No more shame: Living with HIV in the Philippines

By Laurindo Garcia, December 1, 2016, http://cnnphilippines.com/life/culture/2016/12/01/living-with-HIV-in-the-Philippines.html

Manila (CNN Philippines Life) — For the last nine years, three tablets that I take every morning have kept me from dying. These anti-HIV tablets are life savers. While people are increasingly aware of HIV testing, surprisingly few know about HIV treatment or what happens after someone is diagnosed HIV positive.

Imagine that HIV is glitter, and picture your body as a room. If you are HIV positive, there’s glitter everywhere in your room. If you leave HIV untreated, the glitter will replicate and choke up the room. HIV medication is the vacuum cleaner you’ll need to suck all the glitter up. Every particle must be sucked up. If not, then the glitter will replicate.

Extracting 100 percent of all the glitter is difficult without causing some damage to your room. But vacuuming everyday helps you keep the glitter at bay. Without a vacuum, your room will become overwhelmed once again. Vacuum cleaners need regular maintenance to ensure they are working well. But just because you vacuum doesn’t mean your whole room is clean and livable. And even though newer models of vacuums are available overseas, the range available locally is limited.

At last count, the number of people known to need HIV antiretroviral medication is more than 38,000. Less than half of these people have access. A vast majority of Filipinos living with HIV are men and transgender women 30 years old or younger. Many Filipinos do not know they are HIV positive and the epidemic is skyrocketing.

In many cases, patients need to travel great distances to access HIV treatment because the expertise, commodities, or equipment is not available in their barangay, town, or city. Some people refuse to access services at a local treatment hub for fear of being outed.

Antiretroviral medication must be taken daily to suppress the replication of the virus. This daily regime continues for a lifetime and is one essential pillar of comprehensive HIV treatment. But there are other pillars. Your immune system and vital organs need to be checked regularly to determine if one’s medication is working at optimal levels. Regular tests also screen for other infections or conditions that get in the way of staying healthy.

While current government policy guarantees access to HIV treatment for all Filipinos, the cost of medication and regular check-ups is a significant barrier that the average Filipino struggles to overcome. Through our public health insurance scheme, Philhealth, a Filipino living with HIV can access a ₱30,000 package of services that includes antiretroviral medicine and blood tests to check the immune system. While Philhealth has thrown a lifeline to many people, some grave gaps have been exposed.

For example, when many Filipinos are diagnosed HIV positive, other co-infections are often found, the most common of which are syphilis, gonorrhea, hepatitis or tuberculosis. The Philhealth package is insufficient for covering the diagnostics and treatment of many of the other infections. And the tragedy is that many Filipinos living with HIV simply can’t afford it. Moreover, exacerbating this problem, many Filipinos living with HIV don’t have jobs because of discriminatory and unlawful practices among employers.

In many cases, patients need to travel great distances to access HIV treatment because the expertise, commodities, or equipment is not available in their barangay, town, or city. Some people refuse to access services at a local treatment hub for fear of being outed. Imagine having to travel for several hours to visit your treatment hub every three months for a check-up and refilling supply of your life-saving medication. Once you arrive, you’re confronted with waiting times at the clinic lasting at least half a day. Not to mention the hardship and cost of medical travel.

Sadly, private health insurance is not an option. This is because insurers in the Philippines and other parts of Southeast Asia choose to be myopic. Coming from a personal experience, insurers here will generally refuse to cover a person living with HIV. Those exceptional insurers who do offer coverage charge exorbitant premiums making the cost prohibitive. It seems counterintuitive for insurers not to invest in HIV treatment especially when investments would be returned with better health among customers and fewer claims in the future.

Another dimension of HIV treatment in the Philippines is the range of available antiretroviral medications. Options for Filipinos living with HIV are extremely limited. There are two options for conventional entry-level HIV medicine. Both have known side effects. This poses significant challenges for people to stick to their daily regime that keeps the virus at bay. Some people are unable to work because the medicine triggers severe dizziness or rashes.

Fortunately, newer options for medicines that are more tolerable with lower risk of side effects are available overseas. International public health analysts validate that these new medicines are also cost effective for developing countries such as the Philippines. However, HIV medicines are not included in laws that guarantee access to cheaper medicines.

The greatest hurdle we have to overcome is the shame and stigma attached to the virus. Shame and stigma fuel a common belief that people living with HIV deserve to die.

The need for new medicines in the country is urgent, underscored by growing risk of HIV viral resistance, which could render the medicines we have in the country ineffective. Fast and prudent action can help avert a future disaster. The Department of Health needs to take strident action instead of sitting on its hands.

Some Filipinos think that we are dependent on foreign aid to deliver HIV services. On the contrary, our national budget has ample funds to increase supply and quality of HIV and other health services in the country. Thanks to the so called sin tax on alcohol and tobacco we have the means to bring our health system on par with international standards.

On this year’s World AIDS Day our government and community leaders will no doubt pay lip-service to urgency of the HIV epidemic in the Philippines. They have yet to put the money where their mouth is, and we need to remind them to do their job.

Health Secretary Paulyn Ubial said in a speech that HIV is not a death sentence. And yet inaction from the government has contributed to senseless deaths and misery for so many people. We will not see the end of the HIV epidemic until more Filipinos living with or affected by HIV raise their voices and hold our government accountable to their duty of health for all. The greatest hurdle we have to overcome is the shame and stigma attached to the virus. Shame and stigma give license to doctors to turn patients away and governments to short-change its citizens. Shame and stigma fuel a common belief that people living with HIV deserve to die.