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This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”.
More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

When Rommel, 51, tested HIV-positive, it was “accidental” – i.e. he was out clubbing with his BF and friends, and he just told his BF “why don’t we get tested?”

He recalled being surprised, though, why his BF’s rapid test was already done, and yet his still wasn’t; he even reprimanded the counselor, telling him to rush as the show in the club they were going to was already about to start.

At ayun na nga, positive,” he said. His BF tested negative. And at that very moment, they became a serodifferent couple.

But also looking back, Rommel said a year prior to getting tested, he remembered getting really, really sick. It just so happened that his BF is a doctor, so they had contacts who helped make him get better. He also noted that he was treated with “lahat na (just about everything)” but that his HIV status was not even checked then.

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And then – months after already getting better – he also had boils all over his upper body (neck included), so he said he sort of suspected something was up.

Perhaps – just perhaps – it was also because he had an open relationship and was engaged in unprotected sex with multiple sexual partners. “Sa totoo lang, dumating na yung point sa relationship namin na i-spice up ang sex life (To be honest, we reached a point in our relationship where we had to take steps to spice up/enliven our sex life),” he said. So they had threesomes, et cetera. “Siguro isa sa mga naka-threesome namin doon ako nakakuha ng HIV (Maybe I was infected by one of our sexual partners).”

After his baseline tests, Rommel’s CD4 count was found to be already “very low” – at 36. Not surprisingly, he needed to make lifestyle changes – e.g. if he used to party a lot in the past, and if his priority was to hang out with friends, “naging ang priority ko bigla, health (health suddenly became my priority).”

Rommel said that “wala naman blaming na naganap sa relationship namin (No blaming happened in our relationship)”. In fact, he thinks this made them closer.

His HIV status also made him appreciate family members (i.e. he immediately informed them of his HIV status), particularly since they have been accepting of him. “Mas lalo ko naramdaman ano talaga ang ibig sabihin ng love (I really understood what love truly means)… I also appreciate them more now.”

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Rommel believes in looking forward – and that includes when living with HIV.

“I hate the word ‘pagsisisi (regret)’,” he said.

To be more proactive, he – in fact – established Courage Pilipinas in 2018 as a support group for people living with HIV.

He advises for those who want to go into HIV advocacy to select who they work with/for; and not to allow oneself to be used by fake advocates.

For those who have yet to get themselves tested for HIV, Rommel said “huwag na kayong magpa-tumpik-tumpik pa (stop gallivanting).” He thinks that everyone should “normalize” HIV testing – as if one is just getting a haircut, manicure/pedicure, or even doing laundry.

And for people who have HIV, particularly those who were only recently diagnosed, “my message is… not to be ashamed. Don’t dwell on the past. Face what’s in front of you. Just fight on. And remembers, it’s just a virus.” – with Michael David C. Tan

POZ

Faulty immune receptor may be why many face HIV complications

Patients with malfunctioning receptors can’t shut off their immune systems, which can put the body in a chronic proinflammatory state. This constant activation can negatively affect other organs and tissues.

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Photo used for illustration purpose only. Photo by Vittore Buzzi from Unsplash.com.

HIV treatments that control the infection have come a long way, but many still struggle with a host of other disease-related complications, such as neurocognitive disorders, cardiovascular issues, diabetes and chronic inflammation.

Why these complications occur isn’t exactly known, but many indicators point to an overactive immune system, something HIV patients are all too familiar with.

Michigan State University scientists discovered SLAMF7, an immune receptor that has the ability to tone down the body’s immune response when activated on certain white blood cells, called “monocytes.” The finding was made after studying both healthy and HIV-infected patients. Yet, for certain HIV patients who experience a myriad of health issues, the researchers found that these patients’ receptors don’t work properly.

They also discovered that SLAMF7 made the monocytes more resistant to HIV by increasing the level of a protein, called “CCL3L1,” which is known to make it harder for the HIV virus to get inside cells.

The federally funded study is published in the Journal of Immunology.

“SLAMF7 can act like a seesaw and keep the balance of the immune system in check,” said Patrick O’Connell, a fourth-year doctoral student who led the project with Yasser Aldhamen, an assistant professor of microbiology and molecular genetics in the College of Osteopathic Medicine. “When receptors need to turn immune cells on because of an infection, they bind to the cells and work with fellow receptors to activate the immune system. When signs of infection or inflammation go away, the receptors switch gears and turn off the immune response.”

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O’Connell explained that for HIV patients, their inability to fight infections stems from chronic immune activation, which exhausts certain cells, such as T-cells, that are needed to help the body ward off diseases.

Patients with malfunctioning receptors can’t shut off their immune systems, which can put the body in a chronic proinflammatory state. This constant activation can negatively affect other organs and tissues.

“If you have too much activation, you see autoimmune disorders where the body attacks its own tissues and if there’s not enough activation, you see cases where the body can’t fight off infections,” O’Connell said. “HIV patients are different because they can experience both, which can lead to all sorts of health issues and make treatment difficult.”

O’Connell and the team tested the blood of study participants, isolated their white blood cells and stimulated them with interferon alpha, a protein that boosts the immune system’s response to infections, sometimes to an unhealthy level. They then investigated how the SLAMF7 receptor responded, and found that it was unresponsive in certain HIV patients who struggled more with complications and often times had a worse prognosis.

Understanding the molecular mechanism of the SLAMF7 receptor and how it works could lead to new drug treatments that target immune activation. This could make SLAMF7 a functioning team player again in the immune system – something Aldhamen and O’Connell are looking at in their next phase of research.

“There’s always a need to get new drugs that can target different mechanisms related to a disease,” O’Connell said. “Most HIV drugs target the virus itself. Our work comes at it from a different angle – to potentially modify the immune system so we can fight the virus. Finding a drug that does this is our ultimate goal.”

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NEWSMAKERS

Teaching Deaf Mindanawons about community-based HIV screening

Select members of the Deaf community in Mindanao were trained not only on the basics of HIV, but also on community-based HIV screening.

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“We’ve (actually) been given info on the basics of HIV,” admitted Prime Truya, a local Deaf LGBTQIA community leader from Davao City, “but past efforts have been limited to ‘basic knowledge’ sharing.”

With this, select members of the Deaf community in Mindanao were trained not only on the basics of HIV, but also on community-based HIV screening.

This endeavor – part of a project by Bahaghari Center for Research, Education an Advocacy, Inc. (Bahaghari Center), backed by collaboration between Youth LEAD and Y-PEER (Asia Pacific Center), which eyes to address Sexual Reproductive Health and Rights (SRHR) needs of Young Key Populations (YKPs) In Asia and the Pacific – is the first to actually teach the Deaf about actual screening/testing.

The goal, said Disney Aguila of Bahaghari Center and Pinoy Deaf Rainbow, Inc., is not just to “inform them that this issue is just as important to them. It is also to equip them with the actual know-how on what to do to become solutions in dealing with this issue.”

This project is also a follow-through of the public service announcements (PSAs) developed in Filipino Sign Language (FSL) to specifically tap the Deaf community.

PSA on HIV basics released in Filipino Sign Language

PSA on getting tested for HIV released in Filipino Sign Language

PSA deals in Filipino Sign Language what happens after rapid HIV test

Aguila lamented that “the Deaf community is often left behind in HIV-related efforts. Not surprisingly, we have a lot of catching up to do.”

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In Davao City, for instance, at least prior to the Bahaghari Center project, none of the Deaf community members were trained to screen/test others for HIV. This “approach of not empowering us makes us dependent on Hearing people,” Aguila said, adding that this dependence is not always good because “it disempowers us in dealing with this issue.”

Aguila admitted that the Deaf community will continue to have “an uphill battle in fighting HIV exactly because of this playing catch-up,” she said. “But every effort than can be done now should already be done now.”

The community-based HIV screening trainings are provided by The Red Ribbon Project, Inc.

Other supporters of the project include: Outrage Magazine, Fringe Publishing, Pinoy Deaf Rainbow, TransDeaf Philippines, Deaf Dykes United and Pinoy Deaf Queer.

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NEWSMAKERS

Cebu’s Deaf community taught community-based HIV screening

Select members of the Deaf community from the Province of Cebu were trained on the basics of HIV, and on community-based HIV screening in an effort to “inform them that this issue is just as important to them, and that – given the chance – they can help become the solutions to deal with this.”

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Helping Deaf Filipinos to help themselves.

Select members of the Deaf community from the Province of Cebu were trained on the basics of HIV, and on community-based HIV screening in an effort to “inform them that this issue is just as important to them, and that – given the chance – they can help become the solutions to deal with this,” said Disney Aguila of Bahaghari Center for Research, Education an Advocacy, Inc. (Bahaghari Center) and Pinoy Deaf Rainbow, Inc.

The training is part of a project by Bahaghari Center, backed by collaboration between Youth LEAD and Y-PEER (Asia Pacific Center), which eyes to address Sexual Reproductive Health and Rights (SRHR)needs of Young Key Populations (YKPs) In Asia and the Pacific.

This project is also a follow-through of the public service announcements (PSAs) developed in Filipino Sign Language (FSL) to specifically tap the Deaf community.

PSA on HIV basics released in Filipino Sign Language

PSA on getting tested for HIV released in Filipino Sign Language

PSA deals in Filipino Sign Language what happens after rapid HIV test

Aguila lamented that “perhaps because the Deaf community is often left behind in HIV-related efforts, we have a lot of catching up to do,” she said.

In Cebu City, for instance, even if participants recognized the importance/urgency of tackling HIV, there are sectors that are still “unable to go beyond their fear of talking about sex and sexuality.”

Noticeably, the Hearing community “may already talk about SOGIE concepts and so on, but – because we have not always been included in discussions, we’re still learning the basics,” Aguila said.

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This is why, for Aguila, every effort counts to “ensure that we are included in the discussions; and perhaps just as importantly, also empowered so that we need not be dependent on the Hearing community just to be able to access lifesaving services.”

Aguila said that “this development may not come immediately, but every step leading there helps.”

The community-based HIV screening trainings are provided by The Red Ribbon Project, Inc.

Other supporters of the project include: Outrage Magazine, Fringe Publishing, Pinoy Deaf Rainbow, TransDeaf Philippines, Deaf Dykes United and Pinoy Deaf Queer.

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Editor's Picks

Worsening #ARVshortage in the Phl?

On Jan. 9, the Philippines gained a new HIV and AIDS law that is supposed to better the lives of Filipinos living with HIV. But many in the HIV community mark this day with distress, largely because of the worsening ARV shortage.

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In September 2018, Xander (not his real name; anonymity requested), a Filipino living with HIV, claimed that he was told by the person working in the pharmacy of his hub to “consume already-expired medicines (the three-in-one tablet of Lamivudine/Tenofovir/Efavirenz)”, and that “it is “still good for three months after the expiration date.”

Since dealing with ARV-related issue is not new to him (it happened to him in the last quarter of 2013), he complained and was given newer meds. Noticeably, “those who didn’t complain – like I did – ended up using the expired meds,” he said.

Xander can only recall how he earlier lamented – again in 2013 – that the ARV shortage will happen again, particularly considering the continuing denial of the Department of Health (DOH) about this issue.

TAINTED ‘SUCCESS’

The 9th of January is supposed to be a happy day particularly for Filipinos living with HIV and their advocates. On that day, the newly-signed Republic Act 11166 or the Philippine HIV and AIDS Policy Act was released after it was signed into law by Pres. Rodrigo Roa Duterte. By replacing the 20-year-old Republic Act 8504 or the Philippine National AIDS and Control Act of 1998, this new law is supposed to boost the government’s response to HIV and AIDS by making health services for HIV and AIDS more accessible to Filipinos.

But many in the HIV community mark this day with distress, largely because of the worsening ARV shortage, which is not helped by the denial of the issue by various heads of offices – including government officials, as well as those helming treatment hubs/facilities and even select non-government organizations (NGOs).

In an unsigned statement (as if so that no one can be “chased” to be held accountable for the same statement), the DOH seemed to belittle the issue by outright claiming that there’s an ‘alleged’ shortage of ARVs; even as it also stated that they take the issue of HIV infection in the country seriously. Part of this is to take “great steps to ensure that access for HIV treatments are available for those who are diagnosed with HIV.”

The DOH statement added:
“As of October 2018, we have enrolled 32,224 persons living with HIV for treatment with ARV such as Nevirapine, Lamivudine/Tenofovir. The DOH has been providing free ARV to Filipinos living with HIV through our HIV treatment hubs.
“Based on our records, there are 3,200 registered PLHIV who are on Nevirapine and 1,791 PLHIV on Lamivudine/Tenofovir, as of December last year.

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That just about half of the total PLHIVs in the Philippines use ARVs is worth noting, even if it’s another issue altogether.

But the mention of these two meds/cocktails is important because the complaints reaching – among others – Outrage Magazine, Bahaghari Center for SOGIE Research, Education and Advocacy, Inc. (Bahaghari Center) other and HIV-related community-based organizations/non-government organizations particularly currently mention these.

In Quezon City, for instance, at least eight PLHIVs alleged that they have been given incomplete medications – i.e. they were supplied with either Lamivudine/Tenofovir or Lamivudine/Zidovudine, but they have not been receiving Nevirapine because this is not available. These people are, therefore, taking incomplete meds.

Pinoy Plus’s hotline, PRC, has received similar allegations of non-delivery of Nevirapine.

In Cavite (Imus, Bacoor and Dasmariñas), at least three clients surfaced to allege about the same issue. PLHIVs are now “borrowing” each others’ Nevirapine supply just so they don’t miss their required dosage because their hub does not have supplies from the DOH.

There are similar allegations in Cagayan de Oro City, Davao City and Zamboanga City.

And in Alabang, the pharmacy of a treatment hub even posted on January 8, 2019 an announcement that “due to the shortage and delay of the deliveries at DOH, only one bottle will be dispensed of the following medicines: Nevirapine (200mg tablet); Lamivudine (150mg)/Zidovudine (300mg tablet); and Lamivudine (300mg)/Tenofovir (300mg tablet).” The same hub is telling its clients to “wait for further announcement on stock availability.”

Note that the RITM-AIDS Research Group’s pharmacy is putting the blame on the DOH.

DOH’s CLAIM

The same DOH statement stressed that “the latest data, as of January 4, confirms that Nevirapine has already been delivered to the 16 treatment hubs to meet the requirements for February-April 2019. For Lamivudine/Tenofovir, a month’s supply has also been delivered to Regions X, VI and I. The rest of the regions will expect deliveries within this week.”

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Noticeably, the DOH statement responds to issues only this January, even if this concern has been circulating in the PLHIV community since 2018, and only peaked now.

There are fewer ARV refills now. If, in the past, the usual practice is for hubs to give PLHIVs three bottles of ARV to last them for three months, a growing number are now complaining about the supply being cut to one month in numerous hubs – e.g. there’s that post in RITM’s pharmacy. Some allege that they are even supplied ARVs just for a week or even just for three days.

Due to the ARV shortage that the DOH is not outright confronting, expired medicines are allegedly being given to PLHIVs – as in the case of Xander.

Also due to the ARV shortage, the medication of a number of PLHIVs are allegedly being changed not because it’s medically sound, but because their usual medicines are not readily available. In Mandaluyong City, there are PLHIVs who claimed to have been told to use Lamivudine/Tenofovir/Efavirenz because it’s the only available ARV. If they refuse to do so, then they will have to stop taking their usual medications until such time when the delivery of supplies are normalized again.

To allow the DOH to respond to these claims, Outrage Magazine repeatedly reached out to the government body. Upon calling the media relations unit (at +63 2 651-7800 loc. 1126), we were turned over to the office of Dr. Gerard Belimac (+63 2 651-7800 locs. 2355, 2352, 2354). Five attempts were made to speak with Belimac or any other authority in his office, but he has been unavailable at those five times; and even after leaving requests for a statement from him on the ARV shortage, as of press time, the publication has not heard back.

As this is a continuing story, coordination will continue to – eventually hopefully – extensively hear from the DOH on this issue.

WHAT NOW?

The DOH statement also stated that it is “working closely with our suppliers to ensure that there are no gaps in our supply chain. In fact, we are waiting for deliveries of an additional 12,375 bottles of Nevirapine good for another three months and 7,024 bottles of Lamivudine/Tenofovir good for another two months.”

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The DOH also claimed that it is continuing to explore “for more partners in providing excellent support for Filipinos living with HIV-AIDS and in ending the deadly disease.”

As if wanting to pacify the complaining PLHIVs, the DOH statement transferred to responsibility to “HIV doctors to explore possible options”, or visit Facebook page (PLHIV Response Center) or email dohnaspcphiv@gmail.com. Note the use of a gmail account for a body with millions in budget.

No investigations on where the errors in the supply chain is happening so that these can be fixed is forthcoming. No one being held accountable here.

THE NEED TO GO BEYOND LIP SERVICE

Incidentally, Article V, Sec. 33 of the newly signed HIV law states: “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… A manual of procedures for management of PLHIV shall be developed by the DOH.”

The IRR is not even there yet, but this mandate to provide life-saving meds is now already cast in doubt.

Xander – who only had a refill of his ARVs – said that many like him who posted about this issue online were told to stop doing so “because we are supposedly creating panic among PLHIVs.”

He now says that people who cover up this issue are “as worse as those paid to work on this issue. Because if you go to the HIV community, we’ve long lived with worrying that our meds may not be given us at any moment. If some people think complaining about this is wrong, then they shouldn’t be in HIV advocacy, but work as PR people of those failing to do their jobs.”

In the end, “this needs to be resolved fast. Enough with discussing semantics on what we’re having is a shortage or a stockout; the fact remains that there are PLHIVs not getting their supplies. Lives are at stake. So supply the ARVs; now.”

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POZ

HIV and AIDS Policy Act signed into law

The Philippine HIV and AIDS Policy Act updates Republic Act 8504 to incorporate lessons from the current HIV response by introducing “newer evidence-based, human rights-informed, and gender transformative strategies to prevent and treat the epidemic.”

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The Philippines now has a new law eyeing to strengthen the country’s comprehensive response against HIV and AIDS

People may already be familiar with RA 8504, or the Philippine AIDS Prevention and Control Act of 1998. When it was introduced, RA 11166 or the Philippine HIV and AIDS Policy Act intended to update Republic Act 8504 to incorporate lessons from the current HIV response by introducing “newer evidence-based, human rights-informed, and gender transformative strategies to prevent and treat the epidemic.”

The Philippine HIV and AIDS Policy Act was ratified by both the Senate and the House before Congress went on recess on October 10, 2018. It was then transmitted to Pres. Rodrigo Duterte on November 26, 2018

On December 20, 2018, Duterte signed the new law; although it was only on January 9, 2019 when it was made available to the public.

Some of the new law’s eminent features include:

  • Minors aged 15 to under 18 may now voluntarily get tested for HIV, as stated in Article IV, Section 29 (versus the need for approval of their parents or guardians, as previously required under Republic Act 8504).
  • Mandate for the Department of Health (DOH) to establish a program that would provide free and accessible anti-retroviral treatment and medication for opportunistic infections to people living with HIV who would enroll in the program.
  • Mandate for the Philippine Health Insurance Corporation to develop a benefit package for PLHIVs to include coverage for inpatient and outpatient medical and diagnostic services, including medication and treatment. It is now prohibited by law to deny PLHIVs private health and life insurance coverage and claims.
  • Development of basic and age-appropriate instruction on the causes, modes of transmission and prevention of HIV, AIDS and other sexually-transmitted infections in public and private schools, including alternative and indigenous learning systems.
  • Mandate for the Department of Education to conduct awareness-building seminars in coordination with parent-teacher organizations to provide parents and guardians with a “gender-responsive and age-sensitive HIV and AIDS education.”
  • Provision of education on HIV and AIDS shall to all public and private employers and employees, members of the military and police, overseas Filipino workers, communities and key populations at higher risk for infection.
  • Jail term of six months to two years and/or a fine of not less than ₱50,000 on anyone who discloses the information that a person has AIDS, undergone an HIV-related test, has HIV or HIV-related illnesses or has been exposed to HIV, without their written consent.
  • Prohibition of disclosure of the name, picture or any information that would identify people living with HIV and AIDS or any confidential HIV and AIDS information on media without their written consent. The mass dissemination of these confidential information would be punished with imprisonment for two years and one day to five years, and/or a fine of ₱150,000 to ₱350,000.
  • Jail term of six months to five years and/or a fine of ₱50,000 to ₱500,000 for those discriminating against PLHIVs; and may have their business permit, business license or accreditation or professional license suspended or revoked.
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Incidentally, the Philippines has the fastest growing HIV epidemic in the Asia-Pacific, with infections jumping by 140% from 2010 to 2016. The country currently records 32 new HIV cases every day, though responses to this have varied – e.g. the DOH has been criticized for complaining about budget cuts, and yet spending money on a beauty pageant; while there are NGOs criticized for putting profit before service in HIV-related efforts.

Following the signing of the Philippine HIV and AIDS Act by Duterte, Secretary of Health Francisco T. Duque III released a statement via the media relations unit of the DOH stating that “the signing of the Philippine HIV and AIDS Act is a huge step forward in responding to the growing HIV epidemic in the Philippines” because now, “mabibigyan na natin ng tamang suporta ang mga Pilipinong may HIV-AIDS (we can give proper support to PLHIVs).”

But the sentiment may be put in bad light because of the ongoing ARV shortage affecting the HIV community, wth a growing number of Filipino PLHIVs now lamenting: 1. not receiving regular supplies of ARVs (some allegedly getting meds only for a week or even three days, instead of the usual three months’ supply); 2. being shifted to another ARV because their usual/regular medicines are not available due to procurement issues by the DOH; or 3. being made to use expired medicines because there are no other available medicines for them.

With the new law, the next step is now to develop and then properly execute an Implementing Rules and Regulations to guide executive officials in implementing the law, as well as the public in how to comply with the law.

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UPDATED ON JANUARY 9: An earlier version of this article stated that the the HIV and AIDS Policy Act lapsed into law, 30 days since it was transmitted by Congress to Malacañang, where Pres. Rodrigo Duterte failed to sign it. Laws transmitted to Malacañang which are not acted on for 30 days lapse into law; and initially, it was thought that Duterte neither signed nor vetoed the HIV and AIDS Policy Act, therefore it lapsed to becomes the country’s new HIV-related law. However, the copy of the RA 11166 released by Malacañan Palace shows that the law was actually signed by the President on December 20, 2018.

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POZ

Community-based HIV testing effective in reaching undiagnosed populations – study

New strategies and models of HIV testing are urgently needed to reach undiagnosed populations and help them enroll in antiretroviral therapy. And here, community-based HIV screening is an effective approach.

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It is estimated that one in three people living with HIV remain undiagnosed, so that new strategies and models of HIV testing are urgently needed to reach undiagnosed populations and help them enroll in antiretroviral therapy (ART).

This was stressed by an evaluation study published in PLOS ONE, which noted that HIV testing by lay providers can serve as a critical addition to efforts to achieve the United Nations’ 90-90-90 global HIV targets by 2020 and help to cover the “last mile” of HIV services to at-risk populations.

The evaluation study was done in Vietnam by PATH, in partnership with the Vietnam Ministry of Health, the United States Agency for International Development (USAID), and the Center for Creative Initiatives in Health and Population in Hanoi. It found that community-based HIV testing is “an effective approach to reach people at risk of HIV who have never been tested or test infrequently.”

Key at-risk populations include people who inject drugs, men who have sex with men, female sex workers, and first-time HIV testers.

A cross-sectional survey of 1,230 individuals tested by lay providers found that 74% of clients belonged to at-risk populations, 67% were first-time HIV testers, and 85% preferred lay provider testing to facility-based testing. Also, lay provider testing yielded a higher HIV positivity rate compared to facility-based testing and resulted in a high ART initiation rate of 91%.

According to Dr. Kimberly Green, PATH HIV & TB director, “innovation in HIV testing is absolutely critical to meet (the 90-90-90) ambitious targets, and community-based HIV testing offers a promising solution to connect undiagnosed people with the services they need.”

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Lay providers participating in this study belonged to community-based organizations led by at-risk populations in urban areas and to village health worker networks in rural mountainous areas. Providers used a single rapid diagnostic test in clients’ homes, at the offices of community-based organizations, or at any private place preferred by the client. This approach helped to overcome barriers that had prevented key populations from seeking facility-based testing services, such as a perceived lack of confidentiality, fear of stigma and discrimination, inconvenient service opening times and distance, and long waiting times for test results.

Clients who had an HIV-reactive test were referred to the nearest health facility for HIV confirmatory testing, and those who received a confirmed HIV-positive result were referred to a public or private clinic for enrollment in ART. Clients with non-reactive test results received counseling to re-test after three or six months and were referred to a local health facility for HIV prevention services.

The study stresses the effectiveness of HIV testing administered by non-health care workers representing key populations and frontline village health volunteers. The results also support findings from community-based HIV testing approaches in other regions, including sub-Saharan Africa, that have demonstrated comparatively high rates of HIV testing uptake, high HIV positivity yields, and high success rates in linking people to care.

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