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This disconnect is heartbreaking…

Michael David C. Tan notes that while the use of PEP is already common overseas, just as the use of PrEP is gaining ground, in countries like the Philippines, these are not even discussed. “It’s almost as if – by not making available in developing countries life-saving medications that are already READILY AVAILABLE in Western countries – we’re basically letting people there die. It’s as if our lives as non-Westerners don’t matter,” he writes.

This is part of the author’s LGBTQIA encounters in New York City (and beyond), where he is a State Department Fellow/Community Solutions Leader of the 2014 Community Solutions Program (CSP), a program of the Bureau of Educational and Cultural Affairs of the United States Department of State, and implemented by IREX.

“Mick. Emergency.”

That was the message that woke me up, as it popped up in my Facebook Messenger at 4:30AM. I was half asleep in New York when I grabbed my phone, recognizing fully well that the friend who sent the message – knowing of the time difference (12 hours – they’re ahead, we’re late) – may be in a tight spot, and when in dire situations, we understandably reach out to as many people as we can.

Then she continued: “Would you know where I can get post-exposure prophylaxis (PEP)?”

PEP is a “short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure, either occupationally or through sexual intercourse”. PEP, by the way, “must be started as soon as possible to be effective — and always within three days of a possible exposure.”

I was… stumped.

Because in the Philippines, PEP is NOT AVAILABLE.

And because I am halfway across the world, all I could do was link her with people who may be able to help – though, as one of them told me when I explained the situation, PEP may be available in the Philippines ONLY for medical practitioners who may have inadvertently put themselves at risk for HIV infection.

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In other words, for common tao/people, YOU’RE FUCKED (excuse the language)!

Unless of course you’re moneyed and can fly out of the country ASAP to get PEP.

And this just breaks my heart.

As soon as I arrived in the US last August, and – more particularly – as soon as I became part of the LGBT community here, I noted that one of the issues that continues to be discussed is the rollout of PrEP (pre-exposure prophylaxis), i.e. the “use of an antiretroviral medication to prevent the acquisition of HIV infection by uninfected persons”.

PEP is already commonplace; but the use of PrEP is just gaining ground.

Not many hate on the idea of PEP. After all, and supposedly, the idea is: You didn’t mean to put yourself at risk (e.g. you use protections, like condoms, but it broke). But so many still question PrEP (e.g. it promotes unsafe sexual practices, since now, barebackers can go at it again; and how pharmaceutical companies are ending up as the biggest winners, since non-HIV positive people will then be ‘forced’ to take drugs for life) – so much so that the likes of Advocate had to allocate spaces after spaces to “dispel the myths” surrounding PrEP, thereby promote its use.

But while the heated arguments continue, it can be stated that PEP is available FOR FREE in the US, including in New York City (where I currently am located). And so is PrEP.

Because I’m from a developing country (i.e. Third World, before they changed the term to make it more palatable), the disconnect with the practices there (the Philippines, among other developing countries) versus the practices here (developed country/First World) is heartrending.

It’s almost as if – by not making available in developing countries life-saving medications that are already READILY AVAILABLE in Western countries – we’re basically letting people there die. It’s as if our lives as non-Westerners don’t matter.

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Who do we blame?

  • The Department of Health (DOH)? It already bungled even the procurement of antiretroviral medicines for Filipino people living with HIV (PLHIV), so can it be expected to offer more life-saving solutions? And no, “lack of fund” can’t be used as an excuse – Global Fund (GF) subsidizes treatment in the country; while people living with HIV also have to enroll in PhilHealth to get “free” antiretroviral (ARV) meds.
  • The GF (which was actually mum even when the DOH’s ineptitude was highlighted)?
  • Other international agencies working in HIV advocacy in the Philippines for failing to include PEP and PrEP in the discussions?
  • The greed of the capitalists (in this case, pharmaceutical companies)? As an HIV advocate succinctly puts it: “Don’t expect any cure to be made available soon. Why cure HIV if they can make you take their meds for life?”
  • Organizations/institutions/et cetera that were formed supposedly to ensure that the spread of HIV is stopped, while the needs of the PLHIVs are taken care of? After all, even with the formation of the likes of the Philippine National AIDS Council (PNAC) , the Philippines continues to be one of a handful of countries that show an increase in the rates of HIV infection.
  • Treatment hubs that fail to broaden the services that could see distribution of PEP and even PrEP to those in need?
  • HIV activists in the Philippines for not including this (i.e. PEP and PrEP) in the discussions?
  • PLHIVs for not demanding for more from the service providers?

Yes, we do the finger-pointing.
But blaming can only go so far.

Action needs to be done NOW.

These life-saving meds should be made available to everyone NOW.

A few days ago, Claire Pires of GLAAD asked me how those not in the Philippines can help those who are in the Philippines.

I told her what donor agencies should be told – i.e. show us the money. That is, they should finance efforts that prove to work. In the advancement of equal rights for all (particularly LGBT people), for the likes of the USAID, World Bank, and UN agencies to ensure that their programs are pro-LGBT. And in dealing with HIV, this means ensuring that the money non-Filipinos (like GF, as an institution) provides be used as they should be used – e.g. if this means making PEP and/or PrEP available in the Philippines to help curb the spread of HIV, so be it.

And I hastened to add: Include us in the discussions. We are as affected by the issues in the West, so solutions ought to reach us, too. The WHO, for instance, already recommended the use of PrEP, but it seems so out-of-touch with the real world – e.g. in countries like the Philippines, we don’t even have the right ARVs.

Thinking again about the debate on PrEP in these parts of the world, I am aghast.

While I agree with PrEP’s selling point as an additional option to keep people safe from getting infected with HIV, I’d have to say that there needs to be a stepping back to see the broader picture. Because to date, Western privileges are NOT universal. To forward this discussion, include us non-Whites (and those who are not in Western shores) in these debates. Help us help ourselves, instead of leaving us behind. You’ve been through this shit (excuse my language again) before, so why not help us NOT go through the same shit?

Because for goodness’ sake, there’s an entire world out there in need of help!

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Otherwise, when another person from the Philippines – like that friend who sent a message – asked about PEP, we’d be forced to say there’s nothing we can do, and NOT because nothing can actually be done, but because we’re just too uncaring to do something.

The founder of Outrage Magazine, Michael David dela Cruz Tan completed BA Communication Studies from University of Newcastle in NSW, Australia. He grew up in Mindanao (particularly Kidapawan and Cotabato City), but he "really came out in Sydney" so that "I sort of know what it's like to be gay in a developing, and a developed world". Mick can: photograph, do artworks with mixed media, write (DUH!), shoot flicks, community organize, facilitate, lecture, research (with pioneering studies), and converse in Filipino Sign Language. He authored "Being LGBT in Asia: Philippines Country Report", and "Red Lives" that creatively retells stories from the local HIV community. Among others, Mick received the Catholic Mass Media Awards (CMMA) in 2006 for Best Investigative Journalism, and Arts that Matter - Literature from Amnesty Int'l Philippines in 2020. Cross his path is the dare (guarantee: It won't be boring).


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