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PLHIVs should be included in COVID-19 vaccination priority, say advocates

The Department of Health considers PLHIVs under “persons with comorbidities”; meaning they should be among priority people for COVID-19 vaccination. But PLHIVs still have issues related to this – e.g. absence of clear guidelines from DOH re PLHIV vaccination; stopping of service delivery of many HIV treatment facilities; and the general lack of knowledge or even awareness of PLHIVs on this issue.

Photo by Daniel Schludi from Unsplash.com

Vaccines are part of the essential medicines for people living with HIV (PLHIVs), so if COVID-19 vaccines are available, they should be immediately offered to those who are part of the HIV community.

This is according to Anastacio Marasigan of the TLF Share Collective Inc., a non-government organization that works for the HIV community in the Philippines, where HIV advocates are also pushing for the prioritization of PLHIVs due to their immunocompromised state.

The current list of priority populations to receive COVID-19 vaccination was formulated by the Interim National Immunization Technical Advisory Group (iNITAG), a team of health experts advising the Inter-Agency Task Force on Emerging Infectious Diseases. This list, continuously evolving, prioritizes frontline workers in health facilities (e.g. health professionals and non-professionals like students, nursing aides, janitors, barangay health workers, etc.).

Following them are:

  • Senior citizens aged 60 years old and above 
  • Persons with comorbidities not otherwise included in the preceding categories 
  • Frontline personnel in essential sectors including uniformed personnel and those in working sectors identified by the IATF as essential during ECQ 
  • Indigent population not otherwise included in the preceding categories
  • Teachers, social workers 
  • Other government workers 
  • Other essential workers 
  • Socio-demographic groups at significantly higher risk other than senior citizens and indigent people 
  • Overseas Filipino Workers 
  • Other remaining workforce 
  • Rest of the Filipino population not otherwise included in the above groups

In a statement provided to Outrage Magazine by Dr. Ma. Rosario Singh-Vergeire, Undersecretary of DOH’s Public Health Services Team, PLHIVs fall under “persons with comorbidities”.

This is also why Marasigan said that “this (vaccination) should be an option that must be made available to PLHIVs.”

Marasigan admitted that while “this is a new vaccine (that we still have) very little knowledge or idea on how it would interact or affect the health of the person”, there is still a need for protection, and so “it must be discussed with the PLHIV carefully so that he/she can make necessary decision about it.”

TRICKY TREATMENT

In an online gathering helmed by Positive Action Foundation Philippines Inc. (PAFPI), Dr. Jose Gerard B. Belimac, DOH program manager for HIV/AIDS and sexually transmitted infections, stated that their current recommendation is for PLHIVs to get vaccinated only after they provide CD4 test result within the past six month. If CD4 count is unknown, “defer vaccination”.

Singh-Vergeire wrote to Outrage Magazine that PLHIVs are “advised to undergo individual assessment by their attending physician for a shared decision making process which should be properly documented. This is part of the precautions that both potential vaccine recipients and healthcare workers should take because although immunocompromised individuals are included in vaccine trials, there is limited data on PLHIVs and COVID-19 vaccines (as of this writing).”

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This is, however, out of touch of the reality. 

For one, COVID-19 hindered the delivery of HIV-related services in the Philippines – e.g. many treatment facilities have not been allowing their clients to pay visits, focusing only on the delivery of antiretroviral medicines (ARVs).

Also, many treatment facilities (e.g. Research Institute for Tropical Medicine) no longer provides CD4 tests to their regular clients (providing the same only to new clients), so that the DOH requirement is unrealistic.

According to Elsa Chia, project officer at AIDS Society of the Philippines (ASP), “PLHIVs with undetectable status and stable CD4 count (>200) have the same risk of getting COVID-19 as a person without HIV.” Nonetheless, “since, right now, treatment hubs are taking a wait-and-see approach to the vaccine, awaiting clarity from DOH. We also recommend waiting for further guidance. Philippine General Hospital (PGH) indicated that PLHIVs with CD4 count <200 should not get vaccinated until their CD4 stabilizes.”

Singh-Vergeire, for her part, noted the position of the Philippine Society for Microbiology and Infectious Diseases (PSMID), which stated that PLHIVs may receive COVID-19 vaccines as long as they do not have severe or immediate reaction to any of the ingredients in the vaccine. They may also be vaccinated “as long as the prioritization framework is concerned”.

This is why for her, “the decision to provide PLHIVs with the COVID-19 vaccine shall depend on the individual risk assessment conducted between the attending physician and patient.”

TAKE THE VAXX!

London-based Simon Collins of HIV i-Base said that “the risk from COVID-19 is much more real and much more serious.” For PLHIVs, in fact, “the latest research… shows that PLHIVs have a higher risk of serious outcomes from COVID-19. This is even if we have an undetectable viral load and good CD4 count. If your CD4 count is low though or if you are not on effective treatment, the risk from COVID-19 is even higher. If you are worrying about the vaccine, you should be much more worried about COVID-19.”

Collins also stressed that “HIV positive people were included in the vaccines studies; they are both safe and effective.”

Collins recognizes that there are actually PLHIVs who may not be comfortable disclosing their HIV status before getting COVID-19 vaccine. “

There is unfortunately still discrimination against HIV-positive people,” he said, adding that while “medical information is confidential, COVID-19 vaccines are likely to be given in health settings with low experience of HIV, especially in some rural settings.”

Photo by Daniel Schludi from Unsplash.com

Collins emphasized issues related to this.

First, there are no special processes involved when PLHIVs are given COVID-19 vaccines. And so “if we do get earlier vaccines because of a medical reason (i.e. HIV), the medical details are not important. This process shouldn’t involve making anyone anxious about their HIV status. As there is no safety concern, that choice should be up to the individual person living with HIV.”

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Also, not everyone who will get vaccinated know of their HIV status. Meaning, “if this was important, they would have to ask everyone getting a COVID-19 vaccine to also have an HIV test – which, of course, isn’t the case.”

PLHIV RIGHTS

In online registrations for COVID-19 vaccination of local government units (LGUs), the medical condition of registrants are actually asked.

TLF Share Collective Inc.’s Marasigan said that he recognizes this as “part of the checking of medical history”. Doctors in hospitals, for instance, ask patients if they are taking medicines that could cause possible contraindications. However, “being ‘forced’ is wrong.”

Marasigan stated that even data collection by LGUs should be covered by medical confidentiality and data privacy law, and so “there should be a mechanism/protocol/system to ensure data privacy and integrity.” 

He added that LGUs should have privacy officers or point persons to “ensure that the information shared is protected.”

He similarly added that Republic Act 11166 “is clear about access to medicines of PLHIVs; it is illegal to deny PLHIVs.”

Photo by Hakan Nural from Unsplash.com

Singh-Vergeire stated that “all vaccine recipients will be registered in an integrated information system for monitoring purposes. The Vaccination Information Management System (VIMS) developed and maintained by the Department of Information and Communications Technology shall be used as the main platform for vaccine-related interventions for immunization.”

All the same, she stressed that “LGUs and other identified Personal Information Controllers (PICs) are expected to comply with provisions of the Data Privacy Act of 2012; issuance by the National Privacy Commission and Department of Information and Communications Technology; and other applicable legislations to ensure data security.”

ASP’s Chia noted the potential for the emergence of privacy violation issues. And while “we believe that LGUs have good intentions, but we cannot guarantee how this information will be used in the future.”

For Chia, therefore, “LGUs should not force disclosure in order for PLHIV to access vaccines.”

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ORGANIZE AND DEMAND

In the end, said Singh-Vergeire, PLHIVs are “considered immunocompromised individuals. Since they are at risk for developing severe COVID-19, immunization of PLHIV is encouraged.”

For now, though, “we are also in the process of developing specific guidelines for special populations such as those with comorbidities in order to ensure that those who are most at risk will be prioritized in the vaccine deployment.”

ASP’s Chia said that PLHIVs “should organize… to ensure that they are able to secure priority positions on the vaccination list. PLHIVs have a strong activist culture, particularly surrounding their right to health, and they should tap into this activism to ensure their voices are recognized amid the pandemic.”

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