Blogging about Parenthood in the Philippines

The legendary AIDS Law

Digging up my office desk and reflecting on our history of HIV work, the legendary international best practice passage of National AIDS Law (Republic Act 8504) in 1998 did not happen without a story behind it. The passage was based on reasons.

Being engaged in estimations and projections, I had access to the reports and methods used around that time.

On the first few years of his presidency, President Fidel Ramos was warned that by year 2000, around 100,000 Filipinos will have HIV if his administration will not do something. This was a red flag at the time when less than 100 cases were being reported per year (only 6 cases a month).

The stars aligned on those moments, the AIDS activism was alive, government and civil society partners were on top of things, the media covered spectacular stories of Dolzura Cortes and Sarah Jane Salazar, AIDS as a health issue was on all-time high in the awareness of the public.

The result, the world praised the Philippines for passing a landmark national policy in 1998.

NEXT - No Cases. Where did it go?

READ THE SECTIONS ONLY

READ THE COMPLETE POST HERE

No cases. Where did it go?

Many were happy that by the year 2000, the dreaded 100,000 HIV cases did not happen. Perhaps the Y2K scare also eclipsed every other issue that emerged around that time.

A year later after the AIDS law was passed.

Another 5 years passed.

Presidents Estrada and Arroyo administrations later… still, the number of HIV cases were low.

Was the AIDS law so magnificent that we were successful in preventing new HIV infections? Or was it that majority of male Filipinos were circumcised? Or the archipelago of more than 7,000 islands is a natural deterrent for HIV to cross one island to another? Or did we simply miss the cases, because we did not know where to find them?

On my first year in HIV work, in 2006, I was happy monitoring the 100% Condom Use Program (100% CUP) in around 10 sites around the country. The CUP was an international best practice initiated by Thailand which brought down HIV and STI infections within months of implementation among entertainment establishments in Chiang Mai and Bangkok.

With the acceptability and simplicity of CUP in these cities, the Philippine government wanted to replicate it in many parts of the country. However, many of our cities then had a hard time understanding why they have to have the CUP.

I recall one visit in one of the cities in the Visayas. The city councilor who was the chair of the city’s legislative committee on health asked us particularly the DOH “Since you have the AIDS registry, why don’t you just tell us the names and addresses of the HIV victims in our city? We need to find them so that we will know how to avoid them. We can warn others. We can stop these infections”. It was a situation reflective of the situation in other cities in the country at that time.

For me, it was not merely ignorance, but a real, genuine reaction to our proposed solutions on an imagined epidemic. They cannot feel the presence of HIV. They cannot see the epidemic. They wanted real cases seen in their cities. They wanted a face of the epidemic, the Dolzura or Sarah Jane of their communities.

Yes, at that time in 2006, as I have narrated above, a mere 300 HIV cases were reported in the registry, and majority were seen from the clinics of Metro Manila.

The chance of a remote city having a real face with HIV was… also remote.

NEXT - Confused

READ THE SECTIONS ONLY

READ THE COMPLETE POST HERE

Confused

The experts were becoming confused.

Data from HIV surveillance since the 1990s told us that sexual activity remained to be high among young people. Age of sexual initiation was becoming younger. Multiple sexual partners remained to be high, while unprotected sex particularly non-condom use during risky sexual encounters (anal sex) stayed to very low among Filipinos identified to be most vulnerable or at risk to HIV infections – the entertainment workers (and technically called sex workers) and their clients, gay men and other men who have sex with men, and Filipinos who inject drugs.

Why was HIV not spreading as predicted in the mid-1990s?

NEXT - Wildfire

READ THE SECTIONS ONLY

READ THE COMPLETE POST HERE

Wildfire

Come 2009, the AIDS registry for the first time reported almost 1,000 new infections in a year, with majority of the transmission via unprotected male-to-male sex. A stark contrast to the 20 years previous to this, with which almost all of the infections were heterosexual transmission.

Within the government and among experts, one main answer was given. We were seeing more cases because we expanded the testing sites and we were testing more Filipinos.

We had at that point, 3 valuable grants from the Global Fund to fight AIDS, TB and Malaria. On the government table was Round 3 grant at P585 million ($13 million), Round 5 at P225 million ($5 million), and the largest Round 6 at P810 million ($18 million) from 2004 to 2012 amounting to almost P225 million ($5m -$8 m) a year comprising up to 80% of total AIDS investments in the country. These grants provided valuable prevention commodities and capacities in more than 30 cities around the country – providing valuable learnings in the areas of peer education, social hygiene clinic management, AIDS awareness campaigns especially during International AIDS Candlelight and World AIDS Day.

But epidemiologists and demographers wanted more answers. Yes, we have expanded testing, but is the epidemic really here?

Aside from the passive reports of confirmed HIV positives to the AIDS registry from the HIV testing centers and hospitals around the country, we also looked at different other data sources.

Indeed, the surveys among sample key population in around 10 cities in the country were telling us the same thing, the HIV epidemic is growing. New cases were increasing and majority were among males who have sex with other males.

In the Metro Manila cities where the survey were routinely done every 2 years under the DOH’s Integrated Behavioral and Serologic Surveillance (IHBSS), for the first time has reached beyond 1% prevalence among gay men and other men who have sex with men. One city had 1% HIV prevalence among MSM that jumped to 4% in 2011 to 7% by 2013. This was the case in the other cities. In Cebu, HIV prevalence among people who inject drugs went above 50% by 2010. By 2015, new cities not in the higher prevalence radar prior to 2011, were reported to have at least 5% HIV prevalence among MSM.

Fortunately, enrolment to ARV went to all time high by end of 2015 with more than 12,000 Filipinos taking the daily pill, all provided for free.

Deaths, while underreported as in the case of many death registries of the world, were reported at all-time high in 2015. WE had 461 total deaths by end of last year. A sad realization that 1 Filipino dies everyday due to AIDS.

HIV has finally arrived our shores.

The virus successfully penetrated the circuits of our vulnerable population. It has, unfortunately, entered the sexual network of our mostly hidden group of population.

NEXT - We will bounce back

READ THE SECTIONS ONLY

READ THE COMPLETE POST HERE

We will bounce back

The MDG period ended and the report card of the Philippines was marked with bloody red. We were not able to reverse the epidemic. Actually, we cannot even halt its spread. It has to stabilize first from the spurt of new infections, in the next 5 years, before we can talk of halting it.

But this could be a blessing in disguise.

With good data, better information, evidence-based communication, many more Filipinos are working with us, voicing out their support, standing up to tell everyone that we can do something.

Miss Pia Wurtzbach stunned the world, most specially the judges, when she spoke eloquently about her plans to raise awareness about HIV in our country. Indeed an enigmatic beauty with a heart, she was crowned to be 2015’s most beautiful woman of the world, the 2015 Miss Universe.

For the first time, Malacanang, through its Official Gazette, released infomercials about HIV prevention in January 2016.

The chair of the Philippine National AIDS Council herself shared in November 2015 vital statistics of the epidemic, warning that if we do the same things, we will have more than 130,000 cases by 2022. She verbally expressed her intention to invest more in the HIV program. The same can be said about the highest leaders of the Health Department, HIV is in their advocacy.

By mid -2015, the House of Representatives passed on third reading its consolidated version of the AIDS Law Amendment.

Just this February 2016, a senate version of the AIDS Law amendment has been filed after the senate working committees conducted multiple stakeholder consultations requesting experts, including the UN, and communities for clear evidences of effective HIV prevention and control.

Albeit not perfect, these 2 landmark legislations are laudable.

Our cities, particularly Quezon City, are leading examples that our cities play a key role in bringing down HIV. They are fast tracking the response to overtake the epidemic by investing more local funds, innovating local interventions by bringing services outside of the usual facilities or at least opening them until midnight so that communities in need will access them, and most of all infecting others, not with HIV but with enthusiasm that Yes, cities can!

NEXT - Papang, thank you, I know my HIV status

READ THE SECTIONS ONLY

READ THE COMPLETE POST HERE

Thursday, September 29, 2016

The legendary AIDS Law

No cases. Where did it go?

Confused

Wildfire

We will bounce back