Adults who are at high risk of becoming infected with the human immunodeficiency virus (HIV), which causes AIDS, were also less likely than the general population to be vaccinated against human papillomavirus (HPV), which can cause anal and cervical cancer.

This is according to a study helmed by Lisa T. Wigfall, PhD, MCHES, assistant professor, Division of Health Education, Department of Health and Kinesiology in the College of Education and Human Development at Texas A&M University in College Station. The study was presented to the American Association for Cancer Research.

According to Wigfall, HPV infection is common, and in a healthy individual, is often cleared from the body without ever causing disease. However, since HIV infection compromises the body’s immune system, an HIV-positive person may be unable to fight off HPV infection and may be more prone to developing some types of cancer, including anal and cervical cancer.

Since 2006, vaccines have been available that target the HPV strains most likely to cause anal and cervical cancer. The US Centers for Disease Control and Prevention (CDC) recommends that adolescent boys and girls up to 15 years of age receive two doses of the vaccine, beginning at age 11 or 12. Those who start the vaccine series later, at ages 15 through 26, should receive three doses, according to CDC guidelines.

But uptake of the vaccination has been slower than public health experts would like. In the US, for instance, where more information about HPV is made publicly available, as of 2017, only about 49% of adolescents were up-to-date on HPV vaccination, and 66% had received the first dose, according to CDC data.

For this study, the researchers used data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey to assess HPV vaccination rates in individuals who reported engaging in one or more high-risk behaviors in the year before the survey. Of 486,303 adults who completed the 2016 BRFSS survey, only 16,507, or 3.39%, had used injection drugs and/or engaged in high-risk sexual behavior and were classified as high-risk for HIV infection.

Among that population, only 416 had complete data. In that group, the researchers found that very few people were fully vaccinated against HPV. Vaccination rates varied between high-risk population groups.

Other key findings:

• About one-fourth, or 25.7%, of gay/bisexual males aged 18-33 years had initiated the three-dose HPV vaccine series, and 6.2% had completed it. –
• About one-fourth of high-risk heterosexual females aged 18-36 had completed the three-dose HPV series.
• Only 11% of high-risk heterosexual males aged 18-29 had initiated the three-dose HPV series.
• None of the transgender men and women and gender-nonconforming individuals had initiated HPV vaccination.
• Vaccination rates were much lower among non-Hispanic black respondents than any other racial/ethnic group.

Wigfall said one potential reason for the low rate of vaccination in high-risk populations is that recommendations for people living with HIV were issued several years after the HPV vaccine first became available to the general population.

Previous research has shown that the way physicians talk about the HPV vaccine can influence parents’ decisions on whether to vaccinate their adolescents. For some high-risk populations in this study, such as gay/bisexual men or transgender individuals, providers may not have addressed connections between high-risk sexual behaviors and HIV/HPV co-infection.

“Gender and sexual orientation are important topics that should not preclude us from identifying and targeting HPV vaccination efforts among high-risk populations,” Wigfall said.

Wigfall said that in her opinion, patient-provider communication about the HPV vaccine should be strengthened for high-risk populations, specifically, HIV-positive males or females, as well as HIV-negative gay/bisexual men and transgender individuals.

To increase HPV vaccination among high-risk populations, “a necessary first step would be the wide adoption of routine HIV testing for all adolescents and adults, regardless of perceived risk,” she said, noting that the CDC has recommended routine HIV testing since 2006. That recommendation has not been widely followed, leaving thousands of people living with HIV unaware of their HIV-positive status, Wigfall said.

“Disability is not inability.”

Councilor Raissa Laurel Subijano of San Juan City once said this; she is a graduate of Law, elected into office, and then became a person with disability after the 2010 Bar exam bombing outside DLSU-Taft.

I intend to permeate wisdom from the lack or absence of knowledge of some individuals regarding disability, or it could possibly rectify the societies ignorance from the DISABILITY.

At the end of this entry, there are two possible conclusions based on legal and medical parlance, to wit: (1) HIV and AIDS as a physical impairment, and (2) HIV and AIDS as a psychosocial disability.

The discussion on PLHIVs as PWDs must clearly establish a parameter that nobody is allowed to neither look nor equate disability to INABILITY, INCOMPETENCE, and HELPLESSNESS. Persons with disability are not less than anyone; they are your fair equals.

Under Art. 5 of the Convention on the Rights of PWD, states that: “State parties recognize that all persons are equal before and under the law and are entitled without any discrimination.”

 In our Jurisdiction, Sec. 2(b) of R.A. 7277 or The Magna Carta for the Disabled persons, states that: “Disabled persons have the same rights as other people to take their proper place in society. They should be able to live freely and as independently as possible. xxx Disabled persons’ rights must never be perceived as welfare services by the Government.”

It is a form of discrimination when someone says: “Instead of issuing PWD ID for PLHIV we look for ways to empower them.” It is as if having a PWD ID is not empowering. It is as if being PWD is disempowering. Discrimination of any kind based on disability is prohibited under existing laws.

Under Art. 2 of the Convention on the Rights of PWD, It is considered as a “DISCRIMINATION ON THE BASIS OF DISABILITY” when any distinction on the basis of disability which has the purpose or effect of impairing or nullifying the recognition, xxx on an equal basis with others.

If you’re adamant in your principle that PLHIVs should not be considered PWDs because they are abled; It is as if PLHIVs being considered as PWDs is degrading or an insult to ones ability. Sorry to burst your bubble, that’s not a principle at all; but a form of DISCRIMINATION, much less, IGNORANCE.  Even persons with disability are still considered competent, capable, and productive, as they are other-abled.

There have been several opinions made on the link between disability and HIV; but none of those that disprove the link was intellectually substantiated. Most of the statements made were ranging from dense to shallow premises with no arguments at all. The most that they were able to come up with is the fact that not any existing law expressly mentions HIV and AIDS as a disability. In the same manner, that no existing law expressly LIMITS disability on visual, physical, nor mental impairment to the

I) HIV AND AIDS as a Physical Impairment

Under Sec. 4(c), R.A. 7277 or the Magna Carta for PWD (as amended by R.A. 9442), Disability is defined as Physical Impairment that substantially limits one or more psychological, physiological or anatomical function of an individual. In the definition, Physical would mean anything relating to the body. Physical impairment necessarily follows that it is includes impairment in cells’ function.

Under Sec. 3 (n) of R.A. 1166 or the Philippine HIV and AIDS Policy Act, it defines HIV as a: “virus, which infects cells of human immune system, and destroys and impairs the cells.” Thus, a person infected with HIV has a physical impairment through infection of HIV. Unless, it is cured, the virus is a continuous threat.  The HIV and AIDS Policy Act recognizes that there’s no cure that can eliminate HIV from our system but what the antiretroviral drugs does is it only stops or suppresses viral replication, thereby slowing down the progression of infection.

While it is true that Anti-retroviral Therapy (ART) suppresses the virus; PLHIVs are vulnerable as compared to other individuals considering our condition being immune-compromised. PLHIVs regardless of medication are still at a higher risk of suffering from HIV-related medical conditions; because, our cells’ functions are impaired.

PLHIV also experience disability related to HIV. As it progresses, HIV disease can result in mental and physical conditions that impair ability. In addition, highly active antiretroviral therapy and other treatments, while saving and prolonging lives of PLHIV, can also cause side effects that can be disabling. [Elliot, R. (2009), Journal of the International AIDS Society.]

This is the other half of the truth, which some “advocates” fail to appreciate. Which leads me to this question: “Who do they really advocate?” Perhaps, it’s time that we also reflect upon the term that has long been abused – ADVOCATE. As I mentioned in my previous article: “Recognition: tug of war in HIV advocacy” (2017):

Advocacy is not just about claiming to be an advocate. Advocacy is equivalent to progressive action rather than passive inaction. It can neither be said that a positive diagnosis for HIV/AIDS is an express ticket nor license to the advocacy. One becomes an advocate when he truly understands the cause by exemplifying affirmative actions engaged in the cause; which should preferably be multiple, continuous, and instantaneous; rather than single, isolated, and orchestrated. This is how we become advocates.

There are also some who have been working for the longest time in the advocacy, thanks to you and your efforts for our community; but are you really for us or against us? With your indulgence, how does an act of going against a privilege for the PLHIVs be beneficial for the Community? Perhaps, its time that you retract from self-infested principles at the expense of a larger population, that further over boards existing laws. The laws may not speak well of your belief, but these are the laws, it applies to all with no exception, let the welfare of the people be the supreme law of the (Salus populi est suprema lex.)

II) HIV and AIDS as a PSYCHOSOCIAL DISABILITY

At present, PLHIVs are being ISSUED PWD ID on the basis of Psychosocial Disability. Under the Implementing Rules and Regulations of R.A. 7277, the term Psychosocial is defined as inter-relationship of the psychological aspects pertaining to the thoughts, feelings, reactions, and behavior of a person with social aspects pertaining to the situation circumstances, events, relationships, other people which influence or affect the person sometimes to the point of causing distress. The HIV and AIDS Policy Act of the Philippines recognize discrimination against PLHIVs, a discrimination that causes Psychosocial Disability.

The UNAIDS made a statement in United Nations Commission on Human Rights: Sub-Commission on Prevention of Discrimination and Protection of Minorities, “HIV/AIDS and DISABILITY” (48 Session, August 1996):

The disabilities consequences of asymptomatic HIV is that often people living with HIV, as well as those suspected of being HIV Positive, are very often discriminated against because they are wrongly perceived as being unable to perform; they are wrongly perceived as being a threat to public health… Thus, if they are not actually disabled by HIV-related conditions, they are often disabled by the discriminatory treatment they perceived because of their HIV status… Definitions of disability should move beyond functional limitations to cover medical conditions such as HIV/AIDS.”

In our Jurisdiction, there are no Jurisprudence that may clearly include HIV and AIDS as a form of disability; but there are already existing laws, as such, outside our Jurisdiction. In Australia, The Commonwealth Disability Act of 1992 defines disability as: “broad language referring to disease or illness, such as the following: the presence in the body of organisms causing disease or illness; or the presence in the body of organisms capable of causing disease or illness.” The same definition is also applied in the countries: New Zealand and South Africa.

While the aforementioned law, of Australia, has no applicability in our Jurisdiction. American Jurisprudence may guide us, as the Americans influenced most of our penal laws. Our Revised Penal Code alone was legislated at the time when our country was a colony of America. The Magna Carta for PWD is both a social legislation and penal legislation by virtue of its penal clause; therefore, we can use as a guide the AMERICAN DISABILITY ACT ratified by the U.S. Congress in 1990, which was subsequently interpreted by the U.S. Supreme Court in 1998, Bragdon v. Abbott, that settled affirmatively the legal challenges whether or not HIV should, in and of itself, be considered a disability if the person remains symptom-free and otherwise unimpaired.

The US case involving Ms. Abott clearly establishes a rule that HIV should be considered as a disability for purposes of the American Disability Act in relation to the Convention on the Rights of PWD.

The American Disability Act of the United States of America and the Magna Carta for Person with Disability draws it life from the same accepted general principle of international law, that is, the – Convention on the Rights of the Persons with Disability. I couldn’t see any reason why the same logic shouldn’t be applied in our Jurisdiction, if our law is anchored on the same International Law as that of the American Disability Act.

Now, it can be settled that infection from HIV and AIDS can be disabling but does not necessarily result to inability, regardless being called a person with disability; otherwise, such thought rightly falls under “Discrimination on the basis of disability.”

The application for issuance of an identification card as a person with disability is a matter of choice, which needs to be respected, when exercised or not. A PLHIV who secures a PWD ID should not be ridiculed as less than anyone. This exercise of privilege made by PLHIVs must not be seen as disempowering, as such, mentality is not only a reflection of legal impertinence but also an absence of intelligence.

Principles that deflect from those of PLHIVs, as persons with Disability articulated in a sophisticated language, do not merit any rebuttals from those who advocate PLHIVs as PWD. But don’t force the law to lean in your favor if it apparently does not support your principles, much less – ignorance.

When someone can come up with an argument, better than: “HIV and AIDS is not enumerated under the Magna Carta for PWD as a disability” feel free to send me a message. Otherwise; I’ll leave you with these: the law clearly implies consistent with the words expressly used that PLHIVs have physical disability on the basis of impaired cells, and PLHIVs are psychosocially disabled for being constantly exposed in a possible discriminatory act based on HIV status.

If there is one rule of construction for statutes and other documents, it is that you must not imply anything in them, which is inconsistent with the words expressly used. (Re: a Rebior [No. 335 of 1947][1948] 2 All E.R. 533, per Lord Green M.R.)

I am Posit Bo, I was diagnosed with AIDS and Major Depressive Disorder, which qualifies me as a person with psychosocial and mental disability, respectively. I am a person with disability; but I am not less than anyone because I am your worthy equal despite my disability. You are not to judge me based on my disability or exercise of a privilege granted by law, as I am not to judge you based on your refusal to acknowledge your disability or exercise of privilege. Let us embrace diversity without hatred but instead with respect.

The year started with a worrying bang.

In January 2019, there were 1,249 newly confirmed HIV vases reported to the HIV/AIDS & ART Registry of the Philippines (HARP), which just released its most recent HIV data. This figure is already higher compared to the prior month (in December) when DOH released its HIV data, with 877 cases reported.

For 2019, the DOH already averaged the number of people who get infected with HIV on a daily basis to 42. This is 10 more than the number (32) in 2018.

More male Filipinos are still getting infected, with 95% (or 1,190) of the newly diagnosed cases in January. The median age was 27 years old (age range: 1 – 72 years old); and almost half of the cases (49%, 610) were 25-34 years old and 32% (395) were 15-24 years old at the time of testing.

Almost a third (32%, 402) were from the National Capital Region (NCR). Region 4A (18%, 228 cases), Region 3 (9%, 114), Region 7 (8%, 97), and Region 6 (7%, 92), comprised the top five regions with the most number of newly diagnosed cases for the month, together accounting for 74% of the total.

Sexual contact remained as the predominant mode of transmission (98%, 1,223). Among the newly diagnosed, 62% (780) were males having sex with males, 25% (306) males who having sex with males and females, and 11% were infected through male to female sex. Other modes of transmission were sharing of infected needles (1%, 9) and mother-to-child transmission (<1%, 4).

YOUTH AND HIV

In January, 395 (32%) cases were among youth 15-24 years old; 96% were male. Almost all (98%, 390) were infected through sexual contact (31 male-female sex, 266 male-male sex, 93 sex with both males and females). Two cases were infected through sharing of needles; while three cases had no data on mode of transmission.

There were 53 newly diagnosed adolescents 10-19 years old at the time of diagnosis. Further, seven cases were 15-17 years old and 46 cases were 18-19 years old. All were infected through sexual contact (three male-female sex, 45 male-male sex, and five had sex with both males and females).

In addition, there were four diagnosed cases less than 10 years old in this reporting period and all were infected through vertical (formerly mother-to-child) transmission.

WOMEN AND HIV

Among the newly diagnosed females in January, eight were pregnant at the time of diagnosis. Four cases were from NCR and one case each from Regions 1, 6, 7, and 8. The age of diagnosis ranged from 15 to 39 (median age: 24).

Reporting of pregnancy status at the time of testing was included in the HARP from the year 2011. Since 2011, a total of 301 diagnosed pregnant cases were reported. More than half (56%, 168) were 15-24 years old at the time of diagnosis, and 38% (113) were 25-34 years old. The regions with highest number of diagnosed pregnant cases with HIV were NCR (49%), Region 7 (24%), Region 4A (9%), and Region 3 (6%).

TRANSACTIONAL SEX AND HIV

In January, 12% (148) of the newly diagnosed engaged in transactional sex. Ninety-seven percent (143) were male and aged from 18 to 72 years old (median: 30 years). Majority of the males (62%, 89) reported paying for sex only, 22% (32) reported accepting payment for sex only and 16% (22) engaged in both. All of the female cases were reported to have accepted payment for sex.

People who engage in transactional sex are those who reported that they either pay for sex, regularly accept payment for sex, or do both. Reporting of transactional sex was included in the HARP starting December 2012.

DEATH AMONG PLHIVs

In January, there were 22 reported deaths due to any cause among people with HIV, and 91% (20) were males. Four cases (18%) were 15-24 years old at the time of death, 13 cases (59%) were 25-34 years old, four cases (18%) were 35-49 years old and one was older than 50 years. Almost all of the cases were reported to have acquired the infection through sexual contact: five of them through male-female sex, 11 through male-male sex, and five through sex with both males and females. One reported death had no data on mode of transmission.

A second person experienced sustained remission from HIV-1; meaning that, effectively, a person with HIV has been cured of the viral infection.

The case – published Tuesday in the Nature journal – comes over 10 years after a somewhat similar (and first) case that involved the “Berlin patient” (later identified as Timothy Ray Brown, 52, who now lives in Palm Springs, California). Both patients were treated with stem cell transplants from donors who carried a rare genetic mutation, known as CCR5-delta 32, that made them resistant to HIV.

The new case, with the patient now referred to as the “London patient”, has been in remission for 18 months since he stopped taking antiretroviral drugs. A male resident of the UK was diagnosed with HIV infection in 2003 and began antiretroviral therapy in 2012. Later, he was diagnosed with advanced Hodgkin’s lymphoma. After chemotherapy, he underwent a stem cell transplant in 2016 and remained on antiretroviral therapy for 16 months.

The London patient quit taking anti-HIV drugs in September 2017. He has now been in remission for 18 months, and regular testing has confirmed that his HIV viral load remains undetectable. This makes him the first patient since Berlin patient/Brown to remain virus-free for more than a year after stopping.

In both cases, the stem cell transplant procedure worked about as well, with the transplant destroying the cancer without harmful side effects. The transplanted immune cells, now resistant to HIV, seem to have fully replaced the vulnerable cells.

Thus far, most people with the HIV-resistant mutation, called delta 32, are of Northern European descent. IciStem maintains a database of about 22,000 such donors.

The International AIDS Society (IAS) welcomed the announcement.

“This is the second reported case of prolonged remission off antiretroviral therapy (ART) post bone marrow transplantation from a CCR5 negative donor,” IAS President Anton Pozniak said. “Although it is not a viable large-scale strategy for a cure, it does represent a critical moment in the search for an HIV cure. These new findings reaffirm our belief that there exists a proof of concept that HIV is curable. The hope is that this will eventually lead to a safe, cost-effective and easy strategy to achieve these results using gene technology or antibody techniques.”

Mark Dybul, co-chair of the Towards an HIV Cure initiative, said: “Despite the great success of ART, there remains a high need for a cure for HIV, especially in low-income settings. This case is as important as it is exciting. There is still more to discover.”

UNAIDS seconded the sentiment, saying that it is greatly encouraged by the news that an HIV-positive man has been functionally cured of HIV.

“To find a cure for HIV is the ultimate dream,” said Michel Sidibé, Executive Director of UNAIDS. “Although this breakthrough is complicated and much more work is needed, it gives us great hope for the future that we could potentially end AIDS with science, through a vaccine or a cure. However, it also shows how far away we are from that point and of the absolute importance of continuing to focus HIV prevention and treatment efforts.”

Stem cell transplants are highly complex, intensive and costly procedures with substantial side-effects and are not a viable way of treating large numbers of people living with HIV. However, the results do offer a greater insight for researchers working on HIV cure strategies and highlight the continuing importance of investing in scientific research and innovation.

In 2017, there were 36.9 million people living with HIV and 1.8 million people became newly infected with the virus. In the same year, almost one million people died of AIDS-related illnesses and 21.7 million people had access to treatment.

Only 16% of gay men surveyed use PrEP; and 67% said that PrEP should be covered by national health agencies and/or other health insurance.

This is according to gay dating app ROMEO, which held a worldwide survey among its members about safer sex. ROMEO was interested in getting an idea of sexual behavior and opinions about condoms, PrEP use, and sexually transmitted infections (STIs). There were 69,551 respondents.

The ROMEO survey showed that 88% of gay, bi males or trans members feel that they are (well)-informed about safer sex and sexually transmitted infections (STIs). But participants indicate that the rise in the spread of STIs is a major concern.

PrEP use was only 16%; though among PrEP users, 91% indicated that they also are willing to use condoms.

“The introduction of PrEP in 2012, a medication that prevents HIV infection, has been a game changer in the gay dating world. At the same time, there is a big discussion about its benefits and risks. With this survey we want to help to find answers,” said Jens Schmidt, founder of ROMEO.

In December 2018, the HIV/AIDS & ART Registry of the Philippines (HARP) reported 877 new HIV cases in the Philippines, with the country now registering 32 new HIV cases every day. And of that figure, 98% (or 861 of the cases) were from sexual contact, which remains the main mode of HIV transmission in the country.

This is the backdrop of the push for condom use of the Positive Action Foundation Philippines Inc. (PAFPI), a non-government organization serving the PLHIV community, via its “Love Walk” advocacy.

Now in its seventh year, “Love Walk” is basically “an HIV awareness campaign” that brings together people to “directly respond to the HIV epidemic affecting the Philippines.”

According to Moses Ayuha, from PAFPI, there are other lessons that may continue to be taught to deal with HIV, including teaching people to abstain from sex to avoid possible HIV infection. However, he said that there is also a need for a more realistic look approach at the situation because “not everybody abstains anyway.”

For Ayuha, and in a gist, there are people who – even if they are already aware of (other) ways to supposedly avoid getting infected with HIV – still have unprotected sex. “These are the people we need to reach.”

For “Love Walk”, PAFPI’s workers/volunteers distributed condoms and lubricants in different areas in the cities of Manila and Pasay, with the approach hoping to “educate (particularly men) and to try to change their attitudes, their outlook, and their (sex) behaviors.”

Ayuha admitted that efforts like the “Love Walk” continue to be challenging, particularly since bringing the sex educating straight to the streets means teaching people about HIV off the bat. “The challenge ay kung paano ipaliliwanag sa mga tao ang HIV sa kalsada at paano rin maiintindhan ng tao ang kahalagahan ng pagpapa-test (The challenge is how to explain HIV to people on the sreets, and how to tell people about the importance of getting tested for HIV),” he said.

It is also not uncomoon to encounter unwanted responses from people who may not support efforts like “Love Walk.”

“Sinasabi namin na hindi naman pag namigay ng condom, (we already) promote sex,” Ayuha said. “It’s just one of the preventive measures. And because – nowadays, people are having sex – we just encourage people to be responsible.” 

In the end, for Ayuha, efforts like the “Love Walk” will continue to be relevant until “we’ve finally properly dealt with HIV.” – ARTICLE FILED WITH LUWELA RODRIGO