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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).

FEATURES

Phl votes for LGBTQIA rights at UN Human Rights Council

The UNHRC adopted a resolution to renew the mandate of the Independent Expert focusing on the protection against violence and discrimination on the basis of sexual orientation and gender identity.

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ALL PHOTOS TAKEN DURING METRO MANILA PRIDE PARADE 2019

The United Nations Human Rights Council (UNHRC) adopted a resolution to renew the mandate of the Independent Expert focusing on the protection against violence and discrimination on the basis of sexual orientation and gender identity (SOGI).

The resolution was adopted by a vote of 27 in favor, with 12 voting against and seven abstentions.

Now this is worth highlighting: The Philippines voted in favor of the resolution.

The Philippines’ UN voting history vis-à-vis LGBTQIA people has been inconsistent. In 2016, when the UNHRC adopted the resolution on “protection against violence and discrimination based on SOGI (which created the post for the Independent Expert), the Philippines abstained from voting for the resolution. It was then under the presidency of Benign Aquino III.

Also to date, the country still does not have a national anti-discrimination policy protecting the human rights of LGBTQIA Filipinos, even if various versions of the anti-discrimination bill (ADB) have been filed in the Upper and Lower Houses of Congress for 20 years now. In 2017, during the last – 17th – Congress, it passed the House of Representatives; but its counterpart version in the Senate failed to gain traction.

Created in 2016, the UN Independent Expert on SOGI has been supported by a growing number of States from all over the world. This new resolution to create and renew the mandate was presented by a Core Group of seven Latin American countries – Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico and Uruguay.

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The UN Independent Expert on SOGI is tasked with assessing implementation of existing international human rights law, by talking to States, and working collaboratively with other UN and regional mechanisms to address violence and discrimination. Through the work of this mandate since 2016, the impact of criminalization of same-sex relations and lack of legal gender recognition, the importance of data-collection specific to SOGI communities, and examples of good practices to prevent discrimination have been highlighted globally, with visits to Argentina, Georgia, Mozambique and Ukraine.

As a top-to-bottom approach, however, the immediate impact of the UN Independent Expert on SOGI on grassroots LGBTQIA activism remains a sore issue for those critical of its.

The renewal process of the mandate had to overcome 10 hostile amendments, but the core of the resolution in affirming the universal nature of international human rights law stands firm.

RESULTS OF THE VOTE

Voting in favor of the resolution

Argentina, Australia, Austria, Bahamas, Brazil, Bulgaria, Chile, Croatia, Cuba, Czech Republic, Denmark, Fiji, Iceland, Italy, Japan, Mexico, Nepal, Peru, Philippines, Rwanda, Slovakia, South Africa, Spain, Tunisia, Ukraine, UK, Uruguay

Voting against the resolution

Afghanistan, Bahrain, Bangladesh, China, Egypt, Eritrea, Iraq, Nigeria, Pakistan, Qatar, Saudi Arabia, Somalia

Abstaining on the resolution

Angola, Burkina Faso, Democratic Republic of Congo, Hungary, India, Senegal, Togo

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SOGIE Equality Bill filed anew in 18th Congress

In the Lower House, Lumad leader-turned-Bayan Muna Rep. Eufemia Cullamat has refiled the SOGIE Equality Bill as House Bill 258. Meanwhile, in the Upper House, Akbayan Sen. Risa Hontiveros refiled the bill as Senate Bill 159, one of her priority measures.

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ALL PHOTOS TAKEN DURING METRO MANILA PRIDE PARADE 2019

We continue to #ResistTogether.

Versions of the Sexual Orientation, Gender Identity and Gender Expression (SOGIE) Equality Bill have been re-filed in the Lower and Upper Houses of Congress.

In the Lower House, Lumad leader-turned-Bayan Muna Rep. Eufemia Cullamat has refiled the SOGIE Equality Bill as House Bill 258. Co-authors are Bayan Muna Reps. Karlos Ysagani Zarate and Ferdinand Gaite.

Meanwhile, in the Upper House, Akbayan Sen. Risa Hontiveros refiled the bill as Senate Bill 159, one of her priority measures.

The explanatory note of HB 258 talks about intersectionality, stating that “LGBT (people) often find it difficult to exercise their rights as persons, laborers, professionals, and ordinary citizens.”

For instance, “LGBT students are denied admission or expelled from school due to their sexual orientation or gender identity. Companies block the promotion and stymie the career advancement of gay or lesbian employees due to the deeply embedded notion that homosexuality denotes weakness. Laws such as the current anti-vagrancy law are also abused by the law enforcement agencies to harass gay men.”

Incidentally, the latter – i.e. anti-vagrancy law – was repealed in March 2012 (via Republic Act 10158), but members of the LGBTQIA community (particularly gay and bisexual men) often still fall prey victim to harassment by law enforcers.

“It is therefore imperative to define and penalize practices that discriminate against LGBT (people),” continued the explanatory note of HB 258.

Hontiveros, for her part, said the time has come for the enactment of the SOGIE Bill; even vowing that the incoming Congress will be a “massive victory against hate and discrimination.”

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“If the Senate’s 17th Congress was a big win for women and health, the 18th Congress will be a massive victory against hate and discrimination. The SOGIE Equality Bill will pass. It is a measure whose time has come,” Hontiveros said.

In 2017, the House of Representatives actually passed the SOGIE Equality Bill. The Senate’s version, however, did not gain the final approval of the 17th Congress.

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Over 50,000 parade for Pride in Metro Manila

The Pride-goers gathered not just to show force and then party, but also to highlight the need to create safe spaces for LGBTQIA Filipinos.

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Growing rainbow number.

Over 50,000 people gathered in Marikina City to attend the annual LGBTQIA Pride parade in a largely disorganized event affected by sporadic downpours and marred by event planning/execution issues. The Pride-goers gathered not just to show force and then party, but also to highlight the need to create safe spaces for LGBTQIA Filipinos.

While confusion continued to exist even during Pride day about what revelers were supposed to #ResistTogether – this year’s catchy theme – there was at least a call to recognize the sector (particularly with the number) by passing the anti-discrimination bill (ADB) that has been pending in Congress for two decades now.

And despite the numbers fascination, the total number of attendees is still undetermined even with the mandatory/forced registration of all participants (else not be allowed entry into the premises), with the information desk “told to say it’s 52,000” while a host inconsistently bragged figures reaching 70,000. All the same, this year’s number easily eclipsed last year’s estimated 25,000 revelers.

Notably, this year’s gathering attempted to “return” the format to the older Pride parades in Metro Manila by allowing various groups/organizations to speak onstage, as opposed to only those affiliated with the political party/leaning of the organizing Metro Manila Pride.

According to Regie Pasion, who helms LGBTbus, the Marikina-based LGBTQIA organization that helped in organizing this year’s Pride (and the gatherings in 2017 and 2018), “at it’s core, Pride remains a protest” and “will remain so until LGBTQIA human rights are recognized”.

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Locally, for Marikina, while the ADB continues to languish, the city’s mayor Marcy R. Teodoro signed the local anti-discrimination ordinance (ADO), passed ahead of the Pride parade. In signing, Teodoroo said that the ADO will “nagbibigay sa lahat ng pantay at parehong karapatan sa trabaho, edukasyon, tirahan, at mga serbisyo ng pamahalaan (give everyone equal right to access education, work, accommodation and government services).”

The same ADO was passed after Marikina hosted the Pride parade for three years; pushed exclusively by the local LGBTQIA community.

Coming from Lucena City to attend the 2019 Pride parade, Aaron Moises Bonette of QZN Pride and Bahaghari QZN said that the challenge remains “for us to utilize this same number to take the same streets to fight for our actual rights (and not just to parade),” he said.

Last year’s Pride parade, for instance, may have gathered over 20,000 revelers, but when it came to rally for the ADB, the organizers were not able to attract 50 participants.

“Don’t get me wrong: Reaching this big number is admirable. But Pride shouldn’t start and end in June. It should be done every day (hopefully by as many, or even by more) people until we are treated as equals. Otherwise, this thing we call ‘pride’ is but an ideal,” Bonette ended.

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Now illegal to discriminate against LGBTQIA people in Marikina

Marikina City joins the list of local government units (LGUs) that now has an anti-discrimination policy that eyes to protect the human rights of its LGBTQIA constituents. Offenders may be penalized from P1,000 (first offense) to P2,000/P5,000 (second and third-time offenders), along with imprisonment of up to 15 days.

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The rainbow cometh.

Marikina City has joined the list of local government units (LGUs) that now has an anti-discrimination policy that eyes to protect the human rights of its LGBTQIA constituents.

The host of Metro Manila Pride parade since 2017, the city was also – for a while – under scrutiny for claiming to be pro-LGBTQIA but with (seemingly) limited LGBTQIA-related efforts topped by the once-a-year parade held in June.

But the ordinance introduced by councilors Paul Dayao, Mario de Leon, Manuel Sarmiento and Zifred Ancheta eyes to make it a policy of the city to hold non-discrimination of LGBTQIA people (at least there).

Discriminatory acts included in the ADO include: employment- and school-related discrimination; refusal to provide goods/services/accommodation because of a person’s SOGIE; and by subjecting (verbally or by writing) people to ridicule because of their SOGIE.

Offenders may be penalized from P1,000 (first offense) to P2,000/P5,000 (second and third-time offenders), along with imprisonment of up to 15 days.

The ordinance introduced by councilors Paul Dayao, Mario de Leon, Manuel Sarmiento and Zifred Ancheta eyes to make it a policy of the city to hold non-discrimination of LGBTQIA people (at least there).

Surprisingly, while the ADO is creating an Anti-discrimination Mediation and Conciliation Board to deal with ADO-related violations, no LGBTQIA organization/party will be among the board members.

The ADO is awaiting the signature of Marikina Mayor Marcy R. Teodoro, though this is already expected. In 2018, Teodoro told Outrage Magazine that hosting Pride is a way to show the city’s support to Metro Manila’s LGBTQI community, particularly since his office in particular supports this community’s push for a nationally enacted anti-discrimination policy. In the end, Teodoro said, “we want to be known as an inclusive community. We can only do that by recognizing everybody as all equal to each other.”

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Sexuality continues to change and develop well into adulthood – study

Substantial changes in attractions, partners, and sexual identity are common from late adolescence to the early 20s, and from the early 20s to the late 20s, indicating that sexual orientation development continues long past adolescence into adulthood. The results also show distinct development pathways for men and women, with female sexuality being more fluid over time.

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Photo by Sharon McCutcheon from Unsplash.com

Traditional labels of ‘gay’, ‘bisexual’ and ‘straight’ do not capture the full range of human sexuality, and whether a person is attracted to the same, or opposite sex can change over time.

This is according to a study, published in the Journal of Sex Research, which analyzed surveys from around 12,000 students, and found that substantial changes in attractions, partners, and sexual identity are common from late adolescence to the early 20s, and from the early 20s to the late 20s, indicating that sexual orientation development continues long past adolescence into adulthood. The results also show distinct development pathways for men and women, with female sexuality being more fluid over time.

“Sexual orientation involves many aspects of life, such as who we feel attracted to, who we have sex with, and how we self-identify,” said Christine Kaestle, a professor of developmental health at Virginia Tech. “Until recently, researchers have tended to focus on just one of these aspects, or dimensions, to measure and categorize people. However, that may oversimplify the situation. For example, someone may self-identify as heterosexual while also reporting relationships with same-sex partners.”

In order to take all of the dimensions of sexuality into account over time, Kaestle used data from the National Longitudinal Study of Adolescent to Adult Health, which tracked American students from the ages of 16-18 into their late twenties and early thirties. At regular points in time, participants were questioned about what gender/s they were attracted to, the gender of their partners, and whether they identified as ‘straight’, ‘gay’ or ‘bisexual’.

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The results showed that some people’s sexual orientation experiences vary over time, and the traditional three categories of ‘straight’, ‘bisexual’ and ‘gay’ are insufficient to describe the diverse patterns of attraction, partners, and identity over time. The results indicated that such developmental patterns are better described in nine categories – differing for both men and women.

For young men these patterns have been categorized as:

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  • ‘straight’ (87%),
  • ‘mostly straight or bi'(3.8%),
  • ’emerging gay’ (2.4%)
  • minimal sexual expression’ (6.5%).

Young women on the other hand were better described by five categories:

    null
  • ‘straight’ (73.8%),
  • ‘mostly straight discontinuous’ (10.1%),
  • ’emerging bi’ (7.5%),
  • ’emerging lesbian’ (1.5%)
  • ‘minimal sexual expression’ (7%).

Straight people made up the largest group and showed the least change in sexual preferences over time. Interestingly, men were more likely than women to be straight – almost nine out of 10 men, compared to less than three-quarters of women.

Men and women in the middle of the sexuality spectrum, as well as those in the ’emerging’ gay and lesbian groups showed the most changes over time.

For example, 67% of women in the ‘mostly straight discontinuous’ group were attracted to both sexes in their early 20s. However, this number dropped to almost zero by their late 20s, by which time the women reported only being attracted to the opposite sex.

Overall, women showed greater fluidity in sexual preference over time. They were more likely (one in six) to be located in the middle of the sexuality continuum and to be bisexual.

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Fewer than one in 25 men fell in the middle of the spectrum; they were more likely to be at either end of the spectrum, as either ‘straight’ or ’emerging gay’. Relatively few women were classed as ’emerging lesbian’.

“In the emerging groups, those who have sex in their teens mostly start with other-sex partners and many report other-sex attractions during their teens,” Kaestle said of her findings. “Then they gradually develop and progress through adjacent categories on the continuum through the early 20s to ultimately reach the point in the late 20s when almost all Emerging Bi females report both-sex attractions, almost all Emerging Gay males report male-only attractions, and almost all Emerging Lesbian females report female-only attractions.”

Kaestle said that the study demonstrates young adulthood is still a very dynamic time for sexual orientation development.

“The early 20s are a time of increased independence and often include greater access to more liberal environments that can make the exploration, questioning, or acknowledging of same-sex attractions more acceptable and comfortable at that age. At the same time – as more people pair up in longer term committed relationships as young adulthood progresses – this could lead to fewer identities and attractions being expressed that do not match the sex of the long-term partner, leading to a kind of bi-invisibility,” said Kaestle.

For Kaestle, “we will always struggle with imposing categories onto sexual orientation. Because sexual orientation involves a set of various life experiences over time, categories will always feel artificial and static.”

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Importantly, although the study found nine categories of sexual orientation development, limitations in the statistical methods used mean that more categories could exist.

The names of the categories are also in no way meant to replace or contradict any person’s current self-labelled identity. Rather, Kaestle hopes that these findings will help researchers in the future to better understand how a range of sexual orientation experiences and patterns over time can shape sexual minorities’ experience of distinct health disadvantages, and the effects of discrimination.

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Transgender people are not mentally ill, says WHO

The new classification is not expected to affect the healthcare provision to respond to the needs of transgender people, but – all the same – it’s expected to improve social acceptance among transgender people while still making important health resources available.

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Photo by Cecilie Johnsen from Unsplash.com

The World Health Organization (WHO) has decreed that transgender people are not mentally ill, with the WHO’s legislative body voting to move the term used to describe transgender people – “gender incongruence” – to the panel’s sexual health chapter from its mental disorders chapter.

The new standard of classification appears in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11); but will go into effect on January 1, 2022.

The WHO uses “gender incongruence” to describe people whose gender identity is different from the gender they were assigned at birth.

The new classification is not expected to affect the healthcare provision to respond to the needs of transgender people, but – all the same – it’s expected to improve social acceptance among transgender people while still making important health resources available, according to the United Nations health agency last year when it announced the intended change.

Dr. Jack Drescher, a member of the ICD-11 working group, wrote: “There is substantial evidence that the stigma associated with the intersection of transgender status and mental disorders contributes to precarious legal status [and] human rights violations”.

It is worth noting that the WHO still classifies intersex traits as “disorders of sex development”.

This is not the first time the ICD changed a classification related to sexuality. In 1990, the WHO declared that “sexual orientation alone is not to be regarded as a disorder.”

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