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Same-day HIV testing & treatment improves outcomes for PLHIVs

A study suggests that initiating antiretroviral therapy (ART) on the same day as HIV testing may actually lead to improved retention and outcomes in people living with HIV.

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PHOTO BY KROPEKK_PL FROM PIXABAY.COM

Waiting sucks.

At least if the discussion revolves around HIV testing and accessing treatment; with a study suggesting that initiating antiretroviral therapy (ART) on the same day as HIV testing may actually lead to improved retention and outcomes in people living with HIV.

The current practice in diagnosis and treatment of HIV is to first conduct counseling before a person is tested for HIV; and if a person does test positive, he/she will then be asked to return numerous times for laboratory procedures before ART is even initiated.

In the Philippines, the practice is made more complex – if not tedious – by an antiquated mandate of the Republic Act 8504 (or AIDS Law). Those who want to get tested are (usually) given the rapid test first after a pre-test counseling. If the result is non-reactive, it is recommended that they return some three months after their suspected risk of exposure for a follow-up test; but if their result is reactive, the blood sample taken from them is forwarded to the STD/AIDS Cooperative Central Laboratory (SACCL) of San Lazaro Hospital (in Metro Manila) for a more comprehensive test to be done to confirm the result. This step – the “confirmatory test” – is what ascertains if a person is “positive” or “negative”. This period takes days for those in Metro Manila; though for those outside Metro Manila, it could take weeks or even months before the confirmatory test results are given back to the persons who got tested.

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This is the very issue tackled by Serena P. Koenig , Nancy Dorvil, Jessy G. Dévieux, et al in “Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial”, published by PLOS Medicine, with the researchers noting that “multiple visits for counseling, laboratory testing, and other procedures to prepare patients for initiation of antiretroviral therapy (ART) are burdensome and contribute to the high rate of attrition during the period from HIV testing to ART initiation.”

The researchers randomly assigned patients who presented for HIV testing at a clinic in Port-au-Prince, Haiti to standard ART initiation or same-day HIV testing and ART initiation (356 in the standard and 347 in the same-day groups). The standard group had three weekly visits with a social worker and physician and then started ART 21 days after the date of HIV diagnosis; while the same-day ART group initiated ART on the day of HIV diagnosis.

All participants in the same-day ART group and 92% of participants in the standard group initiated ART.

Twelve months after HIV testing, a higher proportion of participants in the same-day ART group were retained in care (80% versus 72%), and a higher proportion were retained in care with viral load <50 copies/ml (53% versus 44%) and viral load <1,000 copies/ml (61% versus 52%).

While the study is limited by being conducted at only one clinic in urban Haiti, the researchers nonetheless stressed that “this study demonstrates that it is feasible to initiate ART on the day of HIV diagnosis for patients with early HIV clinical disease and that same-day treatment leads to increased ART uptake, retention in care, and viral suppression.”

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With the World Health Organization (WHO) changing its guidelines to recommend ART for all persons living with HIV (no matter the CD4 count and/or viral load), the researchers hope for further similar studies to be done to ascertain if this strategy will also be effective in other settings.

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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.”

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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).

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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.

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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.

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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.

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‘‘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.

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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.

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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.”

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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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