As the Department of Health (DOH) issued the latest data on the number of HIV and AIDS cases in the Philippines, DOH Assistant Sec. Eric Tayag said in an interview by ANC that the government agency is working out details for making HIV tests compulsory.
This is because although, in recent months the number of people who have been responsibly taking the test to know their status have increased, there reportedly remains a great number of people at risk who are not making the effort to know their status.
“(DOH Sec. Enrique) Ona would want to shift from voluntary testing to something that’s compulsory. We’re working out the details, how this is possible, and all. We want health providers to screen adults who may have a risk for HIV, so that they can be properly counseled on what to do next,” Tayag said.
As per DOH data, in March 2014, there were 498 new HIV cases recorded, a 35% rise from the same month last year. Specifically, 381 of the 498 cases were men who have sex with men (MSM), 54 were because of drug use (through injecting), 63 were overseas Filipino workers (OFWs) who had unprotected sexual relations, and one case was from a mother-to-child transmission. Since January 2014, there were already 1,432 cases that have been recorded; 146 of which developed to full blown AIDS, and 434 resulted in death.
“We have been reminding everyone since last year to be more careful and conscious about their health. It won’t be long until we reach the all-time high of 500 new cases,” Tayag said. “We’re also appealing to those who are at risk to get themselves tested, and that’s just the tip of the iceberg.”
He added that the numbers may continue to rise in the coming months, since not everyone at risk are that “responsible enough” to get themselves tested. Also, based on their projections, “there are still many who are still undetected.”
WHAT THE LAW SAYS
Making HIV testing compulsory is actually a violation of the existing law concerning HIV and AIDS in the Philippines.
Section 3: Declaration of Policies of the Republic Act No. 8504 (or “Philippine AIDS Prevention and Control Act of 1998”) specifically states that “compulsory HIV testing shall be considered unlawful”.
In a statement, the Network to Stop AIDS (NSAP) lambasted the DOH proposal to enforce mandatory HIV testing, saying that it “demonstrates that among those involved in addressing the HIV epidemic in the Philippines, the health agency is by far the most backward and the most out-of-tune.”
Added NSAP: “The current legal framework allows for various modes of HIV testing, but they have to be voluntary and confidential. This is clearly rights-based, but this is also premised on existing evidence that coercive modes of HIV testing actually result in a decrease in the coverage of testing – those who need to get tested fear discrimination and abuse, so they hide underground once authorities require HIV testing. This fear is not unfounded, as HIV-related stigma and discrimination remain unaddressed in the Philippines. Imposing compulsory testing is operationally problematic (also unnecessarily costly) and it encourages human rights abuses.”
This was seconded by Michael David C. Tan, editor of Outrage Magazine, the only lesbian, gay, bisexual, transgender and queer (LGBTQ) publication in the Philippines, which also conducts HIV-related projects. He stated that forcing people to get tested will not deal with the spread of HIV, and could – in fact – only worsen the situation. “‘Witch hunt’ easily comes to mind,” he said, “particularly since the idea of having compulsory testing will specifically target populations that are deemed at higher risk for HIV infection. By saying ‘compulsory’, we actually only aim at making specific groups of people get tested; as such, we’re abetting in the unnecessary stigmatization of members of these groups.”
Members of the LGBTQ community (particularly men who have sex with men, including gay and bisexual men), overseas Filipino workers (OFWs), and those working in the business process outsourcing (BPO) industry should be wary, said Tan, because they are “only some of the people who have been stigmatized to be at higher risk for HIV infection at certain points in time. Their plights could only worsen with making HIV testing mandatory.”
NSAP also added: “Even DOH possesses evidence that show the complexity of Filipino sexual behavior. In a concentrated epidemic among MSM and transgenders, who do you actually require to get tested? This population does not conveniently fit whatever stereotypical images that Sec. Ona may have about the community. By definition, this sexual behavior includes any man who engaged or engages in sexual acts with other men – the heterosexual partners of transgender people; those who do not consider themselves as gay but engages in sex with other men; even the heterosexual ex-congressman whose life story was featured in a TV show a few years ago where he admitted to engage in transactional sex with a ‘bakla‘ to support his schooling. Would DOH require all of them to get tested? The agency is also in possession of data that shows that a significant portion of men who have sex with men and transgender people have female sexual partners – would they be required to get tested, too?”
Tan believes that the current responses of the government remains lacking, which – in turn – affects the continuing fear of HIV.
“In (HIV) advocacy, we say that no one should die from HIV anymore at this time and age because treatment is available, and the disease can already be managed,” he said. “But working at the grassroots, among HIV-related issues we’ve come across include the shortage of the antiretroviral (ARV) medicines in the Philippines, employment-related discrimination encountered by people living with HIV (PLHIV), and cases when PLHIV are kicked out of their homes after family members find out their HIV-positive status. You can’t even ensure that PLHIV live just as good a life as non-reactive people, and you expect them not to be fearful?”
Tan added that “if services are bettered, then no forcing needs to be done. HIV, after all, is not just a health concern, but a complex social issue. Deal with the connecting issues, too. That’s the only way for people to know for sure that there is nothing to fear.”
The DOH is supposedly also exploring the possibility of making the testing process faster by acquiring rapid HIV test kits.
“The only problem we see with this rapid testing is that anyone can have it, just like the pregnancy test kits in the drug stores, (and) we cannot properly monitor the numbers. The people who will buy these kits will not be counseled by peer educators before they take tests, just like what the hospitals are doing, and HIV/AIDS counseling is essential so you’ll know what to do,” Tayag said.
He added that “in the Philippines, HIV testing is not done like how they’re doing it in other countries, (so) only few people get themselves tested. The only way it can be done is when it is being offered, especially to people who are at risk. But if the person still refuses to take the test after it was offered, it will not be forced to them.”
Tayag said that the DOH is already working with local governments to address high HIV cases in several areas in the Philippines, including in the National Capital Region, Southern Luzon, Central Luzon, Cebu, and Davao, to double their efforts to lessen the continuous growth of the people who get infected.
“The only sure way to protect yourself from getting HIV is abstinence, but who can really abstain for so long? So the next effective way to protect yourself is to use condoms. Sec. Ona wants to push for more efforts when it comes to HIV, and we have to do our part so we can ensure the success of the plans,” Tayag said.
For NSAP, there are alternatives to compulsory testing, including community-led HIV testing. In fact, in the last years, collaboration between community groups and government-run HIV testing facilities has intensified, accounting for the increase in the uptake on HIV testing.
“A recently conducted review by international and local HIV experts of existing HIV interventions being implemented in the Philippines has cited this model as an effective approach in a concentrated epidemic. Incidentally, the same review, which was already accepted by the Philippine National AIDS Council (PNAC) that Sec. Ona himself chairs, has already warned authorities against coercive HIV measures, including mandatory testing,” NSAP stated. “Yet Sec. Ona seems to be blind to what the situation is, what the evidence says, and what needs to be done. It’s not a question of knowledge or awareness – he has had several interactions and dialogues with community groups where various issues were discussed, from stigma to gaps in testing and other services. But he refuses to listen.”
Outrage Magazine‘s Tan calls for the government to “focus, really focus on your services – what you should be doing to better what are currently being offered,” Tan said. “Because the continuing worsening situation only highlights that the existing efforts are currently wanting. We need long-term human rights-based solutions to a huge problem that will just continue to worsen right under our noses if we continue having only kneejerk reactions.”