RITM to stop giving CD4 count to PLHIVs on treatment
HIV treatment hub RITM-ARG is slated to stop giving the every-six-months CD4 count to PLHIV to instead focus on providing viral load test. While the move is actually in line with the WHO guidelines that recommended the use of viral load testing as the preferred method of monitoring response to ART and detecting treatment failure, there are still those who express alarm.
HIV treatment hub Research Institute for Tropical Medicine-AIDS Research Group (RITM-ARG) is slated to stop giving the every-six-months CD4 count to people living with HIV (PLHIV) who are enrolled to receive treatment, care and support (TCS) from one of the pioneering treatment hubs in the Philippines. As of press time, no date was specified when this will commence.
A CD4 count is a lab test that gauges the number of CD4 T lymphocytes (CD4 cells) in a sample of blood. The CD4 count of an uninfected adult/adolescent who is generally in good health ranges from 500 cells/mm3 to 1,200 cells/mm3; while a very low CD4 count (less than 200 cells/mm3) is one of the ways to determine if a PLHIV has progressed to stage 3 infection (AIDS). As such, a CD4 count is considered as one of the “most important laboratory indicators of how well (the) immune system is working and the strongest predictor of HIV progression”.
Instead, RITM-ARG will provide viral load test, which measures the number of HIV virus particles in a milliliter of blood. “Viral load” refers to the amount of HIV in a sample of blood – that is, if the viral load is high, there is more HIV in the body, and it could mean that the immune system is not fighting HIV as well even with antiretroviral therapy (ART, or the treatment with HIV medicines).
Communicating through email, Dr. Rossana A. Ditangco, research chief at RITM-ARG, stated to Outrage Magazine that “CD4 level does not have good correlation with treatment response. The most reliable test for treatment response is viral load. In fact, there are now questions among experts to scrap even baseline CD4 since the current recommendation globally is to treat all regardless of CD4 count.”
In the past, RITM-ARG provided every PLHIV free CD4 and CBC tests every six months. And yearly, during the “anniversary” of a PLHIV, RITM-ARG provided free CD4, CBC, blood chemistry (depending on what antiretroviral medicines the PLHIV is taking), and viral load tests. If the doctor suspects treatment failure, a free viral load test will be done anytime, plus HIV drug resistance testing.
Now, with this development, RITM-ARG will still do baseline CD4 test to determine if a person living with HIV will need prophylaxis for opportunistic infection/s, and will do viral load instead of CD4 test after six months of initiating treatment. There will be another viral load on the 12th month.
In essence, since RITM-ARG will still provide viral load test that it has been providing annually anyway, it is only the CD4 count that will now no longer be offered to PLHIV continuing their treatment.
“If viral load is consistently undetectable, then viral load will be monitored every 12 months thereafter,” Ditangco stated.
IN LINE WITH INTERNATIONAL PRACTICES
The move is actually in line with the World Health Organization (WHO) guidelines on ART (released in July 2013), which recommended the use of viral load testing as the preferred method of monitoring response to ART and detecting treatment failure.
As per WHO, “although evidence from clinical trials for a survival benefit of viral load testing is limited, it can provide an early indication of treatment failure, and the 2013 guidelines strongly recommend using it for detecting virological failure and/or confirming treatment failure among people with evidence of clinical and/or immunological failure… The main rationale for recommending viral load monitoring as the preferred approach compared with immunological and clinical monitoring is to provide an early and more accurate indication of treatment failure and the need to switch to second-line drugs, reducing the accumulation of drug-resistance mutations and improving clinical outcomes. Measuring viral load can also help to discriminate between treatment failure and non-adherence… and can serve as a proxy for the risk of transmission at the population level.”
WHO, nonetheless, stated that “there is still limited evidence to support any additional survival benefit of viral load monitoring over CD4 and/or clinical monitoring among individuals with HIV receiving ART.”
VIRAL LOAD TEST IN A DEVELOPING COUNTRY
As it is, viral load measurement is already a method of choice for detecting treatment failure in developed countries. However, there are studies that note that the “determination of the HIV load is not recommended in developing countries because of the costs and technical constraints” (See also THIS, THIS, THIS and THIS, among others).
According to WHO (from reports by the Clinton Health Access Initiative, UNITAID and Médecins Sans Frontières), the “price per viral load test can range widely ($10 to $60) depending on the manufacturer and country”.
Recently, The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), the largest funder of the international HIV response, teamed up with seven manufacturers of the test to bring down the cost from as high as $85 per test to $15 inclusive of all costs.
In the Philippines, though, viral load measurement remains prohibitive, with a test costing upwards of P6,000. In contrast, CD4 count costs around P2,000.
RITM-ARG’s Ditangco also stated that “the decision not to do post-treatment CD4 has nothing to do with PhilHealth.”
In the Philippines, a PLHIV enrolled in PhilHealth is covered by the Outpatient HIV/AIDS Treatment (OHAT) package. The revised OHAT Package released last June 2015 states that “covered items under this benefit are drugs and medications, laboratory examinations based on the specific treatment guideline including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), and test for monitoring anti-retroviral (ARV) drugs toxicity and professional fees of providers.”
Outrage Magazine already reached out to PhilHealth to get its take on this development, but no response has been received as of press time (Outrage Magazine will continue following up not only with PhilHealth, but also with other concerned offices regarding this issue – Ed).
As it is, various treatment hubs all over the country already give PLHIV different services even if they pay the same premium to PhilHealth, so that Department of Health Undersecretary Vicente Y. Belizario Jr. earlier stated to Outrage Magazine that the DOH is pushing for “harmonization”.
In Cagayan de Oro City, Stephen Christian Quilacio of the Northern Mindanao AIDS Advocates (NorMAA) expressed concern over the “repercussions of the big change.”
As it is, “the inconsistency in the delivery of services of treatment hubs is already lamentable,” Quilacio said.
With this development, Quilacio is worried of “the eventual response of other treatment hubs, particularly those outside of Metro Manila, which will not surprisingly follow suit.” In his way of seeing, “basta himuon sa Manila, sundon lang baya sa local (practices done in Manila are also done in local settings).”
And while Quilacio said that “putting in best practices is ideal – perhaps as in the case of using viral load measurement over CD4 count – we have to be realistic with the capacities of treatment hubs.”
In Mindanao, for instance, many PLHIV do not have viral load measurement at all (with treatment hubs having no machines to do the test), and there are times when even CD4 count is not done because of the unavailability of CD4 count machines and/or reagents.
Quilacio’s sentiments were shared by Fritzie Estoque, chairperson of the Misamis Oriental-Cagayan de Oro AIDS Network (MOCAN). Particularly if the same effort (i.e. cancellation of CD4 count) is done in treatment hubs outside Metro Manila, “sana (hopefully) health authorities will first conduct a thorough evaluation of the service delivery capacities of the treatment hubs in the rural areas before doing this move. As per the experiences of our clients, it really takes forever to get them scheduled to have viral load tests. And already considering the difficult process of getting viral load tests in provincial treatment hubs, if you also remove the CD4 measurement tests, then what will be left for PLHIV here? A plan without a thorough evaluation and assessment is equal to failure of health service delivery. Failure of health service delivery will result to early deaths of PLHIV,” Estoque said.
“We have to make sure that if we take big leaps to progress, we don’t leave any people – in this case, PLHIV outside of Metro Manila – behind,” Quilacio ended.
THIS IS A DEVELOPING STORY, AND OUTRAGE MAGAZINE WILL CLOSELY FOLLOW UP WITH OTHER PARTIES OF INTEREST TO GET THEIR TAKE ON THIS ISSUE.
‘We need inclusive responses to HIV’ – Bahaghari Center
For Ms Disney Aguila, board member of Bahaghari Center, “it needs to be emphasized that HIV can only truly be dealt with if everyone is on board.”
In early 2019, Jay (not his real name), a Deaf gay man who lives outside Metro Manila, was encouraged by his friends who knew community-based HIV screening (CBS) to get himself tested. It was, he recalled, “the first time someone offered me this service; so I caved in.”
Jay was reactive; and “my world crumbled,” he said.
Though his friends tried to comfort him, telling him that knowing his status is good, “since at least now I can take steps to get treatment and live a normal, healthy life,” Jay wasn’t assuaged. His friends had to eventually go back to Metro Manila, and he worried that he would be left on his own to “find ways to access treatment.” And the same issue that did not make testing accessible for him – i.e. him being Deaf – is now the same issue he believed would hinder him from getting treatment, care and support (TCS).
Jay’s case, said Ms Disney Aguila, board member of the Bahaghari Center for SOGIE Research, Education and Advocacy Inc. (Bahaghari Center), highlights how “numerous sectors continue to be ignored in HIV-related responses.”
Aguila, the concurrent head of the Pinoy Deaf Rainbow, the pioneering organization for Deaf LGBTQIA Filipinos, added that “it needs to be emphasized – particularly today as #WAD2019 – that HIV can only truly be dealt with if everyone is on board.”
WORSENING HIV SITUATION
As reported by the HIV/AIDS & ART Registry of the Philippines (HARP) of the Department of Health (DOH), the Philippines has 35 new HIV cases every day. The figure has been consistently growing – from only one case every day in 2008, seven cases per day in 2011, 16 cases per day in 2014, and 32 cases per day in 2018.
In July, when HARP released its (delayed) latest figures, there were 1,111 newly confirmed HIV-positive individuals; this was 29% higher compared with the diagnosed cases (859) in the same period last year.
Perhaps what is worth noting, said Aguila, is the “absence in current responses of minority sectors” – e.g. when even data does not segregate people from minority sectors, thus the forced invisibility that used to also affect transgender people who were once lumped under the MSM (men who have sex with men) umbrella term.
For Aguila, this is “detrimental to the overall response re HIV because specific needs are not answered.”
DEAF IN FOCUS
In 2012, Bahaghari Center conducted “Talk to the Hand”, the first-of-its-kind study that looked at the knowledge, attitudes and related practices (KAP) of Deaf LGBT Filipinos on HIV and AIDS. The study had numerous disturbing findings.
To start, majority of the respondents (33 or 54.1%) were within the 19-24 age range at the time of the study, followed by those who are over 25 (21 or 34.3%). Most of them (53 of 61 Deaf respondents) had sex before they reached 18. Many (36.1%) of them also had numerous sexual partners, with some respondents having as many as 20 sex partners in a month.
Only 21 (34.4%) use condoms, and – worryingly – even among those who used condoms, 12 (19.7%) had condom breakage during sex because of improper use.
Perhaps the unsafe sexual practice should not be surprising, considering that not even half (29, 47.5%) of the respondents heard of HIV and AIDS, with even less that number (23, 37.7%) knowing someone who died of HIV or AIDS-related complications. And with not even half of the total respondents (29) familiar with HIV and AIDS, not surprisingly, only 19 (31.1%) considered HIV and AIDS as serious, with more of them considering HIV and AIDS as not serious (20, 32.8%) or maybe serious (22, 36.1%).
The study also noted that the level of general knowledge about HIV and AIDS is low, with 40 (65.6%) of them falling in this category. Only about 1/5 of them (12, 19.7%) had high level of knowledge about HIV and AIDS. Even fewer (9, 14.8%) may be classified as having moderate knowledge level.
For the Deaf community, at least, accessing testing and – if one tested HIV positive – the TCS is challenging because “we’d need Filipino Sign Language (FSL) interpreters who can help make sure we’re getting the right information/treatment/et cetera, Aguila said. And in the Philippines, the numbers of service providers who know FSL remain very limited.
Already there are Deaf Filipinos trained to conduct CBS particularly for other Deaf Filipinos – here in “Stop HIV Together“, a photo campaign stressing the need for inclusion.
INCLUDING OTHER MINORITIES
Aguila stressed that forced invisibility, obviously, does not only affect the minority Deaf community as far as HIV-related responses are concerned – e.g. “other persons with disability continue not to have HIV-related interventions,” she said.
For Aguila: “To truly stop HIV and AIDS, we need to be inclusive.”
Back in the city south of Metro Manila, Jay was forwarded to a counselor who knows FSL so that he can be supported in accessing TCS. Even that was “problematic,” said Jay, because “I was ‘forced’ to come out to someone I didn’t necessarily want to disclose my status only because I had no choice.”
For him, this highlights “how we just have to make do with what’s there; and there really isn’t much that’s there to begin with.”
He feels “lighter” now, however, having started his antiretroviral treatment (ART). But he knows he’s one of the “lucky people with contacts”; and that “not every one has access to the same support I had… and that’s something we need to deal with.”
‘Ang laban ng LGBT ay laban ng mamamayan’
As Baguio City holds its 13th #Pride March, there is emphasis on the de-commercialization of Pride to ficus on issues affecting all minority sectors including the #LGBT community. As stressed by Nico Ponce of Bahaghari-UP Baguio, hopefully other sectors join the fight for human rights for all because “ang laban ng LGBT ay laban ng buong mamamayan.”
The struggle of the LGBTQIA community is the struggle of the people/nation.
So said Nico Ponce, chairperson of the UP-Baguio University Student Council and of Bahaghari-UP Baguio, which helmed Amianan Pride Council (APC), the organizer of the 13th Pride March in Baguio City.
This is why, Ponce added, at least particularly for Pride in Baguio City, there was an intent to veer away from commercializing Pride, to instead focus on the issues of all LGBTQIA people no matter the sector they belong to. There was also an emphasis on intersectionality – i.e. that other minority sectors have a stake in the fight for equal treatment of LGBTQIA people, also a minority sector.
“We are against the commercialization of Pride,” Ponce said, “since naniniwala tayo na ang historic roots of Pride ay… sang protest (we believe in the historic roots of Pride as a protest).” And so, to maintain the militant nature of Pride, we “make calls that… are comprehensive; and that affect not just LGBTQIA people but all Filipinos.”
The position, of course, is relevant considering the seeming (if not eventual) move towards commercialization of Pride events – e.g. cash-dependent Metro Manila’s Pride parade was able to gather over 50,000 participants in this year’s party/gathering; though the same number won’t surface to push for the anti-discrimination bill (ADB) that has been pending in Congress for 19 years now.
“There is still no equity,” said transgender activist Ms Santy Layno, which makes hosting Pride still relevant.
“We still march,” added Rev. Pastor Myke Sotero of MCC-MB, “because even if people say that LGBTQIA people are already tolerated in the Philippines, we continue to suffer discrimination… with our transgender siblings still killed/murdered. We still need to march for Pride… as a form of protest.”
‘We (still) need Pride because of the apparent need of the LGBTQIA community (for acceptance) in all sectors of society,” Ponce added.
Baguio City already has an anti-discrimination ordinance, passed in April 2017, that wants to ensure that “every person… be given equal access to opportunities in all fields of human endeavor and to equitable sharing of social and economic benefits for them to freely exercise the rights to which they are rightfully entitled, free from any prejudice and discrimination.”
But the city also has anti-LGBTQIA history. For instance, in 2011, eight pairs of LGBTQIA people had commitment ceremony there, under MCC-MB. Oppositions were raised by the Catholic Church and a group of pastors from Baguio and Benguet. Bishop Carlito Cenzon of the Baguio-Benguet Vicariate of the Roman Catholic Church, for one, stated that “these unions are an anomaly.”
In the end, said Sotero, Pride is a way to inform society “that we’re here, we’re not going anywhere, so society should accept LGBTQIA people.”
“To people who ridicule/mock us, we’re open to discussions,” said Ponce. “Hindi sila kaaway… kaya sana makiisa kayo dahil ang laban ng LGBTQIA ay laban ng buong mamamayan (We are not enemies… so we hope you join the struggle because the fight for equality of LGBTQIA people is similar to the fight for social justice of the entire nation).” – WITH ALBERT TAN MAGALLANES, JR.
Baguio marks 13th LGBTQIA Pride
The “City of Pines” marked its 13th LGBTQIA Pride March, themed “Diverse but equal” to stress that “despite diversity, everyone remains inherently equally human.” According to Rev. Pastor Myke Sotero of MCC-MB, Pride is a way to inform society “that we’re here, we’re not going anywhere, so society should accept LGBTQIA people.”
Equally diverse; equally human.
The “City of Pines” marked its 13th LGBTQIA Pride March, themed “Diverse but equal” to stress that “despite diversity, everyone remains inherently equally human.”
According to Rev. Pastor Myke Sotero, who helms Metropolitan Community Church-Metro Baguio (MCC-MB), which is part of the Amianan Pride Council (APC), the organizer of the annual event, even now that LGBTQIA issues (continue to) gain traction in mainstream awareness, holding a Pride event remains relevant because “kahit na sinasabi nating tolerated na ang mga LGBTQIA dito sa Pilipinas (even if it is said that LGBTQIA people are already tolerated in the Philippines), we continue to suffer discrimination.”
Sotero noted that, in fact, “patuloy pa din ang pagpatay sa mga kapatid natin na transgender (our transgender siblings are still being murdered/killed).”
Only in September, for instance, the lifeless body of Jessa Remiendo was found on the shore of Patar in Bolinao, Pangasinan – only approximately 94 kilometers away from Baguio City (just over two hours of road trip).
A few weeks before the gruesome murder, LGBTQIA people have been highlighting the need to pass an anti-discrimination law in the Philippines, particularly since the bill that eyes to protect the human rights of sexual minorities have been pending in Congress for 19 years now.
“Kailangan pa ring ipagpatuloy ang pagmamartsa sa Pride bilang sang protesta (Marching for Pride is still needed as a form of protest),” Sotero said.
Sotero added that Pride is also a way to inform society “na andito kami, hindi kami aalis, at dapat i-accept ang mga LGBTQIA people (we’re here, we’re not going anywhere, so society should accept LGBTQIA people).”
Baguio City actually already has an anti-discrimination ordinance, passed in April 2017, and notes that “discrimination is a crucial and serious issue” and it wants to ensure that “every person… be given equal access to opportunities in all fields of human endeavor and to equitable sharing of social and economic benefits for them to freely exercise the rights to which they are rightfully entitled, free from any prejudice and discrimination.”
But the city also has anti-LGBTQIA history – e.g. in 2011, when eight pairs of LGBTQIA people had commitment ceremony there, under MCC-MB, there were oppositions from the Catholic Church and a group of pastors from Baguio and Benguet.
In reaction, Bishop Carlito Cenzon of the Baguio-Benguet Vicariate of the Roman Catholic Church stated at that time that “these unions are an anomaly.” Meanwhile, the Guiding Light Christian Church maintained that “marriage should be between a man and woman only”.
And so for Det Neri, chairperson of Bahaghari-Metro Manila, a multisectoral militant and nationalist LGBTQIA organization based in Metro Manila (and whose arm in UP Baguio healed this year’s gathering), even now, LGBTQIA people are still mocked and “ginagawang katatawanan (made fun of).” And so celebrating Pride is “mahalaga para hindi tayo nawawala sa kasaysayan, hindi tayo mawawala doon sa hinaharap (we aren’t erased in our history, and we aren’t neglected as we head into the future).”
Neri added that Pride’s essence remains militant, and should remain as such. – WITH ALBERT TAN MAGALLANES, JR.
Dumaguete City passes SOGIE equality ordinance
In a victory for members of the LGBTQIA community in the City of Dumaguete, an ordinance was passed in the City Council to ensure non-discrimination based on sexual orientation, gender identity and expression (SOGIE).
In a victory for members of the LGBTQIA community in the City of Dumaguete, an ordinance was passed in the City Council to ensure non-discrimination based on sexual orientation, gender identity and expression (SOGIE).
Dumaguete is a 3rd class city in the province of Negros Oriental. According to the 2015 census, it has a population of 131,377 people.
It is the capital and most populous city of the province of Negros Oriental, it has a population of 131,377 people, according to the 2015 census.
Authored by Councilor Rosel Margarette Q. Erames with co-authors Councilors Lei Marie Danielle Tolentino, Bernice Ann Elmaco, Edgar Lentorio Jr., Lilani Ramon and Nelson Patrimonio, the anti-discrimination ordinance (ADO) penalizes actual or perceived SOGIE-based discrimination in the workplace, school and other similar acts that undermines and harms the rights of the LGBTQIA people.
Under the ordinance among the prohibited acts include:
- Actual or perceived SOGIE-related discrimination from employment, training, promotion, remuneration;
- Delaying, refusing or failing to accept a person’s application for admission as a student;
- Expelling or any penalty on the basis of SOGIE;
- Harassment and intimidation committed by teachers, administrators and fellow students;
- Refusing to provide goods or service, or imposing onerous terms and conditions as a prerequisite for such;
- Denying access to health services and facilities;
- Refusing or failing to allow LGBTQIA to avail of services or accommodations;
- Denying application for licenses, clearances, certifications or other documents;
- Vilifying, mocking, slandering or ridiculing LGBTQIA people through words, action and in writing; and
- Executing any activity in public which incites hatred towards or serious contempt for or severe ridicule of LGBTQ and other analogous acts.
The bill didn’t have smooth sailing before it passed. For instance, the Diocesan Commission on the Laity (whose members consist of 42 Parish Pastoral Councils from the different parishes of the Diocese of Dumaguete, covering the provinces of Negros Oriental and Siquijor, with the exception of the municipalities of La Libertad and Vallehermoso, and the cities of Guihulngan and Canlaon), as well as the Diocesan Organization of Renewal Movements & Communities (composed of 14 organizations) expressed their opposition of the ADO.
When the passage of the ADO also made the news, a handful of locals expressed their disapproval, stating – among others – that LGBTQIA people do not face discrimination in Dumaguete (thereby contradicting their own statement), prioritizing other issues of the city, and that protecting the human rights of LGBTQIA people is against the will of God.
But now with the ADO, first time violators will be made to attend a gender sensitivity training. Second time offenders may be jailed for not less than 60 days but not more than one year, or be fined with not less than P2,000 but not more than P 5, 000 (or both at the discretion of the court).
With the ADO, SOGIE-related concerns will be incorporated in the functions of existing Barangay Violence Against Women and Children (VAW) Desk, which will document and report cases of discrimination against LGBTQIA persons.
Ilagan City in province of Isabela enacts SOGIE-specific anti-discrimination ordinance
General Ordinance 198-2019 finds the “need to prohibit… discrimination against people on the basis of actual or perceived SOGIE on the areas of work, accommodation, education, provision of goods, facilities and services, memberships in organizations, and the administration of local laws and programs.”
The rainbow rises up north.
Ilagan – officially the City of Ilagan – a first class city and capital of the province of Isabela, enacted its own anti-discrimination ordinance based on sexual orientation, gender identity and expression.
Authored by City Councilor Rolando Tugade, General Ordinance 198-2019 stated that the office of the Sangguniang Panglungsod “finds the need to prohibit, so far as is possible, discrimination against people on the basis of actual or perceived SOGIE on the areas of work, accommodation, education, provision of goods, facilities and services, memberships in organizations, and the administration of local laws and programs.”
According to Yonidick Pascua, president of City of Ilagan Gay Association, who pushed for the passage of the ADO, having the same is important “para mapangalagaan ang bawat LGBTQIA person,” he said. This is also needed, he added, to show respect to the rights and “dignidad ng bawat LGBTQIA person; para sa pagkapantay-pantay (na trato) bilang tao sa lipunan.”
Passing the ADO was challenging, said Pascua.
“Marami pa rin sa ating mga kababayan ang lubos na hindi naiintindihan kung ano ba talaga ang SOGIE,” he said, adding that this is – nonetheless – exactly why the ADO is needed. Fortunately, for him, City Mayor Josemarie L. Diaz and Vice Mayor Kit Bello backed the ADO.
With the ADO, “inaasahan natin na magiging mas ligtas ang bawat LGBTQIA person (dito sa Ilagan); inaasahan natin na mas lalong magkakaroon ng lakas ng loob at mamuhay ng mas panatag ang bawat LGBTQIA person, at inaasahan natin ang mas masaya at makulay na pamumuhay ng bawat LGBTQIA person dito,” he said.
Aside from the aforementioned acts prohibited by the ADO, also deemed unlawful is “discrimination through verbal or non-verbal ridicule and vilification,” where it is declared “unlawful for any… person to vilify or ridicule any person on the based of perceived or actual SOGIE which may result in the loss of self-esteem or sense of safety and security, or the infliction of psychological harm through: contemptuous imitating or mockery; and uttering of abusive and slanderous statements.”
Persons who violate the ADO may be jailed for up to 60 days, and/or fined up to P5,000.
With the ADO, the city mandates its barangays to “develop a system to record and document reported cases of discrimination and violence against LGBTQIA persons, and provide assistance to victims.” But the ADO also establishes an LGBTQIA council.
“Yakapin po ninyo ang LGBTQIA people, itaguyod ang SOGIE para sa proteksyon ng bawat LGBTQIA person at bigyan sila ng pagkakataon na mamuhay ng mapayapa at ligtas sa pamamagitan ng pagpasa ng ADO,” Pascua said. “Ang mga LGBTQIA people ay kasama sa lipunan kaya nararapat laman na yakapin, tanggapin at bigyan ng respeto.”
Behind the bars on LGBTQIA life in prison
In the Philippines, it remains hard to monitor wrongful accusations (and eventual wrongful convictions); much more on how badly this affects members of the LGBTQIA community. Outrage Magazine interviews a gay man who experienced this, and what he went through as a minor behind bars.
It was a tiring day for then-16-year-old Harry (not his real name). He just got home from two consecutive weddings, and so – right after arriving at their house in San Jose City in Nueva Ecija – he asked his mother if he could skip school to just rest.
Harry’s mother indulged him; but she also asked Harry to look after a younger sibling as she had to do some errands. On her way out, Harry saw his mother speak to the nine-year-old son of their neighbor outside their house; he said he was just wandering to catch a dragonfly.
With his mother gone, and before getting some sleep, Harry decided to harvest some mangoes from the tree beside their house. And while atop the tree, he noticed that the nine-year-old boy was no longer in the street. After getting down from the tree, he went inside their house, locked the door, and then slept.
It seemed that only a few minutes passed, but Harry was woken by knocking on their front door. He got up to open the door; it was the nine-year-old boy’s mother, asking about the clothes Harry wore to one of the weddings that day. When Harry moved to go inside the room to get the pants he wore, the nine-year-old boy surfaced from inside the room.
“Anong ginagawa mo diyan (What are you doing there)?” the mother asked her son, flabbergasted.
He said “tinitingnan ko lang ‘yung kapatid ni Harry (I was just looking at the younger brother of Harry).”
Harry joined the conversation, saying he didn’t know that the boy was even inside.
The boy’s family went straight to the police station, accusing Harry of child molestation. Harry was eventually taken into custody.
Though he was only 16 then, Harry was detained at the lock-up facility of the Philippine National Police (PNP). This is – by itself – a violation of Republic Act 9344 or the Juvenile Justice Law of 2006, which sets the minimum age of criminal liability at 15 years old. This means that those between 15 to 18 years old (and Harry was 16 when the alleged rape happened) may be detained in youth centers and go through rehabilitation programs, while those under 15 years old are exempted from criminal liability and undergo intervention.
After a month with the PNP, Harry was transferred to the custody of the Bureau of Jail Management and Penology (BJMP), an agency of the Department of the Interior and Local Government (DILG), mandated to direct, supervise and control the administration and operation of all jails in the Philippines.
Here’s a sobering fact: the incarceration rate of lesbian, gay and bisexual (LGB) people is up to three times than that of the general population. Sexual minorities (or people who self-identify as LGB and people who do not identify as LGB but reported a same-sex sexual experience) comprise: 9.3% of men in prison, 6.2% of men in jail, 42.1% of women in prison, and 35.7% of women in jail.
Note: As is often used, “jails” are facilities that hold inmates awaiting trial or serving short sentences, while “prisons” are facilities for those serving their (often longer) sentences.
Now this is worth stressing: Even if this has already been (partly) studied overseas, this continues to be largely ignored in the Philippine context.
One study – “Incarceration Rates and Traits of Sexual Minorities in the United States: National Inmate Survey, 2011–2012″, co-authored by Ilan H. Meyer, PhD, Andrew R. Flores, PhD, Lara Stemple, JD, Adam P. Romero, JD, Bianca D.M. Wilson, PhD, and Jody L. Herman, PhD and published in the American Journal of Public Health – found that sexual minorities are not only incarcerated at disproportionately high rates, but that once incarcerated, they are more likely to experience mistreatment, harsh punishment and sexual victimization.
A LIFE IN FEAR
“Nung first time kong pumasok sa loob ng selda, binuhusan ako ng isang pulis ng tubig habang natutulog pa ako (The first day I got detained, a police officer splashed water on me while I was sleeping),” Harry recalled. Dazed and confused, and not knowing who the person was (because she was not wearing uniform), “tinanong ko siya kung naka-detain din ba siya; hindi ko alam na pulis siya. Nalaman ko lang nung bigla niyang pinakuha yung batuta niya (I asked if she was also a detainee; I had no idea she was a police officer. The moment she asked for her club/cudgel, everything just came to me).”
There was a time when Harry was almost transferred to Boystown (a facility for offending minors), but his mother pleaded for this not to be done since he would then be too far from home and she would be unable to visit him regularly. And because he did not entirely understand what was being discussed, all Harry said he could do was cry, “too scared of everything.”
Bullying/getting maltreated was a “norm” particularly for those who just enter prison.
In Harry’s case, he was beaten – an act, he was told, was “a way to welcome new inmates.”
“Ano yung ginagawa ng mga jail officers? Wala lang din. Wala silang ginagawa kasi minsan parang sila na din yung nagsasabi o nagbibigay ng memo na i-welcome yung mga bagong inmates (The jail officers are not acknowledging this issue. They are not doing anything about it because there are times when they, themselves, are the ones who give orders to welcome new inmates in that way),” Harry said.
Inside the jail, minors are supposed to be separated from the adult inmates. But this policy is also amendable, depending on the whims of the warden. In their case, an inmate who was also a minor tried to escape because he wanted to celebrate his birthday outside the prison, but “after that incident, the (minors were already treated as adult inmates), included with the adult prisoners.”
Men and women have separate sections; but transgender women are mixed with men.
“Wala silang sariling lugar doon sa kulungan. Isinasama sila sa mga lalaki kasi para sa mga tao doon, lalaki pa din sila (There’s no designated place for them. The jail officers still see/treat them as men),” Harry said.
Also as big as a risk for new inmates like Harry was getting raped.
“Meron talagang rape na nangyayari sa loob. Lalo na sa mga bagong pasok. Yun din minsan ang parang pinaka-welcome ng mga inmates na lalaki sa mga inmates na bakla. Kahit ayaw mo, talagang pipilitin at pipilitin ka (It is undeniable that rape occurs inside the jail. They specially do it to the newcomers. This is how straight inmates would welcome gay people in their cell. Even if you don’t want to, you will be forced)” Harry recalled.
Harry was not exempted from this experience because, “sabihin ko man na ayaw ko, hindi pa din sila pumapayag na huwag kong gawin. Pag sinabi ng isang inmate na gawin namin, wala na lang din akong magawa kundi sumunod na lang (Even though I didn’t want to, I would never have a choice. If a straight inmate asked for it, you just have to obey them),” Harry said. “Na-experience ko yun as a welcome sa akin nung pagpunta ko don (I experienced it as a welcome greeting when I first got there).”
At 16, Harry was raped in jail by a 23-year-old.
“Pag na-gustuhan ka nila, may mga grupo don tapos lalapitan ka nila. Papapasukin ka nila sa lugar nila tapos gagalawin ka nila. Mapapasunod ka na lang kesa masaktan ka (If you caught their interest, groups of boys would approach you and ask you to join them in their cell to rape you. You won’t have any other choice because if you refuse, they will hurt you),” he said.
This maltreatment, by the way, is not exclusive to members of the LGBT community in jail/prison, since “there, no matter what your gender is, they will hurt you if they wanted to.”
Though these may – no doubt – be known to those running the country’s jails/prisons, Harry said that they didn’t have access to any contraceptives and/or protection while inside the jail/prison.
“Hindi sila nakakapag-provide ng ganun. Kahit minsan nasusubukan namin magkaroon ng sakit, hindi din kami nabibigyan ng kahit anong gamot. Itinatawag lang namin sa mga magulang namin yung mga ganun (They can’t provide things like that. Even at times when we were sick, no medicines were made available to us. We still rely on our relatives outside),” he said, adding: “Saka pa lang nagkakaroon ng aksyon pag parang mamamatay na yung tao (They only really act when someone is already really close to dying.)”
There was a point in time when Harry said he almost gave up. But he kept telling himself that “hindi yun ang panahon na dapat akong mawalan ng pag-asa dahil naniniwala ako noon na darating at darating yung oras na malalaman talaga kung ano yung totoo (That was not the time for me to just give up. I had faith that the truth will come out),” Harry said.
Much has already been said about prison management in the Philippines.
To start, and as noted by the Human Rights Watch (HRW), critical and chronic overcrowding has long been a perennial topic when discussing the country’s jail facilities. BJMP runs 415 detention facilities in 17 regions, and on average, its jailhouses report 380% overcapacity. In Metro Manila alone, the BJMP’s total cell area of 22,318 square meters, designed for 4,749 detainees; but it currently holds 21,868 detainees (a congestion rate of 361%).
The surprising – and somewhat senseless – thing worth noting here is that between 85% and 90% of the more than 94,000 inmates in the custody of BJMP are awaiting or undergoing trial.
“This makes the Philippines the Southeast Asian country with the highest number of pretrial and remand detainees and the second highest in all of Asia. Prolonged detention without charge or trial violates international human rights instruments, including Article 9 of the International Covenant on Civil and Political Rights, which the Philippines ratified in 1986. Moreover, it ‘shall not be the general rule that persons awaiting trial shall be detained in custody,’ but rather released with guarantees of appearing for trial,” HRW stated.
HRW also noted that “the injustice of lengthy detention is compounded by the horrific conditions of the jail facilities (with) many detention centers in the Philippines failing to meet the minimum United Nations standards for such facilities, including inadequate amounts of food, poor nutrition, and unsanitary conditions.”
And yes, “torture and other forms of ill-treatment are also common,” HRW similarly noted.
Inside jail, fighting for oneself was never really an option, Harry said, because the inmates could just – eventually – get back to you for fighting back. Giving in to just go with the flow was the attitude being in jail teaches inmates.
Though one time, Harry said he tried to fight for his basic human right of… simply existing and being treated more humanely.
One time, he recalled, a lady jail officer started pushing his chest with her fist and kept asking him if it hurts. It reached a point where the officer was already pointing a knife at him.
“Sabi ko sa kanya, hindi rin ako papayag na gaganunin niya ako. Bilang isang inmate, itrato din naman sana kami na parang tao dahil hindi naman kami iba sa kanila. Kasi sabi ko wala naman kaming ginagawang masama sa kanila. Tapos sabi ko pwede ko silang ireklamo sa ginagawa nilang ‘yun (I told her that I won’t let her do that to me. I may be an inmate, but I am also a person just like her. I told her that I did not do anything wrong to deserve the way she is treating me. I also told her that I could file a complaint on how she is treating me),” he said.
That – fortunately for Harry – silenced and prevented her from doing more harm.
It was while in jail that Harry finished high school under the Alternative Learning System (ALS) program offered there.
ALS is a practical option for learning in the Philippines, offering education to those who could not usually attend and access the formal type of schooling.
It was also while in jail when Harry first found love.
Harry met another minor, and “we became BFs.”
Prisoners who are in relationships and want to have sex may ask for permission from the jail officers who then give them space to do so. “Pwedeng-pwede lalo na pag LGBT ka; pero pag babae at lalaki, medyo mahirap kasi inmate na lalaki at inmate na babae, bawal ‘yun (ipagsama) (The officers are very open to that matter specially if you are a part of the LGBT community. But if the sexual intercourse is going to be between a man and a woman, they don’t allow it).”
Their relationship lasted for a year and three months.
THE WRONGLY ACCUSED
While in jail, Harry was repeatedly told that he would be transferred to “The Mansion” (how inmates called New Bilibid Prison, located in Muntinlupa as the main insular penitentiary designed to house the prison population of the Philippines). He was scared; and he was feeling bad, though not just for himself but also his mother who – even if she just gave birth – continued to regularly visit him.
And then one day, his lawyer – while on a visit – just handed him his already-signed release paper.
“Bigla po akong na-congratulate ng attorney ko dahil nai-panalo ko daw yung kaso ko (My lawyer congratulated me because we won the case),” Harry said.
Relieved, he said he just wanted to have a life outside.
It is worth noting that Harry’s case is not exactly rare. And the warning bells have long been ringing.
In 2004, Free Legal Assistance Group (an NGO that provides legal assistance mainly for human rights cases) conducted a survey of death convicts in the Philippines, and it found “significant figures that could indicate a high judicial error rate”. The survey showed that 73.9% of the convicts were arrested without a warrant, 78.3% were not informed of their constitutional rights at the time of arrest, and – get this! – 90% were not assisted by counsel during police investigation and interrogation.
Perhaps it is also worth noting that 52.2% of the convicts belong to the lowest socioeconomic class.
In 2014, Innocence Project (a litigation and public policy organization composed of human rights advocates in Ateneo, UP Law School and De La Salle University College of Law, headed by Jose Manuel “Chel” Diokno) revealed that some 400 prisoners were wrongfully convicted by the court; most are charged with rape.
And in 2017, the Philippine Daily Inquirer reported of the Supreme Court’s admission that seven in 10 death penalty convictions in 1993-2004 by the lower courts, submitted for automatic review, were wrongly judged. Also, during trials, 59% of the suspects were represented by lawyers from the Public Attorney’s Office, but 54.1% did not have regular consultations with their trial lawyers, and 10.2% never even had a consultation.
So in 2017, during the 17th Congress, former Sultan Kudarat Rep. Horacio Suansing Jr. and Nueva Ecija Rep. Estrellita Suansing filed House Bill 5582 to create a commission mandated to review all cases in which an innocent person was convicted; identify the causes of wrongful convictions; and identify current laws, rules and procedures implicated in each identified cause of wrongful convictions. This is because, the politicians noted, “at present, there is no government entity in our country charged with conducting the independent expert review of wrongful convictions necessary to identify the primary and potential causes of wrongful convictions.”
The same bill was actually originally filed by the late Senator Miriam Defensor Santiago during the 14th Congress and refiled during the 16th Congress. It failed to pass the 17th Congress.
Suffice it to say, in a country like the Philippines, it remains extremely hard to monitor wrongful accusations (as in the case of Harry) and eventual wrongful convictions; much more on how badly this affects members of the LGBTQIA community. And then – yes – add to this the extra layer of hardships experienced by members of the LGBTQIA community if/when they are sent to jail/prison, some of them experienced by Harry, solely because of their sexual orientation, gender identity and gender expression.
THE WORLD OUTSIDE
Upon his release from jail, Harry’s first stop was his brother’s house, where they accused him of escaping. “They only believed me when I showed them the release paper,” he recalled.
Not surprisingly, the complainants weren’t too happy that Harry was released. And this was even if other stories emerged – e.g. that the family of the complainant just paid the medical exam to release a report that stated that the boy was raped; that when the nine- year-old boy was interviewed, he actually denied that he was raped; and that the complainant demanded P30,000 from his family in exchange for his freedom.
Harry was also told that if he wants to turn the tables on them and file a case against his complainants, it would be a very strong lawsuit.
But not that Harry even cared at that point in time. “Pinabayaan ko na lang. Hindi ko inisip na maghiganti pa sa kanila (I moved on. Revenge is not what I wanted),” Harry said.
Harry’s relationship with his fellow minor inmate also did not prosper.
The BF is also already out of jail, Harry said, and he’s already married (to a woman). “Wala naman akong magawa kundi maging masaya na lang para sa kaniya. Pero magkaibigan kami ngayon (There’s nothing I can do but be happy for him. We’re still friends though),” Harry said.
As a freed man since 2016, Harry eventually found a job working for a local government official.
“Sa totoo lang, mahirap talaga ang buhay sa loob ng kulungan kapag kayo ay papasok so kailangan talaga na mag-ingat kayo na wag gumawa ng kasalanan (My advice to the LGBT people is for them to watch their actions because it is very hard to live behind the bars),” Harry said.
And to the incarcerated: “Sana mag-ingat na lang din sila kasi kailangan din nilang maipagtanggol yung sarili nila sa lahat ng maling gawain doon sa loob (To those who are inside, they should take care and learn to fight for themselves from every wrong thing that is happening inside).”