While many countries, including in Southeast Asia, have seen a fall in new HIV infections, the Philippines has seen a sharp rise
Bureaucracy, a conservative society and the Catholic Church are the main stumbling blocks to effective action
Decades after the human immunodeficiency virus (HIV) was identified in the 1980s, the number of Aids-related deaths worldwide is the lowest it has been this century. Fewer than one million people are dying each year from complications arising from the disease – versus two million each in 2004 and 2005 – thanks in part to access to antiretroviral therapy treatment, which has reached a record 21.7 million sufferers. Three out of four people living with HIV now know their status.
That’s according to the 2018 Global Aids Update of UNAids, released in June. However, the rate of new infections is not falling fast enough, the United Nations agency found. HIV prevention services are still not being provided on an adequate scale or with sufficient intensity.
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The picture in Southeast Asia is patchy. Sustained efforts to reach “key populations” – which UNAids describes as young people aged 15 to 24 – has led to a significant fall in new cases in Thailand, Vietnam, Cambodia and Myanmar.
The Philippines, however, is one country in the region where the number of new cases is on the rise – and at an alarming rate. UNAids says the number of new infections in the country among young people has risen 170 per cent since 2010.
From an average of one new case a day in 2008, the country now clocks an average of 26 new cases daily, the agency found.
There is no indication that the trend will slow down any time soon. Annual new infections more than doubled in the Philippines in the seven years to 2017, to an estimated 12,000. The sixth HIV & Aids Medium Term Plan (2017 to 2022) of the Philippine National Aids Council states that as of June 2016, the number of people living with HIV had reached a total of 34,999. There are updated figures available.
The plan cites a number of factors as contributing to the trend: the shift in the disease’s mode of transmission from mainly heterosexual to largely homosexual contact; the spread via needles among intravenous drug users; and the need for parental consent before HIV testing of minors – which hinders early detection and treatment.
To get a grip on the epidemic, the private sector is playing its part in spreading awareness, offering support and erasing the stigma of the disease.
One organisation doing its part is LoveYourself, an HIV prevention advocacy group with a mission of “embracing and nurturing self-worth and inspiring others to do the same” through counselling, testing, treatment and life coaching.
It also runs HIV/Aids awareness campaigns and education seminars in schools, companies and various communities.
Raybert Domingo, LoveYourself’s deputy head of communications, says that empathy is an effective way to enable people to make healthy life choices and break cultural stigmas.
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“People are more encouraged to take action about their health if we don’t present the topic in a way that’s scientific or righteous,” he says. “If we relate to them like real human beings who experience sex, make wrong life decisions and can even be ignorant of things, then we would be able to show that help is here.
“There are people who are willing to give care and attention to your health needs in an understanding and private space.”
Paul Victor Junio, LoveYourself’s head of communications, says the organisation’s five clinics in Metro Manila – a cluster of 16 cities and one municipality that account for 80 per cent of reported HIV cases in the country – are open to everyone for free counselling and testing.
The LoveYourself treatment programme is accredited by the Department of Health and government-owned insurer PhilHealth.
Junio says that one big challenge in advocacy is local culture: the Philippines is a conservative society.
“There is still that cringe factor and that’s definitely an issue,” he says. “You can only talk about HIV in the context of sex. If people are uncomfortable discussing sex, then they’ll be uncomfortable discussing HIV.”
Qualms about discussing reproductive and sexual health are widespread in the Philippines, possibly because roughly 83 per cent of Filipinos profess to be Catholic. The Catholic Church still wields enormous influence in Philippine society, and has always been steadfastly opposed to policies such as artificial family planning and subsidised birth control programmes.
Bic Chua, executive director of advocacy group Catholics for Reproductive Health, says a great deal of opposition comes from the Roman Catholic hierarchy, including priests, bishops and cardinals – who decry contraception policies as a moral evil. That’s despite the fact that “more than 70 per cent of Filipino Catholics actually want a family planning programme”, Chua said in a recent interview.
For the government’s part, the Department of Health has established a number of HIV treatment hubs across the country that provide access to life-saving antiretroviral drugs, and is urging those living with HIV to take advantage of the free treatment.
In Metro Manila, local governments have earmarked resources and initiated HIV prevention services.
Quezon City, for example, has opened three “Sundown Clinics” that provide speedy HIV testing and counselling in a non-stigmatising environment for gay men, men who have sex with men, and transgender people.
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The city has also increased its HIV funding nine times since 2012 and has been urging other local authorities to do the same.
Moreover, the health care community is advocating UNAids’ 90-90-90 strategy, wherein “by 2020, 90 per cent of persons living with HIV will know their status, 90 per cent of them will be placed on ARVs [antiretrovirals, or drugs that prevent the growth of the virus], and 90 per cent of those on therapy will have viral suppression”, says Dr Nonoy Marella, an infectious diseases fellow at Makati Medical Centre.
There may be one reason to be hopeful about the various awareness campaigns in the country: Marella believes that the increase in the reported HIV cases in the Philippines is “probably due to the early detection of individuals with HIV”.
Still, gaps exist in the country’s response to the health threat. A Senate policy brief published in September pointed to the outdated, 20-year-old HIV/Aids legal framework for prevention and control; inadequate public information about the disease; barriers to condom access and low condom use; and a decline in external funding support.
Some harm reduction initiatives that could reduce HIV transmission could not be enacted because they run counter to certain laws. Increasing the availability and utilisation of sterile injecting equipment among intravenous drug users, for example, is prohibited under the Comprehensive Dangerous Drugs Act of 2002.
Another legal impediment is the Philippine Aids Prevention and Control Act of 1998, which has a section requiring parental or legal guardian proxy consent before a minor can be tested for HIV.
To their credit, the House of Representatives and the Senate acknowledge the importance of updating the country’s legal framework on HIV. In 2018, both houses approved a third and final reading of their respective versions of the bill, seeking to amend key provisions of the 1998 act.
Faustine Luell Tupas Angeles Jnr, founder of Pedal for HIV, an advocacy organisation involved in formulation of the Sixth HIV and Aids Medium Term Plan, says many intravenous drug users are afraid to seek treatment because of President Rodrigo Duterte’s tough stance on the war on drugs.
He says that in early December, during filming of a documentary he is producing, Complexities of ChemSex (a term for people who use drugs during intercourse), two actors wearing police uniforms were arrested during a re-enactment. He puts this down to the authorities “trying to cover up the drug war situation”.
The country is at a critical point in its fight against HIV, says the Department of Health, which regards the disease as a national development issue rather than just a serious health concern. Only with the full commitment of all concerned sectors can the Philippines tackle the problem effectively and reverse the current trend.
That sentiment is shared by Eamonn Murphy, UNAids regional director for the Asia and the Pacific.
“The Philippines has a small window of opportunity to act fast and stop a major HIV epidemic from taking hold,” Murphy has said. “This commitment is achievable if cities where the epidemic is having a big impact take the lead.”
Published by South China Mourning Post