Suspension of Disbelief

And Ryan met Sebastian

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Outrage Magazine | 18 June 2016

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“He has been my crush since I saw ‘Bubble’ (Sebastian Castro’s music video),” Ryan Chua said.

But initially, there were no intentions for the two to have an actual face-to-face meet-up.

“I was (just) thrilled when he added me on Facebook and followed me on Twitter,” Ryan added.

As is common with online friends, the two chatted now and then.

But then fate had other plans for them.

In 2013, they finally met when Sebastian invited Ryan to his art exhibit. And that first time they met, “no one had to put his best foot forward or send chocolates and flowers just to please each other,” Ryan said to Outrage Magazine.

It was not an immediate “thing”; there wasn’t even any second meet-up. At that time, Sebastian had to fly to US and Ryan had to prepare to leave for the UK for his journalism scholarship.

But their communication continued. That is, while they were away from each other, they would Skype on a regular basis and talk about different things – from Philippine politics and entertainment gossips, to ideas for Sebastian’s new songs. And there were also surprise visits in between.

Ryan-and-Seb“We became best friends first even before any love confession was made,” Ryan said.

When Ryan finished his scholarship, he returned to the Philippines. The two started living together.

As a couple, they were almost always present in LGBT-related events. But as their relationship grew stronger, it also attracted bashers, many even from within the LGBT community.

“Hearing (negative) views comes with making a relationship public, especially when it’s between two men,” said Ryan, who nonetheless noted that the observations were somewhat superficial, comparing Ryan and Sebastian on “how we look.” “But we don’t let those comments affect our relationship. Most people see only the physical. Often, they don’t see the emotional and intellectual connection.”

But just as they’ve started establishing a life together in Manila, an opportunity came up for Ryan to work for a media outlet in Beijing, China.

Being apart from each other is not new to them; after all, they started out as online friends. Now, social media has become a tool for them to constantly communicate with each other.

“It is not always easy. Being away from each other always has challenges. I miss him every day. Nothing beats physical contact and intimacy,” Ryan said. “But we’re both mature enough to appreciate the joys of a one to three-hour Skype or Facetime call. When we don’t have time to call, short messages would do.”

Sometimes they would even watch movies or TV shows together while on a video call “because enjoying anything with him is always double the fun,” Ryan added.

Though they had not planned too far ahead into the future, they are currently focused on their own respective fields, so eventually, they could enjoy their successes together.

“I am very fortunate to have a partner who knows me more deeply than anyone does, who has big dreams like I do, and who understands that, sometimes, we need to be apart so that we could build a stable future,” Ryan ended.

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(Established in April 2007, Outrage Magazine remains the only publication exclusive for the lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual and allied community in the Philippines.)

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Divided we fall

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Outrage Magazine | 18 June 2016

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Faces-of-LGBT

We love to say that the LGBT community revels in diversity – after all, our multi-colored rainbow flag is supposed to highlight that even if there are many of us who may come from different walks of life, we are still united in our struggle for the same cause (i.e. seeking equal rights for all).

Suffice it to say, I have seen the various faces that constitute the LGBT community in the Philippines.

I have met some who claim to represent (and – perhaps reflective of the elevating of the rich in a largely elitist heterosexual society – with actual pride at that) the “coño/conyo/konyo LGBT”, the elite who fail to see their privilege.

I have met some of the “karaniwan (common)”, whose main concern is to ensure day-to-day survival.

And I have met some of the “bekinals (a play with “beking kanal” or gays from the gutters; a term that may be politically incorrect, but is still used by many when referring to themselves to highlight their lowly status), those who are at the fringes of society; and whose very existence is marked by the hardships encountered not only by being LGBT, but also by their social status.

I’d have to say that, unfortunately, these segregations do not at all “blend”. That is, at least as far as my experience in the Philippines is showing, there’s no “waving of the same banner/flag” for the LGBT community.

We are too… broken; too divided.

And this could spell our fall.

Hear so many of the “coño/conyo/konyo LGBT” speak supposedly on behalf of the “entire LGBT community” while only focusing on such issues as marriage equality and passing the anti-discrimination bill in Congress (they do this in between parties or photoshoots or the likes). The mainstream media gives them the platform; and their allies in the ruling class (from politicians to celebrities) only “consult” with them on just about every LGBT-related issue (before publicly claiming they already spoke with the entire LGBT community). But they remain mum on other day-to-day issues, e.g. the policies being developed in Muslim areas in Mindanao that also affect LGBT people there, the effect among LGBT pensioners of the veto for SSS pension hike, and the failure of the Department of Health and PhilHealth to deal with the disparity of services offered in treatment hubs. Here, there seems to be more concern with faux publicity stunts that supposedly banned the expression of LGBT love, than actually finding practical solutions to deal with those who perpetuate the ills that affect us.

And then hear many of the karaniwan and bekinal LGBT people, whose stance is – because they are often ignored anyway – to just keep to themselves.

We call our divisions “diversity”, as if by doing so the cracks from within are covered up and are therefore made more appealing. In reality, there is nothing empowering about this often unspoken great divide.

We have to bridge the divide.

Because there is always room for everyone on the table.

Start getting immersed in different contexts. Ask the karaniwan and bekinal LGBT people to speak about their issues (in Congress/Senate, in the media). Stop only talking about the glamorous and start including issues of those who are unable to speak.

Because only if everyone is represented will our community be truly united.

And only then will we be truly a “community of diversity”.

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(Established in April 2007, Outrage Magazine remains the only publication exclusive for the lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual and allied community in the Philippines.)

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What the SSS pension hike means to senior LGBTs

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Outrage Magazine | 01 February 2016

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Growing-old-and-gay

Poverty knows no sexual orientation or gender identity.

With Philippine President Benigno Aquino III vetoing the bill that would have increased the pension to be received by beneficiaries of the Social Security System (SSS), pensioners who are also members of the LGBT community are joining the fray against the move considered as both “inhumane” and “anti-poor”.

Dati akong nagtatrabaho sa isang kooperatiba (I used to work in a cooperative),” said 62-year-old gay pensioner Andrea del Rosario. “As an SSS member, my contributions were automatically deducted from my salary; and during that time, hindi ko masyadong pinag-aralan kung ano mangyayari sa kontribusyon kobasta ang alam ko, may aasahan ako pagtanda ko (I didn’t closely look at how my contributions were handled; I just knew that when I grow old, I’d have something to fall back on).”

And now that Aquino’s government refused to “give us minimal increase, even if the SSS executives profit from us, talagang pinapahirapan kami (we’re really placed in a difficult situation),” Del Rosario said.

FAILED JOURNEY

As early as March 2011 a bill seeking for an increase in monthly retirement pension to a minimum of P7,000 a month was already submitted to Congress. This did not pass, so that in January 2013, a new bill substituted the previous version, this time looking into a reduced increase of a maximum P2,000-a-month pension. In July of the same year, another bill was passed in response to the substitution, again highlighting the need for the proposed increase.

Not incidentally, also in July 2013, Aquino said in his State of the Nation Address that “it is time to amend the SSS pension scheme. We must establish measures that remedy the outflow of funds.” Interestingly, Aquino is also a defender of granting SSS executives hefty bonuses.

It was only in 2015 when, finally, the Congress approved the P2,000 across-the-board pension hike.

However, Aquino vetoed the increase in January, stating that “while we recognize the objective of the bill to promote the well-being of the country’s private sector retirees, we cannot support the bill in its present form because of its dire financial consequences.”

GROWING OLD AS LGBT

For Del Rosario, the effects of Aquino’s “anti-poor SSS stance” are very defined among LGBT pensioners like himself.

Kaming mga gay senior citizens na walang binubuhay ang mas may kailangan (Gay senior citizens like us who do not support anyone, need the money most),” he said.

On one hand, exactly because they do not support others, “wala rin kaming aasahang susuporta sa amin pagtanda namin (We expect no one to support us when we grow old),” Del Rosario said. As such, “we only live on what we get.”

On the other hand – and this is reflective of the Philippine society expecting those who supposedly do not have families of their own (such as LGBT people) to help look after the families of their relatives – Del Rosario said that his pension is also used “para makatulong sa mga pamangkin at apo (to help my nephews/nieces and grandchildren),” he said. “Sila ang aking tinutustusan at pinagbibigyan kung may hinihingi o pangangailangan sila (I support them when they ask or need something).”

The small pension he receives makes it “difficult to live, much more to help out.”

FALSE HOPE

Del Rosario said that “many like me resort to utang (borrowing money).”

Talagang hindi sapat ang nakukuha naming pensyon. Nababaon kami sa utang at ang mga lending institutions na may matataas na interest rates lamang ang nakikinabang, pinapahirapan nila kami lalo (The pension we receive is not enough. We are deep in debts, and only lending institutions with high interest rates benefit from this, as they make our lives more miserable),” del Rosario said.

He also added that he is one of many seniors – LGBT and non-LGBT – still hoping for some changes to happen to “acknowledge ang pinagdadaanan namin (what we’re going through), considering that we have to spend more sa gamot, pantustos sa mas maraming tao (for medicines, to support a bigger family)…”

But beyond this, though, Del Rosario said he hopes for a change of heart to “start ensuring that the elderly are taken care.”

Magkaroon sana sila ng magandang pananaw at kabuuang malasakit para sa mga senior citizens (I hope they gain better understanding of the plight, and have more compassion for the senior citizens),” del Rosario ended.

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(Established in April 2007, Outrage Magazine remains the only publication exclusive for the lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual and allied community in the Philippines.)

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QC LGBT Pride celebration: More than just a parade

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VERA Files | 13 December 2015

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More than the parade, more than the march and festival, this celebration is the delivery of actual programs and policies for LGBT (Lesbian, Gay, Bisexual, Transgender) people,” Percival Cendaña, commissioner of the National Youth Commission, said of the recent LGBT Pride celebration in Quezon City.

The celebration took special significance held after the court ruling on Jennifer Laude’s case, which found US Marine Lance Corporal Joseph Scott Pemberton guilty of homicide.

Though many LGBT advocates and groups said that “murder” should have been the rightful verdict, they still see it as something that they can learn from. “Now, more than ever, especially because of the decision on Laude’s case, is the right time for the [LGBT] community to get together and reflect on what happened to Jennifer, and to also inspire the next course of action,” Cendaña explained.

Cendaña also said that the event is the highlight of all the achievements throughout the year, specifically the passage of the Gender-Fair Ordinance in Quezon City.

An ordinance providing for a comprehensive anti-discrimination policy on the basis of sexual orientation, gender identity and expression signed November last year, is the first of its kind in the Philippines.

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The ordinance states: “It is hereby declared a policy of Quezon City to actively work for the elimination of all forms of discrimination that offend the equal protection clause of the Bill of Rights enshrined in the Constitution, and other existing laws and to value the dignity of every person, guarantee full respect for human rights, and give the highest priority to measures that protect and enhance the rights of all people.”

According to Councilor Lena Marie “Mayen” Juico (First District), author of the Gender-Fair Ordinance, “they (Quezon City officials) have tackled all areas where the LGBT community may experience discrimination.”

“The Quezon City government expanded the ordinance to be the most comprehensive so far. In fact, it is more comprehensive than the anti-discrimination bill that is still pending in Congress right now,” Cendaña added.

There were more young participants in this year’s Pride celebration, which was a good indication that LGBTs are slowly becoming aware of their rights, observed Juico.

“LGBTs in Quezon City [should] take the time to find out what their rights are. The city already has an ordinance that encompasses all areas where they can experience discrimination. It is all a matter of utilizing it and making sure that it is implemented,” she explained.

Juico also said that it is the desire of Mayor Herbert Bautista to see gay union or gay marriage happen in Quezon City. Adding, Bautista also knows, “it can only happen if gay marriage becomes a national policy.”

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(Founded in March 2008, VERA Files is put out by veteran journalists taking a deeper look at current issues. Vera is Latin for “true.”)

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PhilHealth benefit package for people with HIV under review

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VERA Files | 01 December 2015

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PhilHealth HIV - ARV Bottles

ARV Bottles

As the country commemorates World AIDS Day today (December 1), the Philippine Health Insurance Corp. (PhilHealth) is set to begin a formal review of its benefit package for people living with HIV (human immunodeficiency virus), or PLHIVs.

“We are currently reviewing the Outpatient HIV/AIDS Treatment (OHAT) Package, the implementation of it in treatment hubs, and the current rates, and if patients have questions, we can discuss it with them.  PhilHealth is going to conduct a formal review of benefits, this year up to next year, to address these issues,” Dr. Mary Antoinette Remonte, Medical Specialist II and Millennium Development Goals Benefit Products Team Head of PhilHealth, said.

PLHIVs in the country, who are members of PhilHealth, are entitled to several benefits under the OHAT Package. Every year, a member is entitled to P30,000, or P7,500 every quarter, worth of treatment, care and support (TCS) services from his chosen PhilHealth accredited treatment hub.

Also included in the OHAT Package are the following: drugs and medicines; laboratory examinations based on the specific treatment guideline, including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), test for monitoring antiretroviral (ARV) drug toxicity; and professional fees of providers.

Hospitalization coverage from PhilHealth ranges from P11,000-20,000, depending on the case. Any amount that will exceed the allotted budget will be charged to the patient.

DOH National Epidemiology Center

DOH National Epidemiology Center

However, PhilHealth has received  reports from several PLHIVs that the TCS services they get from their treatment hubs are different compared to other TCS providers.

“It has come to our attention that some treatment hubs charge for some laboratory tests, even after the release of the OHAT Package circular. Also, according to the guidelines set by the DOH (Department of Health), viral load testing is also covered by the OHAT Package,” Dr. Remonte said.

In the case of Paolo (not his real name), a person living with HIV  (PLHIV) from Manila who is receiving HIV TCS at San Lazaro Hospital, he was made to pay for the viral load test even if he is a PhilHealth member.

Sadly, if you are a PHLIV who had been charged for a particular TCS service, that is supposedly covered by the OHAT Package, “you cannot be reimbursed for what you spent, because the reimbursement goes directly to the facility. This is why it is important for a facility to properly maximize the reimbursement claims so they can help the patients,” Dr. Remonte added.

But the practice in other treatment hubs, like in the Research Institute for Tropical Medicine (RITM), is different. PLHIVs are able to receive free baseline laboratory tests and CD4 count.

“The OHAT Package does not cover baseline tests yet, but due to good financial management, we can provide them for free to new patients. And once they start their treatment, they would be eligible for OHAT,” Dr. Rosanna Ditangco, research chief head at RITM-ARG, explained.

For patients who are already starting their antiretroviral therapy, “we provide free CD4 and CBC tests. Yearly, during their anniversary, we provide free CD4, CBC, blood chemistry – depending on what ARV they are taking, and viral load. And if the doctor suspects treatment failure, a free viral load test will be done anytime plus HIV drug resistance testing,” Dr. Ditangco added.

That has been the system of RITM ever since PhilHealth released their OHAT Package circular.

“The HIV treatment regimen is standard for all treatment hubs, but the cost of laboratories are not the same. The practice is also different on how they utilize the PhilHealth reimbursement and this is because of administrative problems in the treatment hubs,” Dr. Remonte explained.

She also reminded PLHIVs to check if their treatment hubs were filing claims and if they find out that there were lapses, they could write a complaint, anonymously if they are worried about confidentiality.

For PLHIVs who want to avail of the benefits of the OHAT Package, they should be PhilHealth members with three to six months contributions; submit a waiver allowing PhilHealth to look in to their records; and provide a copy of their HIV confirmatory result and treatment regimen.

There are currently 22 accredited hospitals all over the country that are designated treatment hubs for PLHIVs. There are also several satellite clinics that provide TCS services for HIV management.

Like other agencies and institutions, PhilHealth is increasing its efforts to help manage the detrimental effects of HIV.

The Philippines is one of the countries where the prevalence of HIV has been increasing.

On the other hand, statistics from other countries show that HIV is already decreasing, or at zero growth.

As of August this year, there were already more than 5,000 reported HIV cases in the Philippines, according to the DOH. This number is 17% higher compared to the same period last year.

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(VERA Files is put out by veteran journalists taking a deeper look at current issues. Vera is Latin for “true.”

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PhilHealth clarifies OHAT coverage

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Outrage Magazine | 29 August 2015

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This is a continuing story on the disparities in the services received by PLHIVs in different hubs in the Philippines, even if they are required to pay the same amount by PhilHealth.

As the Red Ribbon Project eyes to help the country get to zero (i.e. zero new HIV infection, zero AIDS-related death, and zero HIV-related discrimination), its beauty queens – Binibining ARV-Universe, Bb. ARV-World and Bb. ARV-International; joined by Miss ARG 2012 – gives the “beauty with a purpose” tagline flesh, this time by reaching out to Filipino PLHIVs in RITM.
“That there’s still something to live for,” is the goal of the outreach, said Pozzie Pinoy, who helms Red Ribbon Project – seconded by Bb. ARV-Universe, who said in the vernacular that “if we can – even for a while – shed some hope, that’s good and well.”

In the Philippines, the treatment, care and support received by most people living with HIV (PLHIVs) are covered by the Philippine Health Insurance Corporation’s (PhilHealth) Outpatient HIV/AIDS Treatment (OHAT) Package. Specifically, to those who are enrolled in PhilHealth, P30,000 is allocated per PLHIV per year, or P7,500 every quarter.

But – as stated in a previous report by Outrage Magazine – PLHIVs from different treatment hubs in the country experience different and at times confusing disparities in the services that they receive, even if they pay the same PhilHealth premium/amount of approximately P2,400 per year.

READING THROUGH

After the release of PhilHealth’s OHAT Package circular in 2010, DOH published Administrative Order No. 2010-0036 – The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos – in December 2010, signed by then Health Secretary Enrique Ona.

It stated that “the Aquino Health Agenda (AHA) is a focused approach to health reform implementation in the context of HSRA (Health Sector Reform Agenda) and F1 (FOURmula One), that all Filipinos especially the poor receive the benefits of health reform.”

ARV is part of the “free” TCS services received by PLHIVs in the Philippines

Under that guideline is the attainment of health-related Millennium Development Goals (MDG), which include the reduction of HIV/AIDS prevalence.

The administrative order also mentioned that the “DOH shall develop guidelines and protocols to organize the community health team and service delivery network, implement a functional referral system, deliver health service packages, contract with private providers, implement clinical practice guidelines, generate, retain, and use hospital revenues, and establish hospital pricing system to maximize benefits from PhilHealth.”

In the 2010 OHAT Package circular, it stated that the “package shall be based on Department of Health (DOH) guidelines on anti-retroviral therapy among adults and adolescents with human immunodeficiency virus infection. All treatment hubs in accredited facilities are required to follow the guidelines set by the DOH.”

Meanwhile, the Guidelines on Antiretroviral Therapy (ART) among Adults and Adolescents with Human Immunodeficiency Virus (HIV) Infection – DOH Administrative Order No. 2009-0006 – released in January 2009 stated that as part of monitoring the response to ART treatment, “for patients with good compliance to ART, clinical response is recommended to be used together with CD4 count and viral load determination (whenever feasible) to detect treatment failure.”

And that “treatment hubs through its HIV AIDS Core Team (HACT) shall provide treatment and clinical monitoring of patients under ART.”

ACTUAL COVERAGE

In an interview with Outrage Magazine, PhilHealth’s Medical Specialist III and Millennium Development Goals Benefit Products Team Head Dr. Mary Antoinette Remonte said that “it has come to our attention that some treatment hubs charge for some laboratory tests, even after the release of the OHAT Package circular.”

The 2010 circular only specifically stated that “covered items under this benefit are drugs and medicines, laboratory examinations including Cluster Difference 4 (CD4) level determination test and test for monitoring of anti-retroviral drugs (ARV) toxicity and professional fees of providers.” As such, Remonte said that “some treatment hubs take what was written in the circular literally.”

Remonte, however, said that if a PLHIV needs “viral load, if it’s really needed, they can still charge it on the OHAT package. Any laboratory tests related to ART treatment, they can use the OHAT Package for it.” For Remonte, “even if viral load testing was not written in the first circular, it was already included in the coverage.”

The revised OHAT Package released last June already clearly states that “covered items under this benefit are drugs and medications, laboratory examinations based on the specific treatment guideline including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), and test for monitoring anti-retroviral (ARV) drugs toxicity and professional fees of providers.”

PhilHealth also monitors the disparities among the services offered by treatment hubs, particularly on whether they are putting into effect what were stated in the circulars that were released.

“We are currently reviewing the OHAT Package, the implementation of it in treatment hubs, and the current rates; and if they have questions, we can discuss it with them,” Remonte said.

PLHIVs, meanwhile, are encouraged to contact PhilHealth if they have concerns regarding their PhilHealth membership and coverage.

PROPER MANAGEMENT

According to Dr. Rosanna Ditangco, research chief atThe Research Institute for Tropical-AIDS Research Group (RITM-ARG), a treatment hub located in Alabang, management issues also come to play in the delivery of TCS services to PLHIVs.

For instance, while “the OHAT Package does not cover baseline tests yet”, at RITM-ARG, PLHIVs are able to receive free baseline laboratory tests, such as CBC, chest x-ray, PPD and blood chemistry (i.e. lipid profile, BUN, Creatinine, FBS), and CD4 count.

“Due to good financial management, we can provide these free baseline services to new patients; and once they start treatment, they would be eligible for the OHAT Package and RITM would be able to regain the initial investment,” said Ditangco.

Older PLHIVs, meanwhile, can already use their PhilHealth membership when availing different services and laboratory tests that are needed and related to their antiretroviral therapy (ART) treatment.

There are minimum number of tests that DOH mandates for treatment hubs to give to PLHIVs, so that hubs now offer different services aside from those mandated – and even if the amount they pay to PhilHealth remain the same

There are minimum number of tests that DOH mandates for treatment hubs to give to PLHIVs, so that hubs now offer different services aside from those mandated – and even if the amount they pay to PhilHealth remain the same

“Every six months, we provide free CD4 and CBC tests. And yearly, during their anniversary, we provide free CD4, CBC, blood chemistry – depending on what ARV they are taking, and viral load tests. If the doctor suspects treatment failure, a free viral load test will be done anytime, plus HIV drug resistance testing,” Ditangco said.

Ditangco added that “all of these are covered by OHAT. And this has been our system ever since PhilHealth released their first circular.”

RITM-ARG also receives “additional support” from the DOH, which the facility also uses when providing TCS services to PLHIVs.

“Our funding is mostly from our OHAT reimbursement, but every now and then, we receive funding from DOH and we use this to provide free viral load, CD4 or HIV drug resistance testing for other treatment hubs,” Ditangco said.

WAY FORWARD

Interviewed by Outrage Magazine in Davao City during the 1st HIV Summit in southern Philippines, DOH Usec. Vicente Y. Belizario Jr. said that the DOH mandates the “minimum package (to be provided by hubs to PLHIV).” However, “(health care) is decentralized to local government units, (and) there are LGUs that are more innovative.”

“The challenge is to ensure harmonization,” Belizario said, adding that this is what the DOH “will continue to push.”

For Dr. Jose Narciso Sescon of the AIDS Society of the Philippines, “one bright move towards ensuring standardization is that these are being discussed and taken on. This is a healthy step towards a more robust HIV package of services offered to clienteles… if and only if we are all open (government and private service providers) to take on to discuss and accept the real challenges faced by our program.”

“I believe all major government treatment hubs must agree on a standardized treatment package offered to their patients that can be availed under the PhilHealth OHAT Package. Having a national standard on HIV treatment services offered to Filipino PLHIVs will help avoid confusion and unnecessary inconvenience for patients,” said Kevin Kane Li of The AIDS Treatment Action Group (TATAG) Philippines.

Meanwhile, for Pozzie Pinoy of The Project Red Ribbon, “if your hubs are charging you for your laboratory tests in succeeding tests, you should start asking.”

Pozzie Pinoy likens the PhilHealth to having an insurance package, wherein “if you have an HMO, you have packages, and you must know what’s being spent on you.”  In the case of PhilHealth, “ask your hub what in your P30,000 is being spent. You paid for it, so it should be used for you. Learn to ask. Don’t turn a blind eye just to save face. This can be solved by asking.”– WITH INTERVIEWS BY MDCTAN

PhilHealth may be reached at (+63 2) 441 7444 or (+63 2) 441 7442, or email actioncenter@philhealth.gov.ph.

Outrage Magazine is one with the PLHIV community in demanding for a uniform implementation of TCS services, particularly as mandated by PhilHealth. 

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(Established in April 2007, Outrage Magazine remains the only publication exclusive for the lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual and allied community in the Philippines.)

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PLHIVs ask PhilHealth to reconsider HIV response

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Outrage Magazine | 14 August 2015

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This is a continuing story on the disparities in the services received by PLHIVs in different hubs in the Philippines, even if they are required to pay the same amount by PhilHealth.

PhilHealth-on-San-Lazaro1

Living with HIV for eight years now, Paolo’s* CD4 count was going down. And so his attending physician told him to have his viral load counted. This test, Paolo said, “costs P6,000!”

PhilHealth-on-San-Lazaro2For Paolo, the costs of the viral load testing is not the problem per se; instead, it is the inconsistency of the services offered by the treatment hubs. At least in his treatment hub (i.e. San Lazaro Hospital), part of the treatment, care and support (TCS) that he receives is getting his ARV supplies every three months, and paying two other visits for his CD4 test to ascertain if his ARVs are working for him. The viral load counting is not included in the services offered, thus the need for him to cough up approximately P6,000.

There are other treatment hubs in the Philippines that provide other TCS services to PLHIVs enrolled in their systems. For instance, RITM-ARG in Alabang requires PLHIVs enrolled in its system to get their viral load counted, as well as CBC, Creatinine, TB skin test or PPD, and X-ray at least once a year, during their “anniversary” (that is, when they were enrolled into the system).  These tests are provided for free as part of PhilHealth’s Outpatient HIV/AIDS Treatment (OHAT) Package.

Paolo, like most PLHIVs who are taking ARV medications, is also a PhilHealth member. And his treatment hub requires him to completely pay, and then submit to them the necessary PhilHealth documents before they could serve him.

“Even if I’m an old PhilHealth member and I’m able to avail free CD4 count tests and my ARV medications, I was still asked to pay that amount [for the viral load test],” Paolo said.

CONFUSING DISPARITY

In an interview with Outrage Magazine, newly appointed PhilHealth director Risa Hontiveros said that particularly for a government hospital, not providing the complete tests could constitute a violation.

Under PhilHealth’s Circular No. 19, s-2010 or the Outpatient HIV/AIDS Treatment Package, “covered items under the benefits are drugs and medicines, laboratory examinations, and professional fees of providers.”  The circular adds that “all treatment hubs in accredited facilities are required to follow the guidelines set by the DOH.”

PhilHealth-on-San-Lazaro3

Meanwhile, under the revised OHAT Package, Circular No. 11-2015 released last June, PhilHealth once again stressed that “there shall be no separate accreditation for HIV/AIDS Treatment Hubs as OHAT Package providers, as long as they are PhilHealth accredited health care institutions.”

Similar to the first circular, the newer circular emphasized that “covered items under this benefit are drugs and medicines, laboratory examinations based on the specific treatment guideline, including CD4 level determination test, viral load (if warranted) and test for monitoring ARV drugs toxicity and professional fees of providers.”

The revised guidelines also stated that the OHAT package can already be accessed in all 22 DOH-designated HIV/AIDS treatment hubs in the country.

Some PLHIVs enrolled in San Lazaro Hospital, and who were interviewed for this article claimed that they already asked about the “missing” services that other hubs are offering. They were, however, only told to discuss the issue with the PhilHealth coordinator/s assigned at the treatment hub. Some followed the advise; but the services continue not to be offered.

The disparities in the services received by PLHIVs do not only happen in treatment hubs in Metro Manila.

In Davao City, a PLHIV – who also works with the Mindanao AIDS Advocates Association Inc. – similarly said that viral load count is not offered to PLHIVs, even if they, too, pay the same PhilHealth amount. To his knowledge, only those who enrolled after April 2014 get free viral load count; though only once, upon enrollment.

He admitted that there is a feeling of “lugi (not getting what you paid for)” for not being given the viral load count, particularly since they know it can be offered since “gi-offer na man saManila (it is already being offered in Manila).”  But as far as they know, “walang (there is no) VL machine in Davao, so it can’t be offered here because of this”.

Meanwhile, in Cagayan de Oro City, a PLHIV, who is a volunteer at the Northern Mindanao Advocates Society (NorMA), said that viral load count is also not given to those enrolled in the treatment hub there.  Again, they are required to pay the same PhilHealth amount, since “pareha ra man ginabayran sa PLHIVs (all PLHIVs pay the same rate),” he said.

The NorMA volunteer added that there was even a time when “nahudtan ug reagent (the hub run out of CD4 reagent), so even the CD4 count was delayed.”  Nonetheless, at least as far as CD4 count is concerned, “naayo na gamay karon (it has bettered now)”, but as far as viral load count is concerned, “nganga (we wait for nothing).”

Because of the inconsistencies in the services offered by treatment hubs, there are PLHIVs who “shop around” – that is, they look for hubs with “the most number of services offered,” he said.  “Pero maayo ra kung tanan ka-afford mubalhin ug (But it’s not as if everyone can afford to move to another) hub. For those who can’t, suffer jud (you really suffer).”

For Hontiveros, situations like this “cannot be tolerated, it has to be corrected. The point of generating demand through an institution like PhilHealth creates the obligation to make the supply side available and accessible to the members or patients. So we have to correct that.”

RAISE THE ISSUE

Outrage Magazine coordinated with the office of Dr. Rosario Jessica Tactacan-Abrenica, HACT head of the HIV/AIDS Pavilion of San Lazaro Hospital, to get the facility’s position on the issue; but was forwarded to the office of Dr. Winston Go, Medical Center Chief II of San Lazaro Hospital. No response has been received from the latter’s office as of press time (The response/s of Dr. Go will be included in a follow-up article on this issue, along with the positions of other people also involved in HIV-related work in the Philippines – Ed).

But in San Lazaro Hospital, one PhilHealth coordinator who asked not to be named stated that “sa RITM lang libre ‘yun. Dito kasi, matagal na namin naayos ‘yung mga PhilHealth papers ng mga pasyente at na-submit na namin sa admin ng San Lazaro. Siguro natagalan lang (the viral load count is only free in RITM. Here, we’ve long prepared the documents of the PLHIVs and submitted these to the administrators of San Lazaro Hospital. Perhaps the inclusion of viral load count is just taking longer).”

For PLHIVs dissatisfied with the services rendered by their treatment hubs; or even if they have concerns, Hontiveros said that “members can write us (about the situation). They can also send proof of having been made to pay for a benefit package that is supposedly covered by the policy.”

This way, PhilHealth can “get back to the hospital and we will penalize them. Sisingilin namin sa kanila ng doble ‘yung ginastos ng pasyente (We will make them pay double what the patients paid). We really go after hospitals, including or especially government hospitals that don’t extend the mandated services of the PhilHealth institution,” Hontiveros said.

For Paolo, this is a welcome development. He just hopes “it doesn’t take forever”.

PhilHealth may be reached at (+63 2) 441 7444 or (+63 2) 441 7442, or email actioncenter@philhealth.gov.ph.

Outrage Magazine is one with the PLHIV community in demanding for a uniform implementation of TCS services, particularly as mandated by PhilHealth. 

Article amended on August 14, 5:30PM to include the interviews from Mindanao AIDS Advocates Association Inc. and Northern Mindanao Advocates Society (NorMA).

*NAME CHANGED TO PROTECT THE PRIVACY OF THE INTERVIEWEE

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(Established in April 2007, Outrage Magazine remains the only publication exclusive for the lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual and allied community in the Philippines.)

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