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PNoy gov't's inadequate program to combat HIV/AIDS hit amid worsening epidemic


By: Tricia Aquino, Interaksyon.com

MANILA, Philippines - From 1984, when the first case of HIV infection was formally reported in the Philippines, the number of monitored people living with HIV (PLHIV) ballooned to 21,312 as of March this year.

Of these, 86 percent or 18,453 cases were reported just in the last five years and three months or from January 2010 to March 2015.

From 1984 to March 2015, the National Capital Region recorded the most number of PLHIV with 10,086 cases or 47 percent of total cases followed by Region IV-A (Calabarzon) with 2,882 cases (13.5 percent of the total); Region VII (Central Visayas) with 2,134 cases (10 percent of the total); Region III (Central Luzon) with 1,769 cases (8.3 percent of the total); and Region XI (Davao) with 1,286 cases (6 percent of the total).

Meanwhile, the number of reported people living with AIDS (PLA) also swelled to 1,918 in March 2015 from only one in 1984.

For 26 years or from 1984 to 2010, the yearly number of reported PLA never reached 100 until 2011 when figures started to rapidly increase to 109 and then 187 in 2012. The number further jumped to 337 in 2013, reaching its peak in 2014 with 543 cases.

With the administration of President Benigno Aquino III having to care for the largest number of people living with HIV/AIDS in the history of the Philippines, how well was the task performed, and what programs were implemented to curb the incidence of the disease?

The Millennium Development Goals had aimed to halt the spread of HIV and AIDS by this year, as well as reverse the trend.

However, the latest report of the National HIV/AIDS and STI Surveillance and Strategic Unit under the Department of Health (DOH) showed that, on average, 21 Filipinos are newly diagnosed with HIV per day, compared to one in 2008.

There were 748 newly diagnosed HIV cases this May.

"We don't want to look at it negatively, because, while there's the fact that HIV cases are increasing, the fact remains that testing and prevention programs are getting more aggressive," HIV & AIDS Support House (HASH) executive director Desi Andrew Ching told InterAksyon.com in an interview.

Central to this has been the partnership between DOH and civil society organizations such as HASH. The private business sector was also helpful in funding such projects, with Ching citing the Shell Foundation as a major partner, in particular.

Unfortunately, local government units also needed to play its part in HIV/AIDS response, with local AIDS councils tasked to take the lead, "but, in most cities, the response has been weak." According to Ching, funding still depended on how mayors viewed the project.

Intervention and funding

In the case of Quezon City, its health department mobilized interventions specific to men having sex with other men (MSM), whose behavior put them at risk for infection. Peer educators were hired to increase referrals for MSM services in its clinics.

Klinika Bernardo was established in 2012 "as a stigma-free and non-discriminatory environment" for MSM. MIMAROPA and Cebu also had their own HIV/AIDS programs, running a service delivery network that allows PLHIVs to easily access a variety of services.

According to data from UNAIDS, HIV spending from domestic public sources in the Philippines increased by over P500,000 from 2010 to 2013 (P3,372,467 to P3,923,604).

Meanwhile, the World Bank said that, from 2010 to 2014, 1.4 percent of the country's gross domestic product (GDP) was spent on health, versus 1.3 percent in 2005 to 2009.

"Response was great, but not enough. It would never be enough," Ching said, noting that the majority of government funds would just go to antiretroviral drugs (ARV).

Antiretroviral therapy

Some 10,207 PLHIV are on antiretroviral therapy. The government supplies them with antiretroviral drugs quarterly through 22 treatment hubs in the country.

Since these drugs are not sold commercially in the country, PLHIVs have to resort to going abroad – the nearest being Bangkok, Thailand – to buy them during times of shortages.

According to Project Red Ribbon care manager Ed Busi, there had been at least three instances of shortages under the Aquino administration: last year in February and May, and this year, in June, just a few weeks before interview with InterAksyon.com.

Shortages could be attributed to erroneous forecasting of the amount of drugs the government should procure, Busi said. "Newly diagnosed HIV cases should also be taken into account in the forecast."

Hospitals could also be failing to report the number of new cases monthly, Ching said.

"There is a lot of finger-pointing. But at the end of the day, it is the users who are affected," he added.

A small sector of the PLHIV population was clamoring to make the drugs available commercially, but it would not be good for business because of the relatively low number of people on antiretroviral therapy, the two explained.

Line One, Line Two

So-called "Line One" treatment could cost about P500 to P700 per month, while "Line two" could cost about P3,000, Ching said.

Between the two, line two is stronger. The drugs help boost the immune system "by bringing down the viral load to undetectable levels, and to increase the CD4 count," he added.

CD4 count is a way of measuring the status of one's immune system. A count of above 500 is good, but below it, one would have to start taking ARV drugs.

"Our medications, while they are very effective, aren't necessarily updated. For example, WHO (World Health Organization) already recommended the phase-out our Line One drug. But we continue to use it," Ching said, "simply because it was what the government could afford."

Also due to budget constraints, pre- and post-exposure prophylaxis, in common use in other countries, are not readily available in the Philippines. Aside from providing protection, these were used as maintenance by persons with HIV-positive partners so that they would not be easily infected and had proved effective abroad.

"There is a semblance of willingness on DOH's end, but discussions always stop because of the issue of budget," Ching said.

Case management

The method of case recording at treatment centers also needs to be addressed, he said. "We cannot vouch for the integrity of the report because our recording is still paper system, folder system, envelope system. There is no computerization."

A PLHIV would go to a treatment hub, give his or her assigned number, and the staff looks for that person's records among their folders. If this folder gets misplaced, it could take an entire day to find, if at all, Ching added.

He also wanted to know the whereabouts of the other 15,000 PLHIV who were not recorded as receiving antiretroviral therapy.

Benefits

PhilHealth coverage for PLHIV remains at the same level, Busi said. A treatment center could reimburse patients for P30,000 every year. The only problem was, the agency took a long time paying for claims.

"In fairness, PhilHealth is open to dialogues with the community as to how they can extend more assistance," he said. "Unfortunately, sometimes nothing concrete would come out of these discussions. For example, the community suggested coverage for certain opportunistic infections, but failed in advancing on this."

A PLHIV also cannot be sure about getting the same service for the same cost in all treatment hubs. Services were cheaper in the Research Institute for Tropical Medicine or San Lazaro Hospital, compared to, say, Makati Medical Center, because private hospitals were not cooperative in the standardization of costs.

Busi and Ching said that PLHIV who were not being assisted by organizations usually perceived the lack of government response more.

But there were major achievements, the two stressed.

Modest achievements

National HIV Testing Week was held for the first time from May 11 to 15, providing Filipinos free HIV testing in all social hygiene clinics in the country.

"They have been very aggressive in the expansion of reach of treatment centers," Ching added. The government had also been certifying satellite treatment centers to reach more PLHIVs.

"The other PLHIVs don't really notice this, but in truth, this is what has been achieved," Busi said.

PCSO assistance

Definitely they will be aware of the assistance extended by the Philippine Charity Sweepstakes Office (PCSO), which is the government's charity arm.

"Their (PCSO) help is massive," Ching said.

People are known to queue up as early as 3:00 a.m. outside of the PCSO office, hoping to get a guarantee letter that they could then present to hospitals to show the amount that PCSO would cover.

"You will work on it for one whole day, from the wee hours of the morning, but by the time you get home, you have a guarantee letter," Busi said.

While the full amount of one's bill might not always be covered, the patient could always come back to arrange for more assistance.

"So thank you to PCSO. That's why I buy lotto tickets, to help others in return," Busi added.

Legislation

In terms of legislation, work had been slow, Ching said.

Senator Miriam Defensor Santiago sought the amendment of R.A. No. 8504 or the Philippine AIDS Prevention and Control Act of 1998, through Senate Bill No. 186 or the Philippine HIV and AIDS Policy Plan Bill in June this year.

In November last year, the House of Representatives approved on second reading House Bill 5178, or the revised Philippine HIV and AIDS Policy Act.

Changes were to include allowing those aged 15 to 17 access to HIV testing even without parental consent. Under the present law, the age of consent was 18. Penalties for violators of the law would also be graver, while other offenses would be accompanied by penalties, as well.

Confidentiality would also be extended, while before this only applied to medical practitioners, in the amended law, a PLHIV could tell anyone his or her status and the latter would be barred from discussing it with anyone else, Ching explained.

Asked for a final plea to the government, given President Aquino's final State of the Nation Address on Monday, the two had these to say.

Even just a one-liner

"Sana may one-liner man lang siya about HIV (I wish he had even just a one-liner about HIV)," Ching said. "Comment on the condition. Because, come to think of it, this Administration does have something to brag about if that is what they want to present compared to the past few years. But they make more noise about MERS (Middle East Respiratory Syndrome) than HIV. Just speak about it once and for all."

As for Busi, he said he hopes the government would come up with a stronger project for dealing with HIV/AIDS.

"Also, a stronger public information and awareness campaign. I know about this program only because I am associated with it, I work in it, but many other people ought to become aware of it," he said.

Livelihood projects are especially important. Busi scoffed at initiatives that have PLHIVs making candles, "when no one would buy them anyway but people from the same community. Livelihood projects have to be more realistic and meaningful."

Visit HIV & AIDS Support House online at on.fb.me/1HZWMA7. The organization works on the gaps in the HIV prevention and care continuum. Its latest project is to bring HIV testing out to communities.

Visit Project Red Ribbon online at bit.ly/1LJpbz2. The organization delegates care managers in treatment hubs to assist PLHIVs, particularly in looking for donors for their treatment.