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@pozzieblue: The HIV-positive OFW

Contributing writer @pozzieblue tested HIV-positive only this July, while working as a nurse in the Middle East. And so he faced not only the difficulty of being a person with HIV, but also the accompanying problem this status entails for an overseas Filipino worker, as he found himself at first isolated and then deported. And while months have passed and he is now starting a new life, he believes that “what matters is that I’m better now.”

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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.

I’m @pozzieblue.
Yup, I’m HIV positive.
I’m a nurse, and just like any other Filipino nurse, I had a huge dream for my family. That was why I decided to work overseas.
Now I want to share my story.

I’ve read lots of love stories related to HIV.
But this is a bit different…

It was on July 17, 2013 when I was diagnosed with the virus. Time: 9:00 AM. Place: Abu Dhabi, United Arab Emirates.

It was a week after sleepless nights and agonizing when I was asked to go back to the clinic for my visa screening. I was asked to submit another blood sample for the confirmatory testing for my lab exam.

“One of your lab results is vague,” the doctor said.

He didn’t mention which blood exam.

But I was somewhat sure… though I was still hoping it’s not HIV.

Seven days later, the confirmatory result arrived.

“You are HIV positive,” the HR personnel said to me. “We need to deport you. You need to go back to Philippines.”

READ:  Malaysia begins blocking online HIV and AIDS, LGBT travel information

I had just taken a few steps to fulfill my dream. I was already in a position that most nurses only dream to have. To earn more than enough for my family.

But everything broke into small pieces…

I remembered excusing myself for a while to go to the washroom.

I called my brother, who’s also a nurse at the same country, but he’s residing in the middle of the desert. He’s six hours away from me. I just told him my situation, and begged him not to ask how I got infected. I’m a closet gay… but I know he knows it, and I didn’t want to elaborate things to him.

He told me to be strong, and that he’ll accompany me as soon as he can…

He arrived and we slept together in one room. He tried to joke with me, attempting to make the situation easier. “Ikaw talaga, pati dito gagawa ka ng eksena.”

That was the longest night of my life.

Everytime he touched me to comfort me, it was as if my heart was crushed because of my guilt. I wanted to say I’m sorry. But I needed to pretend to be strong. I didnn’t want my brother to get hurt because my pain will just worsen if I see him also hurt.

When the morning came, we expected for me to be sent back to the Philippines. But that wasn’t what happened. Unfortunately, my papers or clearance won’t be processed for five more days. And to comply with the law, I had to be detained.

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My things were confiscated. I was placed in an isolated facility in the middle of a desert. I was alone in the room. I cried and begged to the police officers to hand me my phone so I could talk to my brother. My brother still managed to visit me at the detention center to bring me food and show his support. And it crushed my heart whenever the Arab police asked him to leave; I was only allowed to be visited for 15 minutes. I felt sorry for him because it’s 50 degrees outside and he had to travel for several hours to see me. But I never heard him complain.

And so came the day for me to go back to my homeland.
I was already at the boarding area, and I called my brother and told him what my heart really felt. I said thank you. And I said sorry… I said I’m sorry because I left him in our battle… That I can no longer help him financially sustain our family.
I was crying but he still tried to comfort me.
I repeatedly said I was sorry.
He just told me to be strong and that he loves me.

I left the country with a lighter heart because I told him finally what my heart is aching about.

Months passed and I’m now starting a new life.
My family is wondering what really happened to me in the UAE, but it’s my brother’s and my biggest secret.
We became closer now and more expressive of our feelings.
He sends ILY text messages more often.

READ:  HIV problem persists, 750 new HIV cases reported in Dec. 2016

A huge twist just happened in my life.
But what matters is that I’m better now.

NEWSMAKERS

Condom use pushed to deal with HIV

For “Love Walk”, PAFPI’s workers/volunteers distributed condoms and lubricants in different areas in the cities of Manila and Pasay, with the approach hoping to “educate (particularly men) and to try to change their attitudes, their outlook, and their (sex) behaviors.”

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ALL PHOTOS BY LUWELA RODRIGO

In December 2018, the HIV/AIDS & ART Registry of the Philippines (HARP) reported 877 new HIV cases in the Philippines, with the country now registering 32 new HIV cases every day. And of that figure, 98% (or 861 of the cases) were from sexual contact, which remains the main mode of HIV transmission in the country.

This is the backdrop of the push for condom use of the Positive Action Foundation Philippines Inc. (PAFPI), a non-government organization serving the PLHIV community, via its “Love Walk” advocacy.

Now in its seventh year, “Love Walk” is basically “an HIV awareness campaign” that brings together people to “directly respond to the HIV epidemic affecting the Philippines.”

According to Moses Ayuha, from PAFPI, there are other lessons that may continue to be taught to deal with HIV, including teaching people to abstain from sex to avoid possible HIV infection. However, he said that there is also a need for a more realistic look approach at the situation because “not everybody abstains anyway.”

For Ayuha, and in a gist, there are people who – even if they are already aware of (other) ways to supposedly avoid getting infected with HIV – still have unprotected sex. “These are the people we need to reach.”

For “Love Walk”, PAFPI’s workers/volunteers distributed condoms and lubricants in different areas in the cities of Manila and Pasay, with the approach hoping to “educate (particularly men) and to try to change their attitudes, their outlook, and their (sex) behaviors.”

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Ayuha admitted that efforts like the “Love Walk” continue to be challenging, particularly since bringing the sex educating straight to the streets means teaching people about HIV off the bat. “The challenge ay kung paano ipaliliwanag sa mga tao ang HIV sa kalsada at paano rin maiintindhan ng tao ang kahalagahan ng pagpapa-test (The challenge is how to explain HIV to people on the sreets, and how to tell people about the importance of getting tested for HIV),” he said.

It is also not uncomoon to encounter unwanted responses from people who may not support efforts like “Love Walk.”

Sinasabi namin na hindi naman pag namigay ng condom, (we already) promote sex,” Ayuha said. “It’s just one of the preventive measures. And because – nowadays, people are having sex – we just encourage people to be responsible.” 

In the end, for Ayuha, efforts like the “Love Walk” will continue to be relevant until “we’ve finally properly dealt with HIV.” – ARTICLE FILED WITH LUWELA RODRIGO

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‘Change minds to deal with HIV’

An interview with a person living with HIV, who believes that it’s stigma that kills, not the virus. And so there is a need to change minds if we are to successfully deal with HIV.

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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.

Like others who test HIV-positive, Ron, 36, was “shocked” when he found out his HIV-positive status in April 2018. But he admitted that he was only “a little bit shocked” because he sort of anticipated testing positive because he knew he engaged in risky sexual behaviors in the past. He still couldn’t help but feel some “lungkot (sadness)” because “I let it happen.”

Interestingly, “my family found out about my HIV status before I did,” he recalled. This was because his sister knew the medical practitioners in the hospital where he was tested; and they disclosed his status to her.

Ron said he didn’t want to “break down” in front of family members, particularly since he’s the only boy in the family (and following the stereotypical male expectation that males shouldn’t show weakness by crying/breaking down). However, he realized that his family’s members were apparently also showing the same “strength”, not wanting to show their sadness and even disappointment with him.

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Ron was, therefore, “lucky” that his family showed him “good things; and support”.

When he tested HIV-positive, Ron’s CD4 count was 202, at “the brink of AIDS stage”, he said. And so he had to immediately start his antiretroviral treatment (ART). Immediately becoming healthier was one of the more immediate effects of testing HIV-positive. Another was “turning my life around”, he said – i.e. he rediscovered his faith, which he said he “lost” a few years back, and which may have led to him getting infected with HIV. “I shifted to following the right path,” he said.

Though he is still not open/out about his HIV status, Ron believes that – eventually – one should not hide one’s status. “Being HIV-positive is not an issue,” he said, “so long as you’re focusing on your treatment. You’re just like everybody else; nadagdagan ka lang ng isang pill, or two (you just happen to need to take a pill or two).”

For those afraid to get tested for HIV, Ron said that “if you love yourself and your family, undergo testing. Being HIV-positive isn’t a death sentence; and you may even find your purpose.”

In the end, Ron believes there is a need to deal with stigma. “People are scared about the virus. They just link this mostly with sex, so they look down on this. But if they find out that there’s life – and love – after diagnosis, then it may change their minds.” – WITH STEPHEN CHRISTIAN QUILACIO

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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.”

READ:  HIV problem persists, 750 new HIV cases reported in Dec. 2016

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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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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