Some time back, Kurt (a.k.a. @MoanerBottom) opened a Twitter account as a form of revenge. “I found out that my ex had an ‘alter’ account and he was fooling around with different people,” he recalled. And so “I wanted to prove to him that I can also do the same thing.”

Little did Kurt know at that time that he would become a mainstay in the alter world/community. A few months since opening his own alter account, he garnered over 130,000 followers, all of them craving – and even waiting – for what he would post, usually dominated by sexual encounters (“kalat videos,” he calls them) with mostly students, including a basketball varsitarian “who likes to penetrate deeply”, a Blue Eagle who allowed for his orgasm to be videoed, a Tamaraw who also allowed himself to be videoed as he orgasmed, and bending for a Red Lion.

“I must admit that I am a shy person in real life,” Kurt said. But “here in Twitter, it is like I have less shame and more courage to do kalat (contextually: shameless) posts and videos.”

Kurt is, obviously, only one of the people – not just Filipinos – with alter accounts, which many like him, say is similar to a “pseudonym — like Batman to Bruce Wayne, or Superman to Clark Kent; where people can have a separate account from their primary accounts, usually used to express themselves more ‘wildly’ yet more ‘discreetly’/anonymously.”

And so welcome to the alter world, where people tweet and retweet their or other people’s sexual “collaborations”, hookups, fetishes, fantasies and social engagements, with the audiences often never really knowing the content generators/producers/distributors.

Getting noticed

That the alter world is often dominated by sexual content is a given.

Onin (a.k.a. @Onin_NuezPH), for example, sees his alter account “as an avenue for me to express myself and my sexuality. I am able to let everyone know within the community about my sexual desires without the fear of being judged.”

Looking back, it was actually “a friend who is an alter too introduced me in this alter community,” Onin said.

One of the early instances Onin trended was when some of his nude photos circulated on Twitter. Many got curious, asking the person who previously reacted or shared the photos if there were more.

It whetted Onin’s interest; and so he started posting more photos and short videos. His followers quickly increased, reaching more than 145,000.

Taking pride that he is one of the more talked about alters out there, Onin has produced content that may seem trivial… but these have been keeping the alter community and lurkers interested, from balancing a shampoo bottle on top of his erect penis, sharing a photo of his endowment while asking his followers if they want to kneel in front him, a comparison of the length of a deodorant spray with his penis, wearing a see-through underwear, and teasing his latest sexual collaboration.

Standing out

Standing out in a platform where hundreds (even thousands) of alters saturate news feeds is a challenge. After all, it is not an easy feat to attract someone’s attention — what more to make them like, share, or follow an account.

For FUCKER Daddy (a.k.a. @ako_daddy), therefore, it all comes down to the type of content being posted, not just being well-endowed, willing to perform bareback sex, or how often the face is shown.

A licensed professional who has a son, FUCKER Daddy started as a “lurker’ (i.e. one who lurks, or just consumes content/views profiles) on Twitter. At that time, he wrote “my real-life sex stories, hoping it will pick up from there,” he recalled. “Unfortunately, alter peeps seem to be more into live action.”

And so FUCKER Daddy met someone from Telegram, without realizing that the person was “sort of (a) big (personality) on Twitter.” This guy discretely took a short clip of their sexual encounter, and then posted it on his alter account. “It was hit. (And) the rest is history.”

By August 2019, FUCKER Daddy said his inbox started receiving direct messages from different users – e.g. asking for more, congratulating him, wanting to collaborate, and so on.

He actually now has several sex videos in his cam. But he still doesn’t make recording the primary thing when engaging in sex “as my goal is to have hookups; videos are only secondary.”

Besides, he said that “I do not want to spoil the moment for sex and think only of it as merely for Twitter.”

But every time FUCKER Daddy posts a video, he said his over 95,000 followers respond to them “with enthusiasm, getting more curious and intrigued.”

Making a living

The concept of alter, however, isn’t set in stone.

For one, there are actually alter accounts whose owners prefer to use their real names and show their faces (like Onin), mixing their personal and private lives along the way. Following the Batman/Bruce Wayne and Superman/Clark Kent analogy, there are also people who follow the Tony Stark/Iron Man mantra, i.e. openly announcing that they are one and the same.

Secondly, monetizing is actually possible.

Also, one may be part of the alter community without knowing it – i.e. one engages in alter activities without recognizing it as such.

The likes of John (a.k.a. @johnnephelim on Twitter and Instagram), who has over 130,000 followers, comes to mind, using Twitter as a platform “to promote a job.”

“I do not even know that I am involved in the world of alter,” John said, adding that he did not even know what the term meant until it was presented to him. Instead, his account is used to “promote my RentMen and OnlyFans accounts”, just as he also promotes his availability for “personal appointment to people.”

John actually used to work as a brand ambassador, but because of this change in his work, he “can no longer work (in) that (field) because I am doing porn.”

He admitted that “this type of thing is double-edged.” On the one hand, “you can earn a great amount of money,” he said, “but there will be sacrifices.”

He noted, for instance, that the perception of people about me changed; most people judge you right away because of what you do, and not because of who you are as a person.”

But he ignores the naysayers; “I do not mind because this job gives more than what I expected!”

Like John, Onin also promotes his JustFor.Fans (JFF) account on Twitter to respond to the requests of his followers.

“They (my followers) want to see me in action and they are willing to subscribe too,” Onin said, with his exclusive content including: he and his partner having sex, and collaborations with other alters. “You will not earn that much, but pretty enough to compensate for the contents that we are posting.”

Not all alters think alike, obviously. FUCKER Daddy, for instance, won’t monetize his content, saying: “I value sex as it was created. I never sell any (videos) because I think it is something that is worth free. I simply treated it as making memories while those (who) watch put up the numbers.”

Behind the handles

The world of alter has actually already caught the attention of researchers.

For instance, in a study by Samuel Piamonte of the Philippine Council for Health Research and Development, Mark Quintos of De La Salle University Manila, and Minami Iwayama of Polytechnic University of the Philippines, it was found that the alter community may seem overtly sexual, but there is more to it than that.
“The sexual aspect of alter is the core of alter, but it has been enriched by more complex social benefits to users such as including formation of new friendships, sharing of information and advocacies, reciprocations of emotional support, and provision of a ‘safe space’ for those who wish to express their sexuality but find that doing so outside of the alter community could be met with stigma from their peers and family.”

Kurt sees his alter account as an avenue for him to tap his inner self and show the Twitter universe his kalat. Onin uses his alter account to broadcast his sexual side (together with his partner). And FUCKER Daddy uses his alter account as “a constant source of info, hookups, convo… and to learn social demographics as well.”

The evolution, indeed, continues.

Hate from within the community

Yes, yes, yes… with increasing numbers of followers, multiple likes and shares, and the creation of alter “celebrities”, this has not been spared from criticisms.

And sadly, said Kurt, at least in the Philippine setting, the prejudice against alters comes from within the community. “Kapuwa LGBT ang nagsisiraan at nagpapataasan sa isa’t-isa,” he said. “I know… that I cannot please everyone (but) for me it is okay, as long as I know that I am not doing anything wrong.”

Perhaps a “surprise” is the audience’s inability to “appreciate” the free content given them, with Kurt noting that there are times when “they are also pissed off with the things I post.”

This seems to contradict the findings of Piamonte, Quintos and Iwayama, since – here – the alter community can become a fearful place, too.

John, like Kurt, noted how people resort to demeaning others when they do not fit preconceived notions. But he just laughs this off, saying: “Do not hate me because I look good and make money (from) it. Life is too short to be a bitter person. If you do not like what we do, then shut the fuck up.”

The Pandora’s box, so to speak has been opened; and lessons learned along the way can just “make you stronger and bring out the best in you,” said Onin, who like many alters, “just focus on my goals.” And it is exactly because of the existence of this interchange – the content creation, and the love-hate reaction to what’s created – that alter is not going to disappear anytime soon (or at all).

Details and photos of sexual encounters were lifted from the Twitter accounts of the interviewees.

The rainbow rises in Zamboanga City.

The 1st class highly urbanized city in the Zamboanga Peninsula of the Philippines, Zamboanga, joins the growing number of local government units (LGUs) that now has an anti-discrimination ordinance (ADO).

As helmed by Hon. Lilibeth Macrohon Nuño, the ADO passed the third and final reading at the Sangguniang Panglunsod of the City of Zamboanga on October 6.

The ADO is actually not only specific to sexual orientation and gender identity and expression. Instead, it is a more comprehensive ADO that also prohibits discrimination based on race, color, civil and social status, language, religion, national or social origin, culture and ethnicity, property, birth or age, disability and health status, creed and ideological beliefs, and physical appearance.

The ADO now goes to the desk of Mayor Maria Isabelle Climaco-Salazar for signing.

As the sixth most populous and third largest city by land area in the Philippines, Zamboanga has a population of 861,799 people (as of 2015). The ADO was pushed by local LGBTQIA organization, Mujer-LGBT Organization Inc.

MUJER-LGBT Organization: Confronting LGBT-related stigma and discrimination in Zamboanga

A not-so-comprehensive anti-discrimination bill after all.

A proposed “Comprehensive (sic) Anti-Discrimination Act” is being considered in the House of Representatives (HOR), though the bill eliminates LGBTQIA people among those in need of protection.

In a virtual meeting of the technical working group of the Committee on Human Rights of HOR, Rep. Jesus Suntay presented “An act prohibiting discrimination on the basis of ethnicity, race, religion or belief, sex, gender, language, disability, HIV status, educational attainment and other forms of discrimination”.

“If you eliminate SOGIE, you can’t call it ‘Comprehensive ADB’. It’s an oxymoron.”

Rep. Geraldine Roman

Another proposed bill, the SOGIE Equality Bill, is getting criticized because it is supposed to be limited to a specific class of people – i.e. LGBTQIA people. And so there is a proposal for it to be included, instead, in the more and supposedly comprehensive anti-discrimination bill (CADB).

Those opposing SOGIE Equality Bill claim to be ‘pro-human rights’… but not for LGBTQIA people

According to Rep. Bienvenido Abante Jr., himself a pastor cum politician: “We are trying to avoid approving any bill that would be classified as class legislation… This is why it is CADB.”

Abante – nonetheless – believes in the inclusion of sexual orientation in the CADB, just not gender identity and expression.

However, the move to exclude “discrimination based on sexual orientation, gender identity and gender expression” from the CADB is a win for anti-LGBTQIA people by eliminating SOGIE Equality Bill and then excluding LGBTQIA people from the CADB.

According to Rep. Geraldine Roman, the first transgender congressperson in the Philippines: “If you eliminate SOGIE, you can’t call it ‘Comprehensive ADB’. It’s an oxymoron.”

The proposed bill also removes SOGIE in Sec. 2: Declaration of Policy, and in the definition of terms.

Defending the erasure of SOGIE in the bill he presented, Suntay said that there are already 15 SOGIE-related bills filed with the Committee on Women. For him, if SOGIE is also included in the CADB, it “may be deemed also as SOGIE Equality Bill.”

But Roman does not agree with this.

That argument, she said, “is totally irrelevant… By eliminating SOGIE (in the CADB), it contradicts the very claim that it’s CADB. By eliminating us, you are discriminating against us.”

Roman added: “We have to be brave enough and recognize that there is discrimination happening against people like me who has a gender identity that is considered as different from what’s considered as conventional.”

Suntay noted that an anti-discrimination bill has been passed since the 13th Congress; and he hopes to eventually “steer this to success”, apparently even with LGBTQIA exclusion.

WRITE TO, OR CONTACT THE OFFICE OF REP. JESUS SUNTAY. INFORM HIM OF THE NEED TO KEEP SOGIE IN THE COMPREHENSIVE ANTI-DISCRIMINATION BILL.
FB Page: https://www.facebook.com/congsuntay/
Email provided in FB: congressmansuntay@gmail.com
Mobile no.: 09190847873

Different parties opposing the passage of the SOGIE Equality Bill frame themselves – and their arguments – as “for equality” and “for human rights for all”, but stress all the same that they do not support granting LGBTQIA people human rights because any anti-discrimination law will grant LGBTQIA people “special rights”.

This – along with the imposition of religious beliefs – was repeatedly stressed during the August 28 virtual hearing on the SOGIE Equality Bill of the Committee on Women & Gender Equality of the House of Representatives.

SOGIE Equality Bill filed anew in 18th Congress

Rep. Benny Abante of Manila’s 6th district, for one, stated that “the LGBTI are human beings like all of us… I might not agree with their lifestyle (sic), but I will defend their rights to express themselves.”

But while he stated that “nobody in this country is a second-class citizen,” he reiterated his “refusal to be included as a co-author (of the SOGIE Equality Bill) does not speak of opposition” to it. Instead, it is to uphold what’s in the bible.

Abante also misgendered Rep. Geraldine Roman of Bataan’s First District, referring to the first transgender woman to win a seat in Congress as “congressman” and using the male pronoun “him”. Roman is a co-chair of the Committee on Women & Gender Equality.

Abante’s position was similar to many others who spoke at the virtual hearing.

Stanley Clyde Flores of Jesus is Lord (JIL) religious group stated: “Hindi kami bulag sa katotohanan na maraming miyembro (ng LGBTQIA community) ang nakakaranas ng diskriminasyon.” But JIL does not support the SOGIE Equality Bill because “it rids others of their rights.”

In fact, JIL believes that “God gave gender”, and the fringe religious group believes that members of the LGBTQIA community who want to “welcome God and change their gender” should do so.

JIL’s anti-LGBTQIA position was established by its founder turned politician, Rep. Eddie Villanueva, his position itself a slight on the concept of the separation of Church and State.

Jesus Is Lord Church founder cum politician claims SOGIE Equality Bill will only promote ‘special’ rights

Presbyterian Sec. Gen. Nelson Dangan similarly stated the church’s supposed support for non-discrimination. But Dangan stressed that the anti-discrimination bill “supports approval of homosexual behavior”, assaults the truth of Biblical sexuality, does not focus on procreation as human’s key reason for existence, and is “anti-God because God opposes homosexuality.”

Dangan also refuted the existence of intersex people because the word does not exist in his bible.

“Philippines will be like Sodom and Gomorrah if we pass (this bill),” he said, also insinuating that Covid-19 is a wrath of God and that passing a law for the human rights of LGBTQIA people will further anger this God. “We respect all people created by God… but we oppose this bill… because we violate the will of God and invite the wrath of God.”

GOD’S NAME IN VAIN?

Bishop Leo Alconga, the national president of the Philippines For Jesus Movement, similarly stated that they stand “against any form of discrimination”, but that God does not agree with this, quoting an antiquated Catholic perspective that homosexuality is “an act of great depravity”.

Alconga similarly linked the SOGIE Equality Bill with marriage equality, which is not at all part of the bill.

For Bro. Ramon Orosa of Philippines For Jesus Movement, one of the most notorious sins in the scripture is homosexuality and lesbianism. And for him, “the question is not whether they exist, but not giving in to them.” Using the punitive Old Testament God, he said that “God is not tolerant of any sin.”

Orosa also said that “this is being imposed on everybody else” and that “we will be discriminated upon if we disagree.”

For Iglesia ni Cristo’s Edwil Zabala, everyone is entitled to all human rights. But for him, SOGIE is “not a fundamental right” and does not even exist. Like the others, he said that laws should not be made to favor select/special beneficiaries.

HATE FROM GOV’T BODIES?

But church people were not the only parties opposing the SOGIE Equality Bill.

From the side of the government, for instance, Department of Interior and Local Government (DILG) Usec. RJ Echiverri echoed the right-wing religious perspective. After claiming he, too, is against discrimination and the provision of equal opportunity for everybody, he questioned if the proposed law will give special rights to others.

Echiverri also had issues with trans women joining competitions for those assigned female at birth; as well as the “blurring of identities”.

Meanwhile, an Armed Forces of the Philippines (AFP) resource person stated that while AFP – as a government institution – does not discriminate, it also “does not support protection of special groups at the expense of others.”

HATE HIGHLIGHTS NEED FOR THE LAW

But other parties also expressed their support for the passage of a law that has been pending in Congress for 20 years now.

Philippine National Police (PNP) head of PNP Women and Children Protection Center (WCPC), Colonel Alessandro Abella, for instance said that they support upholding the rights of all people irrespective of SOGIESC. However, the PNP position that Abella read at the hearing, which is contrary to AFP’s, has yet to be officially vetted by his higher ups.

Still, he said, PNP is lobbying to rename WCPC to “Women, Children and Gender Rights Protection” as it’s more generic and will cover all forms of gender-based violence.

PNP’s recruitment process at present is already SOGIESC-sensitive, focusing on “merit and fitness”, he said, so “PNP supports this.”

Clarifications given on SOGIE Equality Bill; focus on ‘facts over fake news’ pushed

Other government officials who also expressed support were Esmeralda Amora-Ladra from Commission on Elections; Sandy Montano of the Philippine Commission on Women; Elizabeth Angsioco of the Department of Social Welfare and Development; and Paul Moreno of the Bureau of Jail Management and Penology.

For Prof. Evelyn “Leo” Batad of UP GLLP, this is a long overdue law that “recognizes the long-standing struggle of people due to their SOGIESC.”

The 1987 Philippine Constitution, in fact, stipulates the value the dignity of all human persons. But the country does not have executory laws for this; and so “a legislation providing for the protection of people with diverse SOGIESC is overdue.”

Batad added that “religion is not meant to support specific beliefs”, and that “morality referred to in law is public and secular, not religious.” The Supreme Court already stated that if the government relies on religious beliefs in the making of laws, then this will require conformity in particular religious programs and the concept of morality of those managing them. This – by itself – becomes an imposition, which violates the very concept of freedom of religious affiliation by making some more dominant than others.

“We cannot impose religious beliefs on others,” Batad said. “Religious belief is distinct from what is spiritual.”

LGBTQIA PEOPLE EXIST

Rep. Roman, for her part, said that “you cannot treat the Bible like a science book.” For instance, the intersex condition is a biological fact; so citing the bible to question the existence of intersex bible is erroneous.

“As St. Agustine said: If you want to convince other people, you cannot ignore empirical data,” she said.

Roman helped push the SOGIE Equality Bill’s passage in 2017, when the bill got the nod of 198 congresspeople, with none opposing it.

SOGIE Equality Bill passes House of Representatives

“Despite the promise of equality, vulnerable groups are still discriminated,” said Rainbow Rights Project Inc.’s Atty. Jazz Tamayo. “Must we undergo discrimination before we (are able to) access the law? The State needs to (deal with) this.”

For her part, Lagablab Network’s Atty. Claire de Leon said that “discrimination still persists”, with LGBTQIA students refused entry to schools, LGBTQIA people excluded from social support, and the prevalence of workplace discrimination due to people’s SOGIESC, among others. “LGBTQIA people remain vulnerable,” and this ought to push for the passage of the SOGIE Equality Bill that has been wallowing “for over 20 years now.”

Constant rainbow support?

While people in the Asia-Pacific region continue to show little consensus on the subject, at least 73% of Filipinos surveyed say homosexuality should be accepted. This is the same figure as the one reported by a similar survey conducted in 2013, making the Philippines the only participant country that did not change its perception from 2013 to 2019.

This is according to a new Pew Research Center report conducted in 2019 involving 38,426 people in 34 countries. This is a follow-up study to the one made in 2013.

To ask them how they perceived homosexuality, the participants were asked: “Which one of these comes closer to your opinion? ‘Homosexuality should be accepted by society,’ or ‘Homosexuality should not be accepted by society.'”

People who said they don’t accept homosexuality was pegged at 24% (versus 26% in 2013).

Among the countries surveyed in the whole of Asia (i.e. India, Indonesia, Japan, Philippines and South Korea), the Philippines had the highest number of respondents who said they were accepting of homosexuality.

But countries in Asia-Pacific (and Oceania) showed extreme results – e.g. aside from the Philippines’ 73%, more than three-quarters of those surveyed in Australia (81%) say homosexuality should be accepted, but only 9% of Indonesians agree.

According to Pew Research Center, the survey shows that “while majorities in 16 of the 34 countries surveyed say homosexuality should be accepted by society, global divides remain.”

Mimicking the figures from APAC (and Oceania), other parts of the world also highlighted this global divide re homosexuality – e.g. 94% of those surveyed in Sweden say homosexuality should be accepted, but only 7% of people in Nigeria say the same.

Now, if it’s any consolation, across the 34 countries surveyed, a median of 52% agree that homosexuality should be accepted (versus 38% opposing it).

Other findings include:

• In 17 years, Pew Research Center found that many of the countries surveyed showed a double-digit increase in acceptance of homosexuality, such as in the cases of South Africa and South Korea.
• Those in Western Europe and the Americas were found to be more accepting than those in Eastern Europe, Russia, Ukraine, the Middle East, and sub-Saharan Africa.
• At least for a number of countries, more women than men support homosexuality.
• Younger generations were found to be more accepting. In 22 of 34 countries surveyed, younger adults are significantly more likely than their older counterparts to say homosexuality should be accepted by society.
• In most countries surveyed, those who have greater levels of education are more likely to say that homosexuality should be accepted in society than those who have less education.
• Religion plays a role in the response of those surveyed (e.g. in some countries, those who are affiliated with a religious group tend to be less accepting of homosexuality than those who are unaffiliated). As per the research, in most cases, the affiliated comparison group is made up of Christians; and yet “even among Christians, Catholics are more likely to accept homosexuality than Protestants and evangelicals in many countries with enough adherents for analysis.”
• Political ideology plays a role in acceptance of homosexuality (i.e. those on the political right are less accepting of homosexuality than those on the left).
• Attitudes on this issue are strongly correlated with a country’s wealth (i.e. people in wealthier and more developed economies are more accepting of homosexuality than are those in less wealthy and developed economies) – e.g. in Israel, 52% of higher income earners say homosexuality is acceptable in society versus only three-in-ten of lower income earners.

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.

PLHIVs battle access to meds during quarantine

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?”

Living with HIV at the time of Covid-19 lockdown

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.

GOOD PRACTICES

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.”