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Isang bote ng ARV lang binigay sa iyo? Sisihin ang DOH sa stockout, at ang hubs for profiteering

Every Filipino with HIV experienced receiving only 15 tablets or one bottle of antiretroviral medicines due ARV stockout, or because treatment hubs hold ARVs hostage until PLHIVs pay PhilHealth. Reasons for this include: DOH’s procurement issues, profiteering of some hubs, and – yes – HIV “leaders” knowing about this for years but not taking actions anyway.

Sa bawat punto ng buhay ng isang Pinoy na may HIV (At various points in the lives of Filipinos living with HIV), I am certain you experienced receiving less than three bottles of antiretroviral (ARV) medicines. For those who experienced the “extreme”, there may have been times when you were only given 15 (or even less) tablets; meaning, kailangan mong pabalik-balik sa treatment hub mo para kumuha ng supply mo (you had to repeatedly return to your treatment hub to replenish your supplies). And no, the hub did NOT care you had to skip work (and lost income), or that you had to spend more to get your meds (and spent money you may not have had).

Sa panahong kulang ang gamot na natanggap mo (At times when you did not receive the right amount of ARV supplies), who do you blame? In a gist: ang Department of Health for its still-fucked-up procurement process, and ang mga HIV treatment hubs for not doing their jobs related to procurement properly, or if they did, the profiteering that comes with this.

Ganito yan (It’s like this):

  1. As a practice, PLHIVs are supposed to visit their treatment hubs every quarter. Kasabay ito ng pagkuha ng pirma mo para maka-kolekta ng PhilHealth ang treatment hubs (This is linked to the treatment hub needing your signature so they can collect money from PhilHealth).
  2. Obviously, the frequency of your visit could change if any hub doctor thinks you need more frequent visits (Duh!).
  3. In the past, punahin nyo (if you’d notice), PLHIVs only had a once-a-year all-encompassing battery of laboratory tests. This has been changed so that – supposedly – during every quarterly visit, PLHIVs should also be getting lab tests; meaning, hinati-hati (they divided) the lab tests.
  4. And so every PLHIV visit means getting ARVs + lab tests.

Ngayon (Now), as noted, there have been instances when the country does not have enough ARVs. DOH doesn’t use the word “stockout” (o walang supply). They prefer “shortage” (kulang). To be blunt, though, since the impact is the same anyway – that is, walang gamot na nakukuha ang mga PLHIVs (PLHIVs do not get ARV meds), we’re really talking of the same thing. A case of “You say tomato, I say tomato.” Because – ulitin natin (let’s repeat) – walang gamot (there aren’t any supplies of the meds).

May mga bagay na dapat malaman (There are things you need to know).

Una (First), the DOH is tasked to procure ARVs.

Nakasulat ito sa (This is written in) RA 11166, or the Philippine HIV and AIDS Policy Act. Section 33 of Article V (Health and Support Services) states that:

“The DOH shall establish a program that will provide free and accessible ART and medication for opportunistic infections to all PLHIVs who are enrolled in the program. It shall likewise designate public and private hospitals to become treatment s hubs.”

There is even “protection” for the poor who end up becoming victims of treatment hubs that seem to function only when money is involved. Section 34 specifically states that “indigent persons living with HIV shall not be deprived of access to medical services. The DOH and DSWD shall establish a program that will support better access to ART and medication for opportunistic infections to all indigent PLHIV, which includes financial support for necessary medical services related to the person’s HIV condition.”

Now, there are HIV “advocates” who would insist that the budget for the procurement of ARVs are separate from OHAT Package. Meaning, no treatment hub should be allowed to hostage ARVs when PLHIVs have yet to pay PhilHealth; bawal dapat na di nagbibigay ng maramihang ARV kapag di nakapagbayad ng PhilHealth ang PLHIVs (it is supposed to be illegal for treatment hubs to withhold ARVs just because PLHIVs have yet to pay PhilHealth).

Also, ikalawa (second), RA 11166 is also blunt in stating that “the funding requirement needed to provide for the health insurance package and other services for the PLHIV… shall be charged against the PhilHealth’s corporate funds.”

Kaya may mga (This is why there are) treatment hubs that dare to justify their non-rendering of lifesaving services to PLHIVs who have yet to pay their PhilHealth contributions.

Ikatlo (Third), the aforementioned policies remain basically the same in the IRR of RA 11166.

Ika-apat (Fourth), in principle, treatment hubs should supply multiple ARV bottles.

Even yung tatlong bote na binibigay nila, bulok na approach na yan (Even the practice of giving three bottles, that’s outdated already). The DOH has a kautusan (order), DOH Administrative Order 2022-0024, signed in 2022, that recommends employing multi-month dispensing particularly to those who are already established on ART. The multi-month dispensing (MMD) approach actually recommends “providing six months’ supply or more of ARV for PLHIV established on ART depending on the need and situation.” Pero sino sa inyo nakatanggap ng supplies for six months (But who among you received supplies for six months)?

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Ika-lima (Fifth), nakailang stockout na ba tayo sa Pilipinas (how many stockouts have we experienced in the Philippines)?

This has become “normal”, actually, with PLHIVs sort of “expecting” it to happen now and then. Which is a shame because it shouldn’t be normalized, and those who made/make this happen should be fired/completely removed from HIV advocacy/activism. Note that when PLHIVs don’t take ARVs it could kill them, so the stockouts could actually cost lives.

Ika-anim (Sixth), because DOH has issues with procurement, hubs were “empowered” in a manner of speaking, to replenish their stocks of ARVs without solely depending on DOH.

PhilHealth Circular No. 2021-0025 allows treatment hubs to use 80% of the OHAT Package that they collect from PhilHealth for “the delivery of the required service/s such as, but not limited to drugs (ARV, TB preventive therapy, drugs for opportunistic infection), vaccines, supplies, laboratory reagents and cartridges, equipment (including procurement and maintenance of viral load and CD4 machines), payment for outsourced services and referrals like laboratory tests, courier services for ARV delivery, and other necessary services.”

Ika-pito (Seventh),since treatment hubs can procure their own ARVs, and charge the same to the OHAT Package, then this is where things become tricky for some of these treatment hubs.

That is, since they procured, and then charge it to the OHAT Package, they therefore need for PLHIV clients to pay PhilHealth. When hubs procure using their “own” money (and yes, I know it’s not “theirs”), then they need to get it back.

Mahabang (This is a long) article trying to touch on:

  • ARV stockout/shortage that has been “normalized” already, deadma sa buhay ng (not caring for the lives of) PLHIVs
  • No one being held accountable for the stockout/shortage
  • Some treatment hubs worsening the situation by holding hostage the ARVs among PLHIVs who have yet to pay PhilHealth
  • HIV “leaders” who know of this issue for years already, and still have not taken steps to remedy this (e.g. no impact at all in the problematic procurement processes of DOH)

Don’t stop disrupting the “business as usual” approach of DOH to HIV. Feel nyo ba na worried sila na lumalala ang sitwasyon ng HIV sa bansa (Do you feel that they’re worried about the worsenng HIV situation in the country)? Yeah… the sense of urgency still isn’t there; so don’t stop calling them out (To HIV “leaders”: Don’t just party with them!).

Don’t stop calling out treatment hubs that hostage your ARVs. Ireklamo nyo sila (Report them). Ipahiya nyo sila (Shame them). Kung kaya lumipat, iwanan ang mga oprtunistang hubs (If you are able to, leave these hubs that are opportunists).

And don’t let fake HIV “advocates” dictate the directions to be taken by the HIV community (they’ve been there for years, and see… the “one bottle until you pay PhilHealth” is still an issue). I chatted with “advocates” who insisted that there’s a policy that mandates treatment hubs to not hold the ARVs hostage. Here’s what’s interesting: ONLY they know about this policy, and – apparently – they did not even share the info to the people they claim to serve. That’s gatekeeping for you…

Huwag tantanan. Dapat na silang lahat kalampagin (Don’t leave them alone. It’s time to interrupt them all).

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

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