June’s done, and – sadly – for so many members of the LGBTQIA community, “Pride” is also done for the year, as they await next year’s hopefully bigger “Pride”. So – with this limited way of looking at “Pride” (i.e. that it’s a one-day, or even one-month “party” with realistic – though at times also only pretend – calls to support those who can’t join the party) – the end of the so-called “Pride month”/start of July is also a good time to assess how we’ve been marking “Pride” in the past years.
Yes, I’ve attended numerous “Pride” celebrations from all over the world – some of them full-blown festivals, some of them one-day gatherings, though all of them topped by “marches” or “parades”. In a gist, they’ve all been celebratory, yes (and who doesn’t like to party now and then, right?). But their approaches are often very different/defined because of their intent. The way I see it, the overarching distinction is when “Pride” ceases to be about… “us”, and more about “them”; when it can be said that we’ve been (in a word) bought.
So in my assessment (and yes, knowing that this won’t be to everyone’s liking), here are eight ways to know when we’ve sold “Pride”.
1. When sponsors outnumber the LGBTQIA people.
I’ve witnessed “Pride” events with contingents from sponsors easily outnumbering LGBTQIA participants. Or – to qualify that – participants who were only able to join the parade because they paid to be in that parade. I’m not sure this is Pride; more like co-opting (or even hi-jacking) it.
2. When sponsors get to decide the form of “Pride”.
Yeah, money matters in this world. But when earning the same becomes the sole driver of holding an event, then we’re fucked. In the case of “Pride”, the moment the sponsors get to decide who “leads” the event because they gave so much money, then we’re double fucked. Because this is the sure sign we’re willing to eat our so-called pride and accept any shit given to us as long as we get money for it.
3. When organizers speak of minorities in the LGBTQIA community, but then you don’t see these minorities in the “Pride” celebration.
Yes, bringing up the interconnected issues is admirable; but if you stop there, then that inaction speaks more about the real intent. This could well be co-opting/hi-jacking of another minority group’s struggle.
4. Related to #3, when organizers claim to be “inclusive” of minorities in the LGBTQIA community, but then won’t allow these minorities to speak about their own issues during “Pride”.
I’ve attended a “Pride” event where sex workers (among others) were not allowed to speak during a program because, according to the organizers, of “time constraints”. However, politicians were allowed to use that “Pride” to campaign because they gave financial support and, well, they’re allegedly/supposedly politically aligned with these organizers or were popular. Then there are other “Pride” events where organizers spoke on behalf of/for minorities even with ACTUAL minority LGBTQIA people right there only watching their community being discussed seemingly in spite of them. For me: Just give them the mike. Else it reeks of co-opting/hi-jacking.
5. When organizers enable the abusers because they’re popular/useful as “partners”/et cetera.
There are actually “partners” whose alleged dirts are ignored by “Pride” organizers – e.g. biz owners with members of the LGBTQIA community accusing them of abusing them. In the era of #MeToo, they – therefore – become enablers.
6. When organizers use speakers no matter their wrong notions on LGBTQIA so long as they’re popular/known/cheap/et cetera.
In Metro Manila’s latest “Pride” gathering, a trans host actually said that she’s a “real woman” because she now has a vagina. I don’t know if she even considered her insinuation that post-op (or non-op) trans people are therefore not “real”. There were also hosts who kept calling trans men “tibo” (i.e. lesbian) and “tomboy”; just as they kept referring to lesbian women as “tomboy”. SOGIE 101 lessons can easily remedy this, yes; but those in “power” ought to teach these people before giving them the mike (!).
7. When “Pride” accountability flies out of the window.
All over the world, I’ve seen LGBTQIA community infighting because of handling of “Pride” profit – e.g. where’s the money earned, who handles it, how the extra is handled, and so on. Heck, New York has a number of counter-Pride events because of the commercialization of Manhattan’s “Pride”!
Considering that, in 2013, a Pride event was held in the City of Manila with approximately only P5,000, so this money talk nowadays highlights points 1 and 2…
8. When the organizers claim that “‘Pride’ is not a one-day event” and then you don’t see them at all the entire year (to help gather the ranks to fight for the LGBTQIA community’s other needs, from legislation protecting our human rights to joining the picket lines of LGBTQIA people dismissed from their work due to illegal employment practices) as they’d only really surface again in June next year, and in June again the year after that.
While attending L.A. Pride! last June, I was “warned” to lower my “political expectation”; it’s really just one big party there. I suppose this “honesty” is – well – refreshing because then, we know what to expect when going there. This “approach” also “broke” the “Pride” in Toronto, with the “big” parade separated from the “Dyke March” and the “trans march”. And sans these delineations, our expectation re “Pride” becomes idealistic – i.e. that it’s one “fight for equality”, when really, it always isn’t. Because – let’s be blunt about this; and considering the number and iterations of “Pride” celebrations all over the world now – for some, “Pride” can be and is being sold…
Worsening #ARVshortage in the Phl?
On Jan. 9, the Philippines gained a new HIV and AIDS law that is supposed to better the lives of Filipinos living with HIV. But many in the HIV community mark this day with distress, largely because of the worsening ARV shortage.
In September 2018, Xander (not his real name; anonymity requested), a Filipino living with HIV, claimed that he was told by the person working in the pharmacy of his hub to “consume already-expired medicines (the three-in-one tablet of Lamivudine/Tenofovir/Efavirenz)”, and that “it is “still good for three months after the expiration date.”
Since dealing with ARV-related issue is not new to him (it happened to him in the last quarter of 2013), he complained and was given newer meds. Noticeably, “those who didn’t complain – like I did – ended up using the expired meds,” he said.
Xander can only recall how he earlier lamented – again in 2013 – that the ARV shortage will happen again, particularly considering the continuing denial of the Department of Health (DOH) about this issue.
The 9th of January is supposed to be a happy day particularly for Filipinos living with HIV and their advocates. On that day, the newly-signed Republic Act 11166 or the Philippine HIV and AIDS Policy Act was released after it was signed into law by Pres. Rodrigo Roa Duterte. By replacing the 20-year-old Republic Act 8504 or the Philippine National AIDS and Control Act of 1998, this new law is supposed to boost the government’s response to HIV and AIDS by making health services for HIV and AIDS more accessible to Filipinos.
But many in the HIV community mark this day with distress, largely because of the worsening ARV shortage, which is not helped by the denial of the issue by various heads of offices – including government officials, as well as those helming treatment hubs/facilities and even select non-government organizations (NGOs).
In an unsigned statement (as if so that no one can be “chased” to be held accountable for the same statement), the DOH seemed to belittle the issue by outright claiming that there’s an ‘alleged’ shortage of ARVs; even as it also stated that they take the issue of HIV infection in the country seriously. Part of this is to take “great steps to ensure that access for HIV treatments are available for those who are diagnosed with HIV.”
The DOH statement added:
“As of October 2018, we have enrolled 32,224 persons living with HIV for treatment with ARV such as Nevirapine, Lamivudine/Tenofovir. The DOH has been providing free ARV to Filipinos living with HIV through our HIV treatment hubs.
“Based on our records, there are 3,200 registered PLHIV who are on Nevirapine and 1,791 PLHIV on Lamivudine/Tenofovir, as of December last year.
That just about half of the total PLHIVs in the Philippines use ARVs is worth noting, even if it’s another issue altogether.
But the mention of these two meds/cocktails is important because the complaints reaching – among others – Outrage Magazine, Bahaghari Center for SOGIE Research, Education and Advocacy, Inc. (Bahaghari Center) other and HIV-related community-based organizations/non-government organizations particularly currently mention these.
In Quezon City, for instance, at least eight PLHIVs alleged that they have been given incomplete medications – i.e. they were supplied with either Lamivudine/Tenofovir or Lamivudine/Zidovudine, but they have not been receiving Nevirapine because this is not available. These people are, therefore, taking incomplete meds.
Pinoy Plus’s hotline, PRC, has received similar allegations of non-delivery of Nevirapine.
In Cavite (Imus, Bacoor and Dasmariñas), at least three clients surfaced to allege about the same issue. PLHIVs are now “borrowing” each others’ Nevirapine supply just so they don’t miss their required dosage because their hub does not have supplies from the DOH.
There are similar allegations in Cagayan de Oro City, Davao City and Zamboanga City.
And in Alabang, the pharmacy of a treatment hub even posted on January 8, 2019 an announcement that “due to the shortage and delay of the deliveries at DOH, only one bottle will be dispensed of the following medicines: Nevirapine (200mg tablet); Lamivudine (150mg)/Zidovudine (300mg tablet); and Lamivudine (300mg)/Tenofovir (300mg tablet).” The same hub is telling its clients to “wait for further announcement on stock availability.”
Note that the RITM-AIDS Research Group’s pharmacy is putting the blame on the DOH.
The same DOH statement stressed that “the latest data, as of January 4, confirms that Nevirapine has already been delivered to the 16 treatment hubs to meet the requirements for February-April 2019. For Lamivudine/Tenofovir, a month’s supply has also been delivered to Regions X, VI and I. The rest of the regions will expect deliveries within this week.”
Noticeably, the DOH statement responds to issues only this January, even if this concern has been circulating in the PLHIV community since 2018, and only peaked now.
There are fewer ARV refills now. If, in the past, the usual practice is for hubs to give PLHIVs three bottles of ARV to last them for three months, a growing number are now complaining about the supply being cut to one month in numerous hubs – e.g. there’s that post in RITM’s pharmacy. Some allege that they are even supplied ARVs just for a week or even just for three days.
Due to the ARV shortage that the DOH is not outright confronting, expired medicines are allegedly being given to PLHIVs – as in the case of Xander.
Also due to the ARV shortage, the medication of a number of PLHIVs are allegedly being changed not because it’s medically sound, but because their usual medicines are not readily available. In Mandaluyong City, there are PLHIVs who claimed to have been told to use Lamivudine/Tenofovir/Efavirenz because it’s the only available ARV. If they refuse to do so, then they will have to stop taking their usual medications until such time when the delivery of supplies are normalized again.
To allow the DOH to respond to these claims, Outrage Magazine repeatedly reached out to the government body. Upon calling the media relations unit (at +63 2 651-7800 loc. 1126), we were turned over to the office of Dr. Gerard Belimac (+63 2 651-7800 locs. 2355, 2352, 2354). Five attempts were made to speak with Belimac or any other authority in his office, but he has been unavailable at those five times; and even after leaving requests for a statement from him on the ARV shortage, as of press time, the publication has not heard back.
As this is a continuing story, coordination will continue to – eventually hopefully – extensively hear from the DOH on this issue.
The DOH statement also stated that it is “working closely with our suppliers to ensure that there are no gaps in our supply chain. In fact, we are waiting for deliveries of an additional 12,375 bottles of Nevirapine good for another three months and 7,024 bottles of Lamivudine/Tenofovir good for another two months.”
The DOH also claimed that it is continuing to explore “for more partners in providing excellent support for Filipinos living with HIV-AIDS and in ending the deadly disease.”
As if wanting to pacify the complaining PLHIVs, the DOH statement transferred to responsibility to “HIV doctors to explore possible options”, or visit Facebook page (PLHIV Response Center) or email email@example.com. Note the use of a gmail account for a body with millions in budget.
No investigations on where the errors in the supply chain is happening so that these can be fixed is forthcoming. No one being held accountable here.
THE NEED TO GO BEYOND LIP SERVICE
Incidentally, Article V, Sec. 33 of the newly signed HIV law states: “The DOH shall establish a program that will provide free and accessible ART and medication for opportunistic infections to all PLHIVs who are enrolled in the program… A manual of procedures for management of PLHIV shall be developed by the DOH.”
The IRR is not even there yet, but this mandate to provide life-saving meds is now already cast in doubt.
Xander – who only had a refill of his ARVs – said that many like him who posted about this issue online were told to stop doing so “because we are supposedly creating panic among PLHIVs.”
He now says that people who cover up this issue are “as worse as those paid to work on this issue. Because if you go to the HIV community, we’ve long lived with worrying that our meds may not be given us at any moment. If some people think complaining about this is wrong, then they shouldn’t be in HIV advocacy, but work as PR people of those failing to do their jobs.”
In the end, “this needs to be resolved fast. Enough with discussing semantics on what we’re having is a shortage or a stockout; the fact remains that there are PLHIVs not getting their supplies. Lives are at stake. So supply the ARVs; now.”
On beauty pageants and messed up priorities in dealing with HIV in Phl…
After encountering a young PLHIV who has to prostitute himself just to access ARVs, Michael David Tan finds it infuriating that the Department of Health saw it fit to allocate lots of money to HOLD A BEAUTY PAGEANT. For him, from the get-go, this approach needs to be closely looked at.
I am chatting with a person whose HIV rapid test only recently showed he’s reactive. He was told by this satellite clinic in Mandaluyong City that he can actually proceed to get the meds; though only if:
- He pays his PhilHealth; and
- He pays for all his lab tests.
The problem is, this young person – who did not even finish schooling – is unemployed.
So he is chatting with me now to “manghiram ng P100 (borrow a hundred pesos) so I can go to a client who will give me P1,000; which I can then use to pay for my lab tests.”
Yes, he is resorting to selling himself. To access life-saving medicine that is supposedly – and ERRONEOUSLY claimed to be – “free”.
It is cases like this young person’s that make it infuriating that the Department of Health (DOH) saw it fit to allocate lots of money to… HOLD A BEAUTY PAGEANT.
In a pageant-obsessed country like the Philippines, at least superficially, this seems like an “intelligent” move.
But from the get-go, this approach needs to be closely looked at and reconsidered.
- The pageant is supposed to create “HIV advocates”. BUT only those who fit specific qualifications can enter – e.g. age limit, height limit, vital stats requirement of participants (with the candidates even told to ‘model’ in swimwear as part of the screening process). So now – with this ‘move’ – what is being insinuated is that you need to be young, beautiful/handsome and be willing to strut in your bikini first before you can be considered an HIV ‘advocate’…
- We are supposed to dismantle this lookist society; to recognize people’s worth NOT based solely on how they look. Pageants – by their very nature – promote the status quo (of lookism) by giving “positions of power” only to those who “fit” socially-constructed standards of beauty and attractiveness.
- The country has a lot of REAL advocates who do for free what should be DOH’s job – e.g. community-based HIV screeners who go from barangay to barangay without any payment. There are those doing community-based HIV screening (CBS) who are RUNNING OUT OF RAPID TEST KITS, so they are now unable to serve; unable to be advocates. Seriously now, if there’s money for a beauty pageant, surely there’s money that can be given to those already working on the ground, or even to buy life-saving paraphernalia used in battling HIV in the Philippines.
- One of the supporters of this beauty pageant told me that Pia Wurtzbach’s effort to bring the spotlight to HIV is a good example of the “relevance” of a beauty pageant like this, as it could “create another Pia”. In a marketing standpoint, this is not a well-thought response; mainly because if you wanted to “create” someone to be like Pia to promote HIV awareness in the Philippines, then… JUST HIRE PIA HERSELF!
Besides, as a friend aptly said: You can’t just “create” a Pia. She “works” because she’s unique.
- If you need a crown, a title and the prize money before you start advocating for HIV-related issues in the Philippines, then you’re not really an “advocate” and what you’re doing is not “advocacy”.
The fact is, numerous HIV-related issues continue to plague the country.
We get 31 new cases every day now.
A growing number of those getting infected are getting younger and younger (e.g. in July, 28% were from the 15-24 age bracket).
The ARVs in treatment hubs are OLD – e.g. many have expired, and the Philippines still uses meds already discontinued in Western countries. Don’t get me started with the shortage that the DOH continues to deny is happening.
We still don’t have widely-distributed pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
Newly-diagnosed PLHIVs – like that young person at the start of this article – are still unable to pay for their baseline tests; and so they can’t proceed to the next steps (including starting their ARV therapy). And even if they can get the lab tests done, their ARV supply is compromised because they can’t pay their PhilHealth.
There are treatment hubs that do not have viral load machines, so that PLHIVs do not know their VL years and years after they tested HIV-positive. And this is even if they have been paying the same PhilHealth amount that should give them that VL test. DOH accredited these hubs; they need to monitor if the hubs comply with policies related to their accreditation.
There are accredited hubs that do not even offer CD4 test. This is accepted as “normal”, and again, this is even if the PLHIVs in these hubs still pay the same PhilHealth amount that should grant them the CD4 test. Similar to the above: DOH accredited these hubs; they need to monitor if the hubs comply with policies related to their accreditation.
There remains lack of updated knowledge even among existing service providers – e.g. try asking them about U=U, and you’re more likely to encounter internalized stigma and discrimination, largely because… this is not even openly discussed in the Philippines, including by DOH.
There are no Filipino Sign Language interpreters who can assist Deaf Filipinos to get tested for HIV; and – if they test HIV-positive – access treatment, care and support.
I can go on and on and on…
But just try bringing these issues up (e.g. to government people or NGOs) and you’d more likely be told “there’s no money”.
Well… apparently there is money; just not for these…
DOH is complaining about the pending budget cut, but – the way I see it – it shouldn’t/can’t/ought not to complain about any budget cuts when it can spend money ON A BEAUTY PAGEANT. This may sound harsh, but words that immediately come at least to my mind include misuse, squandering (with a friend going as far as using the word “misappropriation”) or words similar to that…
As it is – and yes, I recognize this – I’ve already been repeatedly told that I’m too… negative.
I’m not sure I’m being “negative”; instead, I am being more “realistic”.
And the thing is, as long there are PLHIVs like that young person who has to prostitute himself just so he can access life-saving meds and services even as a big amount of money is spent on a beauty pageant, I say we all should be…
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.
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.
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.
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).
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.
BUT there’s this disconnect that is too painful to just ignore.
All because there are “advocates” who see HIV as a cash cow.
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.
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.
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…
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.
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.
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:
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…
And so here’s another fact: Unless these are dealt with, expect for the worst to come.
On doing the same thing over and over again and expecting a different result…
The anti-discrimination bill has been pending in Congress for 19 years now. There are anti-LGBTQI politicians hindering the bill’s passage; but it may also be time to REALISTICALLY look at the current handling of the ADB to ascertain what needs to be changed from within the LGBTQI community so we don’t wait for another 19 (or more) years…
Insanity: Doing something over and over again and expecting a different result.
This witticism has been attributed to, among others, Albert Einstein, Benjamin Franklin and Mark Twain (though when Rita Mae Brown used it, she attributed it to the Narcotics Anonymous “Basic Text” released in November 1981). But no matter the “origin”, the thought remains – i.e. it’s silly (perhaps even idiotic) doing the same thing over and over and over again when we already know what the result will be.
This thought kept nagging at me in the way the anti-discrimination bill (ADB) is being handled – particularly why, after 19 years, it continues to languish in Congress (in either the Lower or Upper House, or in both – depending on the year being discussed).
Let’s state the “givens” first.
1. There will always be haters IN Congress.
In the past, in the House of Representatives, it was Rep. Bienvenido Abante (6th District, Manila City) who – this one is the most ironic of all – chaired the Committee on Human Rights; as well as the likes of Rep. Lito Atienza (of Buhay Partylist). Currently, and in the Senate, we have the likes of Sens. Tito Sotto, Manny Pacquiao and Joel Villanueva.
2. Numerous politicians use the LGBTQI community to advance personal interests.
For instance, Sotto’s “Eat Bulaga” earns a lot of money by parading members of the population he refuses to grant human rights (i.e. Super SiReyna and Suffer SiReyna). And Villanueva USED TO support LGBTQI human rights, back when he needed the votes; but when he already got that, the narrative changed…
3. The haters can be “persuaded” to side with what’s right.
Even the Catholic Bishops Conference of the Philippines (somewhat) changed it’s tune: it is now anti-discrimination of LGBTQI human rights (as long as it will still be able to discriminate, of course).
Some forms of “persuasion” can be harder/harsher – e.g. take the moolah away from Pacquiao, and he starts “reaching out” to the people he considered “masahol pa sa hayop (worse than animals)”. Some efforts are done behind closed doors – e.g. trans Rep. Geraldine Roman reaching out to Atienza to allay his fears that the SOGIE Equality Bill has nothing to do with marriage equality (and discuss the “toilet issue”), so that he ended up supporting this.
Now here’s where the “argument” of this article enters the picture.
Largely, it seems that the current approaches to promote the ADB (seem to just) continue to be the same.
And so we continue to be failing.
1. The ADB development continues to be “exclusive”.
Even when the ADB was comprehensive and mentioned other minority sectors (like PWDs, seniors, Indigenous Peoples, religious minorities, people living with HIV, et cetera), no representatives of these sectors were invited in the development of the same ADB.
Forgive me for saying this, but this is typical of a “top-to-bottom” effort – i.e. when someone basically dictates what’s good for… everyone (without hearing from the supposed beneficiaries).
2. The constant “othering”. And this happens outside and inside the LGBTQI community.
“They” are the “enemies”; only “we” are the “heroes” (there were even pro-ADB factions who wanted to discredit Roman who helped pass the ADB in the Lower House in 2017 after only a year).
“They” don’t know what’s good for the people; only “we” know better what’s good for them.
“We” don’t have to engage “others”; “they” do nothing but complain and complicate the ADB.
“We” can’t support any other form of ADB; we just want “our” version to pass.
This is “our” ADB because we’ve backed this for so long.
3. Efforts related to ADB tend to be elitist.
The “handlers” of ADB continue to not see that – yes – online presence is good, but if the people supposed to benefit from it do not even know of it, of what good it could do to them, then the “noise” created is just that, exactly: noise.
I say: Try going to some beauty parlor in Valenzuela, or Quiapo, or Tondo, or… just about everywhere in the Philippines. Ask the parlorista if he or she knows of the ADB. If he or she does, that’s GREAT; but if he or she doesn’t, then reconfigure plans to make sure that these people know of it.
I remember during the Pacquiao debacle, when Luzon-centric activists/“activists” were flown to Mindanao to meet with the boxer. The local LGBTQI community there were – basically – ignored, treated as inconsequential to the cause they’re supposed to be part of.
4. We can’t show the numbers.
Last June, “we” were so proud to have held a “Pride” event in Marikina that was attended by approximately 25,000 people (the claim).
But – get this – when a “unified political rally” was held to push for the ADB, we couldn’t even get 1/4 (or even 1/8!) of that number. And then another more recent “rally” was held in the Senate, again to push for the ADB, and the attendees did not even reach 50. We’re not “25,000 strong”; instead, it seems, and in a few words, we are “25,000 weak”.
One of the continuing “sore” issue re ADB is its association with marriage equality. The truth is, many people – including politicians – continue to think it advocates marriage equality. If – after 19 years! – the ADB continues to be misunderstood even by people who are supposed to have access to copies of the ADB, then – let’s admit this much – the messaging is failing…
Nineteen years is far too long a time to wait for the passage of a law that will protect us from discrimination because of our SOGIE.
So yes, we thank everyone – from Etta Rosales to Kaka Bag-ao to Roman to Sen. Rosa Hontiveros, and so on and so forth – who are pushing the ADB (no matter the version) in Congress.
But we also have to REALISTICALLY look at ourselves (and those handling the ADB) and check why we continue to fail. Again, we have “enemies” on the outside, yes. But unless we see (and admit, and start doing something about it) that some of what needs to be changed are from within the LGBTQI community, then we may have to wait for another 19 (or more) years…
Start with that wo/man in the mirror…
With revisionism, credit-hogging, co-opting/hijacking of causes, et cetera happening even within the LGBTQIA community, Michael David C. Tan says “we need to look at ourselves closely and see if we have become the very people/systems we seek out to destroy/dismantle.”
“…I’ve been a victim of a selfish kind of love
It’s time that I realize
That there are some with no home, not a nickel to loan
Could it be really me, pretending that they’re not alone?
I’m starting with the man in the mirror
I’m asking him to change his ways
And no message could have been any clearer
If you want to make the world a better place
Take a look at yourself, and then make a change…”
Man in the Mirror, 2008
This is going to be short; and yet I hope… crisp.
But – to start – considering Michael Jackson’s tattered past, let me apologize for starting this article with portions from his “Man in the Mirror” hit. Not to lift him up (he doesn’t need me for that) or attack him for his flaws (and he sure had many – e.g. child molestation charges), but his words sort of easily sum up a key message so many of us want to forget. That is, that for change to happen, we need to start with us. It’s a hackneyed statement/cliché, I know; but – guess what? – the stock statement has not gone stale.
Here’s the thing: So many of the (now out-to-the-world) flaws from within the LGBTQIA community merely reflect what we sought out to change. And so many of these same flaws are there because of our refusal to see that, in so many ways, we have become mini versions (some are actually exact replicas) of those we attack.
Off my head, check:
Yes, LGBTQIA people (like non-LGBTQIA people) claim that the Marcoses – and by extent, the role played by the likes of Pres. Rodrigo Roa Duterte here – seem to be busy amending our Martial Law history. By all means, we should be mindful of all forms of revisionism; we should not forget our past (the good and the bad) because we can only move forward if we know our history.
But – this is what’s unnerving! – there are also LGBTQIA community members (many of them the most loud in criticizing the revisionism that is happening) who are revising the LGBTQIA history in the Philippines – e.g. who should be credited for starting “Pride”, who we should thank/adore/praise/treat as gods for starting (not even for getting pass) an anti-discrimination law, et cetera. When we criticize what we, ourselves, are doing, that’s called (in a word) hypocrisy.
We go back to former strongman Ferdinand E. Marcos; and we now have Pres. Duterte, both we attack for their (what we refer to as) “wanton desire to cling on to power”. Rightfully, it should be said.
But then we look inside our LGBTQIA community, and we have:
A) Metro Manila-centric “leaders” who would go to LGUs to ask/dictate/tell them to develop ADOs sans community consultation of the LGBTQIA people there;
B) So-called “networks of LGBTQIA organizations” with “leaders” who are there as forever heads (with no mechanisms for passing of power); and
C) “Leaders” who help dictate where funds go, and yet only give the same to their inner circles.
3. Idya-idya/Sila-sila/Nepotism/Special groups.
That the supporters (no matter how evil they may be) end up dividing the spoils of war is an oft-cited observation. In the past, the term we used was “cronies”. The terms may have changed, but the concept remains the same – i.e. that a small circle of people end up benefiting from those in power.
Yes, this is wrong; and yes, this has to be criticized (and changed).
But looking inside the LGBTQIA community, it’s not like we’re “exempted” from this practice.
A) The non-inclusive approach to developing the anti-discrimination bill (ADB) (I have said this in the past, and I am saying it again and again and again);
B) As noted in point #2, the giving of available funds ONLY to inner circles; and
C) The continuing Metro Manila-centric-controlled discourse re “LGBTQIA movement in the Philippines” (there are those who’d deny this, of course; that’s their right. But that these same people are based in Metro Manila or are even overseas bely their very denial).
We often hear – as reasoning or as excuse, depending on how this is interpreted – that it’s because our LGBTQIA movement is “still young” And yes, this may be true. But the fact remains that when we’re no better than the very people we attack; when the systems we say are wrong/erroneous are the same inside our movement, then who are we kidding, really?