reach out everyone”, adding – somewhat sardonically – that “if we believe we’re doing just fine with whatever we’re doing now, the numbers of Filipinos getting infected should have been dwindling, not increasing.”
ALL HANDS NEEDED
Tan stressed that, “just as we repeatedly say, all efforts that eye to stop the worsening HIV situation in the Philippines matter,” he said. “But we need an urgent and very realistic reassessment of the services we’re currently offering to see what works and what doesn’t; or for that matter, who works and who doesn’t. Remove those that/who aren’t working. Remove politicking and even profiteering in releasing existing funding. Amend the law (RA 8504), and start implementing it. Start implementing (and funding, for that matter) new approaches re HIV (e.g. CBS, U=U, PrEP, PEP). Stop the profiteering happening in the HIV advocacy. Deal with elitism in HIV advocacy (e.g. gaining traction in social networks is all good and well, but reach out to those who do not even have access to the Internet). Reconsideration of how we deal with the sex industry. If we act like it’s business as usual, then we’re f***ed.”
Quilacio seconded this, adding more succinctly the “need to go beyond only the popular approaches to instead put into place those that truly work.” On this end, he advocates the “funding of ‘right’ advocates, not opportunists who are benefiting from the HIV cause. Reaching out to grassroots communities that continue to be neglected by ‘popular’ campaigns that may generate lots of media mileage and funding but are actually very limited. Inclusion of responses to the needs identified by PLHIVs themselves, such as psychosocial support, legal counsel (particularly for those who are discriminated against), and others.”
For Quilacio, “solving problems is always possible. But we can’t just keep talking about solving this issue, yet fail to actually deliver the solutions.”
Bisdak Pride Inc.’s Doron is similarly advocating for prompt reconsideration of efforts. “We should reexamine and reevaluate our national HIV response if it is still relevant,” he said, stressing that “now having 30 cases per day cases means that we need to work more since the data suggest an alarming trend that has, in fact, been going on for years now.”
More specifically for Doron, “the national HIV response should be recalibrated to include various groups, sectors and areas.”
MOCAN’s Estoque hopes for “bigger participation of so many neglected sectors – e.g. religious sector to come up with a ‘genuine Christian response’ in solving the HIV epidemic.” Similarly, she hopes for government to have “ngipin (contextually: political will and will power)” when implementing HIV-related programs – e.g. local AIDS ordinances should be properly implemented, AIDS Councils should be made active, and the Department of Health should go beyond media savvy. “Hindi na sapat ang mga pa-konswelo lang (Consolation efforts no longer suffice),” Estoque ended.