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HIV stigma and discrimination and official indifference?

Outrage Magazine takes a closer look at alleged discrimination experienced by some Filipinos living with HIV at some government agencies. This begs the question of whether it is time to re-visit “official” policies to ensure that they do not violate the rights of PLHIVs, and even end up promoting stigma and discrimination of those living with HIV.

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Time to revisit ‘official’ approaches to HIV?

The Bureau of Quarantine’s (BOQ) form specifically states that it “encourages” those who will get the yellow fever (YF) vaccination (to get their “yellow card”, which is needed by those traveling to/from select Latin American and African countries, among others) to be “honest” to “avoid possible medical complications”. But honesty, in this case – and as relayed by a Filipino living with HIV, Xander* – came at a price.

“The first step is to fill in a form that expects one to detail his/her medical condition. This form is then checked by a nurse (the second step), who will decide if you can proceed to the third step, which is the actual vaccination. If he/she has doubts about your entries in the form, you will be sent to one of the doctors on duty; he/she will determine if you can get vaccinated,” Xander relayed to Outrage Magazine.

The problem, said Xander, is in the handling of HIV-related cases.

When he went to the BOQ in the City of Manila, first, “my filled-in form was handled by at least three people who passed it around before I was forwarded to the doctor on duty (that day).” And because this section of the BOQ did not have partitions that could have afforded him privacy, Xander deemed what happened to him as “invasive, as it failed to respect my right to privacy,” he said. “In fact, by the time I was forwarded to the doctor on duty, even the other people who were also only there to get vaccinated already knew of my HIV status.”

And then the doctor on duty “was not even familiar with HIV-related cases,” Xander alleged, basing his assumption/observation on this doctor’s “lack of knowledge about CD4 and ARV (antiretroviral medicines) – he kept saying ‘Kailangan ko yung CD-CD ba ‘yun (I think I need that CD thing)?’ and ‘Dalhin mo lahat ng gamot mo sa akin. Hindi ko masyado alam ano yang Lamivudine-Tenofovir-Efavirenz (You have to show me all your medicines. I’m not very familiar with Lamivudine-Tenofovir-Efavirenz).” The doctor’s table was, by the way, right beside the waiting area (where people who were already vaccinated were awaiting their yellow card) and the cashier (where those who get vaccinated pay for the services received), so that everything discussed was done in public.

Xander – with head hanging low – left the BOQ sans knowing that the vaccination he desired; but also shamed because of his HIV status.

HIV AND YF VACC

The doctor on duty when Xander went to the BOQ was – in a way – right to be cautious when he asked for more information about Xander’s health condition.

In a study titled “Yellow fever vaccination in HIV-infected patients”, published in HIV Therapy, Olivia Veit, Christoph Hatz, Matthias Niedrig and Hansjakob Furrer stated that “millions of HIV-infected individuals are at risk to YF, a severe hemorrhagic disease which is endemic in tropical areas of Africa and Latin America.” To deal with this, “the 17D YF vaccine (17DV) is the most effective preventive strategy.” The World Health Organization (WHO), in fact, recommends that all people aged ≥9 months living or travelling in areas where there is a risk of YF transmission to be vaccinated.

Particularly in relation to HIV, there are some things worth stressing here.

First, “data regarding safety and immunogenicity of 17DV in HIV-infected individuals are limited to small studies, mainly in travelers with CD4 cell counts above 200 cells/mm”.

Second, even with sparse information, “according to current recommendations, 17DV should only be given to asymptomatic HIV-infected individuals with a CD4 cell count above 200 cell/mm” since “rare serious adverse events cannot be excluded”. As per WHO, “the vaccine is contraindicated for people who are severely immunocompromised”.

And third, at least according to some studies, “yellow fever vaccine did not result in any serious adverse events in HIV-positive individuals. However, people with HIV responded less well to the vaccine than their HIV-negative counterparts, and the protective effects of the vaccine wore off more quickly.”

All in all, though, there is still “a special need for further studies to investigate the safety and efficacy of 17DV in HIV-infected individuals”.

Section 41 of the IRR (implementing rules and regulations) of the RA 8504 states: “Medical confidentiality shall protect and uphold the right to privacy of an individual who undergoes HIV testing or is diagnosed to have HIV."

Section 41 of the IRR (implementing rules and regulations) of the RA 8504 states: “Medical confidentiality shall protect and uphold the right to privacy of an individual who undergoes HIV testing or is diagnosed to have HIV.”

LAW OF THE LAND

But again, as Xander stressed, YF vaccination isn’t his issue, per se; instead, it is the handling of his situation by a government office as a Filipino living with HIV.

Republic Act 8504 (or the Philippine AIDS Prevention and Control Act of 1998, otherwise known as the AIDS Law) states (in Section 3b): “The State shall extend full protection of human rights and civil liberties to persons living with HIV.” Part of the protection clause of the existing law is ensuring that “the right to privacy of individuals with HIV shall be guaranteed.”

Section 41 of the IRR (implementing rules and regulations) of the RA 8504 states:

“Medical confidentiality shall protect and uphold the right to privacy of an individual who undergoes HIV testing or is diagnosed to have HIV. It includes safeguarding all medical records obtained by health professionals, health instructors, co-workers, employers, recruitment agencies, insurance companies, data encoders, and other custodians of said record, file, or data.

“Confidentiality shall encompass all forms of communication that directly or indirectly lead to the disclosure of information on the identity or health status of any person who undergoes HIV testing or is diagnosed to have HIV. This information may include but is not limited to the name, address, picture, physical description or any other characteristic of a person which may lead to his/her identification.

“To safeguard the confidentiality of a person’s HIV/AIDS record, protocols and policies shall be adopted by concerned officials, agencies and institutions.”

Section 44 of the IRR, in fact, details the sanctions against violators, i.e.:

“Penalties for violating medical confidentiality, as provided in Sec.s 30 and 32 of RA 8504, include imprisonment for six (6) months to four (4) years. Administrative sanctions may likewise be imposed…”

FAILURES OF THE SYSTEM

YF vaccine can only be had in three BOQ offices in the Philippines – i.e. BOQ – Manila, 25th Street, Port Area, Manila (Monday to Friday, 8am to 2pm); BOQ – Cebu, General Maxilom Avenue (Wednesday and Thursday, 8am-9am); and BOQ – Davao, Chavez St. (Fridays 8-9am).

Xander went to BOQ – Manila.

(Outrage Magazine sent on two separate dates two representatives to observe the processes of BOQ – Manila; and we can verify the same – Ed)

The BOQ “system” is somewhat different in Cebu City, still another place where the YF vaccine can be had; though there, forced HIV disclosure could still happen.

(Outrage Magazine also sent a representative to observe the processes of BOQ – Cebu; and we can verify the same – Ed)

In Cebu, people who intend to get the YF vaccine are first asked to “register”. Then those who will be given the vaccination for the first time are ushered into a private room where they are given a mini-lecture by the resident doctor re YF (and in our undercover representative’s case, sermon re HIV). During this mini-lecture, the resident doctor also asked the group if any one of them is HIV-positive. Not surprisingly, none openly admitted his (as there were only males in that batch) HIV status.

Emails were sent by Outrage Magazine to Dr. Janette L. Garin, Secretary of the Department of Health (since BOQ is under DOH), and to Dr. Ferdinand S. Salcedo, Director of the BOQ.

Specifically, Outrage Magazine sought for more information on:

  1. The intake forms of BOQ – e.g. if these rely on self-disclosure of HIV status, and who handles these forms since (as was reported to Outrage Magazine, these were just left on tables so that everyone could see them; and
  2. The set-up of BOQ – e.g. if the doctors on duty were trained to handle HIV-related scenarios, and if people living with HIV are allowed to get more private consultation (instead of discussing the cases in public).

As of press time, however, NO RESPONSES WERE RECEIVED FROM BOTH GARIN AND SALCEDO.

BOQ's Ferchito Avelino is hopeful that stakeholders “work together and disseminate information on HIV and correct myths that breed unnecessary fear that results to stigma and discrimination.”

BOQ’s Ferchito Avelino is hopeful that stakeholders “work together and disseminate information on HIV and correct myths that breed unnecessary fear that results to stigma and discrimination.”

On May 30, however, Ferchito L. Avelino, M.D. of the BOQ responded to Outrage Magazine, stating the bureau’s appreciation of “your effort to communicate to us your concerns. These information is important to us as we continue to improve client-to-doctor engagement (to) make sure that such engagement is within the bounds of medical confidentiality.”

Specific to the first concern raised by Outrage Magazine, Avelino stated that, “yes, the answer to the query on HIV status is based on self-disclosure of the client… although we strongly encourage client to disclose their status as this information is vital prior to the administration of any antigen. Also, our doctor may request the client to secure a certification from their attending physician on the needed for vaccination.”

(The HIV status is based on self-disclosure because of the confidentiality clause in the law – Ed)

Pertaining the possible breach in confidentiality that Xander noted in BOQ, Avelino stated that “aside from the doctor, (the) nurse on duty handles the information that are inputted in the BOQ form.” He added that “actions are made and continuously being updated to put in place systems and processes to make sure that other clients and service providers will have no access to this information.”

Avelino also stated that “the Bureau has medical doctors trained in internal medicine and in public health”, and that “to be updated on clinical practices, we conduct sessions in handling medical cases. In the past, we had sessions on HIV with representatives from the positive community.”

Avelino is hopeful that stakeholders “work together and disseminate information on HIV and correct myths that breed unnecessary fear that results to stigma and discrimination.”

a person living with HIV (PLHIV) was given a PWD (person with disability) card by the City Social Welfare and Development (CSWD) that identified the bearer as a “PLHIV”. After a complaint was filed, the card was replaced; though the replacement now stated that the bearer of the ID is “mentally ill”.

A person living with HIV (PLHIV) was given a PWD (person with disability) card by the City Social Welfare and Development (CSWD) that identified the bearer as a “PLHIV”. After a complaint was filed, the card was replaced; though the replacement now stated that the bearer of the ID is “mentally ill”.

While the BOQ is used here as a sample government office, it is – incidentally – not the only office (and a government office, particularly) that has issues when dealing with HIV-related cases.

Humphrey Gorriceta, a Filipino living with HIV, once recalled how he was “forced” to disclose his HIV status in the Land Transportation Office (LTO). Upon renewing his license in the LTO in Rosario, Cavite, Gorriceta had to take a drug test (a requirement).

“I just took my ARV about an hour or two before the testing (before giving my urine specimen), and the drug test result turned out positive. They asked me the routine questions if I have consumed alcohol recently or have taken any prohibited drugs. I said no. I asked why, and they said that they will have to send it to the DOH for confirmatory (drug test). I told them no need for that. I confessed that I am on ARV, and possibly the false-negative result is due to my ARV. I showed them my ARV caplets. They asked what ARVs are. I was surprised they didn’t know. I told them I have a lifetime condition that required me to take ARV, and that ARVs are like very strong antibiotics for a specific infection. They still didn’t get it and continued to ask about the meds. So I told them that ARVs are maintenance medication for HIV. I had to make the disclosure. I ended up explaining about HIV and ARV,” Gorriceta said.

Gorriceta added that he “felt it was uncalled for. I felt I was pushed against the wall to do the disclosure. For them to have a drug testing service means that they should be educated or at least be oriented of the possible scenarios why a person would come out (false) positive to drug testing.”

The mandatory drug testing for driver’s license applicants was scrapped after the Republic Act 10586 (Anti-Drunk and Drugged Driving Act) took effect in June 2013.

In another case, this time in Cagayan de Oro City (CDO), a person living with HIV (PLHIV) was given a PWD (person with disability) card by the City Social Welfare and Development (CSWD) that identified the bearer as a “PLHIV”. After a complaint was filed, the card was replaced; though the replacement now stated that the bearer of the ID is “mentally ill”.

For Stephen Christian Quilacio of the Northern Mindanao AIDS Advocates (NorMAA), this highlights “the lack of knowledge in handling an issue that continues to be very sensitive,” he said.

Stephen Christian Quilacio: Voice from Northern Mindanao

NorMAA now helps provide support to the CDO PLHIV.

“While we say that there is no shame in being HIV-positive, as it is supposed to be only a medical condition, we remain cognizant of the fact that society as a whole continues to not be accepting of PLHIV, who are often stigmatized and discriminated. Care should therefore be given in handling HIV-related cases; and this is not always provided even by those in government offices,” Quilacio said.

NorMAA: Safe space for PLHIVs in Northern Mindanao

According to Ico Rodulfo, president and CEO of Project Red Ribbon, “discrimination among PLHIVs in government offices is still rampant. Project Red Ribbon has encountered a lot of reports and from personal experiences in the PLHIV community, where PLHIVs were bullied, not given chances to be promotion or are talked into quitting their posts. The Foundation also had an experience with one government agency which has an HIV program, but where the staff didn’t respect the confidentiality of the PLHIV and disclosed the status of the client to the neighborhood where she resides. This eventually caused her to be bullied and pressured to move out as her neighbors feared that her HIV might infect the entire barangay.”

Project Red Ribbon: Responding to a growing need

CONFRONTING STIGMA AND DISCRIMINATION

Yet another example happened back in Cebu City, with the handling of the cadaver of a PLHIV who passed on. There, after the demise of the PLHIV, his family was allegedly told to “ilubong dayun ang patay kay basin makatakod (immediately bury the dead as it could infect others)”. His casket was also tightly wrapped in layers of plastic.

Outrage Magazine contacted the office of Dr. Ilya Tac-an, head of Cebu City’s Epidemiology Center and STD Detection Center, who said she will refer the publication to the one in charge with the cadaver section. Tac-an, nonetheless, stated that as far as she knows, the City Health Department is following the provision on the proper disposal of dead persons as mandated in the Presidential Decree 856, s. 1975, or the Code on Sanitation of the Philippines.

IRR of Chapter XXI (Disposal of Dead Persons) of PD 856, s. 1975, states that when the death due to “dangerous communicable diseases”, including HIV, the following are the requirements:

  1. The remains shall be buried within 12 hours after death;
  2. The remains shall not be taken to any place of public assembly;
  3. Only the adult members of the family of the deceased shall be permitted to attend the funeral;
  4. The remains shall be placed in a durable, air tight and sealed casket; and
  5. No permit shall be granted for the transfer of such remains.

As of press time, Outrage Magazine did not receive the referral from Tac-an.

However, according to Nenet Ortega, R.N., a licensed embalmer who is with the International Development Leadership and Learning Corporation now as one of its technical experts on health system strengthening/health sector reforms, as long as Universal Precautions (standard infection control guidelines) are followed, the risk of infection from a dead body is very low.

Hindi naman gaya ng Scarlet Fever or diphtheria ang AIDS para ilibing (AIDS is not like Scarlet Fever or Diphtheria that requires for the body to be buried) within 24 hours. It also does not require hermetically sealed coffin,” Ortega said.

Ortega added that “TB, polio, hepatitis and HIV can effectively be killed by formaldehyde and other embalming chemicals. Also, embalmers are trained to protect themselves from getting any infection during embalming process. You know what, as long as there are no microorganism that is resistant to formaldehyde and other embalming fluids and chemicals, and as long as embalmers have the means to protect themselves, embalmers can and will always be able to serve the public.”

The fear of the dead PLHIV infecting others is also baseless, Ortega said. “Remember that the virus need a living cell as its host in order to replicate. When the body dies, all the cells die, so therefore the virus dies as well kasi patay na din ang mga white cells (because the white cells also die) within 24 hours. And by exposing it to formaldehyde earlier than 24 hours, the faster the cells are preserved, but the virus dies.”

Ortega added: “That incident in Cebu exposed the immediate family of the person who died to further stigma and discrimination. That action indirectly tells people na namatay ang taong nasa loob ng ataul na nakabalot pa ng plastic sa isang nakakahawa, nakakadiri at (that the person inside the coffin that is wrapped in plastic died from a contagious, disgusting and) fatal kind of disease.”

For Ortega, “that incident in Cebu is a gross discrimination. As if balutin ng plastic ang coffin (by wrapping the coffin in plastic) would be a protection enough to keep HIV. That is bullshit! Ignorance spreads stigmatization and discrimination, including ignorance of the simple Universal Precaution. And Universal Precaution is basic. It is practiced in all clinics, lying in, hospitals of all levels, in schools with anatomy, physiology, clinical and chemistry laboratories, in morgues, in all places where exposure to bodily fluids may happen.”

For Dr. Jose Narciso Melchor Sescon of the AIDS Society of the Philippines, “the City Health Office is handling and tracking these cases through the death certificate filed by relatives prior to the burial. Hospitals are required by DOH to report the types of infections borne as part of surveillance (PIDSR, or the Philippine Infectious Disease Surveillance Response). Take note what is discriminating is what you put in the death certificate and not necessarily the process or handling as there are funeral parlors highly competent to handle such cases (e.g. Funeraria Oro).”

For Sescon, “the reality is that not all funeral parlors are trained or are competent to handle bodies with infectious diseases. Yes, I agree that standard precautions must apply, but the reality is, not all abide by this. Add to this the reservations of the owners of embalming establishments if they are not trained to deal with such cases.”

In cases where there are no experts that can handle the cadaver of PLHIVs, “there are DOH memorandum or administrative orders that the city must follow that within 24 hours, the body should already be cremated or be buried. If only there are a lot of trained embalmers to handle highly infectious diseases, not only HIV but also the likes of meningococcemia and chicken pox, then it will not be a problem.”

Sescon added that “this may be why a PLHIV’s body had to be cremated or buried within 24 hours, particularly if there are no trained embalmers around, most especially in far-flung areas.”

He added, nonetheless, that “the manner of relaying the correct information is also important so that the situation is better understood.”

Both Ortega and Sescon advocate the further professionalization of the funeral industry for the people in it to know how to properly handle sensitive cases, such as when involving a dead PLHIV.

“I agree with the need to professionalize the profession for only then will this issue be somehow resolved. Professionalizing increases the quality standards of operations, provision of licenses and permit will depend now on meeting the quality standards in embalming bodies and or running a funeral parlor,” Sescon said.

RAMPANT STIGMA AND DISCRIMINATION

HIV-related stigma and discrimination has long been reported in the Philippines by the likes of Remedios AIDS Foundation and Pinoy Plus Association in a study called Exploring the Realities of HIV/AIDS Related Discrimination in Manila Philippines, published in 2005; APN+, Pinoy Plus Association and UNAIDS in AIDS Discrimination in Asia: From the Perspective of Persons Living with HIV/AIDS,

Published in 2002; and GNP+, Pinoy Plus Association and UNAIDS in The People Living with HIV Stigma Index in the Philippines, published in 2010.

These studies, in fact, note that the area where PLHIVs experience most discrimination is the healthcare setting (both public and private), with instances cited including: refusal to treat on the grounds of HIV status, different treatment on grounds of HIV status, testing for HIV without the knowledge of the individual, breach of confidentiality and denied of health insurance.

Eddy N. Razon of the Pinoy Plus Association, in his report AIDS Related Stigma and Discrimination in the Philippines, also noted the “non-availment of redress mechanisms” of PLHIVs. Among the reasons provided include: lack of understanding on what constitute human rights violations; lack of knowledge on available redress mechanism; unwillingness to come out and be identified in public in the course of seeking redress; and the cost of legal action.

And so – back to the access to the YF vaccine at the BOQ – Xander said it is a “Catch 22 situation. We’re damned if we disclose, and damned if we don’t disclose.”

In his case, Xander is first to admit the good of knowing how he may react to what will be injected into his body. He is now seeking medical clearance from his personal doctor, just so he can present some documentation to the BOQ.

But Xander said that he isn’t a “special case – there are others like me who also had YF vaccination, and who opted not to admit their HIV status just to be done and over with with the YF vaccination”.

And Xander said he understands the other PLHIVs, stressing that “unless protections are given to those who openly admit their HIV status, then expect PLHIVs to lie instead to protect themselves from stigma and discrimination.”

In CDO, NorMAA’s Quilacio believes in the need to revisit the approaches in the delivery of services of government offices, among others; though this time, “these need to be informed by the very people they claim to serve. Otherwise, if they persist as if it’s all business as usual, then they’re just going to continue doing things insensitively, and maybe even against the laws that ought to be upheld.”

Rodulfo said that “the challenges are aplenty. First, we need to educate the government offices and agencies about HIV and the law. Second, we need to implement the HIV in the workplace policy as required by RA 8504 and the DOLE mandate, so all government offices educate the workforce re respect of the rights of the workers with HIV. And third, we need to continue to push for anti-discrimination ordinances and policies.”

Rodulfo is, nonetheless, hopeful that change will come soon. “As change is coming with the next President, we are hopeful that reforms will be implemented to finally stop stigma and discrimination of members of the PLHIV community,” he said.

“We may still have a very long way to go when dealing with HIV-related issues,” admitted Xander. “But we’d have an even longer way to go if the very institutions that swore to uphold our rights – i.e. the government – are the very ones that violate them.” And so, “change needs to happen. And they need to happen fast.”

*THE INTERVIEWEE REQUESTED FOR HIS REAL NAME NOT TO BE USED TO PROTECT HIS PRIVACY

THIS IS A DEVELOPING STORY, AND OUTRAGE MAGAZINE WILL CONTINUE PURSUING LEADS THAT HIGHLIGHT NOT ONLY ERRONEOUS PRACTICES BUT BEST PRACTICES WHEN DEALING WITH HIV IN VARIOUS OFFICES

The founder of Outrage Magazine, Michael David dela Cruz Tan is a graduate of Bachelor of Arts (Communication Studies) of the University of Newcastle in New South Wales, Australia. Though he grew up in Mindanao (particularly Kidapawan and Cotabato City in Maguindanao), even attending Roman Catholic schools there, he "really, really came out in Sydney," he says, 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 under his belt)... this one's a multi-tasker, who is even conversant in Filipino Sign Language (FSL). Among others, Mick received the Catholic Mass Media Awards (CMMA) in 2006 for Best Investigative Journalism. Cross his path is the dare (read: It won't be boring).

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Covid-19 and the freelancer’s dilemma

The Philippines is home to a “vibrant gig economy”, with an estimated 1.5 million freelancers in the country. But Covid-19 responses actually do not include them, so what happens to them now?

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Kate is a visual artist. She resigned from her day job to pursue her passion two years ago. Painting and creating origami, her income mainly came from the sales of her artworks; supplemented by home-based art classes to elementary and high school students.  

Nicole is a freelance makeup artist. Her clients varied from celebrities to socialites to brides and debutantes… and everything in between. Nicole used to earn a minimum of P3,000 per client, with the amount increasing depending on the type of service being offered.

Lumina is a drag artist, a common face in dance clubs and in events. Aside from her “talent fee”, she also used to get “tips” from customers.

But when the Covid-19 related Enhanced Community Quarantine (ECQ) took effect in Luzon starting last March 17, their capacity to earn a living was also put on hold. And people like them – a.k.a. “freelancers” – are many.

In May 2019, PayPal (the payment system company) reported that the Philippines is home to a “vibrant gig economy”, with an estimated 1.5 million freelancers in the country. In fact, this is a segment that is fast becoming an influential part of the Filipino workforce and a key engine driving the growth of the country’s economy.

The terms used to refer to them may vary – e.g. In October 2019, the Philippine Statistics Authority reported that of the 73,528,000 population in the Philippines, ages 15 years and over, 95.5% are employed. And 25% of them are “self-employed workers”. Freelancers also fall under PSA’s categorization.

And ECQ has been devastating to these Filipinos.

“The current lockdown left us, freelance workers, in a complete halt — events and shows were cancelled. It technically made us jobless since we do not have the option of working from home,” Lumina said.

Like Lumina, Kate said freelancer workers are “so tied to the situation.”

“Even if I want to sell my work or earn a living, I cannot do anything right now,” Kate added.

Painting and creating origami, Kate’s income mainly came from the sales of her artworks; supplemented by home-based art classes to elementary and high school students. Everything was affected by Covid-19.
Photo by Fallon Michael from Unsplash.com

What gov’t support?

There are supposed to be government support for workers affected by the ECQ.

In a statement released last March 17, for instance, the Department of Labor and Employment stated that they “may be able to address the pressing needs of the rest of the affected workers in the quarantined areas.” 

DOLE developed the following mitigating measures: “Covid-19 Adjustment Measures Program” (CAMP), “Tulong Panghanapbuhay sa Ating Disadvantaged/Displaced Workers” (TUPAD), and “DOLE-AKAP for OFWs”.  

CAMP will serve “affected workers regardless of status (i.e. permanent, probationary, or contractual), those employed in private establishments whose operations are affected due to the Covid-19 pandemic.” TUPAD “aims to contribute to poverty reduction and inclusive growth.” The program is “a community based (municipality/barangay) package of assistance that provides temporary wage employment.” And the DOLE-AKAP specifically caters to overseas Filipino workers who have been displaced due to the imposition of lockdown or community quarantine, or have been infected with the disease.   

DOLE reiterated that the only qualified beneficiaries are the underemployed, self-employed and displaced marginalized workers. To help these people, “employment” is offered – i.e. the nature of work shall be the disinfection or sanitation of their houses and its immediate vicinity, and the duration will be limited to 10 days. The person will be receiving 100% of the prevailing highest minimum wage in the region.

Pre-Covid-19, Nicole could earn from P3,000 per client; nowadays, she relies solely on what her barangay provides: relief goods and minimal ayuda.

Another government body eyeing to supposedly help is the Social Security System (SSS), where employees of small businesses may apply to be considered for the Small Business Wage Subsidy (SBWS) Program. 

To add, the government agency is also geared up to pay some 30,000 to 60,000 workers projected to be unemployed due to possible layoffs or closures of Covid-19 affected private companies.

Some arts-focused institutions like the Film Development Council of the Philippines (FDCP) also developed their own “disaster-triggered funding mechanism” to help address the “lack of support from the government.” In FDCP’s case, the program aims to help displaced freelance audio-visual workers—from talents, to production staff and technical crew members.

But note how all efforts are mum on freelance workers.

For drag performer Lumina, Covid-19 “technically made us jobless since we do not have the option of working from home.”

Making ends meet

And so many are left to do something they never did – i.e. rely on others just to survice.

In the case of Nicole, she relies solely on what her barangay provides: relief goods and minimal ayuda

Sobrang hirap ng sitwasyon ngayon. Hindi ko alam kung saan ako kukuha ng panggastos. ‘Yung ipon ko paubos na, tapos kailangan ko pa magbayad ng renta sa bahay at ibang bills (The situation now is very hard. I don’t know where to get money to spend. My savings are almost gone, and yet I still have to pay for my rent and the bills),” she said.

Lumina, for her part, is “lucky” because she still lives with her family, and “they have been providing for my basic needs since the lockdown started.”

Her luck isn’t necessarily shared by many – e.g. Human Rights Watch earlier reported that “added family stresses related to the Covid-19 crisis – including job loss, isolation, excessive confinement, and anxieties over health and finances – heighten the risk of violence in the home… The United Nations secretary-general has reported a ‘horrifying‘ global surge in domestic-based violence linked to Covid-19, and calls to helplines in some countries have reportedly doubled.”

To add: “In a household of six members, I think the goods that we are receiving from the government is not enough,” Lumina said, hoping that “every freelance worker also receive benefits from the government that would in a way cover the earnings that we lost.”

Bleak future?

In 2017, when PayPal conducted a survey of over 500 freelancers in the Philippines, the results showed that the country had a “very optimistic freelancer market”, with 86% of freelancers claiming they anticipate future growth in their businesses. In fact, at that time, 23% of the respondents said their business is growing steadily, while 46% said their business is stable.

But Covid-19 turned everything upside-down for many.

There are rays of hope.

Toptal survey, for instance, pointed out that 90% of companies depend on freelancers to augment their professional workforce, and – get this – 76% of surveyed executives intend to increase use of independent professionals to provide expertise either to supplement full-time talent or to access skills and experiences they lack in their workforce. 

This may be particularly true to those whose works do not involve face-to-face engagement (e.g. graphics design, BPOs).

And so for the likes of Kate, Nicole and Lumina — and many other freelance workers for that matter, whose works rely on being with people — the way to get through now is to just to make do with what they can grasp on… while hoping for a better future, where reliance (including in a non-responsive government) is not in the picture… 

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A number of local gov’t units include LGBTQIA Filipinos in Covid-19 responses

Various local government units (LGUs) are including LGBTQIA people both as beneficiaries and as implementers of the Philippine government’s Covid-19 Social Amelioration Program (SAP) implementation.

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Photo by Sharon McCutcheon from Pexels.com

Rainbow hope.

Various local government units (LGUs) are including LGBTQIA people both as beneficiaries and as implementers of the Philippine government’s Covid-19 Social Amelioration Program (SAP) implementation.

In Metro Manila, Pasig City includes LGBTQIA partners as beneficiaries in its Supplemental Social Amelioration Program (SSAP), which builds on the SAP.

Not all citizens are covered by the SAP, so Pasig City’s LGU released its SSAP to help families get by at the time of Covid-19. A total of P8,000 will be given to each family to aid with any expenses during the Enhanced Community Quarantine (ECQ).

Based on the listing of beneficiaries from the LGU, LGBTQIA partners with a child/children” are qualified, specifically if the couple lives together and they have a child/children whose surname/s follow/s one of them. “Ito ay kinikilalang pamilya (They are considered a family).”

Makakatanggap ng P8,000 ang bawat Pamilyang Pasigueño na higit na nangangailangan ng tulong pinansyal sa panahon ng krisis.Paalala sa lahat na kailangan may xerox copy ng Valid ID na ipapakita.

Posted by We Love PASIG City on Monday, May 4, 2020

Probably also affecting LGBTQIA families is the LGU’s inclusion of solo parents among the SSAP beneficiaries, particularly single parents (of either sex) whose child/children lives/live with him/her. Not all LGBTQIA parents are in relationships, though they may also be raising a child/children and may encounter difficulties due to the novel coronavirus.

But Pasig City is not the only LGU recognizing LGBTQIA families.

In Quezon City, it was earlier reported to Outrage Magazine that, because of the city’s anti-discrimination ordinance (ADO), SAP is also given to LGBTQIA people in need.

Meanwhile, in Davao City in Mindanao, south of the Philippines, Mayor Sara Duterte said in a radio interview that “the LGBT sector would be the best to understand (issues pertaining ) being inclusive.”

And so Duterte – daughter of Pres. Rodrigo Duterte – is tapping the city’s LGBTQIA network in rice distribution, the fifth round the LGU is doing this.

This is also Duterte’s move to remove the “political structure” in aid-giving because of the “recurring problem” of those handing out aids to only help those that they know.

How to make the distribution of ayuda more inclusive? Delegate it to the LGBT Community, which knows firsthand the need…

Posted by The Shaman of Kidapawan on Thursday, May 7, 2020

Duterte said she already tasked the LGBTQIA people involved in the rice distribution not to favor only LGBTQIA people, but “find the people who (really have nothing).”

Both Quezon City and Davao City have ADOs; but Pasig City still has no non-discrimination policy to protect the human rights of LGBTQIA Filipinos.

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Keeping the faith at the time of COVID-19

Many ask where God is at the time of #Covid19, including #LGBTQIA people who – prior to this – already experienced difficulties because of their #SOGIESC, and now have a hard time with their expression of faith. But #LGBTQIA faith leaders say that this is as good a time as any to also highlight humanity and, yes, the rainbow #pride.

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LGBTQIA people are “no strangers to isolation, hardships and the stress of being alone,” said Bb. Kakay M. Pamaran, Director for Field Education of the Union Theological Seminary Philippines. And while stressing that she is, in no way, trying to “romanticize this, but I think of all people, we know what this level of isolation feels like because we’ve been there… many of us have been there.”

Bb. Pamaran was referring to the isolation/stress of being alone and hardships brought about by Covid-19, with many countries – the Philippines included – forcing people to stay indoors, else risk getting infected. The World Health Organization (WHO), itself, acknowledged that “as the coronavirus pandemic rapidly sweeps across the world, it is inducing a considerable degree of fear, worry and concern in the population at large and among certain groups in particular…”

There are those whose (religious) faith is getting them through; but there are also those who, in times like this, start questioning their faith. This includes LGBTQIA people whose lives, as it is, are often marked by religious persecution. And so for those of faith and who belong to the rainbow family… how does one keep the faith at the time of Covid-19?

RELIGIOUS FERVOR

“When people are afraid, they turn to God,” Bb. Pamaran said. “And the church, for the longest time, has been God’s mouthpiece.”

She, therefore, believes that “the church has a huge responsibility where this is concerned.”

This April, the WHO released “Practical considerations and recommendations for religious leaders and faith-based communities in the context of COVID-19”, which eyes to provide “practical guidance and recommendations to support the special role of religious leaders, faith-based organizations, and faith communities in COVID-19 education, preparedness, and response.”

WHO’s practical recommendations include: discouraging non-essential physical gatherings and, instead, organizing virtual gatherings through live-streaming, TV, radio, social media, et cetera; regulating the number and flow of people entering, attending or departing worship spaces to ensure safe distancing; management of pilgrim sites to respect physical distancing; and actual isolation of those who get ill/develop Covid-19 symptoms.

As stated by the WHO: Faith-based organizations (FBOs) “are a primary source of support, comfort, guidance, and direct health care and social service, for the communities they serve. Religious leaders of faith-based organizations and communities of faith can share health information to protect their own members and wider communities, which may be more likely to be accepted than from other sources. They can provide pastoral and spiritual support during public health emergencies and other health challenges and can advocate for the needs of vulnerable populations.”

Bb. Pamaran agrees – to an extent.

“It is very important, it is imperative for church leaders (and) faith-based organizations (FBOs) to deal with Covid-19 in factual, scientific ways,” she said. This is because “the things you say in the pulpit or all of the platforms that are available to you must always be based on scientific, medical evidence. And you have to exhaust all possible efforts to do your research because people tend to believe whoever is speaking behind the pulpit.”

Bb. Pamaran added that “people turn to superstition if scientific answers are not available. So as faith-based leaders, it is our responsibility to fuse rationality and factual scientific inquiry in these desperate (concerns).”

AN EYE-OPENING EXPERIENCE

According to Rev. Alfred Candid M. Jaropillo, Administrative Minister of the United Church of Christ in the Philippines (UCCP)-Ekklesia in R. Mapa St., Mandurriao, Iloilo City, Covid-19 is an “eye-opener for us that human as we are, we are finite beings, and we don’t have the control of life.”

But Rev. Jaropillo added that this ought to make people see that “people have contributions to the suffering of life, and the suffering of Mother Earth.”

RAINBOW IN FAITH

As FYI: In 2015, the Pew Research Center (PRC) noted that about 5% of the 2014 Religious Landscape Study’s 35,000-plus respondents identified themselves as members of the LGB population. And of that group, a big 59% said they are religiously affiliated. But only 48% of them reported belonging to a Christian faith group, compared with 71% of the general public.

Meaning: Although many members of the LGBTQIA community may feel that most major faiths are unwelcoming to them, a majority of them are still religiously affiliated (though not necessarily as Christian, but also as part of smaller, non-Christian denominations).

Bb. Kakay M. Pamaran, Director for Field Education of the Union Theological Seminary Philippines, said that “people turn to superstition if scientific answers are not available. So as faith-based leaders, it is our responsibility to fuse rationality and factual scientific inquiry in these desperate (concerns).”

Bb. Pamaran noted that LGBTQIA people may not be going to churches because these are unwelcoming, or “they just don’t go to church because they gave up on church altogether. It was difficult for LGBTQIA people to express their faith pre-Covid-19; and now with Covid-19, it would be harder for them, I would imagine.”

Rev. Jaropillo added that it is, therefore, the church’s role to “open its doors… in ministering to people who need God the most: the vulnerable, poor, women, children, the displaced…”

There are, of course, open and affirming (or ONA, the term used by the United Church of Christ/UCC) churches and/or faith-based organizations, or those that affirm the “full inclusion of LGBTQIA and non-binary persons in the church’s life and ministry.”

And they are just as affected by Covid-19.

According to Bishop Regen Luna of the Catholic Diocese of One Spirit Philippines, which is based in the Province of Cavite, the mandate to socially distance meant they had to (temporarily) close, so “Covid-19 had a big impact on us.”

Among others, they had to forego masses, Bible studies, weddings, baptism, et cetera.

Ayaw din namin magkahawahan (We also do not one to infect each other),” he said.

Added Rev. Joseph San Jose, Administrative Pastor of the Open Table Metropolitan Community Church: In the context that we’re a small church, “we don’t have as much of the resources, the facilities that other churches have.”

For instance, the Roman Catholic Church and bigger Protestant churches can broadcast live their masses/worships, “we are unable to do that.”

The composition of the church membership is also proving to be a challenge, geographically speaking. Rev. San Jose, for instance, is in Laguna (approximately 100.3km from Mandaluyong, where the church is located); and members are from the City of Taguig, Quezon City, et cetera. “This is an issue with the Covid-19 lockdowns (that limit mobility of people),” he said.

Bb. Pamaran said that, largely, faith expressions involve corporate worship/gathering in one space. “Without that, faith expressions… significantly change.”

According to Rev. Alfred Candid M. Jaropillo, Administrative Minister of the United Church of Christ in the Philippines (UCCP)-Ekklesia in R. Mapa St., Mandurriao, Iloilo City, Covid-19 is an “eye-opener for us that human as we are, we are finite beings, and we don’t have the control of life.”

RAINBOW LENS

But Bb. Pamaran wants people to draw something from this experience.

“It is also a good demonstration to non-LGBTQIA persons that this kind of isolation… is the normal for LGBTQIA persons even without Covid-19 as far as going to church is concerned, and in belonging in church communities,” she said.

For Bishop Luna, the pandemic is (similarly) showcasing the resilience of LGBTQIA churches.

Sanay na kami sa hirap (We’re used to hardships),” he said, adding that they now know how to “stretch the budget to sustain a small church.” This is even if their main source of income (i.e. donations, for holding of sacraments like baptism, marriage/weddings, et cetera) is affected by the Covid-19 lockdowns.

Added Rev. Joseph San Jose, Administrative Pastor of the Open Table Metropolitan Community Church: In the context that we’re a small church, “we don’t have as much of the resources, the facilities that other churches have.”

RELATED ISSUES

Covid-19, on its own, isn’t the only problem; just as problematic are its effects on other issues.

In the case of Bishop Luna’s church-goers, for instance, “we have members who are also living with HIV.” Issues re access to life-saving antiretroviral (ARV) medicines have been reported on; particularly affecting those who have no access to treatment hubs/facilities, again because of immobility.

Rev. San Jose admitted that it’s a “personal struggle as a pastor” not being able to help out, particularly at a time when people are asking what churches are doing to help the needy. But “with our situation, it’s almost impossible for us to mobilize in the same way that other churches (have been mobilizing).”

DEALING WITH ‘NEW NORMAL’

Covid-19 introduced a “new normal” even to FBOs – here, largely dictated by going online.

Union Theological Seminary, for one, introduced online courses. Metropolitan Community Church hosts webinars and online conversations. Catholic Diocese of One Spirit Philippines has online services – though, as Bishop Luna said, holding sacraments (e.g. weddings) are still not done this way (thus the rescheduling of pre-booked events to next year). Meanwhile, Open Table Metropolitan Community Church’s Rev. San Jose records sermon/homily for Sunday online “gatherings”; which is also the time when members videoconference to discuss their faith and, yes, Covid-19.

“I think that’s going to be the trend,” said Bb. Pamaran. “This is going to be how we facilitate conversations moving forward.”

Rev. Jaropillo – whose UCCP-Ekklesia also has worship services – said that while churches now also use technology in ministering to people, “we don’t stop there. Aside from virtual worship services, we concretize the love of God through relief operations. We address two things: the liturgical/spiritual ministry through virtual worship services, and the physical need of people. Churches should have a holistic approach (to this).”

“It’s best to respond with creativity,” Bb. Pamaran said.

UNSHAKEN FAITH

At the time of Covid-19, Rev. Jaropillo said that “it’s very natural to doubt and it’s human to question one’s faith: ‘Natutulog ba ang Diyos (Is God asleep)?’ But I believe I don’t need to defend God. God understands the doubts of the people nowadays. So as a church, we need to journey with these people who are in doubt, especially at times of crises like now.”

Bishop Luna agrees.

“Some people ask why God would let something like this happen,” he said, adding that while these questions are unnecessary, that they are asked at all is “natural”/understandable. But he said that times like this offer lessons from God, and people should listen. “We believe in a loving God… We believe that God is teaching us – e.g. how to look after the environment, health, and respect of other creatures. We’ve forgotten these. We also live fast lives; we don’t even think it can end in a blink of an eye.”

For Rev. San Jose, it may be worth echoing what Pope Francis said when asked by a child why there’s human suffering. “Sometimes we just don’t know. It is what it is. There is a mystery of suffering and pain. And it would be very arrogant for us to try to answer very difficult and almost no-answer questions. The progressive faith compels us not to ask where God is, but to ask where we are and what we are doing at this time to be the channel of God’s love, comfort, hope for ourselves and for others.”

According to Bishop Regen Luna of the Catholic Diocese of One Spirit Philippines, which is based in the Province of Cavite, the mandate to socially distance meant they had to (temporarily) close, so “Covid-19 had a big impact on us.”

For Bb. Pamaran: “It’s a common question to ask where God is in all these. But perhaps it’s the best time to ask where humanity is in all these. It is the best time to look into our humanity and our creativity, our innovative imaginations to pull through this.”

LGBTQIA OF FAITH

To LGBTQIA people of faith, Bishop Luna calls for prayers – “unified prayers” – while spending time with loved ones, and looking after oneself (e.g. mental health).

Ibigay natin laat ng ito sa Panginoon (Surrender everything to God),” Bishop Luna said, adding: “We believe that this, too, shall pass.”

LGBTQIA people are resilient, continuing to face hardships in life. “We can survive this, too,” he said, “and pass this with flying colors.”

It is also the resilience of the LGBTQIA people that Rev. Jaropillo wants to highlight. That LGBTQIA people find joy/laugh even in dark times is something that can be shared to cheer up communities. “Continue to shine as a rainbow, to inspire other people.”

Covid-19, said Rev. San Jose, is also a good time for the LGBTQIA people to reflect on social justice. “There is a need for us to be more active in engaging in the issues faced by the country, by our community,” he said. “There is really a great need to organize and mobilize.”

“No sector of people understands isolation more than the LGBTQIA community. We can imagine, we can grasp the loneliness and isolation that Covid-19 brings. And so try to remember how you pulled through all these years, and then try to help others do the same,” said Bb. Pamaran.

In the end, “now more than ever, the world needs color; the world needs our color. So be that… for yourself and for others,” Bb. Pamaran ended.

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Being trans at the time of Covid-19 lockdown

#LGBT Filipinos still face legal impediments re their #SOGIESC, so many of the gov’t responses related to #Covid19 exclude them. For #trans community members, interconnected issues include losing livelihood considering many belong to informal sectors, limited access to hormonal medications that could adversely affect mental/emotional/psychological health, and general forced invisibility that excludes them from gov’t support.

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Main photo by Cecilie Johnsen from Unsplash.com

At the moment, LGBTQIA people are (often) excluded in government assistance related to Covid-19, said Magdalena Robinson, CEO of the Cebu United Rainbow LGBTIQ+ Sector Inc. There are various (and many of them interrelated) reasons why this is so – e.g. because marriage equality is not recognized in the Philippines, many LGBTQIA Filipinos live alone (“For example, they just rent rooms”) or perhaps couples live together yet are just considered as board mates, so they are not considered to belong to “homes”/”households”. “That’s a difficulty (that affects) access to the assistance of the government.”

It is the intersection/inter-connection of issues that – in truth – define the experience of transgender Filipinos in particular as they try to survive the Covid-19 lockdown.

WANTED: ACCESS TO MEDS

To start, there’s the issue with accessing hormonal medications.

As noted by Jhen Latorre of the Pioneer FTM (Pioneer Filipino Trans men Movement), members of the transpinoy/trans men community already noted issues re accessing testosterone (hormonal medications). Not only because the stocks are limited, ordering is challenging, but also “mahirap ang shipping (we also encounter issues with shipping).” This is even more so for those in provinces.

Robinson added that many trans people access hormonal medications from the black market. For example, some local suppliers buy from Thailand. But there are now issues with stocks, affected by the lockdown that limits mobility of goods (from overseas, as well as locally).

Now, this is worth highlighting: According to Kate Montecarlo Cordova, founding chairperson of the Association of Transgender People in the Philippines, “people have a hard time understanding the health impact of hormones to trans people.”

Cordova said that many people now “think that taking hormones is just a luxury; that we just want it, and it’s not even needed.”

She added that often neglected in this line of conversation are the biological/physical, economic/financial, and psychological/emotional impacts of not having these hormonal medications – e.g. there are trans women who work as entertainers, and not having access to the needed meds could affect their physicality, which could affect their means of living.

In the end, “these are all interrelated,” Cordova said. “There are intersectionalities.”

‘FORCED INVISIBILITY’

Obviously this touches on the continuing “forced invisibility” of trans people in the Philippines particularly when talking legally – e.g. the country still doesn’t have gender recognition law, and basically misgenders trans people by legally pigeonholing them according to their assigned sex at birth.

According to Kate Montecarlo Cordova, founding chairperson of the Association of Transgender People in the Philippines, “people have a hard time understanding the health impact of hormones to trans people.”

INFORMAL WORKERS

According to Latorre, at least in his group, most of their members have jobs that: 1. allow them to work at home, and 2. still give them regular salaries even during the Covid-19 lockdown.

But there are also those who are affected by “no work, no pay,” he said. So these people now only rely from the support of family members.”

Shane R. Parreno, chairperson of the Transpinays of Antipolo Organization, said that the percentage of members of the trans community who hold regular jobs remains low.

Local figures continue to be limited on this, but at least in the US, 29% of trans people live in poverty, compared to 14% of the general population; and trans people experience unemployment at three times the rate of the general population, with 30% of trans people reporting being fired, denied a promotion, or experiencing mistreatment in the workplace due to their gender identity in the past 12 months.

For Parreno, may trans Filipinos – and LGBTQIA community members, for that matter – are informal workers, e.g. hairdressers, make-up artists/cosmetologists, and tailors/seamstresses. And with “everybody affected by the lockdown, those working in these fields/areas do not have clients, so they do not earn,” she said.

Robinson stressed the same point: There are trans women who work in the beauty industry, fashion industry, et cetera who do not have income now. “So we hope they will not be left out (in the giving of needed support from the government during the pandemic).”

Latorre – who has two kids, but who also did not qualify in the government’s definition of “household” to be given support – said that even before, LGBTQIA families have always been set aside.

And because “there are trans people who are the breadwinners,” Parreno said, “I hope that their SOGIESC won’t be reason for them not to be included in (government support).”

At the moment, LGBTQIA people are (often) excluded in government assistance related to Covid-19, said Magdalena Robinson, CEO of the Cebu United Rainbow LGBTIQ+ Sector Inc.

ACCESS TO MEDICAL CARE

There’s also the difficulty in getting medical care.

Recognizing that trans people may need to see medical professionals (e.g. when transitioning), Latorre also isn’t aware of clinics that are now open for them to access. This issue is ongoing, however, and is apparent even when there’s no lockdown, since there remain few – if any – trans-specific medical practitioners in the Philippines, perhaps even more particularly in provinces.

Sana di na magtagal ito ng sobra (I hope the lockdown doesn’t last long),” Latorre said, because “alam ko din naman na kailangan pa din to see a doctor lalo na sa too-serious na matters (I recognize that there is still need to see a doctor, particularly for very serious matters).”

As noted by Jhen Latorre of the Pioneer FTM (Pioneer Filipino Trans men Movement), members of the transpinoy/trans men community already noted issues re accessing testosterone (hormonal medications).

HELPING EACH OTHER

For Latorre, “nakakatulong ang organization (trans organizations help).” For instance, members of trans organizations can give tips re transitioning, or – if meds are needed – they can “lend” supplies.

In Cebu in central Philippines, Robinson said that transpinays asked their networks on where to get supplies. And when supplies are really hard to get, “we just advise them on the alternatives – e.g. maybe there are fruits that have high estrogen or anti-androgen properties.”

Some food that are estrogen-rich, and help lower testosterone levels include: soy products like edamame, tofu, soy milk and miso; spearmint and peppermint; licorice root; vegetable oils; flaxseed; and certain types of nuts.

“We give out this information so we have alternatives for them,” said Robinson, adding that those who received the information are “advised to share the same to their contacts.”

For Robinson, “everyone is experiencing difficulties,” she said, so “we have to support each other, fix each other’s crown.”

Latorre also has a practical recommendation: Since trans people are at home during the lockdown, they may want to use this to find time to talk to their families. “Baka ito na ang oras to open up (Maybe this is a good time to open up),” he said.

Cordova said that the lockdown highlights that “it’s about time that we comfort each other. We can’t expect our government, or other people to comfort us.”

Shane R. Parreno, chairperson of the Transpinays of Antipolo Organization, said that the percentage of members of the trans community who hold regular jobs remain low.

Meanwhile, Parreno has practical recommendations.

“Let’s support our government – e.g. when it says for us to stay home, stay home. Talagang malaki ang impact nito (This has a big impact),” she said. “Ipakita natin… na hindi tayo pasaway (Let’s show others we’re not troublesome).”

And in the end, “let’s pray that this will end soon para magkita-kita na tayo ulit, maka-rampa na tayo ulit (so we can see each other again, and wander/jaunt again).”

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Living with HIV at the time of Covid-19 lockdown

To date, there is still no evidence that the risk of infection of #COVID19 is different among persons living with #HIV. But the #lockdown is worsening the situation of many PLHIVs – e.g. in accessing their life-saving medicines, loss of income/livelihood, exclusion in government responses, depression, et cetera.

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Nakakadagdag ng takot (Covid-19 adds to the fear) of persons living with HIV,” said Anthony Louie David, a Filipino living with HIV.

According to the World Health Organization (WHO), “at present there is no evidence that the risk of infection or complications of COVID-19 is different among PLHIVs who are clinically and immunologically stable on antiretroviral treatment when compared with the general population.” WHO added that “it is unknown if the immunosuppression of HIV will put a person at greater risk for COVID-19.”

However, “until more is known, additional precautions for all people with advanced HIV or poorly controlled HIV, should be employed.” This is because “PLHIVs with advanced disease, those with low CD4 and high viral load and those who are not taking antiretroviral treatment have an increased risk of infections and related complications in general.”

And so for David, because those with weaker immune systems are at higher risk of getting infected with Covid-19, “andoon yung takot (the fear is there).”

Rogeselle Burdeos Monton, also a PLHIV and the research and development officer of the Culture and Arts Managers of the Philippines, said that there’s that “worry within yourself” that because one is immunocompromised, “you might end up being infected with another virus.”

For Moses Ayuha, “PLHIVs should take precautionary measures… particularly if they go out.” Practically, “wear mask,” he said, though more importantly, “better your immune system… and stop panicking.”

ACCESS TO LIFE-SAVING MEDS

The fear – not just the lockdown – has been limiting.

David, for instance, hasn’t been out of his house for weeks now – e.g. other family members have to do the groceries for him.

David is also troubled that his supply of life-saving antiretroviral (ARV) medicines is about to run out. “My treatment hub is in the City of Manila, and I am now in Biñan City, Laguna (approximately 31 kilometers away).”

With being idle affecting mental health, along with the fear of getting Covid-19 and accessing ARVs, “learn how to divert your attention,” Rogeselle Monton said. “Your fears are valid, but focus on your well-being as a PLHIV.”

Living in a different local government unit (LGU) is also an issue because people from outside Metro Manila (where his treatment hub is) are barred from entering Metro Manila.

At least for Moses Myro Ayuha, another person living with HIV, “luckily, I have supplies until May.” But Ayuha said that there are “blood brothers” who are really having difficulty in accessing their ARVs.

The Department of Health (DOH) tried to remedy this issue.

In March, DOH released an advisory that recognizes that “this current situation poses challenges in accessing life-saving medications… which may result in treatment interruption”, so it is mandating treatment facilities to “exhaust all possible methods to ensure reliable access to PLHIVs to treatment without having to risk increased exposure to Covid-19 when accessing their medicines.”

Meaning: PLHIVs can get their supplies (while the lockdown is ongoing) in other hubs that are nearest to them; or have their ARVs delivered to them, among others.

Monton’s hub delivered his ARVs for him… but he had to pay for the courier/shipping fee on his own, which may be an issue for those who do not have money to do so.

Monton also noted that there are also confusions – e.g. the process of accessing ARVs in hubs not yours, with policies supposedly announced by the DOH causing confusion instead of clarity.

And so Monton said that some end up “borrowing meds.”

David noted how non-government organizations (NGOs) and community-based organizations (CBOs) are stepping up. For instance, there are those that deliver the ARVs to those who can’t leave their houses – e.g. #AwraSafely has some guide for PLHIVs during the time of Covid-19.

Bagot na ba beshie? O heto, basahin ang mga dapat nating malaman tungkol sa HIV at COVID-19.Tandaan: sa panahon ng #COVID19, ang pag-postpone ng awra ay pag-#AwraSafely!

Posted by AwraSafely on Sunday, March 22, 2020

Helping is also done to those who have lost their means of living – e.g. the AIDS Society of the Philippines (ASP) gives out some amount to HIV-positive mothers and/or their kids, as well as healthcare providers who are rendering HIV-related services during the Covid-19 lockdown period.

This is particularly helpful to those “na walang kakayanang bumili ng pagkain nila ngayong may lockdown dahil wala ring trabaho ngayon,” David said.

Sadly – and this is worth highlighting – many of the existing solutions are available for PLHIVs in metropolitan areas, such as Metro Manila, where many NGOs and CBOs operate. Outside of Metro Manila, in the provinces, already problematic access to ARVs are worsened by the Covid-19 lockdown. Monton knows of a PLHIV in Laguna, for instance, who had to spend an entire day just to get through a series of checkpoints to access the nearest treatment hub to him; and then when he got there, “siguro nagmakaawa (maybe he begged) just to be given ARVs.”

WORK WOES

Like the rest of the population, the livelihood of PLHIVs are just-as-affected by the Covid-19 lockdown.

Ayuha, for one, said that – at least where he’s staying, a halfway house for PLHIVs – they now rely on donations of food packs. “Nakakaraos din (We get by somehow),” he said.

But Ayuha said that “I am unable to do (what I usually do daily),” including giving HIV-related lectures (while working for non-government organizations). “Nabago talaga dahil di ka nga makalabas (This really changed because you can’t go out).”

David is the same; with his income usually sourced from giving HIV-related talks. And with gatherings cancelled because of the lockdown, “walang maasahan kundi pamilya ko lang (I only rely on my family).”

Monton, meanwhile, is a freelance worker, so his earnings are also affected. He may be luckier than most because he has savings; but he knows of other PLHIVs who – even now – are already worrying where to source the money for the incoming months’ bills (e.g. rent, utilities, et cetera).

Monton actually hopes that that the government’s financial support be made more inclusive. “When it comes to evaluating people who are currently financially challenged.” At the end of the day, he added, even PLHIVs are “also tax-payers.”

For Louie David, because those with weaker immune systems are at higher risk of getting infected with Covid-19, “andoon yung takot (the fear is there).”

FOCUS ON SELF-CARE

David said that there are other issues affecting PLHIVs now highlighted by Covid-19 – e.g. depression. To deal with this, he recommends “keeping yourself busy.”

So David said: “Better your immune system because Covid-19 isn’t just going to be here now. Even without the lockdown, Covid-19 will still be there. So gain strength so that when the lockdown is lifted and we’re finally allowed to go out, we know we’d still be safe because we’ve properly prepared.”

Monton gives three practical tips.

First, with being idle affecting mental health, along with the fear of getting Covid-19 and accessing ARVs, “learn how to divert your attention,” he said. “Your fears are valid, but focus on your well-being as a PLHIV.”

Second, take precautions – e.g. wear face mask when going out, disinfect particularly before touching the face, et cetera.

And third, “magdasal (pray),” he said. Maybe not even because one is religious, but for “peace of mind… somehow it helps.”

For Ayuha, “PLHIVs should take precautionary measures… particularly if they go out.” Practically, “wear mask,” he said, though more importantly, “better your immune system… and huwag praning (stop panicking).”

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LGBTQIA people as Covid-19’s hidden victims forced to choose between risking infection or starving

How Covid-19 – and the eventual lockdowns – is impacting the livelihood of LGBTQIA people.

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Choosing to go out while the world is panicking over Covid-19 is “scary,” said Bella Abac, a freelance hairdresser/make-up artist from the City of Bacoor in the Province of Cavite. Though she knows she may be putting herself at risk of getting infected by the dreaded novel coronavirus 2019, “kailangan ko naman ay budget… kasi ito yung source of income ko (I need earn… because this is my source of income).”

The government – e.g. the barangay – gave some support; in Abac’s case, a few kilos of rice, noodles and canned goods. But since the Covid-19 lockdown is expected to last for weeks, this is obviously not going to be enough. And so putting one at risk (and others at risk, for that matter) becomes a necessity to survive.

According to Ging Cristobal, project coordinator for Asia & Pacific Islands Region of OutRight Action International: “‘Yung Covid-19, napakalaki ng pinsala sa lahat (Covid-19 did big damage do everyone)” though even more so to minority sectors like the LGBTQIA community.

To start, there’s the damage done to livelihood, she said. Many LGBTQIA people still experience discrimination that force them to engage in informal sectors; “ibig sabihin nito, sila ay hairdresser, staff sa grocery, eatery, palengke… at alam natin na ito ay ‘No work, No pay.’ Mas pagtuunan natin ng pansin yung mga marginalized sectors (this means that these people are hairdressers, staff in groceries or eateries or markets… and they don’t earn if they don’t work. We should give attention to those in the marginalized sectors).”

For Elden Lopena, owner of Top Touch Beauty Salon in Cotabato City, we should be thankful that we’re not as of yet as affected by other bigger countries; but “sana matapos na ito para di na masyado magtagal ang hirap (hopefully this ends soon so the hardships don’t last long)”.
Maureen Mejia Chan, owner of Salon de Maureen in Makati City, estimates that she’d lose over P100,000 because of the lockdown, and so “hindi ko alam ano ang gagawin ko (I don’t know what I’d do).”

ECONOMIC WOES

The economic impact of Covid-19 is now being discussed, including in the Philippines. In February, for instance, Statista.com, for instance, reported that about 75% of Filipinos perceived that the Covid-19 outbreak would affect the international economy, while 65% believed the national economy of the Philippines would be affected.

In fact, as of early March 2020, the global pandemic already contracted a decline of 2.4% in US’s GDP. Specific to the Philippines, the World Bank still sees the country’s economy to grow by 3% at best, contracting 0.5% at worst in 2020 due to the Covid-19 pandemic. But really, it is still too early to see how big an impact Covid-19 will have on the economy.

What abounds now, instead, are anecdotal evidence of the difficulties experienced because of the pandemic, and the lockdowns implemented to monitor/control the same.

DAY-TO-DAY SURVIVAL

For Elden Lopena, owner of Top Touch Beauty Salon in Cotabato City, we should be thankful that we’re not as of yet as affected by other bigger countries; but “sana matapos na ito para di na masyado magtagal ang hirap (hopefully this ends soon so the hardships don’t last long)”.

Lopena lamented that as an owner of a salon, “meron din akong mga tauhan (I also have staff)” and he needs to help them with their daily needs, even as he worries where to source money for would-be expenses for his business (e.g. rental, utilities). Therefore, closing – even temporarily – has a big impact.

Maureen Mejia Chan, owner of Salon de Maureen in Makati City, estimates that she’d lose over P100,000 because of the lockdown, and so “hindi ko alam ano ang gagawin ko (I don’t know what I’d do).”

The difficulty is more pronounced for those who earn daily wages, said Ms Garner delos Reyes Lagare, salon owner/hair and make-up artist/PMU artist and instructor. “Ang nakaka-awa ay yung mga taong walang ipon (It’s sadder for people without savings)” because they don’t have the capacity to buy basic needs (e.g. food, milk for babies, medicines, etc).

Workers in informal sectors – as noted by Cristobal – worry day to day.

Vinz Calvin (a.k.a. Lumina), a drag queen, said that with venues where they perform closed (for three weeks now), they haven’t been earning at all.

To earn, some become more creative.

“Some drag queens, they hold shows online,” Vinz Calvin said. The viewers give “tips” by sending these to remittance centers/apps.

The “creativity” assumes, however, that everyone affected by lockdown has access to the same internet (and speed) services, which isn’t the case. Globe Telecom, for instance, urges subscribers to be ‘conscientious’ with internet use while most Filipinos are working from home, highlighting the impact of the demand on the connections/availability of connections.

Ms Garner delos Reyes Lagare, salon owner/hair and make-up artist/PMU artist and instructor. “Ang nakaka-awa ay yung mga taong walang ipon” because they don’t have the capacity to buy basic needs (e.g. food, milk for babies, medicines, etc).
Though she knows she may be putting herself at risk of getting infected by the dreaded novel coronavirus 2019, “kailangan ko naman ay budget… kasi ito yung source of income ko (I need earn… because this is my source of income)..

Like Abac, who used to occasionally take risks by still services clients out of necessity, Lopena said that he knows of others who also do home service.

Kung makakalabas… lalabas (If we can go out of our houses, we do so to serve clients),” he said, so that “kahit papaano makakatulong din sa pang-araw-araw na gastusin (so it helps in daily expenses).”

But fear (of getting infected or infecting others) is limiting this now, on top of the need to comply with the lockdowns, else risk getting arrested. And so many are basically left to be hungry.

HIGHLIGHTING LGBTQIA ISSUES

For Cristobal, the Covid-19 lockdown also has an unwanted effects.

There’s the surfacing of anti-LGBTQIA practices – e.g. in Quezon City, a lesbian couple complained that they did not receive goods from the local government because they were not considered “household”/”family”. The city is fortunate enough to have an existing anti-discrimination ordinance (ADO) that prohibits discrimination of LGBTQIA people within the city, so that the issue of the lesbian couple was resolved; but other local government units (LGUs) also in lockdown do not have ADOs.

It also puts members of the LGBTQIA community to be in situations/locations where they are at risk of getting abused – e.g. students, for instance, are now forced to be at home for the whole day, even if family members may not be accepting of them, or are even abusive of them.

Itong mga darating na panahon ay hindi ko alam kung mas magiging mabuti na ang kalagayan o mas (sasama) pa. Pero kahit sana anong mangyari, hindi tayo laging iniiwan.”

HELP THE MARGINALIZED

Chan said that she heard of the support the government is supposed to give to small- and medium-sized businesses, like her salon. If true, she said it could help because “it’s difficult for businesspeople who are at a loss on where yo source the fund to continue financing their businesses.”

But Chan is among those at a loss on how to access/avail of this said support.

Vinz Calvin added that, in the case of drag queens for instance, who are also workers in the entertainment industry, “we’re not even sure if we qualify to ask for government support.” And this is even if this support is just-as-needed by them.

For some, giving help is becoming normal (in lieu of relying on government help). Lopena, for instance, said that “yung naitabi naming salapi, tinutulungan na rin namin sila (we use our savings to help our staff).”

But for Lopena, “yung hingi ng mamamayan kasi, yung pagkain… sana mabigyan sila ng tamang ayuda (what people are asking for, including food… hopefully the government can help them with that).”

The sentiment was shared by Lagare who said that getting help is ideal, though currently, the promised help is not reaching to target populations. “Kaya nakaka-awa talaga yung walang ipon sa ganitong panahon (Those who do not have savings are disadvantaged at times like this).”

And so Abac said that government should prioritize those who are in dire need of support. She added, though, that “yung iba naman na kaya namang makabili, huwag na daing nang daing kasi ang government ay kumikilos naman (those who can afford to buy, stop simply complaining because the government is acting anyway).”

Vinz Calvin added that, in the case of drag queens for instance, who are also workers in the entertainment industry, “we’re not even sure if we qualify to ask for government support.”

Eventually, said Vinz Calvin, people should learn to be more prepared.

“Hopefully something like this doesn’t happens again, but in case it does, at least we have savings to use,” he said.

But while everyone is affected, LGBTQIA people should be very mindful, said Cristobal.

Itong mga darating na panahon ay hindi ko alam kung mas magiging mabuti na ang kalagayan o mas (sasama) pa. Pero kahit sana anong mangyari, hindi tayo laging iniiwan (I don’t know if things will get better of worse. But whatever happens, LGBTQIA people shouldn’t be left behind),” Cristobal ended.

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