Suspension of Disbelief

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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LGBT activists: We did not feel Aquino’s presence

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VERA Files | 03 August 2015

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Kapederasyon members air their lament while the President delivers his last SONA. - See more at: http://verafiles.org/lgbt-activists-we-did-not-feel-aquinos-presence/#sthash.YMqOuJ9W.dpuf

Kapederasyon members air their lament while the President delivers his last SONA. – See more at: http://verafiles.org/lgbt-activists-we-did-not-feel-aquinos-presence/#sthash.YMqOuJ9W.dpuf

THE countdown has begun for the last months of President Benigno Aquino III.

Activists from the LGBT (lesbian, gay, bisexual and transgender) community hold out little hope that the Aquino administration will address their grievances in its final months after it failed to respond to their needs in its earlier years.

Murphy Red, chairperson of Kapederasyon LGBT Sectoral Organization, lamented the fact that unlike other marginalized sectors that receive support from local government units or the social welfare department, not one agency caters to the needs of the LGBT community.

“Ang ibang mga marginalized sectors ay, kahit papaano, may mga institution sa pamahalaan na nag-ca-cater sa kanilang mga interest, tulad ng iba’t-ibang programa ng mga LGUs at ng DSWD. Pero sa mga LGBT, wala talagang institution na nasa gobyerno ang nangangalaga,” he said.

The LGBTs joined other protesters to express disappointment at the Aquino government when the president delivered his last State of the Nation (SONA) address last Monday, July 27. They braved the rains as they marched along the stretch of Commonwealth Avenue.

Murphy Red, chairperson of Kapederasyon

Murphy Red, chairperson of Kapederasyon

“Nakalimang SONA na siya, pero ni minsan hindi niya binanggit ang mga LGBT. Wala sa agenda niya ang kalagayan ng mga LGBT,” Red stated.

“Hindi na kami umaasa at nagiilusyon na magbibigay siya ng tulong sa huling taon niya. Pero sana lang sa huling pagkakataon, sa huling taon ng kanyang paninilbihan, mamulat siya sa katotohanang may LGBT sa lipunan na pinagsisilbihan niya, sa bayan na tinuturing niya na boss niya.”

Aside from the lack of support programs for LGBTs, Kapederasyon also regrets that Aquino has not backed the passage of the Anti-Discrimination Bill that would safeguard the rights and security of the community, saying it is not a priority of the government.

“Hindi priority ng rehimen na ito iyong pagpasa ng Anti-Discrimination Bill, para mapangalagaan iyong mga karapatan ng mga LGBT at iyong seguridad ng mga LGBT na nagreresulta sa sunod-sunod na pagpatay,” Red pointed out.

LGBTs stage their own SONA

LGBTs stage their own SONA

The Anti-Discrimination Bill, if passed, will enforce fines and jail time to anyone who commits discriminatory acts against LGBTs.

Some of the prohibited acts in the bill include the denial of access to public and military services; refusal of admission or expulsion from educational institutions; denial of access to medical and other health services; denial of access or use of establishments, utilities, or services including housing that are open to the general – all of which, on the basis of sexual orientation and gender identity.

Contrary to government pronouncements that the LGBT sector is part of state’s gender advocacy, in reality, their needs and concerns are not being addressed, Red added.

As Aquino’s term comes to an end, Kapederasyon calls for the inclusion of LGBT issues in the platforms of the 2016 presidential candidates.

“Sa mga tatakbo sa 2016, para masiguro nila na makukuha nila ang boto ng mga LGBT, kailangan may malinaw silang agendang ilalatag para sa kagalingan ng mga LGBT,” Red concluded.

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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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Did PNoy leave LGBT Pinoys in a ditch?

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Outrage Magazine | 29 July 2015

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LGBT organizations join the protest against President Noynoy Aquino, who has not once mentioned the plight of LGBT people in his SONA

LGBT organizations join the protest against President Noynoy Aquino, who has not once mentioned the plight of LGBT people in his SONA

Where are LGBT people in President Benigno “Noynoy” Aquino III’s so-called “daang matuwid” (straight/righteous path)?

As Aquino nears the end of his term, people are now asking if he has fulfilled his promises to the oft-mentioned “bosses”, the people. But – although since his election Aquino has focused on such issues as the economic growth by cutting the government spending, peace in Mindanao by talking (only) with the Moro Islamic Liberation Front (MILF), and the anti-corruption campaign that saw the arrests (though still sans the needed trials) of the likes of former President Gloria Macapagal-Arroyo, and Senators Juan Ponce Enrile, Jinggoy Estrada and Ramon Revilla Jr. – the issue of LGBT rights was never part of his priorities.

Looking back, Aquino’s addresses to the nation (via the annual State of the Nation Address, or SONA) contained parts that gave hope to minorities – the LGBT community included – whose lives continue to be dire solely because they are minorities.

In Aquino’s his first SONA in 2010, he said that “kaakibat ng ating mga karapatan at kalayaan ay ang tungkulin natin sa kapwa at sa bayan (together with our rights and freedom is our responsibility to our fellowmen and to our country/nation).” In 2012, “kung may inaagrabyado’t ninanakawan ng karaptan, siya ang kakampihan ko. Kung may abusadong mapang-api, siya ang lalabanan ko. Kung may makita akong mali sa sistema, tungkulin kong itama ito (if there is someone disadvantaged and whose rights are stolen, I will side with him. If there are abusers, I will fight them. If I see errors in the system, it is my duty to correct these).” And then last year, “gabi-gabi po, bago ako matulog, thank you at nakalamapas pa ako ng isang araw. Kung, sabi nga noong bata kami, ‘finish or not finish, pass your paper’, eh dumating na sa akin, palagay ko naman naramdaman na ninyo kung anong pagbabagong karapatan ng bawat Pilipinong mangyari. At bahala na kayong ituloy ito (every night, before I go to sleep, I say thanks for surviving another day. When – as it was said when we were kids, ‘finished or not finished, pass your paper’, it already reached me, and I think you already felt the changes to the rights that happened for every Filipinos. It’s now up to you to continue these).

But in actuality, five years hence, none of these changes are LGBT-specific.

This is why, according to Murphy Red, chairperson of Kapederasyon LGBT Sectoral Organization, they are under no illusion that Aquino will do anything anymore for the LGBT Filipinos.

Hindi na kami umaasa, hindi na kami nagiilusyon na magbibigay siya ng tulong sa huling taon niya (sa mga LGBTs). Sana lang sa huling pagkakataon, sa huling taon ng kanyang paninilbihan ay mamulat siya sa katotohanan na may LGBT sa lipunan na pinagsisibilhan niya at sa sa bayan na tinuturing niyang boss (We no longer hope, we are not under any illusion that he will give help in his remaining year to LGBT people. We hope that in the last stretch, in the last year of his office, he will finally see that there are LGBT people among the Filipino people he keeps saying as his bosses),” Murphy Red said.

Aquino’s neglect of the LGBT people may be seen in the non-mention of the need for the passage of an anti-discrimination law, with an anti-discrimination bill languishing in Congress for over 15 years now. If passed, such a law will protect the human rights of LGBT Filipinos by enforcing fines and even jail times to anyone who discriminates against LGBT people.

But, as Murphy Red said, “hindi priority ng rehimen na ito ‘yung pagpapasa ng Anti-Discrimination Bill o yung paghahain ng Anti-Hate Crime Law o Bill, para mapangalagaan sana ‘yung karapatan ng mga LGBT, at yung seguridad ng mga LGBT (this regime has not prioritized the passage of an anti-discrimination bill or an anti-hate crime law that could ensure the protection of LGBT people, and the security of LGBT people).”

Already, the lack of anti-hate laws has “nagresulta na sa sunod-sunod na pagpatay ng LGBTs (this already resulted in the numerous deaths of LGBT people),” said Murphy Red, who cited as an example transgender woman Jennifer Laude, who was brutally killed last year, with the primary suspect a US Marine. 

There are already anti-discrimination ordinances in some local government units (LGUs) in the country, including in Angeles, Bacolod, Cavite, Cebu, Davao, and Quezon City. But even here, there are still reported cases of discrimination, showing that LGU-wide ordinances are not enough to ensure the protection of the rights of LGBT people.

Ang ibang mga marginalized sectors ay kahit papaano may mga institution sa pamahalaan na nag-ca-cater sa kanilang mga interest, tulad ng iba-ibang programa ng mga LGUs o ngDSWD na tumutulong sa mga pangangailangan ng ibang minorities. Pero sa mga LGBT, wala talagang institution na nasa gobyerno na mangangalaga. Kung mayroon man, kami pa ang namimilit (Other marginalized sectors at least have institutions in the government that cater to them and their interests, such as in LGUs and the Department of Social Welfare and Development. But for LGBT people, no government body looks after our interests. And even if they end up serving us, it’s because they are forced to do so),” Murphy Red said.

In this year’s SONA, Aquino’s motherhood statements abound, such as when he said that “kaya gaya sa lahat ng iba pang suliranin, pagkakaisa po ang tanging susi para mapangalagaan ang ating karapatan (like when dealing with all problems, unity is the key to look after our rights).” But while many LGBT people dared join his sloganeering for “daang matuwid“, thereby joining in his fight, Aquino’s administration didn’t show any concrete efforts for the LGBT community in the last five years.

Wala talaga siyang nagawa. Nakalimang SONA na siya pero ni minsan hindi niya binanggit and mga LGBT. Wala sa agenda niya ang kalagayan ng LGBT (He hasn’t done a thing for LGBT people. He already had five SONAs but he did not even mention LGBT people once. The plight of LGBT people is not in his agenda),” Murphy Red said. “Zero ang marka ni PNoy sa buong termino niya (He gets zero mark for his entire term).”

Aquino’s 2015 SONA lasted more than two hours – one of the longest delivered by any President. And as he concluded his speech, some militant lawmakers, staged their protest inside the plenary hall by showing placards that read, among others, “Human Rights Violator”, “Serbisyo Palpak”, and “Pork Barrel King”.

As if Aquino couldn’t do any wrong, those who did not agree with him were booed.

And now the countdown begins for the last months of Aquino’s presidency.

For some LGBT groups like Kapederasyon, there is no longer hope for the current administration to take notice of the struggles of the LGBT people. But as is routine, every six years, they can’t help but hope that the next president will finally give LGBT people the attention.

Sa mga tatakbo sa 2016, para masiguro nila na makukuha nila ang boto ng mga LGBT, kailangan may malinaw silang agendang ilalatag para sa kagalingan ng mga LGBT. At ‘yun lang talaga ang hihilingin namin sa mga susunod na kandidato (To those who will run for office in 2016, for them to get the votes of LGBT people, they should have clear agenda to better the lives of LGBT people. That’s the only wish we have for these next candidates),” Murphy Red ended.

Transgender woman Claire laments how her life as a working LGBT person has worsened – not only did she experience discriminatory practices in her workplace because of her sexual orientation and gender identity and expression, but she also continues to face difficulties because of the pervasive contractualization of workers that empower private companies like her former employer to illegally dismiss her before she can be regularized. For Claire, it’s “layer after layer of difficulties that continued under the presidency of Noynoy Aquino,” she said in Filipino. PHOTO BY AARON BONETTE

Transgender woman Claire laments how her life as a working LGBT person has worsened – not only did she experience discriminatory practices in her workplace because of her sexual orientation and gender identity and expression, but she also continues to face difficulties because of the pervasive contractualization of workers that empower private companies like her former employer to illegally dismiss her before she can be regularized. For Claire, it’s “layer after layer of difficulties that continued under the presidency of Noynoy Aquino,” she said in Filipino.
PHOTO BY AARON BONETTE

Rainbow-rising

At SONA 2015, local LGBT organizations highlighted how much remains to be done to better the plight of LGBT people in the Philippines, such as the urgent passage of the Anti-Discrimination Law that has been languishing in Congress for over 15 years. PHOTO BY AARON BONETTE

At SONA 2015, local LGBT organizations highlighted how much remains to be done to better the plight of LGBT people in the Philippines, such as the urgent passage of the Anti-Discrimination Law that has been languishing in Congress for over 15 years.
PHOTO BY AARON BONETTE

Pink-struggle

Various LGBT organizations also joined those who expressed their discontent with the administration of Pres. Benigno Aquino III, particularly since – almost six years after taking office – the plight of LGBT people has not progressed, with, among others, the lack of an anti-discrimination law. PHOTO BY AARON BONETTE

Various LGBT organizations also joined those who expressed their discontent with the administration of Pres. Benigno Aquino III, particularly since – almost six years after taking office – the plight of LGBT people has not progressed, with, among others, the lack of an anti-discrimination law.
PHOTO BY AARON BONETTE

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(Outrage Magazine remains the only publication for the lesbian, gay, bisexual and transgender (LGBT) community in the Philippines.)

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Having HIV as an ongoing personal battle

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Outrage Magazine | 21 July 2015

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This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”. More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

Positive-life

When Paolo – who was diagnosed to be HIV positive in 2007 – started taking antiretroviral (ARV) medicines, his life changed permanently. But even with the life-saving ARVs, he continues to have doubts if his status is, as many continue to believe, a punishment for his bad deeds, or maybe even a death sentence. After all, there was a point in his life when – knowing how difficult having HIV could be, he still irresponsibly knowingly engage in risky practices that may have infected his partners (i.e. spreading “the gift”). Not surprisingly, Paolo still experiences chronic depression.

Only last month, he faced another battle. His attending physician conveyed her concern toward his declining CD4 count. Because of this, Paolo may have to be shifted to the second line of ARVs.

“It was late last year when my doctor at San Lazaro Hospital told me that I should watch out for my declining CD4 count. She said that it might be a sign of too much stress or a problem with my ARV combination,” Paolo said.

When he went to the hospital last April to get his ARV supply, he was only given meds for one month (versus the usual 3 1/2 months’ supplies). It was also then when he was told that they have to wait for his latest CD4 count before they can give him more supplies.

The following month, Paolo had his CD4 count tested. True to form, yet still shocking Paolo, the decline continued. “My CD4 count was in a downward trend: 388 in May 2015, 426 in November 2014, 454 in May 2014, 470 in November 2013, and 533 in May 2013.”

Paolo’s CD4 count was 582 in December 2008, when he had his baseline tests; with the number immediately falling to 327 in June 2011.

There have been fluctuations (e.g. from 327 in June 2011 to 368 in March 2012), but Paolo’s attending physician said that ever since the last increase, “the numbers continued to go down, and it may be a sign of drug resistance or treatment failure.”

He was immediately asked to have a viral load test to check the number of HIV copies in his blood. His doctor also gave him a heads up on what he should expect if the result was high.

“The test costs P6,000. Even if I’m an old PhilHealth member and I’m able to avail free CD4 count tests and ARV medications, under the OHAT package, I was still asked to pay that amount. When this happens to you, complaining is the last thing on your mind. For me, I just want to know the result,” Paolo said.

He was told to return after three weeks for the result.

“It was probably the longest three weeks of my life. A lot things started running in my head: What if it’s high, would I be able to take the side effects of the level 2 medications? What if it’s low and my CD4 count continues to decline, what will happen to me?” Paolo asked. “During that three weeks, I had sleepless nights. I couldn’t even disclose it to the 16-year-old guy I was seeing. I was really afraid. I had no one to run to. I don’t want to die yet.”

Paolo was also reluctant to reach out to support groups.

“It’s not them who can and will help you because they don’t really know what you’re feeling, HIV is a personal thing. Support groups are not really supportive enough. Yes, you will have someone to talk to, but at the end of the day, it’s not them, not your friends, not even your family, who can help you get over what you’re feeling. Just yourself,” Paolo said.

But Paolo’s life did not stop while he waited for the test ascertaining his viral load.

“I started to see things from a different perspective. I’m able to appreciate and value even the smallest and simplest things. I know that it may be temporary because of the situation I was in, but it gave me a reason to smile and be thankful,” Paolo said.

He told Red, a friend his who is also HIV-positive, about his situation. Paolo reconciled with him after a long time.

“I know I was going to explode if I didn’t tell anyone about my situation. I felt a bit relieved after I told him what I was going through,” he said.

After then, both at work and at home, Paolo became more relaxed. He also started joining different LGBT- and HIV-related events. He even participated in the 21st Metro Manila Pride March last June, where he marched for the first time.

Paolo wanted to much to be optimistic. “There are so many better things that one can do, regardless if you’re a PLHIV or not,” he said.

And then the third week came. Paolo went back to San Lazaro Hospital to get his test result.

“The anxiety of waiting for the folded and stapled paper to be handed to you was really exhausting. The lady who was assisting the clients in the laboratory was moving very slowly. And when she finally handed the paper to me, I was able to breathe normally,” he recalled.

His result indicated 84 copies/mL.

“I was told by my doctor to rest more often and that I should also lessen stressful activities,” Paolo said.

His ARV medications stayed the same, and he was already given three months’ worth of supplies.

His CD4 count will be checked again after six months. And his doctor, provided that he continues to improve his lifestyle, remains optimistic that everything will be okay.

“I know I’m not the perfect role model. But based on what I’ve gone through, being a PLHIV is one difficult challenge. It’s not as simple as some doctors or support groups say. No one can and will help you, but yourself,” Paolo said. “It’s not easy to accept your situation, but instead of being too negative, why not do something about it?”

Paolo recommends self-sufficiency in facing being HIV positive.

“You can always live your life to the fullest, just don’t forget to look out for yourself. It may sound selfish, but at the end of the day, you are responsible for your own welfare,” Paolo ended.

*NAMES WERE CHANGED AS REQUESTED BY THE MAIN INTERVIEWEE TO PROTECT THE PRIVACY OF THE PEOPLE INVOLVED

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(Outrage Magazine remains the only publication for the lesbian, gay, bisexual and transgender (LGBT) community in the Philippines.)

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Confessions of a former ‘gift’ giver…

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Outrage Magazine | 08 June 2015

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This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”. More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

POZ

“I felt a sudden jolt after I came/orgasmed inside the person that I was having sex with bareback,” Paolo said. He didn’t look particularly happy; he even had a blank stare.

But he was open about sharing his sexual experiences with me.

Particularly that part in his life, when he used to be a “participant of a small group of HIV-positive straight-acting gays who frequent different places in the metro and engage in different sexual activities.”

Paolo, by the way, was diagnosed with HIV in 2007. After he registered and submitted his medical documents in San Lazaro Hospital, he didn’t go back until early 2011.

LIVING LIFE TO THE FULLEST

“Maybe I’m the type who doesn’t dwell much on problems. I was aware that I will be battling a lifelong endeavor (being HIV-positive), but I didn’t want to think about it to the point that my life would be hindered,” he said.

When his boyfriend at the time broke up with him, right after he regained his strength from the ARV trial period he had to endure, he lived each day as if it was his last.

“I revealed my condition to some friends and they have been very supportive,” Paolo said. His friends were so supportive, in fact, that “we were going out almost every night.”

It was during one of those night outs that he met Red*.

Red is also HIV-positive; he was diagnosed a year later than Paolo. They became fast friends after their first meeting. “There was nothing sexual nor intimate between us. We were just really good friends,” said Paolo, who found solace in the company of Red.

Partying for Paolo meant frequenting the likes of gay bars, including Bed Bar and O Bar. “I was living my life to the fullest; like I’m HIV-free,” Paolo said.

Bar-hopping – according to Paolo – also happened in the likes of Fahrenheit, Palawan, Blue Fairies, and others.

Though Paolo admitted that he was a regular in those establishments, for a while, he went there solely to party.  Picking up was not in his mind, as he was “still afraid and very cautious to have sex with another person. I was only doing oral sex that time.”

Soon, though, everything changed.

NEWFOUND INDEPENDENCE

As shared by Paolo, during one of their “crazy nights” in a bar in Quezon City, “Red and I met a group of good looking and gym-toned straight-acting gays. We had drinks at (this) bar. And after an hour of laughter, we left the club and went to (a bar) in Ortigas,” Paolo recalled.

The night went by like their “regular night outs”. They watched the performances, ordered several bottles of beer, and flirted with different people.

Little did Paolo know that he actually signed up for a different type of fun that night.

“I think it was around 3:00 AM and we were all very tipsy, when one of our newfound friends, Marvin*, started kissing someone he just met on the dance floor,” Paolo narrated. “And then he pulled me closer to them and started rubbing my crotch.”

Tara, sama ka sa amin (Come join us),” Paolo remembered Marvin saying with a smile.

The three of them left that bar and went to Marvin’s apartment.

“While I was getting head from the guy we picked up from the bar, Marvin positioned himself behind him. He started penetrating him without a condom,” Paolo recounted. “After several minutes, he held the bottom guy closer to him, holding his waist tightly, and shot his load.”

After their encounter, the guy they picked up just got dressed and then immediately left. And while Paolo was fixing himself, Marvin asked if he wanted to grab an early breakfast. He agreed.

Their conversation while eating turned from recounting what happened at Marvin’s apartment to being confrontational.

“’I saw what you took when we were at O Bar, and it wasn’t a party pill!’, Marvin told me. I was silent at first, and then he continued: “It’s okay, don’t worry, pareho lang tayo (we’re the same),” Paolo said.

SHARING “THE GIFT”

From then on, Paolo and Marvin’s group became this close-knit circle that frequented the bars, flirting and picking up random people, and inviting them to go with them for sex.

“It became my routine. I went to those places three to four times a week to meet different people. And I always performed unprotected sex with them. At that time, I thought I was satisfying my ego, that I had the upper hand and in control,” Paolo said, shaking his head.

He also thought “I was sharing the ‘gift’.”

It reached a point where he no longer joined Marvin’s group and just went out to party and pick up on his own.

“Last year was really the height of my inappropriate routine. As people flocked O Bar, for instance, my choices widened. Every time I went there, I always made it a point that I will be bringing someone home. It became very addicting,” he admitted.

And there were times that “after finishing someone, I would go back to bars to pick up someone again.”

Red*, who ended up knowing about Paolo’s “addiction”, tried talking him out of it.  Paolo just “refused to respond to his calls and text messages.”

TURNING POINT

Last March, according to Paolo, when he went to a bar in Ortigas, “I met this really cute guy. He was about the same height as I am, and he had a really good built,” Paolo said.

They shared drinks together and danced to several songs. And like usual, he invited this guy back to his place.

Paolo had unprotected sex with him. But unlike most of the his one-night encounters, this new guy chose to spend the night at his place.

“We had sex three times that night – at all times, I came inside him. The following day, he gave me a call saying that he wanted to have lunch with me,” Paolo recalled.

They met and had lunch together. It was also then that he found out that this new guy really likes him.

“He also confessed to me that he was only 16 years old,” Paolo added.

Paolo paused and lit another cigarette. Suddenly, his phone rang; he excused himself.

He returned, looking apologetic.  “Sorry about that. It was the 16-year-old guy I was telling you about,” he said.  He lit another cigarette.

And then sitting across me again, he continued: “We started dating after that unfortunate night. I really like him. But at the same time I feel guilty. He is still young and I (may have given) him the disease. I was awakened. I wanted to die after learning that he was only 16 years old. I felt really sorry for myself… that I had to do those things.”

Paolo was misty-eyed while talking; he even rubbed his eye, looking more like wiping his tears. He cleared his throat, and then continued smoking, finishing his cigarette.

“I know that I’m a bad person because I did all those things and it took me a long time to realize that,” Paolo said. “If I could only turn back time, I would not have done all those things.”

He also added that if he would be given a chance, he would talk to all the people that he had unprotected sex with and ask for their forgiveness.

“Some people living with HIV do really go around to spread the ‘gift’,” Paolo said. There are those who “are out there victimizing HIV-negative members of the community.”

Being more aware, Paolo also believes in one’s responsibility over oneself – helped, obviously, with further education that empowers people to protect themselves.  “Even if you’re having a fun time, never let your guard down. You should never completely trust anyone when it comes to sex, especially when you are at your most gullible and vulnerable self,” Paolo ended.

*NAMES WERE CHANGED AS REQUESTED BY THE INTERVIEWEE TO PROTECT THEIR PRIVACY

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(Outrage Magazine remains the only publication for the lesbian, gay, bisexual and transgender (LGBT) community in the Philippines.)

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