When hero leads to zero

Achieving an AIDS free generation is always going to be an uphill battle, not because we lack the knowledge, but because we see an erosion of the staying power to get to the end. UNAIDS call for reaching the end of AIDS by 2030 is highly ambitious; it involves breaking apathy, breaking stigma, and significantly increasing the profile of HIV in an age where “Climate is King!”

While the advent of treatment, expanded to more than 15 million people by the end of 2015, has seen a significant drop of both new infections and AIDS related deaths around the world, this is not a trend that has reached the Philippines yet. Rather, the Philippines has the unenviable reputation of having the world’s highest HIV incidence (percentage increase in new infections over the previous period). So, is there an answer? Can an AIDS free generation be achieved by 2030 even in the Philippines?

UNAIDS has set interim targets which will need to be met to tick of the journey to ZERO. There are specs that should be met by 2020, i.e. 90-90-90 – 90% of people who are HIV positive need to know their HIV status, 90% of those who know their status need to be on treatment, and 90% of those on treatment must achieve full viral suppression. Key to this entire process is also the need to remove all forms of stigma and discrimination, since removing the inhibiters of people entering the treatment cascades.

In partnership with Bread for the World and the Church of Sweden, the National Council of Churches in the Philippines (NCCP) embarked on an ambitious program to get more people to test. This was informed by the extremely low figures of testing in the country. Nationally, less than 1% of the total population have got tested for HIV, and among one of the key affected populations in the Philippines – namely men who have sex with men (MSM) – only 8% of them got tested (and returned to fetch the results) in 2015.

Something radically different was needed – the launch of the #preventionnotcondemnation campaign. Within this, key religious leaders in the leadership of NCCP took the bold step of submitting themselves publicly for HIV testing. The publicizing of posters started in earnest in May 2015, and by March 2016, this had achieved measurable results. This was one of the main factors feeding into the June 2016 statement of the World Council of Churches (WCC) Central Committee meeting. In the statement, leaders of churches are called on to lead their faith communities by example and get tested. In a country like the Philippines with its high level of stigma, this can be particularly challenging. In the Philippines where HIV is most strongly associated either with MSM or with people who inject drugs (PWID), frequent questions – mostly negative – have been asked of those senior religious leaders who have participated in the campaign.

But this has not silenced the NCCP and their member churches; rather they have redoubled efforts.

In many senses this can most strongly be seen in the way in which the Iglesia Filipino Independente (IFI) has taken up the challenge. During the month of November 2016, they held clergy convocations for both the regions of Visayas and Luzon. In both meetings they made space for inputs both on HIV and on human sexuality. In addition, through a collaboration between NCCP and non-governmental organizations (NGOs), community based screening (CBS) was offered to all bishops, priests and deacons at these meetings. The results are nothing short of miraculous! In the Visayas meeting some 92 clergy submitted themselves for testing, while in the Luzon meeting, 153 clergy submitted themselves for testing.

In addition, the campaign was extended to the IFI’s two seminaries, namely St Paul’s theological Seminary (SPTS) and the Aglipay Central theological Seminary (ACTS). Once again, extraordinary results were achieved with SPTS recording 47 seminarians and staff getting tested, and ACTS recording 52. The net result is not only a strong advocacy from leadership to church members to also take the step of getting to know their HIV status, but must also be a world first – 344 members of the church leadership in one denomination submitting themselves to be tested for HIV over the course of a week.

Screening in and of itself will however not be enough to fully turn around the devastating figures recorded in the Philippines. In addition, the issue of access to treatment will need to be more fully addressed. While the Department of Health (DoH) records that some 34,000 people have currently tested HIV+ in the Philippines, only about 14,000 of them have access to treatment. In addition, the DoH still does not accept the results of the rapid test, which is used in the CBS, and insist on an expensive Western Blot confirmatory test.

While the World Health Organization now recommends a “Test and Treat” protocol, with the CD4 test falling away completely and viral load being the only test used to establish the efficacy of treatment, the Philippines still has significant capacity building needed before these protocols can be followed. Where faith communities lead as strongly as the NCCP and their member churches do in this regard, it only needs the DoH to acknowledge the amazing work, and support it with their own effort.

90-90-90 is achievable in the Philippines by 2020, but it is going to be an uphill battle playing catch-up with much of the rest of the world.