Trigger warning: The article contains incidents of sexual violence.
This is the second part of the special report of Bulatlat on youth’s access to HIV services in the Philippines.
By DOMINIC GUTOMAN
Bulatlat.com
MANILA – Young people living with HIV (PLHIV) need solid support from peers and their community in order to overcome the personal and collective difficulties in combating the HIV epidemic.
Francis Teope, who was diagnosed with HIV at the age of 19, said he was lucky enough to be able to open up with friends, and family regarding his condition but he admitted that the journey was not easy.
“One advice that I can really give is that you should have a support group that consists of at least one person. One person that you know will not harm you and your situation. It helps me a lot mentally in navigating this journey,” said Teope in an interview with Bulatlat.
Teope resides in Las Piñas, the southern part of the National Capital Region (NCR) in the Philippines. He had a rough past as he became a victim of sexual harassment and rape when he was five years old. He admitted to having “sexual relations” with a 22-year-old stranger when he was 14 years old.
In the Philippine law, sex with minors younger than 16 years old is considered statutory rape, even with perceived “consent” from the child. Anti-Child Abuse Law also defines any sexual activity with a person below the age of 18 as child abuse.
This experience is relatively earlier than the common start of risky behavior among the men who have sex with men (MSM) population. The Integrated HIV Behavioral and Serologic Surveillance (IHBSS) 2018 report revealed that risky behavior among MSM usually starts at age 16 to 17. This report is crucial since it identified the gap that the use of condoms started two to three years later – a long gap that puts the MSM population at risk to various sexually-transmitted infections (STIs), including HIV.
In the first part of Bulatlat’s report, alternative lawyering group Initiatives for Dialogue and Empowerment through Alternative Legal Services (IDEALS) said that the increasing number of youth and/or minors who contracted HIV is a reflection that people are exploring sex at a young age without knowledge about STIs.
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).
Teope recalled that he was not shocked when the results of his HIV test were released. He knew he was vulnerable because he was engaging in unprotected sexual intercourse—the most common mode of transmission for the virus according to the data of DOH. He had not learned about HIV until he reached college and he said that sex education had not been part of his curriculum since primary school.
His experience is consistent with the statements of civil society organizations (CSOs) in a separate Bulatlat interview, saying that the enforcement of comprehensive sexual education is among the policy gaps in the Philippine HIV and AIDS Law.
Read: Special report | Cases among youth reveal policy gaps in HIV law
Accessing the services
“One that really carved my heart and mind is that, there are times when I still think that I won’t live long enough. I can live a long happy life and all, but I would not be shocked if there would be complications in my health,” said Teope.
HIV is no longer a death sentence since anti-retroviral therapy (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.
Teope is already undetectable and fully aware about this but still, the psychological impact of having the virus continues to hound him from time to time. Despite this, he said that he was able to access the HIV services with ease and the ART is available for free. The only time that he encountered a challenge was when he needed to change his ART regimen since there was a slight increase in the amount of viral load in his body.
“I receive the treatment for free. There is an advantage if you are regularly contributing to PhilHealth since they can refill at least three bottles, which is already good for three months. But if you don’t have work, and you cannot contribute, you can only refill once a month.” said Toepe.
In PhilHealth’s list of accredited outpatient HIV/AIDS treatment providers in the Philippines, there are 46 facilities within the NCR. In the southern part of NCR, Toepe was initially availing services from the Research Institute for Tropical Medicine (RITM), a government facility and one of the few facilities where individuals can access a rapid confirmation test. This facility can also provide CD4 count assessments – monitoring of a certain type of white blood cells targeted by the virus – and other crucial baseline tests, which are all necessary to streamline the process for faster diagnosis and treatment planning.
However, this is not the case for John, not his real name, who was based in Iligan, Lanao Del Norte, Mindanao (southern part of the Philippines). He was diagnosed with HIV at the age of 20.
John was connected to Bulatlat through the Philippine chapter of Youth Peer Education Network (Y-PEER), an umbrella of organizations and institutions working in the field of sexual and reproductive health in 52 countries throughout the world. They also facilitated the provision of confidentiality and anonymity form that John signed as part of the interview process, adhering to the standards of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
Regional differences
John has been receiving HIV treatment and care at the Adventist Medical Center, the lone facility in Lanao del Norte that caters to PLHIV. He contracted the virus through sexual contact with his sexual partner back in 2022.
“When I contracted the virus, I felt like I added another layer of burden to my parents. I’ve been independent since I was young. I was a working student. But due to my status, I was forced to stop both my work and education in college to focus on my recovery,” said John.
John eventually went back to studying and is now a third year student in the university. Fortunately, his engagement in advocacy led him to find work in their province.
Prior to his diagnosis, John was working as a housekeeper and gardener in a nearby farm. All the savings he kept from these jobs were depleted even before he received the actual treatment.
“I saved almost P10,000 ($179.68) but it was spent on consecutive checkups, medicines, and out-of-pocket expenses going to the hospital, when I was just having the symptoms. I experienced constant vomiting, diarrhea, fever, and skin asthma. My wounds were also inflamed and even if I took antibiotics, all my symptoms were going back. That’s when I decided to avail of the HIV testing,” said John.
Unlike in NCR where there are 46 facilities for HIV/AIDS treatment, there is only one facility for Lanao del Norte and a total of five facilities in the whole Northern Mindanao region. In separate interviews with Bulatlat, CSOs attributed the concentration of HIV services in the NCR as a factor to the large number of PLHIV gathered by the DOH.
For John, the limited facility in their region makes it more challenging for PLHIV like him who want to access the services.
Since Adventist Medical Center is a private hospital, the baseline laboratories are not free prior to the enrollment of the client to the antiretroviral therapy (ART). With this, the client should seek financial assistance from the Department of Social Welfare and Development (DSWD) through a guarantee letter.
“The DSWD does not grant us one-hundred percent of the expenses. For example, if the baseline laboratories cost P5,400 ($97.03), the grant of DSWD is subject for assessment. Usually, the DSWD can provide P2,000 ($35.94) or P3,000 ($53.9) to us.”
John added that the DSWD has set a guideline about the rate of assistance and frequency of availment of funds. In general, financial assistance may be availed once every three months for medicines, laboratory procedures, and other special treatment.
Due to this policy, John said that each PHLIV can get financial support once every three months even if most of them need regular assistance as they already have opportunistic infections, or infections that occur more often or are more severe in people with weakened immune systems.
In the same guideline, it was also underscored that the DSWD shall establish a centralized database for repeat clients. The clients shall be under case management and they shall be endorsed to LGU where they reside for further intervention. This adds another layer of bureaucratic process for the clients who seek financial assistance, which may violate their supposed confidentiality and anonymity.
John also said that some PLHIV also came from distant cities like Marawi, which is at least one hour away from Iligan. Services from Adventist Medical Center are being sought because there is still a strong need for people to access the services far from their immediate community, to prevent possible discrimination, due to the multiple cultures and religions existing in Mindanao.
“Most of us have to go back and forth to access treatment. We are being passed from the treatment hub to the social workers to process financial assistance. It is tedious and sometimes, I do not want to go back. This is also the reason why some PLHIV do not push through in getting the treatment,” he added.
In a study released in 2023, the most identified HIV treatment barriers reported were the unavailability of transportation and the cost of courier services for ART delivery, the location of treatment hubs, and financial assistance. Since the survey was done from November 26 2021, to January 10, 2022, the context of COVID-19 is crucial for consideration. However, the study also showed the same pattern of barriers exists even before the restrictions during COVID-19 pandemic.
“People like us have to traverse mountain areas or take multiple rides to get to the hub. It is the same process for testing, getting treatment, or refilling our ART medicines. Since some of us are not really enrolled in PhilHealth, we have to refill once a month since they could not provide us with three bottles, which could save us three months of [out of pocket] expenses,” said John.
Leading the fight
Challenges like these prompt young PLHIVs to engage in advocacy. John was previously associated with the network of Y-PEER Pilipinas, under the Ilaw Shared Community, an Iligan-based community organization that advocates for sexual and reproductive health rights for all. Right now, he is focusing on managing the Northern Mindanao Advocates, a support group exclusive only for PLHIV.
“Engaging in advocacy is also what helped me navigate the challenges of HIV. I organize activities within our support group to empower other PLHIV like me. I also get to meet a lot of people within the community who inspire me to accept myself more,” said John.
He said that many PLHIV members in their support group are from lower socio-economic backgrounds. Some of them do not have stable work or source of income, some are not able to finish their studies, depriving them of opportunities. This pushed them to depend only on the available services that the treatment facility can provide. If the treatment facility cannot provide laboratories, they have to go to private facilities, which most of their members cannot afford.
For him, these experiences affect the PLHIV population in achieving an undetectable status. An undetectable status refers when a PLHIV has a viral load so low that it cannot be detected by laboratory tests, achieved through consistent intake of ART. Being undetectable means the virus is also untransmittable (U=U).
Aside from providing psychosocial support among other PLHIV, John also participated in the development of a City Ordinance in Iligan City. From there, he experienced first-hand discrimination with policymakers.
“I witnessed their high level of stigma, which can be attributed to their lack of knowledge about HIV. Even in their language, you can hear discriminatory remarks,” John said. “For instance, a policymaker said that they should not provide too much legal protection for PLHIV since it is their fault that they contracted the virus.”
Discrimination remains to be the top problem identified by their support group. However, John and Teope attributed this to the lack of awareness and education among the general public on the HIV epidemic.
“We may have made good progress when it comes to educating people about HIV. In my past sexual partners, some of them are really aware and know how to prevent or encounter PLHIV. But that was here in Metro Manila. I don’t think it is enough. We have a long way to go, especially in the provinces,” said Teope.
Teope is not associated with CSO advocating for the rights of the PLHIV. However, since he is open about his status, he always accommodates questions coming from PLHIV, especially those who are newly diagnosed. He also previously engaged with the World Health Organization on the issue of the HIV epidemic in the country.
“Confronting our status as PLHIV is not easy. It is important to always go back to the community to make ways to empower each other. We have to always engage our family and friends to have healthy discussions, even if it sometimes hurts us,” John said.
Participation and inclusion are core human rights principles in governance. The Joint United Nations Programme on HIV/AIDS (UNAIDS) introduced a three-lens approach for youth participation: working for youth as beneficiaries, engaging with youth as partners, and supporting youth as leaders.
“From identifying and promoting youth-friendly services to mobilizing peers in school and community settings in order to access HIV and sexual and reproductive health services, young people can make substantial contributions to stronger community responses,” UNAIDS stated in a report.
UNAIDS also added that the capacity of the youth should be supported with technical and financial resources to ensure that their efforts are sustainable and that young people are empowered to lead in reaching the target end of HIV and AIDS by 2030.
The Philippines is among the 165 countries who voted in favor of the adoption of the Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030, prompting its passage in the 2021 United Nations General Assembly (UNGA). The Philippines participated in multiple UNGA and adopted the UN Declarations of Commitment crafted since 2001. #
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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.
