This is the first part of the special report of Bulatlat on youth’s access to HIV services in the Philippines.
By DOMINIC GUTOMAN
Bulatlat.com
MANILA – The number of young people living with HIV (yPLHIV) has been increasing in the recent years, and civil society organizations are concerned that policy gaps in the Philippine HIV and AIDS Law are among the major reasons.
The most recent data from the Department of Health (DOH) revealed that the highest increase in the proportion of cases in the past five years are among those below 15 years old (+86 percent), followed by those aged 15-24 years old (+64 percent).
“It is concerning that those who are diagnosed with PLHIV were increasing among 15 to 24 years old. Its gap with the 25 to 30 years old age group is little. In the data, they’re racing against each other,” said Dennis Cruz, Innovations Manager of LoveYourself, a volunteer-led organization that provides free HIV testing, counseling, and treatment in the country.
The Philippine HIV and AIDS Law (Republic Act 11166) was signed into law in December 2018, providing a comprehensive framework for addressing the HIV epidemic, while ensuring the protection of the rights of PLHIV. This law strengthens the concepts of confidentiality, prohibition on discriminatory practices, and the non-compulsory nature of HIV testing.
Before the implementation of the law, the highest increase in proportion among PLHIV in the last five years (2015 – 2019) came from the age group of 15–24 years old (192.17 percent increase), followed by the 25–35 years old age group (170.79%), based on the computation of Bulatlat.
The pattern is different from the current data after the HIV law was implemented, since the highest increase comes from ages below 15 years old (+80%), followed by 15 – 24 years old (64%) coming from the DOH’s report. However, all of the numbers in various age groups doubled in the last five years before the law was enforced (March 2015 to 2019).
“It may look bad because the numbers are increasing and it’s growing fast, but for us, we somehow see the good thing about it because we are able to provide testing for younger people. From there, we can link them to the next steps from education, treatment, and other access to services,” said Cruz.
In a span of two months, Bulatlat interviewed civil society organizations (CSOs) and the government agency mandated to implement the law to fight the HIV epidemic. Reports from these organizations revealed some common findings, including policy gaps in consenting age, stronger push for education, and implementation challenges.
The consenting age
“In the current law, minors can be tested for HIV without parental consent. It is one of the salient features of the RA 11166,” said Mack Bunagan, program manager of Initiatives for Dialogue and Empowerment through Alternative Legal Services (IDEALS).
“However, the problem now is when they are officially diagnosed positive for HIV. It is not explicitly stated in the law whether the minor can access the necessary treatment without the parents knowing,” Bunagan added.
IDEALS is an alternative lawyering group that focuses on addressing human rights barriers in the collective fight against HIV. The issue about the consenting age for HIV treatment was also mentioned by other civil society organizations that Bulatlat interviewed.
For them, the hesitance of the minors to let their parents know about their sexual activity, identity, and their health status is largely a human rights barrier. Some organizations attributed it to the conservative culture in the Philippines.
“Rather than avail the treatment, they would just let it be,” said Bunagan.
In the testing hubs and centers of LoveYourself, service providers try to explain the situation thoroughly to the minors. They provide them an option to get assistance for treatment, but it will be up to the decision of the minors, especially if they will still consult their parents about it.
“We recognize the inherent capacity of adolescents to decide for themselves in this situation. We want to (provide) them with as much support as we can, from biomedical support to psychosocial support. But still, it is better if the support is being supplemented in their households,” Cruz said.
In the country’s Family Code, parents or legal guardians have the duty to make decisions for their children below 18 years old, including medical care. Given the urgency of the matter, some HIV service providers leave it to medical professionals to decide the urgency of the matter since it is the inherent right to health of the children at stake.
Dr. Joselito Feliciano, executive director of Philippine National AIDS Council (PNAC), acknowledged that it is a policy gap. “We see that there are minors aged below 18 who are not accompanied by their parents during the testing phase. Surely, they can avail the HIV testing, but it is not stated in the law whether they can get treated without their parents.”
Feliciano said that it will be addressed in the new Implementing Rules and Regulations (IRR). Under this document, health workers and social workers can provide consent for the treatment of minors.
The current IRR was issued in October 2019, prescribing the guidelines, procedures, and standards for the implementation of the law. The new IRR is under review by the Council members of PNAC and is yet to be presented to the community stakeholders. There is no final document as of this writing but Bulatlat reached out to PNAC about the copy and timeline of the IRR. The writer will update the article once PNAC responds.
“We are hopeful about this IRR. It also includes the specific actions of different government agencies. It is a product of various consultations from the community,” Feliciano added.
Bulatlat tried to reach out to minors living with HIV through the assistance of CSOs. However, due to the sensitivity of the issue, it will still require the consent of the parents or guardians for the media interview.
Stronger push for education
“One of the primary challenges of RA 11166 is that HIV and AIDS should be cascaded in schools but this is not happening because it still depends on the school administrations,” said Bunagan.
The CSOs also reported that sex education is not being discussed in some schools because school officials do not want to expose minors to that information. For them, it is a big problem since the age of people who contracted the virus is becoming lower – a reflection that people are already exploring sex at an early age. In addition to this, sexual contact has been the dominant mode of transmission in all cases monitored by DOH since 1984, comprising 96 percent (124, 959) of the total PLHIV population.
In the 2021 Young Adult Fertility and Sexuality Study of the University of the Philippines Population Institute, the median age of first sex among males and females is 18 years old. This is not far from the 2018 Integrated HIV Behavioral and Serologic Surveillance (IHBSS) report that revealed the median age for sexual debut was 16 years old, and anal sex with a male was 17 years old.
“Since some schools did not enforce comprehensive sexual education, people, particularly the youth, don’t know where they should go or what are the steps in availing preventive tools for the sexually transmittable diseases (STDs),” Cruz said, highlighting the common problems on the low turnout of youth in their LoveYourself hubs.
“We also encounter cases where even adults don’t know where to access basic commodities related to HIV prevention. They were shocked when we provided awareness stocks, condoms, and lubricants for free,” he added.
Under the Philippine HIV and AIDS Law, different government agencies have specific responsibilities. In the primary and secondary schools, the Department of Education (DepEd) should have the initiative to ensure Sexual and Reproductive Health subjects in the schools. In tertiary schools, it will be under the jurisdiction of the Commission on Higher Education (CHED). Meanwhile, the Department of Interior and Local Governance (DILG) should oversee the sex education for out-of-school youth, while the Department of Labor and Employment (DOLE) should spearhead such initiatives in the workplace.
The United Nations (UN) emphasized that Comprehensive Sexual Education (CSE) leads to improved sexual and reproductive health and the reduction of sexually transmitted infections (STIs), HIV, and unwanted pregnancy. In their study, CSE does not hasten sexual activity but rather, provides opportunities for people to have safer sexual behaviors and can also delay sexual debut.
“For us in PNAC, we also conduct HIV education initiatives in schools and communities in partnership with Sangguniang Kabataan (SK). We always emphasize the need for non-discrimination or the word ‘respect’ every time we discuss HIV. We also capacitate agencies so they can sustain the initiative by themselves,” said Feliciano.
Implementation challenges
While PNAC was reconstituted to ensure the implementation of the Philippines in responding to the HIV and AIDS situation, the fight against the HIV epidemic extends to other government agencies and the communities at stake.
“I think we have one of the best HIV laws in the current times. The challenge is how we can implement it or encourage immediate action for mandated organizations, how we can act together as one and how we can sustain these initiatives,” said Feliciano.
He also reported that for the law to be fully-realized and implemented properly, efforts should be coordinated with a single direction, which he dubbed as “harmonization of the response.” There are initiatives duplicated, and there are best practices that have not been subject to replication. Sometimes, projects depend on funding for sustainability.
PNAC reported that there are almost 300 government facilities or treatment hubs to provide HIV services. However, they also acknowledged that there could still be deficiency in manpower and resources.
“The doctors have to multi-task and sometimes, they have to borrow medical technology. To better approach this epidemic, we need complete equipment and proper training for the professionals,” Feliciano added.
Manpower is a long-standing problem of the health workers in the Philippines. In previous Bulatlat reports, the major challenges include understaffing, overwork conditions, contractualization, and delayed and insufficient benefits. The culmination of these challenges prompt a significant number of nurses and other health workers resigning or migrating abroad to seek better opportunities.
On top of all these challenges, IDEALS also said that while the RA 11166 is well-written as a national framework, there could be lapses in integrating human rights. Bunagan added, “It is not only a health problem, it is also about access to non-discriminatory social security for the PLHIV and the key populations. We should ground our approach to human rights.”
Bunagan also added that some local AIDS councils (LACs) are not functioning in other local governments. In the 2023 annual report of PNAC, it is stated that “many local government units (LGUs) have yet to align their local AIDS ordinances with the law and reconstitute their LACs”
In April 2013, the DILG mandated all LGUs to create LACs, through Memorandum Circular No. 2013 – 29, to effectively implement the prevention of sexually transmitted infections (STIs), HIV, and AIDS at the city level.
Feliciano added that they have not yet mapped out the functional LACs in the country and there is no updated data yet. It is also not clear whether PNAC should have a representation in these localized bodies.
In unison, both government and CSOs highlighted that there is still much to do in fighting the HIV epidemic. In the country’s 7th AIDS Medium Term Plan (AMTP) 2023 – 2028, the Philippines is halfway on its 95-95-95% targets, as a state commitment to UN’s “Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030”.
This target means that 95 percent of PLHIV should know their HIV status, 95 percent of people who know their status are receiving antiretroviral treatment (ART), and 95 percent of people on treatment are virally suppressed. Viral load is the amount of HIV present in the blood. Virally suppressed means that the PLHIV is undetectable, making HIV in their body no longer transmittable.
The Department of Health (DOH) said that the country is currently at 57-65-39 percent. Of the 215,400 estimated PLHIV as of this writing: 57 percent have been diagnosed, 65 percent are alive and on treatment, while only 39 percent on treatment were virally suppressed.
HIV is no longer a death sentence since ART is available. The ART regimen reduces the amount of viral load in the body of PLHIV. However, PLHIVs have to take ART daily to reach viral suppression or undetectable status, and prevent the virus’s progression to become AIDS, the severe phase of HIV infection. #
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This story was written and produced as part of a media skills development programme delivered by Thomson Reuters Foundation. The content is the sole responsibility of the author and the publisher.
