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Because Undetectable = Untransmittable

That an HIV-infected person with potent antiretroviral treatment (ART) is not sexually infectious (that is, he/she does not transmit the virus via sexual contacts) is already scientifically proven. But in the Philippines, no HIV-servicing body has yet to openly and officially back U=U. For Bruce Richman, in a resource-lacking setting like the Philippines, “this is a platform for expanded access to HIV treatment (since) reducing HIV stigma will encourage both testing and treatment.”

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In 2012, when 38-year-old Dave* was just diagnosed to be HIV-positive and his CD4 count was less than 10, he was a “regular” of a treatment hub in Metro Manila, be it because “I’d have fever for days, or I’d have rashes all over my body, or whatever,” he recalled. It was during one of his visits to the hospital when the supervising nurse supposedly told him that “ngayong may HIV ka na, huwag na mag-sex ha. Dadami lang kayo (now that you are HIV-positive, stop having sex. If you do so you’ll just help increase the number of HIV cases like yours).”

This of course highlights the discrimination experienced by PLHIVs from medical practitioners themselves. But this particular emphasis on sex/not having sex to stop the spread of HIV also puts a spotlight on the lack of knowledge even among those who are supposed to know better to be able to properly deliver much-needed services (e.g. in this case, there are safer sexual practices available, after all).

And perhaps when particularly considered in a newer context (say, 2017), the ignorance becomes even more apparent since it is now scientifically proven that people living with HIV who are undetectable cannot transmit the virus to their negative partners.

INTRODUCING U=U

In 2008, Pietro Vernazza, M.D. released a statement (“Advice Manual: Doing without condoms during potent ART”, which was approved by the Executive Board of Swiss Aids Federation) in the Bulletin of Swiss Medicine that claimed that “an HIV-infected person with potent antiretroviral treatment (ART) is not sexually infectious (that is, he/she does not transmit the virus via sexual contacts).”

There were parameters set for the claim, i.e.:

  1. As long as the therapy is practiced consistently and monitored regularly by the treating physician;
  2. The viral load on ART has been below the limit of detection for at least six months; and
  3. No infections with other STI are present.

Viral load, which is the level of HIV in a PLHIV’S blood, shows how active HIV is in one’s system. Usually (though not always), if the viral load is high, the CD4 (or T cells, which help activate immune response) count is low, so that the body’s response to the virus is compromised. A low or undetectable viral load indicates that the immune system is actively working to help keep HIV in check.

ART is medication that helps to keep under control the viral load in the body. The viral load is considered undetectable if test shows lower than 40 to 75 HIV virus particles in a milliliter of the blood. If the viral load is considered undetectable, it means the ART medication is working.

Vernazza’s claim – eventually dubbed as the Swiss Statement – that “under (the above) circumstances, potent ART therefore definitely prevents HIV transmission as safely as condoms” did not sit well with many, including public health and professional organizations (e.g. the US Centers for Disease Control and Prevention or CDC), which questioned Vernazza re his data, and even more pointedly, what he was thinking when he made the supposedly premature claim that was “getting ahead of science”.

Vernazza was, nonetheless, resolute about the message, largely derived from his work with HIV-positive straight people on treatment who wanted to have children with their HIV-negative partners. Condomless sex obviously happened between the serodifferent couples, but of 8,000 patients, not a single report of HIV transmission happened to a partner. This therefore became an ethical dilemma for a clinician like Vernazza since they are supposed to present all equally valid options available and let the patients decide for themselves.

Particularly eight years years later, in 2016, Vernazza was vindicated when studies validated the undetectable=untransmittable (U=U) message – i.e. HPTN 052 and the PARTNER study. But more than the vindication, this also helped evolve the messaging re HIV.

Bruce Richman of the Prevention Access Campaign was able to gather signatures of health experts from all over the world for a consensus statement about U=U; but he reported having a challenging time coaxing US HIV organizations to adopt language that removes the stigma of infectiousness from people who are undetectable.

STAY UNDETECTABLE=STAY UNINFECTIOUS

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The concept is not completely new, since treatment as prevention (TasP) has long been advocated to curb the spread of HIV. But there is now newer and strengthened push for this with the U=U message.

There’s the PARTNER study, which involved 1,166 serodifferent couples at 75 clinical sites in 14 European countries. To be included in the study, one partner had to be HIV-positive and have an undetectable viral load on ART, and the couple did not always use condoms when they had sex. Between September 2010 and May 2014, 1,000 positive/negative couples had 58,000 acts of penetrative sex without condoms. The study reported that not a single infection happened between the couples.

It is worth noting that 11 people involved in the study became HIV positive. However – and this is noteworthy – none of these infections were phylogenetically linked transmissions; meaning, they got infected not from their HIV-positive partners but from others.

The PARTNER study is particularly important because it included both gay and straight couples.

The PARTNER study is being continued, with PARTNER 2 expected to continue until 2019.

The same results from the PARTNER Study were reported in the HIV Prevention Trials Network (HPTN) 052 study, a Phase III, two-arm, randomized, controlled, multi-center trial to determine whether ART can prevent the sexual transmission of HIV-1 in HIV-1 serodiscordant couples. One thousand seven hundred and sixty-three (1,763) HIV serodiscordant couples at 13 sites in nine countries were enrolled in HPTN 052; one person is HIV-infected and the other is not.

In 2011, the study initially showed a 96% reduction of HIV transmission within the couples involved. The final results (reported in 2015) showed a sustained 93% reduction of HIV transmission within couples when the HIV-infected partner was taking ART as prescribed and viral load was suppressed.

The HPTN 052 study was, in fact, relevant in the recommendation of the World Health Organization (in 2013) that ART be offered to all PLHIVs who have uninfected partners to reduce HIV transmission.

U=U is now endorsed by numerous international organizations, including AIDES –France, AIDS Foundation of Chicago, Australian Federation of AIDS Organizations, British Columbia Centre for Excellence in HIV/AIDS – Canada, Human Rights Campaign, National Alliance of State and Territorial AIDS Directors (NASTAD), National Black Justice Coalition, New York City Department of Health and Mental Hygiene, San Francisco AIDS Foundation,, and the Terrence Higgins Trust – United Kingdom.

Various experts responding to HIV also already came out to back U=U.

For instance, Dr. Carl Dieffenbach, director of the Division of AIDS of National Institutes of Health (NIH), stated in an earlier interview: “If you are durably virologically suppressed you will not transmit to your partner… I’ll say this again, for somebody who is in a discordant couple, if the person (with HIV) is virologically suppressed, ‘durably’ – there is no virus in their system, hasn’t been for several months – your chance of acquiring HIV from that person is zero. Let’s be clear about that: zero. If that person the next day stops therapy for two weeks and rebounds, your chance goes up. That’s why we talk about ‘durable’ viral suppression… You’re as durably virologically suppressed as good as your adherence.”

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Dr. Michael Brady, medical director of the Terrence Higgins Trust in London, England was quoted as saying that “we can now say with confidence that if you are taking HIV medication as prescribed, and have had an undetectable viral load for over six months, you cannot pass on HIV with or without a condom.”

Meanwhile, Dr. Myron Cohen, chief of the Division of Infectious Diseases of the UNC School of Medicine; and principal investigator of HPTN 052 stated: “If people are taking their pills reliably and they’re taking them for some period of time, the probability of transmission in this study is actually zero… When you treat a person who is HIV infected you render them no longer contagious. Over a period of years that benefit is further realized… Sexual relationships can be much safer because [treatment] suppresses transmission. There is a societal benefit, a public health benefit, an altruistic benefit. ”

“We’ve also come across the shortsighted view that this information only improves the lives of people living HIV, when in fact this is a game changer for the epidemic because of its impact on HIV stigma, testing, treatment uptake and adherence, which will ultimately lead to more people knowing their status and getting to undetectable,” Bruce Richman said.

RESISTANCE TO THE MESSAGE

The benefits of U=U go beyond the medical – e.g. in helping serodifferent couples conceive. For instance, worth noting is how U=U can help deal with HIV criminalization, particularly since there are countries that still prosecute PLHIVs who do not disclose their HIV status to their sexual partners. The US, for instance, is infamous for sending to jail PLHIVs who spit, scratch or bite others sans disclosure of HIV status, and even if there were no known risks of transmission.

The Philippines’ own Republic Act No. 8504, or the Philippine AIDS Prevention and Control Act of 1998, also makes it necessary to disclose one’s status – albeit (unlike in other countries) it is mum on the possible criminal liability of those who fail to disclose. Section 34 (under Article VI, which deals with confidentiality) mandates disclosure to sexual partners – i.e. “Any person with HIV is obliged to disclose his/her HIV status and health condition to his/her spouse or sexual partner at the earliest opportune time.”

But despite the pluses of U=U, not everyone is on board (perhaps as of yet) with its promotion.

Interestingly – and this is a major point worth stressing, too – many of those who express reluctance (if not blatant opposition) to U=U are HIV community advocates and organizations. In the US, for instance, Bruce Richman of the Prevention Access Campaign was able to gather signatures of health experts from all over the world for a consensus statement about U=U; but he reported having a challenging time coaxing US HIV organizations to adopt language that removes the stigma of infectiousness from people who are undetectable.

The Prevention Access Campaign stated that “the majority of PLHIV, medical providers and those potentially at risk of acquiring HIV are not aware of the extent to which successful treatment prevents HIV transmission… Much of the messaging about HIV transmission risk is based on outdated research and is influenced by agency or funding restraints and politics which perpetuate sex-negativity, HIV-related stigma and discrimination.”

“We had a difficult time in the beginning because NGOs are not always early adopters, and some have been driven by 35 years of fear of HIV and PLHIV. They may not be confident in the science and are understandably concerned about saying anything that will lead to more transmissions,” Richman said to Outrage Magazine.

There’s also the “longstanding history in the field of overprotecting people who do not have HIV at the expense of people with HIV’s basic human rights to accurate information about our social, sexual and reproductive health. We’ve also come across the shortsighted view that this information only improves the lives of people living HIV, when in fact this is a game changer for the epidemic because of its impact on HIV stigma, testing, treatment uptake and adherence, which will ultimately lead to more people knowing their status and getting to undetectable,” Richman added.

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There have been pluses, and “we’re happy to see momentum now. NGOs are beginning to catch on because leaders in the US, like NYC Department of Health and Mental Hygience, National Association of State and Territorial AIDS Directors (NASTAD), Housing Works, and San Francisco AIDS Foundation have made statements and updated their public information and social marketing campaigns. Just (a few weeks ago), Canada’s official source for HIV information, CATIE, endorsed U=U.”

In the Philippines, however, no HIV-servicing body has yet to openly and officially back U=U.

CHALLENGES IN PHL CONTEXT

Dr. Jose Narciso Melchor Sescon, who helms the AIDS Society of the Philippines (ASP), said that U=U may still be considered a “medyo (somewhat) sensitive issue in the Philippines.”

For one, this is the number of PLHIVs availing of ART continues to be low. In November 2016, for instance, the total number of Filipinos living with HIV was pegged at 38,872. But only 17,388 are on ART.

Secondly, “ARV adherence is (still) a major concern.” Among people working in the HIV advocacy, it is not uncommon hearing about PLHIVs who are “lost to follow-up”.

Thirdly, “we should also consider co-morbidities,” Sescon said. One may have undetectable viral load yet still engage in other unsafe sexual practices, such as having numerous sexual partners. “So I’d still offer using (other forms of) protection.”

And fourthly, Sescon expressed apprehension based on “real life” situations particularly “in a context like the Philippines.” While clinical trials may have yielded desirable results, “how much of these can be translated and put into reality or the true context of the Philippines?”

Sescon said that “even with scientific evidence showing non-transmission, it will still take time for this to sink in the minds among serodiscordant couples.”

The benefits of U=U go beyond the medical – e.g. in helping serodifferent couples conceive. For instance, worth noting is how U=U can help deal with HIV criminalization, particularly since there are countries that still prosecute PLHIVs who do not disclose their HIV status to their sexual partners.
IMAGE FROM PIXABAY.COM

The consensus statement from the Prevention Access Campaign admitted certain limitations – e.g. that many PLHIVs may not be in a position to reach an undetectable status because of factors limiting treatment access (including inadequate health systems, poverty, racism, denial, stigma, discrimination and criminalization); pre-existing ART treatment resulting in resistance or ART toxicities; and refusal to start treatment. All the same, it stressed that “understanding that successful ART prevents transmission can help reduce HIV-related stigma and encourage PLHIVs to initiate and adhere to a successful treatment regimen.”

But Richman believes that in a resource-lacking setting like the Philippines (where less than half of PLHIVs access ART), “this is a platform for expanded access to HIV treatment. The more PLHIV on treatment in the Philippines, the closer the country will get to ending the epidemic. Test and treat is the most effective method. Reducing HIV stigma will encourage both testing and treatment.”

BOLSTERING THE U=U CONVERSATION

And while the conversation on U=U continues, perhaps worth underscoring is the relevance of this on how PLHIVs view themselves.

Back in the treatment hub in Metro Manila where Filipino PLHIV Dave goes to (and where he is now “with CD4 count over 500 – way better than the nine when I started; and with undetectable viral load to boot,” he said), U=U has helped him see himself as “a human again.”

“I must admit that there were times in the past when I felt like the virus itself, as if just waiting to make others ‘sick’; and even internalized this oft-repeated notion that people like me are ‘dirty’,” Dave said. “Now I know that if we truly want to deal with stigma and discrimination – not just the health benefits – linked with HIV, we should start talking about U=U.”

*IN THE PHILIPPINES, WHEN A PERSON LIVING WITH HIV IS ENROLLED/REGISTERED INTO A TREATMENT HUB, HE/SHE IS ASKED TO PROVIDE: 1) YEAR OF ENROLLMENT; 2) INITIALS OF FIRST NAME, MIDDLE NAME AND SURNAME; AND 3) NICKNAME. THIS IS THE CODE NAME USED BY THE INTERVIEWEE.

The founder of Outrage Magazine, Michael David dela Cruz Tan is a graduate of Bachelor of Arts (Communication Studies) of the University of Newcastle in New South Wales, Australia. Though he grew up in Mindanao (particularly Kidapawan and Cotabato City in Maguindanao), even attending Roman Catholic schools there, he "really, really came out in Sydney," he says, so that "I sort of know what it's like to be gay in a developing and a developed world". Mick can: photograph, do artworks with mixed media, write (DUH!), shoot flicks, community organize, facilitate, lecture, research (with pioneering studies under his belt)... this one's a multi-tasker, who is even conversant in Filipino Sign Language (FSL). Among others, Mick received the Catholic Mass Media Awards (CMMA) in 2006 for Best Investigative Journalism. Cross his path is the dare (read: It won't be boring).

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Extreme exposure: Journal of a traveling exhibitionist

An interview with a gay Filipino exhibitionist who is unable to stop with what he is doing despite knowing that indecent exposure is: 1) considered a mental health issue, and 2) considered gross indecency, which is a serious criminal offense. As he eyes to enjoy this phase in his life, “go lang nang go (just do it),” he says.

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“I think I’m doing it because I want attention.”

Twenty-three year old Twinky (not his real name) is somewhat forthright about his exhibitionism, recognizing that he does what he does because he wants people to pay attention to him.

In truth, over four years ago, Twinky met a guy who liked having sex in public. That was – in a way – his initiation into exhibitionism, since he admitted “getting excited” having sex with that guy in the open.

Prior to that, Twinky said that his view of any person into exhibitionism was somewhat clouded; but that this guy broke this expectation because he looked “respectable” and was even “very smart” so that “I learned a lot from him”. This guy’s “exhibitionist side” couldn’t be deduced by just looking at him.

But just as Twinky was falling for this guy, he left to live overseas. This devastated Twinky, so that he started doing all by himself what they did together in the past. He recorded this, and then posted it online.

“I never thought that people would also be excited about this,” he said. “I posted the videos to get his attention; instead, maraming (iba) and nakapansin (others started paying attention to them).”

These people – many of them strangers following his Twitter account – messaged him to tell him “ang galing (that’s awesome)” and “malakas ang loob (you’re gutsy).” These served as validation for Twinky, so that – he said – the guy he liked may have continued to ignore him, but at least others already started giving him the attention he desired.

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As of writing, Twinky’s Twitter account already has over 19,500 followers. To put that in perspective, Sen. Leila de Lima’s Twitter account only has 13,420 followers; while Cong. Geraldine B. Roman’s has 4,295 followers.

And so “na-engganyo ako lalo (this enticed me to do more)” until this became a regular thing to do for him (related to his alter account).

BARING THE BARING

In a gist, as written by George R. Brown, MD, “Exhibitionistic Disorder” in MSD Manual, “exhibitionism is characterized by achievement of sexual excitement through genital exposure, usually to an unsuspecting stranger. It may also refer to a strong desire to be observed by other people during sexual activity.”

But Brown also noted that “most exhibitionists do not meet the clinical criteria for a exhibitionistic disorder.” Also, it is diagnosed as exhibitionistic disorder “only if the condition has been present for ≥ 6 months and if patients have acted on their sexual urges with a nonconsenting person or their behavior causes them significant distress or impairs functioning.”

But just to be clear, exhibitionistic practices are sanctionable by existing laws.

The Revised Penal Code of the Philippines, for instance, has specific provisions that offend “decency and good customs”, to wit:

Art. 336. Acts of lasciviousness. — Any person who shall commit any act of lasciviousness upon other persons of either sex, under any of the circumstances mentioned in the preceding article, shall be punished by prision correccional.

Art. 200. Grave scandal. — The penalties of arresto mayor and public censure shall be imposed upon any person who shall offend against decency or good customs by any highly scandalous conduct not expressly falling within any other article of this Code.

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GOING AT IT

That he may be castigated (and even penalized) does occur to Twinky; but – surprisingly – this does not prevent him from exhibitionism.

Twinky’s “magic hours” are from 12.00 midnight to past 3.00AM.

He goes to locations far from where he lives; and before doing anything there, he scouts the place first to make sure that there are no CCTV cameras there (and that the place is, by and large, not going to put him in danger).

This is also his “protection” re illegality of his act.

If the place is conducive for exhibitionism, he then preps his phone to get a video (or ask someone to video him) as he goes about his business.

And “you’d be surprised,” he said, that “90% of those who see me, sumasali sila o nanonood (join or watch me). And that excites me.”

For Twinky, this is worth stressing: No, he does NOT want women to see him; instead, he prefers masculine and muscled men (preferably twinks or twink-ish).

By the time he reaches 30, Twinky hopes not to do this anymore, as he eyes to be “stable” in life – e.g. have a good job, and maybe find a partner in life. “There’d be no place for me to do these things.”

FUTURE FORWARD

Twinky is actually conscious about the videos he posts in his alter account – e.g. he won’t post those that clearly identify him; or he would alter sections that would lead these back to him.

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He knows that this is/may be categorized as a mental illness, but that “it’s what excites me.” He never considered seeking professional help since he doesn’t believe he is addicted to it. “I would know,” he said, adding that maybe if he feels he is becoming addicted, he would seek professional help because “I realize the importance of mental health.”

By the time he reaches 30, Twinky also hopes not to do this anymore, as he eyes to be “stable” in life – e.g. have a good job, and maybe find a partner in life. “There’d be no place for me to do these things.”

No, he isn’t worried his family may know of what he’s doing. He said that the people who may tell his relatives are – themselves – keeping secrets, so he doubts they would out him. For instance, he encountered his brother’s closeted gay friend in Grindr, and this initially scared him since this guy may out Twinky to his family (i.e. they do not even know he’s gay). But since this guy is also not out as a gay guy to his friends, he didn’t inform on Twinky.

In the end, “if someone asks ‘Hindi ka ba nandidiri sa ginagawa mo (Are you not disgusted with what you’re doing)?’ I just smile. I can’t please everyone. I I can’t make them understand where I’m coming from. And if that’s the point, I don’t think there’s a point for me to explain my side.” – With Russelle Dagdayan

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5 LGBTQIA ‘markers’ in Phl for 2018

With an eye to doing more to achieve more in 2019 (and the coming years), here is a short list of some of the markers for LGBTQIA Philippines’ 2018.

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2018 has been busy for the LGBTQIA community in the Philippines, with numerous happenings marking either backward or onward movements for the local LGBTQIA struggle.

With an eye to doing more to achieve more in 2019 (and the coming years), here is a short list of some of the markers for LGBTQIA Philippines’ 2018.

1. Gathering of 20,000+ pax for Metro Manila’s one-day Pride parade

Particularly if the “measurement” is the Western perspective, 2018’s Metro Manila Pride parade proved that LGBTQIA Filipinos may already be woke.

Perhaps showing growing widespread popularity of everything LGBT-related in the Philippines, Metro Manila’s annual LGBT gathering patterned after Western Pride celebration/s was attended by an estimated 25,000 people. Even if figures are wrong, this still easily topped 2017’s 8,000 participants in the event that was held in Marikina City for two years now.

Here’s the thing, though: While the number is impressive as a show of force and as advertising magnet for those targeting the pink market, it – nonetheless – does not necessarily equate to promotion of LGBT causes in the Philippines. The challenge is still how to convert this number to attend not just one-day partying, but – say – joining rallies to push for the passage of the Anti-Discrimination Bill (ADB).

2. Inability of the LGBTQIA community to gather as many to promote Anti-Discrimination Bill (ADB)

The SOGIE Equality Bill was already passed by the likes of Reps. Geraldine Roman and Kaka Bag-ao in the House of Representatives in 2017, the first time it went this far in 11 years. And yet the Senate version – that is in the hands of Liberal Party-aligned Akbayan partylist helmed by Sen. Risa Hontiveros – is not gaining grounds.

Linked to, and stressed by #1 above, actual participation by LGBTQIA people to promote the ADB continues to be very limited. Various LGBTQIA organizations have attempted to hold events to push for ADB to be passed in the Senate; but these were – without mixing words – basically flops, failing to get the “numbers game” of the one-day Pride party.

The elitist and very “exclusive” approach to the ADB is also not helping.

Still, some of these efforts are worth highlighting, e.g.:
In May, student leaders asked the new Senate leadership of Sen. Tito Sotto to prove that it is better. Over 500 students – including lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) Filipinos and their supporters – to the new Senate President Tito Sotto and Majority Floor Leader Juan Miguel “Migz” Zubiri. The call is to end the debates and eventually pass the SOGIE Equality Bill to protect the LGBTQI Filipinos from discrimination based on their sexual orientation, gender identity and expression (SOGIE).

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In June, student councils from seven of the biggest Catholic schools in Metro Manila released a unified statement expressing support for the ADB.

In July, the Commission on Human Rights (CHR) and the United Nations Development Programme (UNDP) called for the speedy passing of bills that could help better the plight of LGBTQIA people in the Philippines.

3. Inadvertently “killing” ADB for this Congress

Perhaps not surprisingly – with anti-LGBTQIA politicians (e.g. Sens. Sotto, Manny Pacquiao and Joel Villanueva) – the Senate version of the anti-discrimination bill (ADB) – the Senate Bill No. 1271 – remains stalled in the Philippine Senate.

Worse, the ADB has become political football; with even supposed ADB supporters ending up backing those opposing it.

For instance, in March, politicians supposed to interpellate the ADB sponsor, Sen. Risa Hontiveros, either balked or walked out. The Senate agenda for March 21 (as an example) reflected Sen. Sherwin Gatchalian as the person who will interpellate (instead of Sen. Villanueva). The switcheroo is bad enough; but Gatchalian left the halls of Senate before his chance to interpellate, thereby effectively stalling the ADB. And for as long as there are senators still wanting to interpellate, the ADB – or any bill – can’t progress to the next steps, so that this is effectively a delaying tactic.
No progress has happened since then.

And with the May 2019 elections in the corner, passing the ADB in the Senate now seems improbable.

4. Growing number of LGBTQIA-related efforts – e.g. Pride parades, ADOs and private initiatives

Still sans a national law protecting the human rights of LGBTQIA Filipinos, many of LGBTQIA-related efforts are going local.

There are educational institutions hosting Pride-related events.

In March, for instance, the LGBTQIA community of the Polytechnic University of the Philippines (PUP) in Sta. Mesa in the City of Manila stressed the importance of “real diversity” as it celebrated its 4th Pride. The hosting of Pride in PUP has actually been inconsistent, with the first one held in the 1990s, and only followed by the second one in 2015. It was only in the last two years when Pride was held consistently. Themed “Putting we in diversity”, the gathering that was helmed by Kasarianlan, the only LGBTQIA organization in PUP, “eyed to emphasize that we can’t truly claim pride if this is not inclusive of all of us,” said Jan Melchor Rosellon, the student organization’s former inang reyna/head.

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Various local government units (LGUs) also still have Pride events.

Themed “This is Pride”, the 12th Baguio LGBT Pride Parade 2018 on November 24 “acknowledged that the community is still facing a lot of issues, so that we are coming out on the streets to continue the struggle for LGBT rights not yet won,” said Archie Montevirgen, chairperson of Amianan Pride Council.

And just as the year was about to close, the City of San Juan held its second LGBTQIA Pride parade. This is part of the mandate of City Ordinance No. 55, or the anti-discrimination ordinance (ADO) of the City of San Juan, which was passed in the third quarter of 2017 to protect the human rights of its LGBTQIA constituents.

Re localized anti-discrimination policies (via anti-discrimination ordinances, or ADOs), a handful of LGUs took the leap to advocate for their LGBTQIA constituents.

In May, the city of Mandaluyong passed Ordinance 698, S-2018, which seeks to “uphold the rights of all Filipinos especially those discriminated against based on their sexual orientation, gender identity and expression (SOGIE).” With this, it is now “the policy of the Mandaluyong City government to afford equal protection to LGBTQI people as guaranteed by our Constitution and to craft legal legislative measures in support of this aim.”

In June, the city of Iloilo joined the ranks of local government units (LGUs) with LGBTQI anti-discrimination ordinances (ADOs), with the Sangguniang Panlungsod (SP) unanimously approving its ADO mandating non-discrimination of members of minority sectors including the LGBTQI community. The ADO was sponsored by Councilor Liezl Joy Zulueta-Salazar, chair of the SP Committee on Women and Family Relations. Councilor Love Baronda helped with the content/provisions of the ordinance.

And in October, Malabon City passed an anti-discrimination ordinance (ADO) that prohibits: discrimination in schools and the workplace, delivery of goods or services, accommodation, restaurants, movie houses and malls. It also prohibits ridiculing a person based on gender and/or sexual orientation. Penalties for discriminatory act/s include imprisonment for one month to one year, a fine of P1,000 to P5,000, or both.

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Meanwhile, companies are finally, finally joining the rainbow bandwagon – whether as a PR initiative (we’re looking at you, Bench!) or to change internal policies – e.g.: As an attempt to ramp up its responses to a diverse workforce, Unilever now offers a 20-day paid leave for fathers, healthcare benefits for same-sex partners and paid absences for adoptive parents. According to Unilever Philippines chairman and CEO Benjie Yap, “diversity is an essential requirement in the today’s workforce, as it lends to new ideas, energies, and solutions.”)

5. New HIV infections now reach 32 cases per day

October highlighted the continuing disturbing worsening HIV situation in the Philippines, with an estimated 32 new HIV cases now happening in the country every day. For October, there were 1,072 new HIV cases reported to the HIV/AIDS & ART Registry of the Philippines (HARP).

It was in September when this number (i.e. 32 new HIV cases per day) was first reported. Prior to that, the country “only” had 31 new HIV cases reported daily, though even this figure was already considered high compared to figures from past years. In 2009, the country only had two new HIV cases per day. By 2015, the number increased to 22; and in the early part of 2018, the number was 31.

From January 1984 (when the first HIV case was reported in the country) to October 2018 (when the latest figures were belatedly – as usual – released by the HARP), the Philippines already had a total of 60,207 HIV cases. It is worth noting that 9,605 of that figure was reported from January to October 2018 alone.

The deaths related to HIV are also getting worrying.

The DOH reported that for August, there were 159 HIV-related deaths; in July, there were “only” 30. The figure may even be higher because of under- or non-reporting.

The worsening HIV situation is perhaps not surprising considering the foot-dragging and wrong priorities of bodies dealing with HIV in the Philippines.

For instance, while the DOH is complaining about budget cut, it was able to spend money ON A BEAUTY PAGEANT in September, showing erroneous prioritization.

NGOs, CBOs or CSOs aren’t always better, with issues similarly affecting them – from profiteering to abusing positions of power to the detriment of people living with HIV and Filipinos in general.

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Relevance of public & private sectors’ support highlighted in Quezon City’s 2018 Pride parade

Highlighting the importance of the participation of all stakeholders, not just the LGBTQIA community but also including the public and the private sectors, Quezon City in Metro Manila held one of the last Pride parades in the Philippines for 2018.

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Highlighting the importance of the participation of all stakeholders, not just the LGBTQIA community but also including the public (including government) and the private sectors, Quezon City in Metro Manila held one of the last Pride parades in the Philippines for 2018.

Hanz Defensor, who helms Quezon City Pride Council (QCPC), the organizer of the annual gathering, told Outrage Magazine in an exclusive interview that Quezon City is “quite fortunate” that it now has an anti-discrimination ordinance (ADO) that protects LGBTQIA people from discrimination.

Signed by mayor Herbert Bautista (whose term ends in May 2019), City Ordinance 2357-2014, otherwise known as The Quezon City Gender-Fair Ordinance, eyes to “to actively work for the elimination of all forms of discrimination that violate the equal protection clause of the Bill of Rights enshrined in the Constitution, existing laws, and The Yogyakarta Principles; and to value the dignity of every person, guarantee full respect for human rights and give the highest priority to measures that protect and enhance the right of all people; regardless of sexual orientation, gender identity and expression (SOGIE).”

But Defensor said that, “admittedly, kulang pa rin (this is still lacking).” This is because – even if they already have the ADO and its implementing rules and regulations (IRR), the actual implementation continues to be challenging.

Quezon City, Defensor noted as an example, has “a lot of business establishments, and while they know that discriminating against LGBTQIA people in the city is prohibited by law, not all of them actually have a copy of the ADO and the IRR to know the small details.”

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As he encouraged particularly those affected by the ADO to “download (the same) from Quezon City’s official website”, he is also encouraging other local government units to already take steps to also protect their LGBTQIA constituents, perhaps learning from Quezon City’s example.

The same sentiment was expressed in a letter sent to QCPC by Pres. Rodrigo Duterte, who remarked that Quezon City’s ADO – which also mandates the annual holding of the Pride parade – “has become a source of inspiration for advocates of gay rights in the Philippines and the rest of the world” because “it has institutionalized the city’s progressive and inclusive policy that eliminates discrimination on the basis of SOGIE.”

Though criticized for pinkwashing, Duterte still expressed hope that Pride further strengthens “the solidarity of (the) community so you may inspire the entire nation with the diversity and dynamism of your talents and skills.”

To contextualize, past administrations did not openly support Pride-related events.

Also, even if Akbayan partylist – which is aligned with Liberal Party that helmed the country under Pres. Benigno Aquino III prior to Duterte’s term – has been sponsoring the anti-discrimination bill for almost 20 years now, it still fails to gain traction, including during Aquino’s administration when it was largely ignored.

As an FYI, Quezon City actually hosted the largely accepted first Pride March in Asia.

On June 26, 1994, ProGay Philippines and Metropolitan Community Church helmed a march in Quezon City. Dubbed as “Stonewall Manila” or as “Pride Revolution”, it was held in remembrance of the Stonewall Inn Riots and coincided with a bigger march against the imposition of the Value Added Tax (VAT).

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Defensor stressed the need to be pro-active when confronting LGBTQIA-related discrimination. While the ADO is there, he said that should LGBTQIA people from Quezon City experience discrimination, “seek help” and know that “QCPC is here, and the LGU will back you.”

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San Juan hosts 2nd Pride parade to stress city’s support for ‘equality in diversity’

The City of San Juan held its second LGBTQIA Pride parade. According to San Juan City Vice Mayor Janella Ejercito Estrada: “San Juan Pride is about people recognizing individuality, diversity and equality. We are all equal…”

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Rainbow explosion in the City of San Juan.

Just as the year is about to close, the City of San Juan held its second LGBTQIA Pride parade. This is part of the mandate of City Ordinance No. 55, or the anti-discrimination ordinance (ADO) of the City of San Juan, which was passed in the third quarter of 2017 to protect the human rights of its LGBTQIA constituents.

Exclusively interviewed by Outrage Magazine, San Juan City Vice Mayor Janella Ejercito Estrada – who backed the ADO when it was still being proposed by Councilor Mary Joy Ibuna-Leoy – said that “San Juan Pride is about people recognizing individuality, diversity and equality. Lahat naman tayo ay pantay-pantay (we are all equal)… and (so) I’m an advocate for equality.”

Estrada added: “We acknowledge that LGBT rights are human rights; and we protect (those) rights here in San Juan.”

Pride – including Metro Manila’s – is admittedly fast be becoming a commercial endeavor. But Faustino “Bubsie” L. Sabarez III, national chairman of LGBT Pilipinas, said that “we still need Pride because it highlights individuality and the celebration of diversity.” He added that “safe spaces are still needed to celebrate being LGBTQIA, and (Pride) is one such space.”

Dindi Tan, Secretary-General of LGBT Pilipinas, added that Pride – such as San Juan’s – shows “where we are now.”

The city, for instance, has its ADO. This ADO, by the way, is not exclusive to LGBTQI people, but is also for those who may experience discrimination based on: race, disability, ethnicity and religious affiliation.

City of San Juan passes LGBT anti-discrimination ordinance

San Juan’s ADO prohibits, among others: employment-related discrimination; discrimination in education; discrimination in delivery of goods and services; discrimination in accommodation; verbal/non-verbal ridicule and vilification; harassment, unjust detention and involuntary confinement; disallowance from entry or refusal to serve; and the promotion of LGBT discrimination. Any person held liable under the ordinance may be penalized with imprisonment for 60 days to a year or fined up to P3,000, or both, depending on the discretion of a court.

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Tan is also realistic in saying that the anti-discrimination bill (ADB) being pushed in the Senate by Sen. Rosa Hontiveros of Akbayan is basically dead. Its counterpart in the House of Representatives was passed with the big help of trans Rep. Geraldine Roman of the First District of Bataan; but the version in the Upper House failed to gain traction not only because of the opposition of select senators particularly Tito Sotto, Manny Pacquiao and Joel Villanueva, but also because of the exclusivist approach in the pushing for the ADB.

“Until an ADB is passed, we need ADOs,” Tan said. And local government units with ADOs “should be commended.”

Tan is also pushing for the election (in the 2019 May elections) of “politicians who will deliver,” she said, particularly “the promise for an ADB.”

Moving forward, Vice Mayor Estrada said that they are already eyeing other LGBTQIA-related efforts – e.g. broadening the city’s anti-HIV efforts to “ensure that testing, and then treatment, care and support are widely rendered in the city.”

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People now embrace different forms of intimate relationships that flout cultural norms

Social media and the internet empowered individuals with diverse identities and relationship practices to find each other, raising awareness of connections that challenge traditional ideas about the meaning of intimacy. 

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Photo by Dani Vivanco from Unsplash.com

The 21st century ushered in a “quiet revolution” in the diversity of intimate relationships. With the scale and pace of this social transformation, what is needed is a “reboot” of relationship studies.

This is according to Phillip Hammack, professor of psychology at the University of California, Santa Cruz; and lead author of “Queer Intimacies: A New Paradigm for the Study of Relationship Diversity,” an article that appeared in the online edition of The Journal of Sex Research. Hammack’s co-authors include David Frost, associate professor of social psychology at University College London, and Sam Hughes, a graduate student at UC Santa Cruz.

For the authors, social media and the internet empowered individuals with diverse identities and relationship practices to find each other, raising awareness of connections that challenge traditional ideas about the meaning of intimacy.

“I’ve been calling it a quiet revolution, because it’s very different than the sexual revolutions of the 1960s and ’70s, which were so visible,” said Hammack.

Hammack said the “quiet revolution” is affected by “queer intimacies”, meaning “any and all intimate relationships that challenge norms.” “It’s a use of ‘queer’ that actually originated at UC Santa Cruz with the phrase ‘queer theory’ in 1990,” Hammack said.

Particularly in countries like the US, Hammack said that marriage equality (same-sex marriage was legalized in the US in 2015) is the backdrop for the explosion of relationship diversity that has occurred since the early 2000s.

“Marriage equality opens up the lens to think about diversity beyond just the gender of the people in a relationship,” said Hammack, noting that asexuality, polyamory, and kink/fetish all challenge dominant notions of intimacy.

Will you open up?

These people are thriving in intimate relationships far from the cultural norms of monogamy and heterosexuality, including asexual, polyamorous, transgender and gender nonbinary, pansexual, and kink/fetish relationships.

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He also said that “it’s a myth that asexual people aren’t in relationships just because they experience little or no sexual desire,” said Hammack. “The assumption is that they are suffering, lonely, and without partners, but that’s not true. They do have intimate relationships, but we don’t know much about them.”

People who identify as asexual “violate the fundamental assumption that intimate relationships are inherently characterized by sex,” said Hammack. They started to organize in the early 2000s, thanks to the internet.

Asexuality was removed from the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in 2013.

In a similar challenge to cultural norms, those who choose polyamorous relationships violate conventions of monogamy by allowing partners to love more than one person. Although gay men have a long tradition of open relationships, and ‘swinging’ was favored by some straight couples in the 1970s, polyamory now appears in the Oxford English Dictionary, following what Hammack referred to as a “simmering movement that challenged heteronormative conventions about what an ideal relationship is supposed to look like.”

Mainstream representations are also affecting concepts and/or relationship practices. For instance, the success of the 2011 novel Fifty Shades of Grey is said to have helped propel mainstream discussion of kink/fetish relationships, which highlight consensual asymmetrical power dynamics in intimate relationships.

Hammack, nonetheless, admitted that even if it made people curious, “the novel was problematic because it didn’t accurately represent the consensual way relationships are configured in the kink community… Kink relationships have been stigmatized because the expectation is that relationships are supposed to be ‘equal’.”

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Unfortunately, Hammack said that researchers still know little about what happens within kink/fetish relationships. “To what extent is the power asymmetry just during sex? We don’t know,” said Hammack. “Most of this science doesn’t talk about the relationships. It just talks about specific kinky practices… There’s almost no recognition of relationships – it’s all about sexual gratification, which is only part of the picture.”

Yet other concepts that have emerged are: “queer heterosexuality”, as well as changes in ideas about “chosen families.”

“Heterosexuality is opening up like never before,” said Hammack. “More people who identify as straight will have some same-sex experience – they even refer to ‘heteroflexibility.’ They are not opposed to same-sex encounters.”

Younger gay men moving away from non-monogamous relationships, study says

This trend is long-established among women, but it’s new among men – and it’s distinct from bisexuality because these men don’t feel equally attracted to men and women. “It’s fascinating to see masculinity opening up this way,” he said.

Hammack noted that still “very, very little” is known about the phenomenon of chosen families as distinct from biological families. This is a phenomenon that has been historically associated with gays and lesbians who “create their own families” after being rejected by biological relatives; however, its prevalence remains a mystery.

This is why Hammack said that more research initiatives should be done to focus on diversity in intimate relationships to “document the diversity of what’s happening out there,” Hammack ended.

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1 percent of children aged 9-10 self-identify as gay, bi or trans

While 1% of youth aged 9 and 10 self-identified as LGBT, their parents reported they believed their children were gay, bisexual or transgender at a higher rate.

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Photo by Sharon McCutcheon from Unsplash.com

About 1% of 9 and 10-year old children surveyed self-identified as gay, bisexual or transgender. 

This finding was detailed in “Child Sexual Orientation and Gender Identity in the Adolescent Brain Cognitive Development Cohort Study,” co-authored by Jerel P. Calzo and Aaron J. Blashill, and which appeared in JAMA Pediatrics.

Majority of studies indicate that lesbian, gay, bisexual and transgender (LGBT) self-identification generally occurs during the mid-adolescent years. So “this is such an important stage, biologically and socially,”said lead author Calzo, an associate professor in the SDSU School of Public Health.

At 9 and 10, youth – whether through their peers, media or parents – are beginning to be exposed to more information about relationships and interacting in the world. Also, they may not see any of this as sexual, but they are beginning to experience strong feelings, said Calzo.

Calzo and Blashill utilized the Adolescent Brain Cognitive Development (ABCD) Study dataset, a multisite, longitudinal study exploring brain development and health among children aged 9 and 10 over a 10-year period, leading to the 1 percent finding for self-identification.

“One percent is sizable, given that they are so young,” Blashill said. “For so long, social scientists have assumed that there is no point in asking kids at this age about their sexual orientation, believing they do not have the cognitive ability to understand.” But “it is important to have a baseline to understand how sexuality develops and how it may change over time.”

Blashill and Calzo also sought to understand how parents perceived their children’s sexual and gender identities. Surprisingly, nearly 7% of parents, when asked about the sexual identity of their children, reported their child might be gay; and 1.2% reported that their child might be transgender.

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Another finding was that children overwhelmingly reported no problems at home or school related to their minority sexual orientation or gender identity while 7% of parents reported gender identity-based problems.

As sexual and gender minorities experience higher rates of physical and mental health issues than do their heterosexual counterparts, the research “may provide crucial insights into resiliency development within the LGBT community”, said the authors, adding that “it could also help lead to improved programs and policies to better serve the community.”

Yet another key finding is the need for researchers to identify better ways to explore identity issues among younger populations, with about 24% of those surveyed indicating that they did not understand questions about sexual orientation.

“If we can understand identity development earlier and can track development using large datasets, we can begin improving research and prevention around risk and protective factors,” Calzo said,.

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