So last night, just as I was about to sleep, I got a frantic text message.
“I got myself tested,” this acquaintance – a young man – said.
I haven’t seen him for a while, maybe for months. So it was actually somewhat surprising when he messaged me, to begin with.
“And?” I asked after a short “Hey, how’ve you been?”.
“I wanna die,” he quipped.
That text messaging turned into an impromptu mini-counseling.
But – over/above the texting – two nagging thoughts were in my head.
On the one hand – based on the monthly report sent out by the HIV/AIDS & ART Registry of the Philippines (HARP) – the number of Filipinos getting infected with HIV continue to be high, with 918 new HIV cases reported in October 2017. Yes, males continue to be mostly affected (95% of the new cases); sex remains the main mode of transmission (873 of the 918 cases in October; and Filipinos getting infected are still getting younger (in October, 269 or 29% of the cases were among youth aged 15-24 years and 96% were male).
But on the other hand, that the responses in the Philippines to deal with HIV continue to be fucked up can’t be stressed enough.
And on the latter, the service “providers” are – at times – the problem.
“The clinic told me to go to (a treatment hub) tomorrow to have my lab tests done,” he said after I was able to assuage (at least even some, I hope) of his worries.
I was… surprised. “Tomorrow’s a Saturday. Will the hub be open then?”
“I don’t know,” he said. “They just told me to go.”
“Will someone be going with you?”
Apparently, “after the rapid test, they just told me to ‘Go to PGH bukas/tomorrow.’” And that’s that; he was dismissed.
One can’t help but feel that the famed (and well-funded) clinic where this young man got himself tested just doesn’t care. It almost felt like they just wanted to “include” him as a number, one of the people they can claim to have “reached”. And now that he’s been counted (to be included in their reports to their funders, no doubt), they’re washing their hands of him; like he’s no longer “their issue.”
“Pinapasa sa iba ang tungkulin (The duty/responsibility is passed to others),” Ayuha said.
And this is what’s… sad, annoying, anger-inducing, et cetera.
Like PAFPI’s Ayuha, The Red Ribbon Project’s Ico Rodulfo Johnson (after hearing of this same story) quipped: “What else is new?”
Yeah, yeah, I know that people are – in the end – responsible for themselves. But this seeming “dumping” of a new PLHIV has long been lamented as one of the reasons for “loss to follow-up”. The likes of Quezon City’s Health Department’s John Jardenil (who used to be with the now-defunct Remedios AIDS Foundation Inc.) knows this too well, considering that – in servicing the HIV community – he actually personally links people to TCS (treatment, care and support) if/when they test HIV-positive. “People have to be helped to help themselves,” Jardenil said.
And so the need to yet again focus ALSO beyond the testing.
I suppose that even with the number of “service providers” to get more Filipinos tested for HIV growing, the current “limit” for many is to “just test”. There seems to be this uncaring attitude with what happens after the testing.
I say: You can’t just test people and then – after finding out they’re reactive/positive – “dump” them to become somebody else’s problem. Because if/when you do, your concept of service provision is too limited, and as such, you’re actually part of the problem you claim to be dealing with…
At what cost? HIV service disruptions at the time of Covid-19
One of the biggest casualties of Covid-19 may be the delivery of other services, such as HIV testing. In the Philippines, HIV prevention services were reduced by 20% to 30%, and HIV testing services reduced by 20% to 80%. And sans clear B&W guidelines, community-based service providers continue to be at a loss.
Ashley Galvinez, board member of the Sta. Catalina Active LGBT Organization in Zamboanga in Mindanao, used to get screened for HIV every month (to every three months). “I’ve been doing this since I became sexually active,” she said to Outrage Magazine via video interview.
But then the world was struck by Covid-19, and the country was placed under lockdown. And this already-regular part of her health monitoring was stopped.
“Kaya sa bahay na lang muna; tiis-ganda,” she said, adding that she was still scared she could get infected with HIV or get sexually-transmitted infections.
The fear of Galvinez isn’t unfounded.
This May, UNAIDS noted with the World Health Organization (WHO) “the need for urgent efforts to ensure the continuity of HIV prevention and treatment services in order to avert excess HIV-related deaths and to prevent increases in HIV incidence during the COVID-19 pandemic. It will be important for countries to prioritize shoring up supply chains and ensuring that people already on treatment are able to stay on treatment, including by adopting or reinforcing policies such as multimonth dispensing of antiretroviral therapy in order to reduce requirements to access health-care facilities for routine maintenance, reducing the burden on overwhelmed health-care systems.”
“Every death is a tragedy,” said Winifred Byanyima, executive director of UNAIDS. “We cannot sit by and allow hundreds of thousands of people, many of them young, to die needless deaths.”
This is in no way limited to the Philippines, too.
UNAIDS similarly noted that “if efforts are not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500,000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021.”
In 2018, approximately 470,000 people died of AIDS-related deaths in that region.
“The terrible prospect of half a million more people in Africa dying of AIDS-related illnesses is like stepping back into history,” Dr. Tedros Adhanom Ghebreyesus, WHO Director General was quoted as saying. “We must read this as a wake-up call to countries to identify ways to sustain all vital health services.”
To be specific, disrupted HIV-related services could include:
- Difficulty in accessing antiretroviral medicines
- Reduced quality clinical care owing to health facilities becoming overstretched
- Suspension of viral load testing
- Reduced adherence counseling and drug regimen switches
- Interruption of condom availability
- Suspension of HIV testing
ALSO IN NEED OF FOCUS
According to Ms Jaya L. Jaud, community HIV outreach worker for the Zamboanga City-based Mujer LGBTQ+ Org., HIV is also a pandemic, and this is something “na dapat ding tutukan.”
Jaud added that there is a need to face reality that HIV cases are increasing in the Philippines.
From October to December 2019, there were 3,029 newly confirmed HIV-positive individuals reported to the HIV/ AIDS & ART Registry of the Philippines (HARP). Sixteen percent (474) had clinical manifestations of advanced HIV infection at the time of testing.
By end-2019, the country was registering 35 new HIV infections per day, up from only one case per day in 2008, seven in 2011, and 16 in 2014.
EMPHASIS ON COVID-19
In Antipolo at the outskirts of Metro Manila, Darwin Tenoria, case manager at Antipolo Social Hygiene Clinic, said that they are already trying to return their HIV-related services to how they were before Covid-19.
“It doesn’t mean that our (HIV-related) services stopped,” he said, but these services were instead only modified. For instance, the actual HIV testing is the same (e.g. blood extraction, et cetera); but the pre- and post-test counseling were amended (via installation of dividers, practice of social distancing, as well as use of face shields and/or masks) so that the counselor and the client are protected.
But at least, Tenoria said, “we have some foot traffic.”
HALTED COMMUNITY-BASED SCREENING
Tenoria, at least, works in a health facility.
But – as far as HIV testing and/or screening is concerned – it is the community-based screening (CBS) that has been greatly affected, many actually stalled.
CBS is the HIV screening process done by the likes of Jaud, wherein a volunteer/screener goes to communities to offer HIV testing and screening. This is particularly beneficial to those who live far from a testing facility or those who may not have the time to visit a testing facility.
In idea, this seems like a good idea particularly at the time of Covid-19 because the lockdowns meant people have no means to access health facilities.
But according to Gregory Rugay from the CBS team of Northern Sanctuary MCC in Baguio City, “screening itself has totally stopped at the moment.”
Instead, the focus has been to link to treatment, care and support those who have tested reactive or positive before Covid-19 lockdowns.
“It is kind of tricky,” Rugay said, “because those who have been calling us, wanting to be tested right away, are people who have symptoms (akin to Covid-19) like fever, colds… and difficulty of breathing. With the pandemic going on, you are at a loss on how to treat this kind of issue because their symptoms can also point to (having) Covid-19.”
WANTED: COMMUNITY-BASED SERVICE PROVIDERS
Rugay’s fear has merit… even if, obviously, the services he used to be able to freely offer is still needed.
On May 18, UNAIDS stated that “the role of community-led organizations must be appropriately recognized and supported in the context of COVID-19. They must be factored into all aspects of planning, design and implementation of interventions to combat both COVID-19 and the efforts required to mitigate the impact of COVID-19 on other health areas, including HIV and tuberculosis.”
And so UNAIDS recommended, among others:
- Including community-led health care service providers into lists of essential service providers
- Policies allowing community-led services to continue operating safely
- Ensure that community-led organizations are provided with personal protective equipment and training to protect them and their clients in service delivery
LACK OF CLARITY?
In terms of CBS, “they do not have specific guidelines,” Tenoria said. “There’s no clear guideline on how to mobilize CBS.”
This is even if three months have passed since the Covid-19 lockdown has started.
Jaud agrees, saying that “there’s no protocol – e.g. in using personal protective equipment (PPE).” What happens now is – at least in her case – they rely on the practices of the city health office, as well as the practices of NGOs.
Still waxing positive, Jaud said that the Department of Health (DOH) may have not focused on this because – obviously – Covid-19 was the focus for a while, and because there may have been this assumption that because there are a lot of NGOs/CBOs in this field already, they may already know what to do.
In Baguio, Rugay himself was told by someone offering CBS that CBS is actually stalled.
He admitted, though, that he can’t imagine himself offering CBS now particularly if doing so would mean he would be exposing himself to Covid-19, and thereby exposing his loved ones to the same when he returns home.
Tenoria said that “perhaps we need (something written in black and white), on what will be the direction (under) the ‘new normal’.”
He admitted that there were shortcomings particularly when the country – and the world – was initially responding to Covid-19. “Medyo napag-iwanan talaga yung HIV program.”
But now, there ought to be guidelines (beyond the initial one developed by DOH, though that one only focused on accessing antiretroviral medicines). For Tenoria, clearer guidelines will also provide clarity to both service providers and those accessing the services particularly as these may align protocols.
HIV BOOM ABOUT TO HAPPEN?
As it is, all lung-related cases in Antipolo are now considered as suspected Covid-19 cases, said Tenoria.
This is worth noting because tuberculosis (TB), for instance, is an opportunistic infection (OI); and it occurs more often/more severe in people with weakened immune systems (like someone with HIV).
So even if a person with HIV who may not have Covid-19 may have lung-related issues, he/she is required to be isolated. This, then, leads to another (and related) issue: The limited capacity of health facilities in the Philippines.
Tenoria admitted as much, saying that looking for facilities for PLHIVs is harder because isolation rooms are being dedicated to Covid-19 patients.
Of course: Those who test reactive but who have no OIs are luckier, as they are automatically enrolled into the system so they can immediately access ARVs.
For Rugay, “at this moment, there’s nothing we can do for (PLHIVs whose detection is late).” But for him, what the HIV arm of DOH should do is “step up in preparing itself for (a possibility of a) barrage of late detections once they figure out how we do screenings again. Are they prepared/equipped to have all those patients come in?”
FROM THE D.O.H.
A June 10 letter signed by Usec. Dr. Myrna Cabotaje from Department of Health (DOH) to Outrage Magazine noted the impact of Covid-19 on HIV program implementation. Specifically: Prevention services were reduced by 20% to 30%; HIV testing services reduced by 20% to 80%; viral load testing reduced by 42%; and ARV refill services reduced by 5%.
These impacts were due to: geographic concerns, transportation issues and strict checkpoints.
As Tenoria already noted, a guideline was actually developed by DOH. But its main focus was on PLHIVs (particularly, access to ARVs by those already diagnosed to have HIV), and not on those who have yet to be tested.
But Cabotaje’s letter stated that data from HARP for January-March 2020 shows 552 new HIV cases. Meaning, according to HARP, “HIV testing, mostly facility-based, were still provided.”
For January-March 2020, 682 PLHIVs were also initiated on ART.
Asked about protocols re HIV testing, DOH stated that “at this point, HIV testing protocol based on current capacity of both the government and CBOs is centered on ether facility-based testing or community-based HIV screening. Our current HIV projects, e.g. Global Fund HIV grant, thru Save the Children, provided essential PPE to our field workers for them to continue performing their prevention and testing work.”
The likes of Jaud in Zamboanga and Rugay in Baguio are, obviously, not recipients of the aforementioned PPEs.
Moving forward, DOH is also looking at self-screening as an approach to HIV testing, although “the country is still currently testing this approach in a limited manner.”
No timelines were mentioned in the letter.
Exactly because HIV-related efforts seemed to have relied on localized practices, some good practices have emerged.
In Naga City, for instance, Tenoria noted that HIV testing is offered with Covid-19 testing.
Still in Zamboanga, when goods are distributed, safer sex kits are included.
And still in Zamboanga, Jaud started tapping clients online; and this is even if this effort remains limiting because not everyone is active online.
“It’s difficult because gatherings of a big number of people are not allowed,” said Jaud. Her target population – i.e. transgender women in Zamboanga – frequently avail of HIV screening when they have gatherings. But now, “tapping social media has been helpful.”
Worth noting is how this immediately limits Jaud’s service delivery – i.e. because she know of the risks related to Covid-19, the clients she now serves are limited to people she knows/are friends with.
PROGRAMS STILL NEED TO CONTINUE
In the end, Tenoria said that people in power hopefully realize that there are still programs that need to be run. “Just as we say in HIV (advocacy), ‘No one should be left behind’.”
This is because sans the needed support, Rugay said people involved in CBS are limited. And so he urges those who want to get tested to, instead, go to health facilities, particularly if they may also have symptoms linked with Covid-19.
“Konting pasensya lang sana,” he said, until “we have clear protocols and figure it out how to make it safe for everyone concerned.”
“We (still) encourage everyone to get tested for HIV,” Tenoria said. But those who want to get tested will have to coordinate first with health facilities to schedule testing. Still, this “should not be a hindrance for you to access services (even during this pandemic).”
For Jaud, “we have to capacitate outreach workers (like myself)”. This may be via supplying with gears (e.g. PPE), training, and – yet again – laying down of protocols to use.
Back in Zamboanga, Galvinez said that government offices should give attention to community-based health workers like Jaud, who’s also “a frontliner. They’re ready to help, and serve the community.”
Keeping the faith at the time of COVID-19
Many ask where God is at the time of #Covid19, including #LGBTQIA people who – prior to this – already experienced difficulties because of their #SOGIESC, and now have a hard time with their expression of faith. But #LGBTQIA faith leaders say that this is as good a time as any to also highlight humanity and, yes, the rainbow #pride.
LGBTQIA people are “no strangers to isolation, hardships and the stress of being alone,” said Bb. Kakay M. Pamaran, Director for Field Education of the Union Theological Seminary Philippines. And while stressing that she is, in no way, trying to “romanticize this, but I think of all people, we know what this level of isolation feels like because we’ve been there… many of us have been there.”
Bb. Pamaran was referring to the isolation/stress of being alone and hardships brought about by Covid-19, with many countries – the Philippines included – forcing people to stay indoors, else risk getting infected. The World Health Organization (WHO), itself, acknowledged that “as the coronavirus pandemic rapidly sweeps across the world, it is inducing a considerable degree of fear, worry and concern in the population at large and among certain groups in particular…”
There are those whose (religious) faith is getting them through; but there are also those who, in times like this, start questioning their faith. This includes LGBTQIA people whose lives, as it is, are often marked by religious persecution. And so for those of faith and who belong to the rainbow family… how does one keep the faith at the time of Covid-19?
“When people are afraid, they turn to God,” Bb. Pamaran said. “And the church, for the longest time, has been God’s mouthpiece.”
She, therefore, believes that “the church has a huge responsibility where this is concerned.”
This April, the WHO released “Practical considerations and recommendations for religious leaders and faith-based communities in the context of COVID-19”, which eyes to provide “practical guidance and recommendations to support the special role of religious leaders, faith-based organizations, and faith communities in COVID-19 education, preparedness, and response.”
WHO’s practical recommendations include: discouraging non-essential physical gatherings and, instead, organizing virtual gatherings through live-streaming, TV, radio, social media, et cetera; regulating the number and flow of people entering, attending or departing worship spaces to ensure safe distancing; management of pilgrim sites to respect physical distancing; and actual isolation of those who get ill/develop Covid-19 symptoms.
As stated by the WHO: Faith-based organizations (FBOs) “are a primary source of support, comfort, guidance, and direct health care and social service, for the communities they serve. Religious leaders of faith-based organizations and communities of faith can share health information to protect their own members and wider communities, which may be more likely to be accepted than from other sources. They can provide pastoral and spiritual support during public health emergencies and other health challenges and can advocate for the needs of vulnerable populations.”
Bb. Pamaran agrees – to an extent.
“It is very important, it is imperative for church leaders (and) faith-based organizations (FBOs) to deal with Covid-19 in factual, scientific ways,” she said. This is because “the things you say in the pulpit or all of the platforms that are available to you must always be based on scientific, medical evidence. And you have to exhaust all possible efforts to do your research because people tend to believe whoever is speaking behind the pulpit.”
Bb. Pamaran added that “people turn to superstition if scientific answers are not available. So as faith-based leaders, it is our responsibility to fuse rationality and factual scientific inquiry in these desperate (concerns).”
AN EYE-OPENING EXPERIENCE
According to Rev. Alfred Candid M. Jaropillo, Administrative Minister of the United Church of Christ in the Philippines (UCCP)-Ekklesia in R. Mapa St., Mandurriao, Iloilo City, Covid-19 is an “eye-opener for us that human as we are, we are finite beings, and we don’t have the control of life.”
But Rev. Jaropillo added that this ought to make people see that “people have contributions to the suffering of life, and the suffering of Mother Earth.”
RAINBOW IN FAITH
As FYI: In 2015, the Pew Research Center (PRC) noted that about 5% of the 2014 Religious Landscape Study’s 35,000-plus respondents identified themselves as members of the LGB population. And of that group, a big 59% said they are religiously affiliated. But only 48% of them reported belonging to a Christian faith group, compared with 71% of the general public.
Meaning: Although many members of the LGBTQIA community may feel that most major faiths are unwelcoming to them, a majority of them are still religiously affiliated (though not necessarily as Christian, but also as part of smaller, non-Christian denominations).
Bb. Pamaran noted that LGBTQIA people may not be going to churches because these are unwelcoming, or “they just don’t go to church because they gave up on church altogether. It was difficult for LGBTQIA people to express their faith pre-Covid-19; and now with Covid-19, it would be harder for them, I would imagine.”
Rev. Jaropillo added that it is, therefore, the church’s role to “open its doors… in ministering to people who need God the most: the vulnerable, poor, women, children, the displaced…”
There are, of course, open and affirming (or ONA, the term used by the United Church of Christ/UCC) churches and/or faith-based organizations, or those that affirm the “full inclusion of LGBTQIA and non-binary persons in the church’s life and ministry.”
And they are just as affected by Covid-19.
According to Bishop Regen Luna of the Catholic Diocese of One Spirit Philippines, which is based in the Province of Cavite, the mandate to socially distance meant they had to (temporarily) close, so “Covid-19 had a big impact on us.”
Among others, they had to forego masses, Bible studies, weddings, baptism, et cetera.
“Ayaw din namin magkahawahan (We also do not one to infect each other),” he said.
Added Rev. Joseph San Jose, Administrative Pastor of the Open Table Metropolitan Community Church: In the context that we’re a small church, “we don’t have as much of the resources, the facilities that other churches have.”
For instance, the Roman Catholic Church and bigger Protestant churches can broadcast live their masses/worships, “we are unable to do that.”
The composition of the church membership is also proving to be a challenge, geographically speaking. Rev. San Jose, for instance, is in Laguna (approximately 100.3km from Mandaluyong, where the church is located); and members are from the City of Taguig, Quezon City, et cetera. “This is an issue with the Covid-19 lockdowns (that limit mobility of people),” he said.
Bb. Pamaran said that, largely, faith expressions involve corporate worship/gathering in one space. “Without that, faith expressions… significantly change.”
But Bb. Pamaran wants people to draw something from this experience.
“It is also a good demonstration to non-LGBTQIA persons that this kind of isolation… is the normal for LGBTQIA persons even without Covid-19 as far as going to church is concerned, and in belonging in church communities,” she said.
For Bishop Luna, the pandemic is (similarly) showcasing the resilience of LGBTQIA churches.
“Sanay na kami sa hirap (We’re used to hardships),” he said, adding that they now know how to “stretch the budget to sustain a small church.” This is even if their main source of income (i.e. donations, for holding of sacraments like baptism, marriage/weddings, et cetera) is affected by the Covid-19 lockdowns.
Covid-19, on its own, isn’t the only problem; just as problematic are its effects on other issues.
In the case of Bishop Luna’s church-goers, for instance, “we have members who are also living with HIV.” Issues re access to life-saving antiretroviral (ARV) medicines have been reported on; particularly affecting those who have no access to treatment hubs/facilities, again because of immobility.
Rev. San Jose admitted that it’s a “personal struggle as a pastor” not being able to help out, particularly at a time when people are asking what churches are doing to help the needy. But “with our situation, it’s almost impossible for us to mobilize in the same way that other churches (have been mobilizing).”
DEALING WITH ‘NEW NORMAL’
Covid-19 introduced a “new normal” even to FBOs – here, largely dictated by going online.
Union Theological Seminary, for one, introduced online courses. Metropolitan Community Church hosts webinars and online conversations. Catholic Diocese of One Spirit Philippines has online services – though, as Bishop Luna said, holding sacraments (e.g. weddings) are still not done this way (thus the rescheduling of pre-booked events to next year). Meanwhile, Open Table Metropolitan Community Church’s Rev. San Jose records sermon/homily for Sunday online “gatherings”; which is also the time when members videoconference to discuss their faith and, yes, Covid-19.
“I think that’s going to be the trend,” said Bb. Pamaran. “This is going to be how we facilitate conversations moving forward.”
Rev. Jaropillo – whose UCCP-Ekklesia also has worship services – said that while churches now also use technology in ministering to people, “we don’t stop there. Aside from virtual worship services, we concretize the love of God through relief operations. We address two things: the liturgical/spiritual ministry through virtual worship services, and the physical need of people. Churches should have a holistic approach (to this).”
“It’s best to respond with creativity,” Bb. Pamaran said.
At the time of Covid-19, Rev. Jaropillo said that “it’s very natural to doubt and it’s human to question one’s faith: ‘Natutulog ba ang Diyos (Is God asleep)?’ But I believe I don’t need to defend God. God understands the doubts of the people nowadays. So as a church, we need to journey with these people who are in doubt, especially at times of crises like now.”
Bishop Luna agrees.
“Some people ask why God would let something like this happen,” he said, adding that while these questions are unnecessary, that they are asked at all is “natural”/understandable. But he said that times like this offer lessons from God, and people should listen. “We believe in a loving God… We believe that God is teaching us – e.g. how to look after the environment, health, and respect of other creatures. We’ve forgotten these. We also live fast lives; we don’t even think it can end in a blink of an eye.”
For Rev. San Jose, it may be worth echoing what Pope Francis said when asked by a child why there’s human suffering. “Sometimes we just don’t know. It is what it is. There is a mystery of suffering and pain. And it would be very arrogant for us to try to answer very difficult and almost no-answer questions. The progressive faith compels us not to ask where God is, but to ask where we are and what we are doing at this time to be the channel of God’s love, comfort, hope for ourselves and for others.”
For Bb. Pamaran: “It’s a common question to ask where God is in all these. But perhaps it’s the best time to ask where humanity is in all these. It is the best time to look into our humanity and our creativity, our innovative imaginations to pull through this.”
LGBTQIA OF FAITH
To LGBTQIA people of faith, Bishop Luna calls for prayers – “unified prayers” – while spending time with loved ones, and looking after oneself (e.g. mental health).
“Ibigay natin laat ng ito sa Panginoon (Surrender everything to God),” Bishop Luna said, adding: “We believe that this, too, shall pass.”
LGBTQIA people are resilient, continuing to face hardships in life. “We can survive this, too,” he said, “and pass this with flying colors.”
It is also the resilience of the LGBTQIA people that Rev. Jaropillo wants to highlight. That LGBTQIA people find joy/laugh even in dark times is something that can be shared to cheer up communities. “Continue to shine as a rainbow, to inspire other people.”
Covid-19, said Rev. San Jose, is also a good time for the LGBTQIA people to reflect on social justice. “There is a need for us to be more active in engaging in the issues faced by the country, by our community,” he said. “There is really a great need to organize and mobilize.”
“No sector of people understands isolation more than the LGBTQIA community. We can imagine, we can grasp the loneliness and isolation that Covid-19 brings. And so try to remember how you pulled through all these years, and then try to help others do the same,” said Bb. Pamaran.
In the end, “now more than ever, the world needs color; the world needs our color. So be that… for yourself and for others,” Bb. Pamaran ended.
Being trans at the time of Covid-19 lockdown
#LGBT Filipinos still face legal impediments re their #SOGIESC, so many of the gov’t responses related to #Covid19 exclude them. For #trans community members, interconnected issues include losing livelihood considering many belong to informal sectors, limited access to hormonal medications that could adversely affect mental/emotional/psychological health, and general forced invisibility that excludes them from gov’t support.
At the moment, LGBTQIA people are (often) excluded in government assistance related to Covid-19, said Magdalena Robinson, CEO of the Cebu United Rainbow LGBTIQ+ Sector Inc. There are various (and many of them interrelated) reasons why this is so – e.g. because marriage equality is not recognized in the Philippines, many LGBTQIA Filipinos live alone (“For example, they just rent rooms”) or perhaps couples live together yet are just considered as board mates, so they are not considered to belong to “homes”/”households”. “That’s a difficulty (that affects) access to the assistance of the government.”
It is the intersection/inter-connection of issues that – in truth – define the experience of transgender Filipinos in particular as they try to survive the Covid-19 lockdown.
WANTED: ACCESS TO MEDS
To start, there’s the issue with accessing hormonal medications.
As noted by Jhen Latorre of the Pioneer FTM (Pioneer Filipino Trans men Movement), members of the transpinoy/trans men community already noted issues re accessing testosterone (hormonal medications). Not only because the stocks are limited, ordering is challenging, but also “mahirap ang shipping (we also encounter issues with shipping).” This is even more so for those in provinces.
Robinson added that many trans people access hormonal medications from the black market. For example, some local suppliers buy from Thailand. But there are now issues with stocks, affected by the lockdown that limits mobility of goods (from overseas, as well as locally).
Now, this is worth highlighting: According to Kate Montecarlo Cordova, founding chairperson of the Association of Transgender People in the Philippines, “people have a hard time understanding the health impact of hormones to trans people.”
Cordova said that many people now “think that taking hormones is just a luxury; that we just want it, and it’s not even needed.”
She added that often neglected in this line of conversation are the biological/physical, economic/financial, and psychological/emotional impacts of not having these hormonal medications – e.g. there are trans women who work as entertainers, and not having access to the needed meds could affect their physicality, which could affect their means of living.
In the end, “these are all interrelated,” Cordova said. “There are intersectionalities.”
Obviously this touches on the continuing “forced invisibility” of trans people in the Philippines particularly when talking legally – e.g. the country still doesn’t have gender recognition law, and basically misgenders trans people by legally pigeonholing them according to their assigned sex at birth.
According to Latorre, at least in his group, most of their members have jobs that: 1. allow them to work at home, and 2. still give them regular salaries even during the Covid-19 lockdown.
But there are also those who are affected by “no work, no pay,” he said. So these people now only rely from the support of family members.”
Shane R. Parreno, chairperson of the Transpinays of Antipolo Organization, said that the percentage of members of the trans community who hold regular jobs remains low.
Local figures continue to be limited on this, but at least in the US, 29% of trans people live in poverty, compared to 14% of the general population; and trans people experience unemployment at three times the rate of the general population, with 30% of trans people reporting being fired, denied a promotion, or experiencing mistreatment in the workplace due to their gender identity in the past 12 months.
For Parreno, may trans Filipinos – and LGBTQIA community members, for that matter – are informal workers, e.g. hairdressers, make-up artists/cosmetologists, and tailors/seamstresses. And with “everybody affected by the lockdown, those working in these fields/areas do not have clients, so they do not earn,” she said.
Robinson stressed the same point: There are trans women who work in the beauty industry, fashion industry, et cetera who do not have income now. “So we hope they will not be left out (in the giving of needed support from the government during the pandemic).”
Latorre – who has two kids, but who also did not qualify in the government’s definition of “household” to be given support – said that even before, LGBTQIA families have always been set aside.
And because “there are trans people who are the breadwinners,” Parreno said, “I hope that their SOGIESC won’t be reason for them not to be included in (government support).”
ACCESS TO MEDICAL CARE
There’s also the difficulty in getting medical care.
Recognizing that trans people may need to see medical professionals (e.g. when transitioning), Latorre also isn’t aware of clinics that are now open for them to access. This issue is ongoing, however, and is apparent even when there’s no lockdown, since there remain few – if any – trans-specific medical practitioners in the Philippines, perhaps even more particularly in provinces.
“Sana di na magtagal ito ng sobra (I hope the lockdown doesn’t last long),” Latorre said, because “alam ko din naman na kailangan pa din to see a doctor lalo na sa too-serious na matters (I recognize that there is still need to see a doctor, particularly for very serious matters).”
HELPING EACH OTHER
For Latorre, “nakakatulong ang organization (trans organizations help).” For instance, members of trans organizations can give tips re transitioning, or – if meds are needed – they can “lend” supplies.
In Cebu in central Philippines, Robinson said that transpinays asked their networks on where to get supplies. And when supplies are really hard to get, “we just advise them on the alternatives – e.g. maybe there are fruits that have high estrogen or anti-androgen properties.”
Some food that are estrogen-rich, and help lower testosterone levels include: soy products like edamame, tofu, soy milk and miso; spearmint and peppermint; licorice root; vegetable oils; flaxseed; and certain types of nuts.
“We give out this information so we have alternatives for them,” said Robinson, adding that those who received the information are “advised to share the same to their contacts.”
For Robinson, “everyone is experiencing difficulties,” she said, so “we have to support each other, fix each other’s crown.”
Latorre also has a practical recommendation: Since trans people are at home during the lockdown, they may want to use this to find time to talk to their families. “Baka ito na ang oras to open up (Maybe this is a good time to open up),” he said.
Cordova said that the lockdown highlights that “it’s about time that we comfort each other. We can’t expect our government, or other people to comfort us.”
Meanwhile, Parreno has practical recommendations.
“Let’s support our government – e.g. when it says for us to stay home, stay home. Talagang malaki ang impact nito (This has a big impact),” she said. “Ipakita natin… na hindi tayo pasaway (Let’s show others we’re not troublesome).”
And in the end, “let’s pray that this will end soon para magkita-kita na tayo ulit, maka-rampa na tayo ulit (so we can see each other again, and wander/jaunt again).”
Living with HIV at the time of Covid-19 lockdown
To date, there is still no evidence that the risk of infection of #COVID19 is different among persons living with #HIV. But the #lockdown is worsening the situation of many PLHIVs – e.g. in accessing their life-saving medicines, loss of income/livelihood, exclusion in government responses, depression, et cetera.
“Nakakadagdag ng takot (Covid-19 adds to the fear) of persons living with HIV,” said Anthony Louie David, a Filipino living with HIV.
According to the World Health Organization (WHO), “at present there is no evidence that the risk of infection or complications of COVID-19 is different among PLHIVs who are clinically and immunologically stable on antiretroviral treatment when compared with the general population.” WHO added that “it is unknown if the immunosuppression of HIV will put a person at greater risk for COVID-19.”
However, “until more is known, additional precautions for all people with advanced HIV or poorly controlled HIV, should be employed.” This is because “PLHIVs with advanced disease, those with low CD4 and high viral load and those who are not taking antiretroviral treatment have an increased risk of infections and related complications in general.”
And so for David, because those with weaker immune systems are at higher risk of getting infected with Covid-19, “andoon yung takot (the fear is there).”
Rogeselle Burdeos Monton, also a PLHIV and the research and development officer of the Culture and Arts Managers of the Philippines, said that there’s that “worry within yourself” that because one is immunocompromised, “you might end up being infected with another virus.”
ACCESS TO LIFE-SAVING MEDS
The fear – not just the lockdown – has been limiting.
David, for instance, hasn’t been out of his house for weeks now – e.g. other family members have to do the groceries for him.
David is also troubled that his supply of life-saving antiretroviral (ARV) medicines is about to run out. “My treatment hub is in the City of Manila, and I am now in Biñan City, Laguna (approximately 31 kilometers away).”
Living in a different local government unit (LGU) is also an issue because people from outside Metro Manila (where his treatment hub is) are barred from entering Metro Manila.
At least for Moses Myro Ayuha, another person living with HIV, “luckily, I have supplies until May.” But Ayuha said that there are “blood brothers” who are really having difficulty in accessing their ARVs.
The Department of Health (DOH) tried to remedy this issue.
In March, DOH released an advisory that recognizes that “this current situation poses challenges in accessing life-saving medications… which may result in treatment interruption”, so it is mandating treatment facilities to “exhaust all possible methods to ensure reliable access to PLHIVs to treatment without having to risk increased exposure to Covid-19 when accessing their medicines.”
Meaning: PLHIVs can get their supplies (while the lockdown is ongoing) in other hubs that are nearest to them; or have their ARVs delivered to them, among others.
Monton’s hub delivered his ARVs for him… but he had to pay for the courier/shipping fee on his own, which may be an issue for those who do not have money to do so.
Monton also noted that there are also confusions – e.g. the process of accessing ARVs in hubs not yours, with policies supposedly announced by the DOH causing confusion instead of clarity.
And so Monton said that some end up “borrowing meds.”
David noted how non-government organizations (NGOs) and community-based organizations (CBOs) are stepping up. For instance, there are those that deliver the ARVs to those who can’t leave their houses – e.g. #AwraSafely has some guide for PLHIVs during the time of Covid-19.
Helping is also done to those who have lost their means of living – e.g. the AIDS Society of the Philippines (ASP) gives out some amount to HIV-positive mothers and/or their kids, as well as healthcare providers who are rendering HIV-related services during the Covid-19 lockdown period.
This is particularly helpful to those “na walang kakayanang bumili ng pagkain nila ngayong may lockdown dahil wala ring trabaho ngayon,” David said.
Sadly – and this is worth highlighting – many of the existing solutions are available for PLHIVs in metropolitan areas, such as Metro Manila, where many NGOs and CBOs operate. Outside of Metro Manila, in the provinces, already problematic access to ARVs are worsened by the Covid-19 lockdown. Monton knows of a PLHIV in Laguna, for instance, who had to spend an entire day just to get through a series of checkpoints to access the nearest treatment hub to him; and then when he got there, “siguro nagmakaawa (maybe he begged) just to be given ARVs.”
Like the rest of the population, the livelihood of PLHIVs are just-as-affected by the Covid-19 lockdown.
Ayuha, for one, said that – at least where he’s staying, a halfway house for PLHIVs – they now rely on donations of food packs. “Nakakaraos din (We get by somehow),” he said.
But Ayuha said that “I am unable to do (what I usually do daily),” including giving HIV-related lectures (while working for non-government organizations). “Nabago talaga dahil di ka nga makalabas (This really changed because you can’t go out).”
David is the same; with his income usually sourced from giving HIV-related talks. And with gatherings cancelled because of the lockdown, “walang maasahan kundi pamilya ko lang (I only rely on my family).”
Monton, meanwhile, is a freelance worker, so his earnings are also affected. He may be luckier than most because he has savings; but he knows of other PLHIVs who – even now – are already worrying where to source the money for the incoming months’ bills (e.g. rent, utilities, et cetera).
Monton actually hopes that that the government’s financial support be made more inclusive. “When it comes to evaluating people who are currently financially challenged.” At the end of the day, he added, even PLHIVs are “also tax-payers.”
FOCUS ON SELF-CARE
David said that there are other issues affecting PLHIVs now highlighted by Covid-19 – e.g. depression. To deal with this, he recommends “keeping yourself busy.”
So David said: “Better your immune system because Covid-19 isn’t just going to be here now. Even without the lockdown, Covid-19 will still be there. So gain strength so that when the lockdown is lifted and we’re finally allowed to go out, we know we’d still be safe because we’ve properly prepared.”
Monton gives three practical tips.
First, with being idle affecting mental health, along with the fear of getting Covid-19 and accessing ARVs, “learn how to divert your attention,” he said. “Your fears are valid, but focus on your well-being as a PLHIV.”
Second, take precautions – e.g. wear face mask when going out, disinfect particularly before touching the face, et cetera.
And third, “magdasal (pray),” he said. Maybe not even because one is religious, but for “peace of mind… somehow it helps.”
For Ayuha, “PLHIVs should take precautionary measures… particularly if they go out.” Practically, “wear mask,” he said, though more importantly, “better your immune system… and huwag praning (stop panicking).”
LGBTQIA people as Covid-19’s hidden victims forced to choose between risking infection or starving
How Covid-19 – and the eventual lockdowns – is impacting the livelihood of LGBTQIA people.
Choosing to go out while the world is panicking over Covid-19 is “scary,” said Bella Abac, a freelance hairdresser/make-up artist from the City of Bacoor in the Province of Cavite. Though she knows she may be putting herself at risk of getting infected by the dreaded novel coronavirus 2019, “kailangan ko naman ay budget… kasi ito yung source of income ko (I need earn… because this is my source of income).”
The government – e.g. the barangay – gave some support; in Abac’s case, a few kilos of rice, noodles and canned goods. But since the Covid-19 lockdown is expected to last for weeks, this is obviously not going to be enough. And so putting one at risk (and others at risk, for that matter) becomes a necessity to survive.
According to Ging Cristobal, project coordinator for Asia & Pacific Islands Region of OutRight Action International: “‘Yung Covid-19, napakalaki ng pinsala sa lahat (Covid-19 did big damage do everyone)” though even more so to minority sectors like the LGBTQIA community.
To start, there’s the damage done to livelihood, she said. Many LGBTQIA people still experience discrimination that force them to engage in informal sectors; “ibig sabihin nito, sila ay hairdresser, staff sa grocery, eatery, palengke… at alam natin na ito ay ‘No work, No pay.’ Mas pagtuunan natin ng pansin yung mga marginalized sectors (this means that these people are hairdressers, staff in groceries or eateries or markets… and they don’t earn if they don’t work. We should give attention to those in the marginalized sectors).”
The economic impact of Covid-19 is now being discussed, including in the Philippines. In February, for instance, Statista.com, for instance, reported that about 75% of Filipinos perceived that the Covid-19 outbreak would affect the international economy, while 65% believed the national economy of the Philippines would be affected.
In fact, as of early March 2020, the global pandemic already contracted a decline of 2.4% in US’s GDP. Specific to the Philippines, the World Bank still sees the country’s economy to grow by 3% at best, contracting 0.5% at worst in 2020 due to the Covid-19 pandemic. But really, it is still too early to see how big an impact Covid-19 will have on the economy.
What abounds now, instead, are anecdotal evidence of the difficulties experienced because of the pandemic, and the lockdowns implemented to monitor/control the same.
For Elden Lopena, owner of Top Touch Beauty Salon in Cotabato City, we should be thankful that we’re not as of yet as affected by other bigger countries; but “sana matapos na ito para di na masyado magtagal ang hirap (hopefully this ends soon so the hardships don’t last long)”.
Lopena lamented that as an owner of a salon, “meron din akong mga tauhan (I also have staff)” and he needs to help them with their daily needs, even as he worries where to source money for would-be expenses for his business (e.g. rental, utilities). Therefore, closing – even temporarily – has a big impact.
Maureen Mejia Chan, owner of Salon de Maureen in Makati City, estimates that she’d lose over P100,000 because of the lockdown, and so “hindi ko alam ano ang gagawin ko (I don’t know what I’d do).”
The difficulty is more pronounced for those who earn daily wages, said Ms Garner delos Reyes Lagare, salon owner/hair and make-up artist/PMU artist and instructor. “Ang nakaka-awa ay yung mga taong walang ipon (It’s sadder for people without savings)” because they don’t have the capacity to buy basic needs (e.g. food, milk for babies, medicines, etc).
Workers in informal sectors – as noted by Cristobal – worry day to day.
Vinz Calvin (a.k.a. Lumina), a drag queen, said that with venues where they perform closed (for three weeks now), they haven’t been earning at all.
To earn, some become more creative.
“Some drag queens, they hold shows online,” Vinz Calvin said. The viewers give “tips” by sending these to remittance centers/apps.
The “creativity” assumes, however, that everyone affected by lockdown has access to the same internet (and speed) services, which isn’t the case. Globe Telecom, for instance, urges subscribers to be ‘conscientious’ with internet use while most Filipinos are working from home, highlighting the impact of the demand on the connections/availability of connections.
Like Abac, who used to occasionally take risks by still services clients out of necessity, Lopena said that he knows of others who also do home service.
“Kung makakalabas… lalabas (If we can go out of our houses, we do so to serve clients),” he said, so that “kahit papaano makakatulong din sa pang-araw-araw na gastusin (so it helps in daily expenses).”
But fear (of getting infected or infecting others) is limiting this now, on top of the need to comply with the lockdowns, else risk getting arrested. And so many are basically left to be hungry.
HIGHLIGHTING LGBTQIA ISSUES
For Cristobal, the Covid-19 lockdown also has an unwanted effects.
There’s the surfacing of anti-LGBTQIA practices – e.g. in Quezon City, a lesbian couple complained that they did not receive goods from the local government because they were not considered “household”/”family”. The city is fortunate enough to have an existing anti-discrimination ordinance (ADO) that prohibits discrimination of LGBTQIA people within the city, so that the issue of the lesbian couple was resolved; but other local government units (LGUs) also in lockdown do not have ADOs.
It also puts members of the LGBTQIA community to be in situations/locations where they are at risk of getting abused – e.g. students, for instance, are now forced to be at home for the whole day, even if family members may not be accepting of them, or are even abusive of them.
HELP THE MARGINALIZED
Chan said that she heard of the support the government is supposed to give to small- and medium-sized businesses, like her salon. If true, she said it could help because “it’s difficult for businesspeople who are at a loss on where yo source the fund to continue financing their businesses.”
But Chan is among those at a loss on how to access/avail of this said support.
Vinz Calvin added that, in the case of drag queens for instance, who are also workers in the entertainment industry, “we’re not even sure if we qualify to ask for government support.” And this is even if this support is just-as-needed by them.
For some, giving help is becoming normal (in lieu of relying on government help). Lopena, for instance, said that “yung naitabi naming salapi, tinutulungan na rin namin sila (we use our savings to help our staff).”
But for Lopena, “yung hingi ng mamamayan kasi, yung pagkain… sana mabigyan sila ng tamang ayuda (what people are asking for, including food… hopefully the government can help them with that).”
The sentiment was shared by Lagare who said that getting help is ideal, though currently, the promised help is not reaching to target populations. “Kaya nakaka-awa talaga yung walang ipon sa ganitong panahon (Those who do not have savings are disadvantaged at times like this).”
And so Abac said that government should prioritize those who are in dire need of support. She added, though, that “yung iba naman na kaya namang makabili, huwag na daing nang daing kasi ang government ay kumikilos naman (those who can afford to buy, stop simply complaining because the government is acting anyway).”
Eventually, said Vinz Calvin, people should learn to be more prepared.
“Hopefully something like this doesn’t happens again, but in case it does, at least we have savings to use,” he said.
But while everyone is affected, LGBTQIA people should be very mindful, said Cristobal.
“Itong mga darating na panahon ay hindi ko alam kung mas magiging mabuti na ang kalagayan o mas (sasama) pa. Pero kahit sana anong mangyari, hindi tayo laging iniiwan (I don’t know if things will get better of worse. But whatever happens, LGBTQIA people shouldn’t be left behind),” Cristobal ended.
Trans kagawad at the COVID-19 frontline
As a frontliner during the COVID-19 pandemic, trans barangay kagawad Kristine T. Ibardolaza of Antipolo City said that her work may be risky, but it’s gratifying because she is one of those who help the needy. Right now, she said, everyone’s fighting, but “this is the time when we should be united as one. We should have one goal. And that is to stop this pandemic.”
“It’s very risky to be at the frontline because (in the case of COVID-19) we can’t see the enemy,” said Kristine T. Ibardolaza, a barangay kagawad of Barangay Mayamot in Antipolo City, one of the frontliners facing COVID-19 pandemic. “But as days (pass), I am able to say that it’s gratifying because you know you are one of those who help the needy.”
Kristine admitted that “you’re also only human so it gets hard. It’s physically draining, and a mental torture.” However, “we still trust that everything (happens for a reason).”
A barangay kagawad (in English, barangay councilor) is an elected government official, a member of the Sangguniang Barangay/Barangay Council of a particular barangay, the smallest administrative division in the Philippines. As local leaders, they are directly in touch with people at the grassroots/communities.
With the Enhanced Community Quarantine (ECQ) due to Covid-19, barangay officials were tasked by Pres. Rodrigo Duterte to helm the response to the COVOD-19 pandemic. And so “with our barangay captain… we pack food for our constituents, while monitoring how they are doing. We also give them hope that this, too, shall pass,” Kristine said.
The barangay – Mayamot – that Kristine serves is big. “It’s like a municipality,” she said, with “more or less 80,000 registered voters.” The number doesn’t include the other family members of these voters – e.g children.
“As much as possible, we want to reach everyone/all families,” Kristine said. But “sorry to say we still haven’t done this… for instance in the food packs made. But at the moment, I think we’ve reached 70% of the families; going to 80%.”
Service delivery is also proving to be challenging.
“I’m not sure if some people think this is a joke; they act like there’s a fiesta. Lack of discipline is the number one challenge. If people follow social distancing, or stay home to save lives, then our job will be easier,” Kristine said.
Already, Kristine – with the other local officials – have been working round-the-clock.
After packing the goods during the day, for instance, and “with help from the sitio chairman, we decided to distribute goods at night, when more people are asleep and are indoors.” This is because when visits are done during the day, people tend to congregate; and this is to be avoided in the time of COVID-19.
“We thought a pandemic like this only happens in movies. It never occurred to me that at a time when I’m the elected barangay kagawad, I’d face a problem like this,” Kristine said.
Kristine said it’s also challenging being a public official because sometimes, “nakalimutan ko pala na may pamilya rin ako. At hindi kami exempted sa pandemic na ito (I forget I also have family. And we’re not exempted from the pandemic).”
To other LGBTQIA elected officials, Kristine said: “Let’s be brave. This isn’t a fight only of LGBTQIA people, but of the whole Philippines and the whole world.”
She added that people should “never underestimate the power of prayers. If everyone prays, this will (soon) end.”
But Kristine said that bickering has to stop.
“Right now, everyone’s fighting; even within the LGBTQIA community. This is the time when we should be united as one. We should have one goal. And that is to stop this pandemic,” she said. “This is the time when we should be loving ourselves the most. This is the time when we should express our love to our loved ones. A simple smile for our frontliners. This could lift their spirits.”
And in the end, “everyone – no one is exempted – is experiencing difficulties. Hopefully, everyone is also eyeing a better future after this pandemic.”
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