A serodifferent love
HIV-positive Louie, 34, said that that when you have HIV, sometimes you think won’t find love. But he met HIV-negative Matt, 28, in 2016. And while many people still doubt their relationship, he says: “What’s important is we inspire each other… while loving and caring for each other.”
People think that when you have HIV, you won’t find love, said Louie, 34, from Biñan, Laguna. “But that’s not true. This thought never entered my mind.”
Louie was diagnosed HIV-positive on July 3, 2013.
At that time, “I felt two emotions. On one hand, I was happy. My live-in partner then had HIV, and I knew he was dying. That’s also what I thought before; that when you have HIV, you die. When I was diagnosed to have HIV, I thought I’d also already die. So we can happily die together. (But) on the other hand, I was also sad. I was thinking, what will happen to my family?”
For Louie at that time, “more than my HIV status, I had a harder time accepting that nothing is permanent. Like my live-in partner who died. I had a harder time moving forward from this.”
In 2016, Louie started feeling… lonely. “I realized how I missed being in a relationship. I missed having a relationship no matter its form – as lovers, partners in crime… so long as you love each other.”
He was working as HIV counselor for Klinika Bernardo in Quezon City then, and “we have targets on the number of people we test for HIV. To reach mine, I joined group chats.”
Matt, 28 from Tondo, Manila, was in one group – HTS.
“One time, his photo appeared in my phone (via the group chat). He was skinnier then. I said, ‘Wow, he’s cute.’ So I gave his photo a heart, and I sent him a personal message. I PM’d him, and he answered,” Louie recalled.
Louie also invited Matt to get tested for HIV.
“Every Friday, we (do HIV testing in a bar) in Cubao. Our team from Klinika Bernardo go there to do HIV testing, and give out condoms. I invited him to come over,” Louie said.
They met in a bar in Cuba, Quezon City.
“I asked him (later) if he wanted to check into a hotel so we can be together. By asking him, of course, I wanted something to happen between us. But he had an (alibi not to join me),” Louie said.
On a later date, Matt visited Louie at Klinika Bernardo.
“I told him I wanted to have sex with him. He actually refused me. It was a first time for me, so I asked him: Why not? He told me he only has sex with his BF. I think this guy’s old fashioned. I told him we’re not kids anymore, we’re not teenagers. If it works out, fine. If it doesn’t, let’s part ways,” Louie said.
Louie stressed that “of course I’m aware I have HIV. But I also know there’s no risk of infecting him because my viral load is undetectable. But I also knew how to take care of myself, and how to look after him. This is why I had the guts to ask him to have sex with me.”
Even early on, Louie said he wanted to tell Matt about his HIV status.
“But I was afraid he’d get angry, he’d fear me, he’d sue me, or he’d bash me,” he said.
That moment came after their first catching up.
DEALING WITH DISCLOSURE
In 2015, a radio station interviewed Louie. “I was asked to share my story. They made a ‘teledrama’ out of it. I made him listen to a recording of this,” Louie recalled.
After listening to the recording, Matt hugged Louie.
“I was surprised when he hugged me after listening to the recording. He didn’t say anything. I asked: ‘What can you say?’. It was funny; he said: ‘Nothing.’ I never felt he feared me. I forced him (to react). I told him it’s fine; I’d understand. He whispered to me; he told me ‘I love you.’ He said he loved me more.”
For Matt: “I couldn’t care less. So what if you have HIV?”
As a side note, Matt had former partners who had HIV.
“Three BFs passed away, all from AIDS-related complications. They were diagnosed late. I knew of their HIV status after they passed away,” Matt said. “So when he told me he has HIV, I didn’t care. It’s normal for me to have a PLHIV for a partner.”
This point does not escape Louie, though.
“I had fears. Based on his stories, all his exes died. I thought: Will I be next? I said to him: ‘Maybe you’re cursed.'”
LIVING AS A COUPLE
As a partner, Matt said Louie can be “difficult… he can get moody. At times at night, after taking his ARV, he’d complain about ailments. I really had to learn to adjust.”
But this is something he now relishes; a part of his life.
“Whenever he gets sick, his mom sends me a text message: ‘Come over, (Louie) is sick.’ And so even if I’m supposed to to go somewhere, I go to Laguna from Tondo to look after him.”
In hindsight, Louie said he knew he already loved Matt when “I miss him when he doesn’t send me text messages. If he doesn’t immediately respond to my messages, I quarrel with him. (I like that his) messages are very sweet. Almost every night, we chat over the phone. When we don’t do any of these in a day, I already miss him.”
For Matt: “It’s good to love someone with HIV because it broadens your way of loving. It broadens your adaptability skills. You will experience real love because a PLHIV will love you completely. Those without HIV can still cheat on you. But if you love someone with HIV, they won’t look for another. Like us, he won’t look for another because I give him the love he deserves.”
Louie admitted that “a person living with HIV may not believe he will be loved by a person who does not have HIV. You may think he’s only there out of pity. That he’s only staying with you because if he leaves, you’ll get depressed and kill yourself. That was my thinking (before): I have HIV. Will someone still love me? Processing this took a while.”
Now, “if people ask me if it’s worth it, I say yes. I believe that aside from my ARV treatment, love also prolongs my life,” he added.
LOVE IS WORTH FIGHTING FOR
People may not support what they have, but Louie said “I don’t care what people will say when they discover our relationship. Maybe they just envy us. When we just started going out, some said we won’t last. I know some of them we just joking. Some said we’d be together only for days, for weeks. We proved them wrong. We did not focus on ‘being in a relationship’. We focused on creating happy moments together.”
Some people may also think Matt is putting himself in harm’s way. But “people should not think I am putting myself in a situation that I can’t handle. I am an adult/a grown up. Maybe they just envy us because we lasted long.”
In fact, Matt said, “people asked me: Why him? You had a lot of suitors who were better looking, who doesn’t have HIV. He’s the one I love. What do you want me to do?”
To find love, Louie said: “Just be honest. If the person (you disclosed to) does not accept you, find another. If you’re honest and he does not accept you, that’s not love. In that case, love won’t materialize. But if a person accepts you even if you have HIV, he’d love you for real.”
There’s no “looking forward” for Louie and Matt.
“We sometimes kid: What if we break up? What if (things don’t turn out well)? We discuss these affectionately. But really, we don’t think of the future; we just think of the present,” Louie said. “What’s important is we’re happy. What’s important is we accept each other. What’s important is we inspire each other… while loving and caring for each other.”
In YouTube, follow @PLHIV Diaries.
Women are not ‘disgusting’; gay men are just not into them…
Why the need to demean women, or express disgust over their body parts, when we can just say, “No, we’re not into women”; or “I’m a man; but I’m (also) into men”?
Time to unlearn sub-/unconscious misogyny.
Here’s the thing: With the demise of Christine Dacera, and with predominantly gay (and perhaps bi) men considered as suspects by the error-filled PNP (Philippine National Police), many members of the LGBTQIA community surfaced to defend members of the rainbow family.
Background info: Christine Dacera, a flight attendant, celebrated her New Year’s Eve with gay/bi friends in a hotel in Makati City. On New Year’s Day, her body was found lifeless. The PNP (pre-empting everything) pushed for questionable narratives – e.g. that she was “raped” (even if the autopsy report couldn’t validate this), and then committed inept acts – e.g. announcing the case to be “solved” when it really wasn’t, jailing three of the people who claimed to have helped Christine that night (with a judge ordering them to release the three; and then basically telling them to, yes, do their job properly), embalming the body before another (independent) autopsy can be done, etc.
It didn’t help PNP at all when one of its top brass stated that “gay men are still men” (Yes, sir, they are; DUH!) and insinuated that gayness can, basically, be cured by alcohol (that is, they’d start having sex with, or even rape women when they’re drunk).
Going online, among the statements of “support” for the gay/bi suspects, however, you’d find statements like “yuck”, gross ang vagina”, “babae, yuck”, “kadiri“, and so on. All these supposedly refer to what gay men “feel” when with women.
And let’s stop spewing these misogynistic statements.
Misogyny – that hatred of, aversion to, or prejudice against women (Merriam-Webster, 2021) – can be blatant. But it can also be “invisible”. And get this, even members of minority sectors – such as those from the LGBTQIA community – can be misogynistic.
This seeming disdain for women – or their body parts – is actually misogynistic.
If you think this I am making a big “leap” with this claim, consider that in Psychology Today, Dr. Berit Brogaard wrote that “in most cases, misogynists do not even know that they hate women.”
After all, why the need to demean women, or express disgust over their body parts, when we can just say, “No, we’re not into women”; or “I’m a man; but I’m (also) into men”?
The antiquated – and, well, fatuous – macho culture in PNP has been harming members of the LGBTQIA community. Let’s not become part of the problem by becoming just as antiquated and, yes, just as fatuous.
To stand united, we also need to watch our tongues…
Our bigger enemy here is injustice… to everyone involved (i.e. Christine; her loved ones; and her friends, many of them treated – even without proof – with prejudice). And how this injustice can be perpetuated even by those in positions of power. But just as important is for us to stay… united against these abuses. And part of this is not to become sources of, well, discrimination ourselves.
I was 28 the first time I was told I’m old. We were in a bar in Malate (the former gay capital of the City of Manila); and then – while partying with friends – this 21-year-old gay guy who was with a friend said: “You’re too old to be in a bar; yuck!”.
Ageism – which refers to prejudice or discrimination on the basis of age – is an issue in the LGBTQIA community. It is an issue that has been tackled repeatedly in the past; though, admittedly, perhaps not as much in the Philippines.
In 2009, for instance, Malcolm Sargeant published “Age discrimination, sexual orientation and gender identity: UK/US perspectives” in Equal Opportunities International”, which noted that LGBTQIA elders suffer from particular discrimination when compared to that suffered by elders in general, and heterosexual elders in particular.
It is, therefore, not surprising that elders have been calling for inclusion; something that Michael Adams, CEO of SAGE (an American organization dedicated to LGBTQ+ elders), said that should be tackled. “Over and over what we hear again from our elders is that they feel invisible and forgotten by the rest of the community, and that includes our younger people… And what we’ve seen is that it’s so powerful when older and younger people come together and engage as activists,” Adams was quoted as saying by Out.com.
These two points – ageism, and the need to dump it if we want to move forward TOGETHER – was re-emphasized to me after hearing from some of PNP’s suspects in the demise of Christine Dacera.
As FYI: Christine, a flight attendant, partied with mostly gay/bi friends during New Year’s Eve. She passed away on New Year’s Day; and the PNP has been “forcing” a narrative that she was “raped”, with a high-ranking policeman even claiming that when gay men get drunk, they “also become men”.
This one’s not to talk about PNP messing everything up; PNP’s assertion that “gay men are still men” (based on this antiquated misconception that “gay men are not ‘real’ men”); PNP’s erroneous belief that alcohol is a “cure” to being LGBTQIA (Hello, CBCP, send some my way!); and PNP’s insinuation that, yes, all men are rapists.
Instead, this is to focus on how “damage” can come from within the LGBTQIA community. And we really need to be aware of this; and even take steps to deal with this.
Now back to ageism and how this happens from within.
When ABS-CBN News interviewed some of the initial suspects (who were released when the court told PNP it, basically, didn’t do its job properly to pin these people down), one of them stated (off-handedly, if I may add; proceed to 56:25 in the YT video below) that they mingled with “mga bakla” in a separate room, but that this room had “matatanda/bakla na may mga edad na” so they may as well move to their room/a different room since “wala namang pogi dito eh“.
Discriminating may have been unintentional (ageism, and yes, lookism); but it’s still there.
The suspects’ names have been unnecessarily dragged by the PNP which committed errors after errors after errors when it dealt with this case – e.g. it prematurely declared the case “solved”; it claimed there was “rape” when the initial autopsy report did not back this claim; its key people even threatened that if the suspects did not willingly surrender, then they should expect the worse (and yes, we all know what THAT meant); and it basically prevented another autopsy from being done to the body when it had the body embalmed sans informing the family, etc.
Our bigger enemy here is injustice… to everyone involved (i.e. Christine; her loved ones; and her friends and acquaintances, many of them treated – even without proof – with prejudice). And how this injustice can be perpetuated even by those in positions of power.
But just as important is for us to stay… united against these abuses.
And part of this is not to become sources of, well, discrimination ourselves. Because how can we stand united if we discriminate against people we hope will actually support us (e.g. the LGBTQIA community as a whole, including the elders and, yes, the “not pogi“)?
So let’s be more self-aware as we start dealing with this…
About sex work (and prostitution) among Filipinos at the time of Covid-19
Various Facebook GCs (group chats) highlight how Covid-19 may have pushed many Filipinos into the sex industry. And yet – except in these GCs – this is largely ignored.
Facebook just prompted me to “join” three GCs (group chats) related to sex work (and even prostitution). One is for “mga lalaking bayaran“, another for masseurs with ES (extra service; the extra being the sexual favor), and another for “for hire daks Pinoys”.
These aren’t exclusive GCs, actually; and they aren’t new, either. Many others like them abound in Facebook (among other social networking sites).
But upon checking, what struck me with these GCs this time around is Covid-19’s effect/s on the (current) memberships. So many are in this because of desperation. For instance, it is not uncommon to see comments like: “Nawalan lang ng trabaho; sino gusto tumulong para may ipa-Pasko kaming mag-aama“; or “Para tulong lang sa online classes.”
This is another facet of the sex industry (and even prostitution) as exacerbated by the pandemic.
And this face – while at least tackled overseas – isn’t really openly discussed in the Philippines…
IN THE SHADOWS
Prostitution is illegal in the Philippines, this is worth stressing. Penalties vary, up to life imprisonment for those involved in trafficking (covered by the Anti-Trafficking in Persons Act of 2003).
No, the country doesn’t distinguish between sex work and prostitution; here, those in the sex industry are largely considered as in need of being “saved”. Not just the body, too; but also the “soul”.
But – get this – prostitution is actually openly tolerated – e.g. let’s stop pretending we don’t know what many GROs actually do; what masseurs offer when they say “E.S.”; and that there are local government units that give workers (of bars, spas, massage parlors, KTV bars, and so on) “pink cards” to guarantee that they are STI-free and are “sexually clean/safe”.
And really, except for the occasional “saving” of trafficked people (who are then turned over to the Department of Social Welfare and Development) we see in TV, the deafening silence on this is what’s remarkable.
This silence is… worrisome.
Particularly because this continues to happen; and yes (yet again), exacerbated by Covid-19.
What the GC members I’ve come across in Facebook are doing aren’t new, actually. The Philippines – dearies – isn’t excluded from the “oldest profession in the world.” This, obviously, includes male sex workers (befitting the handling of this topic here).
Consider that in 2003, the University of the Philippines’ Population Institute and Demographic Research and Development Foundation released the 2002 Young Adult Fertility and Sexuality Study (YAFS3) that noted that about 11% of sexually active young people aged 15-24 did it with someone of the same sex. Of this figure, 87% are men who have sex with men (MSM; meaning they may not self-identify as gay or bi, but have sex with other men).
Here’s what’s worth stressing in UP’s study: Almost half of those who had same-sex encounters also engaged in commercial sex. Approximately 19% paid for sex, while 11% received payment for sexual favors.
At that time, Dr. Corazon Raymundo, project coordinator of YAFS3, stated that it appears that in a fast changing world, the “usual norms and expectations do not hold true anymore.”
There are too many interconnected issues that should be considered here…
There’s poverty; and how this forces people to do things they may not otherwise do.
There’s the continuing lack of government support for its people; otherwise, those who do not want to sell themselves wouldn’t be forced to do so – e.g. selling oneself for “online classes”; because of loss of employment; etc.
There’s the pervasive ignorance re the sex industry; this is what leads to the abuse of those involved in it because – since they are considered illegal to begin with – they can’t even access State support if they are abused, etc.
There’s the impact of tech on the industry.
There’s the ongoing hypocrisy re this – e.g. church people want to “save” sex workers; but ask them to give these same people job in the church, and start counting how many reasons they can come up with just to (basically) say “No way!”.
There’s the continuing “punishment” of those in the sex industry; and yet… look at how the patrons get away with “buying” (e.g. the GCs in Facebook blatantly haggle with the service providers, demanding for the absurd while asking to lower the prices).
There’s the continuing ignoring of the sexual and reproductive health concerns of Filipinos.
There’s the silence re this; it’s staring us in the face, and we don’t even talk about this.
And on, and on, and on we go…
In the end, this needs to be tackled. No matter your angle” – e.g. because it inadvertently signifies the adverse effects of Covid-19 on poorer sectors of society; because it highlights government inaction/misaction; because it needs to be monitored as a health issue; because you’re self-righteous and you want to “save” them all; etc. – this shouldn’t, couldn’t be ignored. Covid-19 is re-emphasizing what was already there; and so please… just address this already…
Stop humanizing a killer
Being jailed is supposed to punish AND rehabilitate a person. In Pemberton’s case… this is arguable. So stop humanizing him. When so many of you can’t even treat the victim – Jennifer – as a human being.
By now, we all know that when Joseph Scott Pemberton – the American serviceman who murdered Filipino transgender woman Jennifer Laude in 2014 – returns to the US, he will go back to school. Oh, he plans to take up Philosophy. And while studying, he also wants to do sports – e.g. swimming.
These info were provided to us by news outlets; courtesy of the Filipino lawyer who’s been pushing for the convicted American killer, Pemberton, to be freed for his “good conduct”.
And – SERIOUSLY – this has to stop.
Fact: Pemberton killed Jennifer. In cold blood.
Fact: Pemberton considered Jennifer as less of a human, repeatedly referring to her as “it”.
Fact: When he was found guilty, Pemberton was jailed in the custodial facility of the Armed Forces of the Philippines (AFP). Not in Muntinlupa, but in an air-conditioned “jail”.
Fact: Whether Pemberton exhibited good conduct or not is hard to ascertain EXACTLY because of the special treatment he’s been getting. (Heck, his supposed handlers should all be fired for not documenting Pemberton’s movements!)
Fact: Pemberton’s camp only recently paid what the court told him to pay the Laudes.
Fact: As mentioned in the news, Pemberton doesn’t “mind” apologizing to the family of Jennifer… though only via a statement/press release.
Being jailed is supposed to punish AND rehabilitate a person.
In Pemberton’s case… this is arguable.
So stop humanizing him.
When so many of you can’t even treat the victim – Jennifer – as a human being.
In case you’ve (conveniently) forgotten, her life was cut short.
Pemberton shoved her head in the toilet bowl until she died by asphyxiation by drowning. He then escaped after committing the crime.
She was only 26 when Pemberton killed her.
She was a breadwinner of her family.
But she is now gone.
She won’t be able to go to college.
Or study Philosophy.
Or choose any sport to have fun.
And the person who killed her will live freely, even comfortably… and unapologetically.
Stop humanizing him; push to make him accountable for his crime.
Call a spade a spade: Deadnaming Jennifer Laude makes you a small-minded bigot
To simplify this argument: You all refer to – among others – Dolphy, Fernando Poe Jr., Nora Aunor, Gary V., Lorna Tolentino, Ogie Alcasid, Zsa Zsa Padilla, Aga Muhlach and Julia Montes with the names they chose for themselves. But when a trans person chooses a name for him or herself, you… refuse? It really just makes you a hater; and one who refuses to learn.
Jennifer Laude is, again, in the news. No thanks to the court-issued order to release her murderer, US Marine Lance Corporal Joseph Scott Pemberton, after staying in a special jail for only six years.
As FYI: Pemberton was initially sentenced to six to 12 years imprisonment by the Olongapo City Regional Trial Court (RTC), Branch 74, in December 2015. He was found guilty of murdering transgender woman Jennifer Laude.
Jennifer – who was only 26 years old at that time of her demise – was found with her head inside a toilet bowl in a room in Celzone Lodge in Olongapo City on October 11, 2014.
Pemberton himself admitted that he killed a “he-she.”
On September 1, the RTC said Pemberton already served a total accumulated time of 10 years, one month, and 10 days. This is including his Good Conduct Time Allowance (GCTA).
With the surfacing of this news is the deadnaming of Jennifer – e.g. by select media practitioners, haters of LGBTQIA people, and those claiming that they’re not haters/bigots but are only doing this because they’re using the “legal name” of the person.
As FYI: Deadnaming is when someone – whether intentionally or not – refers a transgender person with the name given them at birth.
And as another FYI: It’s wrong.
Let’s get this out there once and for all.
And enough already.
That this has to stop not just because it’s “PC” (politically correct). Deadnaming degrades and even erases a person – his or her life, agency, etc. At its very core is the individual’s right to determine who he/she is. And when you deadname, you basically refuse to respect this; you decide for the person because it’s what “comfortable” for you and your warped way of thinking.
This doesn’t make you “respectful” of the law (for those who say they’re “just” sticking to “legal names”).
This doesn’t make you “not hateful of the LGBTQIA community” (for those who may use this excuse, usually added with: “I can’t be anti-LGBTQIA because I know someone who’s LGBTQIA”).
This doesn’t make you “right” either.
It really just makes you a hater.
And for those who are well-read or actually know about this, it also makes you a hater who just refuses to learn.
To simplify this argument: You all refer to – among others – Dolphy, Fernando Poe Jr., Nora Aunor, Gary V., Lorna Tolentino, Ogie Alcasid, Zsa Zsa Padilla, Aga Muhlach and Julia Montes with the names they chose for themselves.
You all refer to Pope Francis as such; and you all know that’s not the name given him at birth.
You all call Lady Gaga, Katy Perry, Madonna, P!nk, Bruno Mars, Gigi Hadid, Natalie Portman, Demi Moore, Joaquin Phoenix, Emma Stone, Prince Harry, Brad Pitt, Lorde, Miley Cyrus, Nicky Minaj, John Legend and Ludacris with the names they chose for themselves.
But when a trans person chooses a name for him or herself, you… refuse?
So let’s call a spade a spade: Deadnaming makes you a small-minded bigot.
At what cost? HIV service disruptions at the time of Covid-19
One of the biggest casualties of Covid-19 may be the delivery of other services, such as HIV testing. In the Philippines, HIV prevention services were reduced by 20% to 30%, and HIV testing services reduced by 20% to 80%. And sans clear B&W guidelines, community-based service providers continue to be at a loss.
Ashley Galvinez, board member of the Sta. Catalina Active LGBT Organization in Zamboanga in Mindanao, used to get screened for HIV every month (to every three months). “I’ve been doing this since I became sexually active,” she said to Outrage Magazine via video interview.
But then the world was struck by Covid-19, and the country was placed under lockdown. And this already-regular part of her health monitoring was stopped.
“Kaya sa bahay na lang muna; tiis-ganda,” she said, adding that she was still scared she could get infected with HIV or get sexually-transmitted infections.
The fear of Galvinez isn’t unfounded.
This May, UNAIDS noted with the World Health Organization (WHO) “the need for urgent efforts to ensure the continuity of HIV prevention and treatment services in order to avert excess HIV-related deaths and to prevent increases in HIV incidence during the COVID-19 pandemic. It will be important for countries to prioritize shoring up supply chains and ensuring that people already on treatment are able to stay on treatment, including by adopting or reinforcing policies such as multimonth dispensing of antiretroviral therapy in order to reduce requirements to access health-care facilities for routine maintenance, reducing the burden on overwhelmed health-care systems.”
“Every death is a tragedy,” said Winifred Byanyima, executive director of UNAIDS. “We cannot sit by and allow hundreds of thousands of people, many of them young, to die needless deaths.”
This is in no way limited to the Philippines, too.
UNAIDS similarly noted that “if efforts are not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500,000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021.”
In 2018, approximately 470,000 people died of AIDS-related deaths in that region.
“The terrible prospect of half a million more people in Africa dying of AIDS-related illnesses is like stepping back into history,” Dr. Tedros Adhanom Ghebreyesus, WHO Director General was quoted as saying. “We must read this as a wake-up call to countries to identify ways to sustain all vital health services.”
To be specific, disrupted HIV-related services could include:
- Difficulty in accessing antiretroviral medicines
- Reduced quality clinical care owing to health facilities becoming overstretched
- Suspension of viral load testing
- Reduced adherence counseling and drug regimen switches
- Interruption of condom availability
- Suspension of HIV testing
ALSO IN NEED OF FOCUS
According to Ms Jaya L. Jaud, community HIV outreach worker for the Zamboanga City-based Mujer LGBTQ+ Org., HIV is also a pandemic, and this is something “na dapat ding tutukan.”
Jaud added that there is a need to face reality that HIV cases are increasing in the Philippines.
From October to December 2019, there were 3,029 newly confirmed HIV-positive individuals reported to the HIV/ AIDS & ART Registry of the Philippines (HARP). Sixteen percent (474) had clinical manifestations of advanced HIV infection at the time of testing.
By end-2019, the country was registering 35 new HIV infections per day, up from only one case per day in 2008, seven in 2011, and 16 in 2014.
EMPHASIS ON COVID-19
In Antipolo at the outskirts of Metro Manila, Darwin Tenoria, case manager at Antipolo Social Hygiene Clinic, said that they are already trying to return their HIV-related services to how they were before Covid-19.
“It doesn’t mean that our (HIV-related) services stopped,” he said, but these services were instead only modified. For instance, the actual HIV testing is the same (e.g. blood extraction, et cetera); but the pre- and post-test counseling were amended (via installation of dividers, practice of social distancing, as well as use of face shields and/or masks) so that the counselor and the client are protected.
But at least, Tenoria said, “we have some foot traffic.”
HALTED COMMUNITY-BASED SCREENING
Tenoria, at least, works in a health facility.
But – as far as HIV testing and/or screening is concerned – it is the community-based screening (CBS) that has been greatly affected, many actually stalled.
CBS is the HIV screening process done by the likes of Jaud, wherein a volunteer/screener goes to communities to offer HIV testing and screening. This is particularly beneficial to those who live far from a testing facility or those who may not have the time to visit a testing facility.
In idea, this seems like a good idea particularly at the time of Covid-19 because the lockdowns meant people have no means to access health facilities.
But according to Gregory Rugay from the CBS team of Northern Sanctuary MCC in Baguio City, “screening itself has totally stopped at the moment.”
Instead, the focus has been to link to treatment, care and support those who have tested reactive or positive before Covid-19 lockdowns.
“It is kind of tricky,” Rugay said, “because those who have been calling us, wanting to be tested right away, are people who have symptoms (akin to Covid-19) like fever, colds… and difficulty of breathing. With the pandemic going on, you are at a loss on how to treat this kind of issue because their symptoms can also point to (having) Covid-19.”
WANTED: COMMUNITY-BASED SERVICE PROVIDERS
Rugay’s fear has merit… even if, obviously, the services he used to be able to freely offer is still needed.
On May 18, UNAIDS stated that “the role of community-led organizations must be appropriately recognized and supported in the context of COVID-19. They must be factored into all aspects of planning, design and implementation of interventions to combat both COVID-19 and the efforts required to mitigate the impact of COVID-19 on other health areas, including HIV and tuberculosis.”
And so UNAIDS recommended, among others:
- Including community-led health care service providers into lists of essential service providers
- Policies allowing community-led services to continue operating safely
- Ensure that community-led organizations are provided with personal protective equipment and training to protect them and their clients in service delivery
LACK OF CLARITY?
In terms of CBS, “they do not have specific guidelines,” Tenoria said. “There’s no clear guideline on how to mobilize CBS.”
This is even if three months have passed since the Covid-19 lockdown has started.
Jaud agrees, saying that “there’s no protocol – e.g. in using personal protective equipment (PPE).” What happens now is – at least in her case – they rely on the practices of the city health office, as well as the practices of NGOs.
Still waxing positive, Jaud said that the Department of Health (DOH) may have not focused on this because – obviously – Covid-19 was the focus for a while, and because there may have been this assumption that because there are a lot of NGOs/CBOs in this field already, they may already know what to do.
In Baguio, Rugay himself was told by someone offering CBS that CBS is actually stalled.
He admitted, though, that he can’t imagine himself offering CBS now particularly if doing so would mean he would be exposing himself to Covid-19, and thereby exposing his loved ones to the same when he returns home.
Tenoria said that “perhaps we need (something written in black and white), on what will be the direction (under) the ‘new normal’.”
He admitted that there were shortcomings particularly when the country – and the world – was initially responding to Covid-19. “Medyo napag-iwanan talaga yung HIV program.”
But now, there ought to be guidelines (beyond the initial one developed by DOH, though that one only focused on accessing antiretroviral medicines). For Tenoria, clearer guidelines will also provide clarity to both service providers and those accessing the services particularly as these may align protocols.
HIV BOOM ABOUT TO HAPPEN?
As it is, all lung-related cases in Antipolo are now considered as suspected Covid-19 cases, said Tenoria.
This is worth noting because tuberculosis (TB), for instance, is an opportunistic infection (OI); and it occurs more often/more severe in people with weakened immune systems (like someone with HIV).
So even if a person with HIV who may not have Covid-19 may have lung-related issues, he/she is required to be isolated. This, then, leads to another (and related) issue: The limited capacity of health facilities in the Philippines.
Tenoria admitted as much, saying that looking for facilities for PLHIVs is harder because isolation rooms are being dedicated to Covid-19 patients.
Of course: Those who test reactive but who have no OIs are luckier, as they are automatically enrolled into the system so they can immediately access ARVs.
For Rugay, “at this moment, there’s nothing we can do for (PLHIVs whose detection is late).” But for him, what the HIV arm of DOH should do is “step up in preparing itself for (a possibility of a) barrage of late detections once they figure out how we do screenings again. Are they prepared/equipped to have all those patients come in?”
FROM THE D.O.H.
A June 10 letter signed by Usec. Dr. Myrna Cabotaje from Department of Health (DOH) to Outrage Magazine noted the impact of Covid-19 on HIV program implementation. Specifically: Prevention services were reduced by 20% to 30%; HIV testing services reduced by 20% to 80%; viral load testing reduced by 42%; and ARV refill services reduced by 5%.
These impacts were due to: geographic concerns, transportation issues and strict checkpoints.
As Tenoria already noted, a guideline was actually developed by DOH. But its main focus was on PLHIVs (particularly, access to ARVs by those already diagnosed to have HIV), and not on those who have yet to be tested.
But Cabotaje’s letter stated that data from HARP for January-March 2020 shows 552 new HIV cases. Meaning, according to HARP, “HIV testing, mostly facility-based, were still provided.”
For January-March 2020, 682 PLHIVs were also initiated on ART.
Asked about protocols re HIV testing, DOH stated that “at this point, HIV testing protocol based on current capacity of both the government and CBOs is centered on ether facility-based testing or community-based HIV screening. Our current HIV projects, e.g. Global Fund HIV grant, thru Save the Children, provided essential PPE to our field workers for them to continue performing their prevention and testing work.”
The likes of Jaud in Zamboanga and Rugay in Baguio are, obviously, not recipients of the aforementioned PPEs.
Moving forward, DOH is also looking at self-screening as an approach to HIV testing, although “the country is still currently testing this approach in a limited manner.”
No timelines were mentioned in the letter.
Exactly because HIV-related efforts seemed to have relied on localized practices, some good practices have emerged.
In Naga City, for instance, Tenoria noted that HIV testing is offered with Covid-19 testing.
Still in Zamboanga, when goods are distributed, safer sex kits are included.
And still in Zamboanga, Jaud started tapping clients online; and this is even if this effort remains limiting because not everyone is active online.
“It’s difficult because gatherings of a big number of people are not allowed,” said Jaud. Her target population – i.e. transgender women in Zamboanga – frequently avail of HIV screening when they have gatherings. But now, “tapping social media has been helpful.”
Worth noting is how this immediately limits Jaud’s service delivery – i.e. because she know of the risks related to Covid-19, the clients she now serves are limited to people she knows/are friends with.
PROGRAMS STILL NEED TO CONTINUE
In the end, Tenoria said that people in power hopefully realize that there are still programs that need to be run. “Just as we say in HIV (advocacy), ‘No one should be left behind’.”
This is because sans the needed support, Rugay said people involved in CBS are limited. And so he urges those who want to get tested to, instead, go to health facilities, particularly if they may also have symptoms linked with Covid-19.
“Konting pasensya lang sana,” he said, until “we have clear protocols and figure it out how to make it safe for everyone concerned.”
“We (still) encourage everyone to get tested for HIV,” Tenoria said. But those who want to get tested will have to coordinate first with health facilities to schedule testing. Still, this “should not be a hindrance for you to access services (even during this pandemic).”
For Jaud, “we have to capacitate outreach workers (like myself)”. This may be via supplying with gears (e.g. PPE), training, and – yet again – laying down of protocols to use.
Back in Zamboanga, Galvinez said that government offices should give attention to community-based health workers like Jaud, who’s also “a frontliner. They’re ready to help, and serve the community.”
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