From the Editor

Under-reporting the HIV problem among non-MSM?

The spread of HIV in the Philippines is said to focus on key affected populations, particularly men who have sex with men. But as stated by a grassroots service provider in Mindanao, at least in their case, in practice, there is an editing out of non-MSM in testing. So for Michael David Tan, “while data may show that, yes, MSM are INDEED greatly affected by HIV, what we have may not necessarily be showing the full picture.”

CAGAYAN DE ORO CITY – We’ve all heard how the spread of HIV in the Philippines has been focused on key affected populations (formerly called the “most at-risk populations”), particularly men who have sex with men (MSM), including gay and bi men (with transgender women, who were assigned male at birth, often included in the stats).

In May, for instance, the Department of Health (DOH) registered in its Philippine HIV/AIDS Registry 748 new HIV cases in the Philippines – a figure that is 51% higher than the 495 cases registered in 2014. Seven hundred and twenty-eight (728) of the 748 people living with HIV (PLHIVs) were infected through sexual contact, and – THIS IS WORTH HIGHLIGHTING TO STRESS A POINT – 86% of them are MSM.

In the past, I have repeatedly asked people working in the HIV community about the over-emphasis/repeated mention of MSM as the population most affected by HIV in the Philippines. Specifically, I ask whether there are just more MSM getting tested compared to the general population, so that more MSM are testing positive.

My line of questioning (and thinking, for that matter) is said to be unnecessary because of the available – I was repeatedly told – data, data, data… “And numbers,” it was stressed to me, “do not lie.”

Mainly, I was told, the trend of the HIV infection in the Philippines has been following the international trend, wherein MSM (and gay men, in particular) are the most affected people.

In fact, historically speaking, when the first cases of AIDS was reported, it wasn’t even known as such – it was, instead, referred to as the “gay related immune deficiency (GRID)”, and is therefore a “gay disease”. Repositioning the epidemic as “everyone’s disease” was also partly a political calculation – that is, by making it everyone’s issues, everyone becomes a stakeholder, not just a largely hated group of people (i.e. the gays).

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Also in fact (at least in the US, according to the Center for Disease Control), even if MSM (including gay and bi men) only represent approximately 2% of the population, they accounted for 81% of HIV diagnoses in 2013.

The Philippines, I was told, is starting to reflect this – even if, in the past, the main mode of transmission in the Philippines was through heterosexual sex (that is, men who have sex with women).

And now, having spoken with people OUTSIDE Metro Manila who also work in curbing the spread of HIV (to emphasize: grassroots workers, not the bosses), I am having not necessarily doubts about the stats that we have, but whether it tells the full picture.

Yes, I know that HIV affects many, MANY MSM – there is no denying this. You just have to go to a treatment hub to see that most of the PLHIVs accessing services are… MSM. So yes, I also know that special attention needs to be given to MSM whose behaviors put them at higher risk for HIV infection.

But – and here’s the important point raised to me by not only one HIV grassroots activist – apparently, in providing HIV testing in targeted places at least in some areas in Mindanao, they’ve been told to “focus only on MSM”.

As such, “we only really test MSM,” flatly stated one community worker who asked to remain anonymous, else risk losing his job.

No, there’s no “written” policy that he can show. But, as he said, “we don’t need written policies to follow sugo sa taas (orders from above/the top).”

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The unwritten policies to focus only on MSM allegedly came from: 1) some international donor agencies, 2) Metro Manila-based organizations that implement the projects funded by the international donors; and 3) heads of local organizations tapped by the Metro Manila-based organizations to head in the implementation of the projects outside of Metro Manila.

And so “when we do outreach activities, we only target MSM and transwomen – not those who were assigned female at birth, even if their behaviors may put them at risk for HIV infection,” the community worker said. To be more specific, and allegedly as their boss emphasized, “mga bayot ra (just the gays).”

And so here – for me – lies a big, BIG problem (which stresses my earlier line of questioning about more MSM getting tested compared to the general population). While data may show that, yes, MSM are INDEED greatly affected by HIV, what we have may not necessarily be showing the full picture.

The first time she heard of this practice, Fritzie Estoque, chairperson of the Misamis Oriental/Cagayan de Oro AIDS Network (MOCAN), expressed her dismay because for her, “one’s sexuality should have nothing to do with access to services,” she said to Outrage Magazine. For her, “angayan unta mag-focus on behavior (the focus should be on behavior). If your behaviors put you at risk for HIV infection, then you should be able to get access to HIV testing – bayot man ka, laki man ka, baye man ka (whether you’re gay, a straight man, a straight woman).”

Earlier, during the 1st HIV Summit in southern Philippines, I asked Dr. Josephine Villafuerte, Davao City Health Officer, if – again – the reported trend of more MSM getting infected with HIV in Davao City is but a reflection of more MSM getting tested. She said no; and that what is happening in Davao City is instead only a reflection of the national trend. The youngest documented HIV case in the city, by the way, involves a 13-year-old GIRL (who got infected from sexual contact).

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So forgive me for my misgivings (even as I, again, stress that I believe that MSM are definitely at higher risk for HIV infection).

Because for me, for as long as a practice like this – i.e. the editing out of non-MSM in HIV testing – actually happens, then what data we have may not be telling the full story/showing the full picture.

For Estoque, this is also limiting because “we’d fail to properly capture the changing populations affected by HIV,” she said. In the Philippines, in particular, it wasn’t always MSM who were most at risk; and it will definitely not always be MSM who will always be most at risk.

We have to be TRUTHFULLY inclusive.

Because if we’re not, then we’re failing non-MSM who are also in need of the services.

And we’re failing MSM people whose (long) association with HIV has long painted them as irresponsible sexually promiscuous people.

We say this is everyone’s issue? Then stop editing out people just as in need of accessing HIV-related services…

*OUTRAGE MAGAZINE IS CURRENTLY REACHING OUT TO PEOPLE AND ORGANIZATIONS MENTIONED BY THE INTERVIEWEE TO ASK FOR THEIR SIDE ABOUT THIS ISSUE. THEIR POSITIONS WILL BE UPLOADED AS SOON AS THESE ARE PROVIDED TO OUTRAGE MAGAZINE

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