Suspension of Disbelief

Posts Tagged ‘department of health

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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RITM: PLHIVs may not receive ARVs next week

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Outrage Magazine | 03 September 2014

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ARV

Time to panic?

Dr. Rosanna Ditangco, research chief at the Research Institute for Tropical Medicine-AIDS Research Group (RITM-ARG, one of the treatment hubs in the country), highlighted the dire situation faced by Filipino people living with HIV (PLHIV) after she reportedly said that the distribution of antiretroviral medicines (ARVs) may be stopped due to processing delays.

In a letter sent to the Department of Health (DOH) Secretary, Dr. Enrique Ona, dated September 2, HIV activist Pozzie Pinoy of the Red Ribbon Project, quoted Ditangco for saying that if the ARVs that are currently being held by the Bureau of Customs (BOC) will not be released by Friday, September 5, then “HIV treatment will totally stop all over the country.”

The Project Red Ribbon claimed receiving insider information that “BOC is requiring DOH to pay P5 million for the tax of the shipment (i.e. ARVs)”, and that “the said shipment has been in the storage of BOC since August of this year.”

DIRE SITUATION 

The number of HIV and AIDS cases in the Philippines already reached 19,915 as of July 2014, the National Epidemiology Center of the Department of Health (DOH) reported. And from January to July this year alone, the number of Filipinos living with HIV who are on antiretroviral therapy (ART) reached 7,172.

Obviously, the numbers are expected to rise, considering the continuing growing number of new cases reported by the DOH.

ON DEAF EARS

This issue was actually raised as early as February of this year, when PLHIVs started receiving limited supplies of ARVs from their treatment hubs. In a blog post by Pozzie Pinoy, Ditangco was quoted as saying that most Philippine HIV treatment hubs give out supplies for only either two weeks or one month, because of the delay in the delivery of meds to DOH.

After two weeks, Ditangco reported that the DOH will already deliver the ARV supplies to the respective treatment hubs.

Interestingly, according to Dr. Jose Gerard Belimac, head of DOH’s National AIDS/STI Prevention and Control Program, there is no delay in the procurement of ARVs, just as there is no “official pronouncement from the DOH to the treatment hubs to control [the distribution of ARVs] because of a delay in the procurement [of ARVs],” he said in an exclusive interview by Outrage Magazine.

Belimac also assured that “this is something we are trying to resolve, to ensure the continuity of treatment for PLHIV.”

What is not discussed is the delivery of ARVs differ from what PLHIVs use, with changes made to regimens of PLHIVs without medically sound reasons.  As a PLHIV whose medicines were changed last March stated, “the ARVs given [to] me were changed because there’s no stock of my usual ARVs. [The doctor said], no choice.”

ABNORMAL SITUATION?

Despite all these pronouncements about the availability of supplies, the fluctuating supply of ARVs continued in the next months. Different PLHIVs from different treatment hubs complained about the insufficient (from two weeks’ to one month’s supply, depending on the hub), ARVs given to them every time they get a refill.

Ditangco, in an interview by Outrage Magazine last April, said that “ang ARV supplies natin ay wala naman talagang problema. Nagkaroon lang tayo ng abnormal situation becausenagkaroon ng miscalculations in ordering (our ARV supplies do not have problems. We’re just having an abnormal situation because of miscalculations in ordering). There’s no need to cause unnecessary panic among PLHIVs.”

But panic is what is happening now.

During those months of notable ARV shortage, Project Red Ribbon actually purchased four boxes of Lamivudine and Tenofovir, a two-in-one mix of the two drugs.

“If there is no problem, why is it that we are buying from other countries to supplement the problems with the stocks? And we were able to release it from the (BOC) in just one week, as opposed to what other people are saying that it’s hard to release it from Customs. The PLHIV community is panicking for the past months now. The DOH has not been transparent with its programs when it comes to ARV medicines,” Pozzie Pinoy stressed.

Also, even as the DOH continues to deny that there is a problem with the supply of ARVs in the Philippines, one by one, treatment hubs started borrowing ARV supplies from other hubs that have “enough supply”.

Ditangco was in fact quoted by Pozzie Pinoy as saying that RITM-ARG, in the last two weeks, has been lending their ARV stocks to other HIV and AIDS treatment hubs in Metro Manila and in the provinces because of the shortage.

DELAY = DEATH

Last August 26, different LGBTQIA organizations from all over the Philippines – including Ladlad Caraga Inc., The AIDS Treatment Action Group Philippines (TATAG), REDx, Northern Mindanao Advocates, and The Well Philippines – wrote a letter to the BOC for it to provide a clearer picture on the following issues:

  1. What and how much were the duties and taxes imposed for the particular shipment?
  2. What is the basis of computation for duties and taxes levied against the imported ARVs?
  3. What is the cause of delay for the release of life saving ARVs to DOH?
  4. Is the agency taking any steps to expedite the release of ARVs to DOH?

To date, no response has been received, no matter the urgency of the issue.

Pozzie Pinoy is appealing to the DOH and the BOC to do something about this life and death situation.

“I am pleading and begging you, on behalf of the entire PLHIV community and the entire country, to please look into this matter immediately and find a quick solution to this problem. What we can do now is to call for the attention of your department, and of the BOC to take action before this gets out of hand,” he stated.

Outrage Magazine is one with the PLHIV community in demanding that the Department of Health should look into this matter as soon as possible and address this issue immediately. 

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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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State of the Nation: The Grievances of PLHIVs

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Outrage Magazine | 22 July 2014

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WAD2013

“It is clear: The state was established to serve you. If you have health problems, the government must care for you. In times of illness, it should be there to give aid and support. What has our government done in this regard?”

That was the question posed by President Benigno “Noynoy” Aquino III himself during his fourth State of the Nation Address last year.

And this year, four years since Filipinos were led to the daang matuwid (righteous/right path)”, the commitment made by PNoy to Filipinos – that there will be a better tomorrow – seems to be untenable.  In fact, there seems to be no decent stopovers along the way, only obstacles.

The plight of Filipino people living with HIV (PLHIVs) exemplify this.

‘WITCH HUNT’

In an earlier interview on ABS-CBN News Channel, Department of Health (DOH) assistant secretary Eric Tayag said that the government agency is working on the details to make HIV tests compulsory.

“(DOH) Sec. Enrique Ona would want to shift from voluntary testing to something that’s compulsory. We want health providers to screen adults who may have a risk for HIV, so that they can be properly counseled on what to do next,” Tayag was quoted as saying.

While the DOH blindly considers this move to be beneficial to everyone, especially to those who are “unaware and reckless with their lifestyle”, different HIV-related organizations and support groups believe otherwise.

“We were surprised and very alarmed by the pronouncement of the DOH. We feel that the mandatory testing, other than being very violative of the AIDS law, will also violate fundamental human rights. If HIV testing would be required for employment or upon entry to educational institutions, then that’s a violation of the socio-economic and socio-cultural rights. It will promote greater stigma and discrimination,” Perci Cedaña, National Youth Commission’s commissioner-at-large, said.

The DOH also noted that the prevalence of HIV among men who have sex with men (MSM) is really alarming and it shouldn’t be taken lightly.

What the DOH leadership fails to see is the diversity of the LGBTQ community, whose members don’t follow the stereotyped images that the media or the everyday Filipino perceive.

“Even (if) DOH possesses evidence that show the complexity of Filipino behavior, in a concentrated epidemic among MSM and transgenders, who do you actually require to get tested? This population does not conveniently fit whatever stereotypical images that Sec. Ona may have about the (LGBTQ) community. Would DOH require all of them to get tested? The problem is not simply about increasing uptake of HIV testing. There’s a more fundamental issue: it’s Sec. Ona himself,” Network to Stop AIDS (NSAP) said in a statement.

Project Red Ribbon, an organization that composes mainly of PLHIV, noted that typecasting a certain group will not solve the growing problem of HIV in the country.

“It’s basically a witch hunt, and different organizations and institutions, especially BPOs, will be affected by this. (We are) so against this because it’s basically typcasting a certain group. The problem is, when you say MSM, not all MSM are gay. So does this mean that they will only focus with this group? What about the other groups? This is a clear typecasting of MSM. We don’t think it’s going to work,” said Pozzie Pinoy, founder of the Project Red Ribbon.

DISAPPOINTMENTS

While the government is “trying” to decrease the prevalence of HIV infection in the country, the quality of service and professionalism among medical practitioners in some health centers and treatment hubs continue to be lacking.

One PLHIV, RT, found out that he’s HIV-positive while he was finishing the requirements needed for a job application in Dubai.

“When I went back to the clinic in Malate to get my confirmatory test, the nurses and medical technicians who were on duty immediately went to the reception area to take a good look at me and they whispered to each other,” he recalled.

And what the attending physician told RT was even more alarming. “Okay lang ‘yan, matagal pa naman ang 10 years. Mga five years pa bago mo maramdaman na may AIDS ka. Marami ka pa naman pwedeng magawa (That’s okay; you still have 10 years. It will take five years before you start feeling the effects of having AIDS. You can still do a lot ’til then).” After hearing that, he just left the clinic.

Several days later, he consulted with another doctor in San Lazaro Hospital.

It has been three years since that incident.

RT is now taking antiretroviral medicines (ARV) to help control the growth and spread of the HIV virus in his body. His doctor told him that he’s in superb shape – he goes to the gym every other day and he hasn’t experienced any opportunistic infections.

Despite the unfortunate initial experience, RT is still “luckier” than most PLHIVs.

In the case of Paolo (not his real name), a 22-year-old barista who is also HIV-positive, the available resources in the Visayas region to attend to the needs of PLHIVs is insufficient, if not lacking.

Mahirap ang kalagayan ng mga may HIV dito sa Visayas. Minsan nangyayari na hindi kami naasikaso kasi hindi available ‘yung doktor namin. Kaya ‘yung iba sa aminnagbibyahe pa papuntang Cebu para macheck-up at makakuha ng ARV (Our status in the Visayas is difficult. At times, no one looks after us because there’s no doctor available. So, some of us have to travel to Cebu just to get checked, as well as to get ARV supplies),” he said.

As a minimum wage earner, Paolo cannot afford to skip work just so he can go to Cebu.

Naalala ko five or six months ago, nagkalagnat ako for three weeks, tapos noong nagpunta ako sa hospital namin ditonakaleave daw ‘yung doktor na naka-assign sa amin, at pinapapunta ako sa Cebu para matignan. Sumabay pa noon, naubos na ‘yung supply ko ng ARV, kaya hindi rin ako nakainom ng gamot ng almost one month. Tapos nag-consult na lang ako sa general practitioner doctor, at sinabi ko ang status ko. Wala naman akong choice (I remember five or six months ago, I had a fever for three weeks, so I went to the hub here, but the doctor was on leave; I was told to go to Cebu for me to get checked. It was also that time that I ran out of ARVs, so I have not been able to take my medicines for a month. I was forced to consult with a general practitioner; I disclosed my status to him. It’s not like I had a choice),” he recalled.

UNNECESSARY PANIC?

Although Filipino PLHIV benefit from PhilHealth’s Outpatient HIV/AIDS Treatment Package, which covers the majority of their hospital and treatment expenses, there is also the growing problem that the government is facing in terms of ARV supplies.

“Actually, we don’t have a problem in ARV supplies. It just so happened that there was an abnormal situation. There was a miscalculation when they ordered the supply, that’s why there was a delay for a few months,” said Dr. Rossana Ditangco, research chief of the Research Institute for Tropical Medicine (RITM).  “We experienced the shortage not because we didn’t have a budget, there was just a delay in the delivery. There’s no need to cause unnecessary panic towards this. As far as the budget is concerned, I don’t think we will experience any problem because the ARVs that we are buying are very cheap, they are just generics. And PhilHealth is there and ready to take over eventually for the cost of treatment.”

Supposedly pacifying words that don’t hold sway to so many PLHIVs.

In the case of JB, who lives in Quezon City, going to RITM Alabang to get ARV supplies is a tedious task, especially if he will only be given one to two weeks’ supply.

“I have been taking ARVs for more than four years now, and this year was the hardest for me, not because of the side effects I feel whenever I take the medicines, but the stress I experience every time I go to RITM. The nurses told me that they cannot give three and half months worth of ARVs, which I normally get, because they are ‘budgeting’ it to accommodate other patients. They only gave me two weeks’ worth of ARVs and I was asked to go back after I finish them,” he said.

The government, it seems, is covering up the real situation by not being open about this, as a consequence, some organizations supporting the PLHIV community end up making their own efforts to help augment the problem.

“The PLHIV community has been panicking for months now. The DOH has not been that transparent with its programs when it comes to antiretroviral medicines. The Project Red Ribbon itself has already purchased ARVs to support the community. So if there’s no problem, why is it that we are buying from other countries to supplement the problems with the stocks?” Pozzie Pinoy said.

(IN)TANGIBLE EFFORTS

PLHIV in the Philippines is protected by the Republic Act 8504 (The Philippine AIDS Law), which includes the following provisions: HIV and AIDS education in the workplace; prohibiting compulsory HIV testing; medical confidentiality; and prohibiting discriminatory acts and policies in the workplace.

But while RA 8504 may be beneficial, it is not fully functional. Truth be told, it is not even being practiced by the people who are dealing with PLHIVs.

As RT, who remains traumatized by the treatment he received at the hands of healthcare providers when he went to the clinic in Malate, is right in saying that he didn’t deserve to be judged by the people who are supposed to take care and make him feel better.

Paolo shouldn’t have suffered for three weeks because the attending physician for HIV patients in his locality was on leave.

JB could have used the time he spent traveling back and forth to Alabang to do other things.

If the government is really doing anything to improve the lives of PLHIVs, then why are there PLHIVs experiencing unnecessary distress?

In the end, as far as healthcare provision is concerned, how long must Filipino PLHIVs should wait until they see concrete efforts from this government? When will they stop questioning the decisions made affecting them, and just enjoy the supposed benefits?

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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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Remembering those who died of AIDS

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VERA Files and Yahoo Philippines | 27 May 2014

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Red-Ribbon-the-symbol-of-HIV-prevention

As of May this year, 966 Filipinos have already died of AIDS (acquired immunodeficiency syndrome) since 1984.

To remember those who had passed on because of the AIDS pandemic, members of the people living with human immunodeficiency virus (PLHIV) community and support groups, organizations and foundations held a candlelight memorial in Quezon City last May 18.

The event, spearheaded by Project Red Ribbon and the University of the Philippines (UP) Student Council, marked the annual celebration of International AIDS Candlelight Memorial (IACM).

Through the years, different organizations have hosted IACM events, to remind everyone that there is still not enough education and awareness about HIV/AIDS.

Mug-with-a-message

“IACM is all about honoring the people who passed on. We want to highlight their stories, learn from their experiences and at the same impart to everyone that there is still a growing need for education,” Pozzie Pinoy, founder of the Project Red Ribbon, explained. “We want to be more current, we want to be more dramatic this time — to make an impact and to make a commitment to the souls who had passed on that we can all be an instrument to make a change.”

Project Red Ribbon is a care management program that links advocacy groups with individuals to assist them to obtain discreet HIV testing, while also conducting awareness programs, and most importantly, provide care and support for PLHIV. It is also the only organization where 99% of the managers are PHLIVs.

“The PLHIV community wants to reach out to other organizations to show them that we are here and that we need their help. And the government should continue talking to different HIV/AIDS advocacy groups so they can hear the real problems.” Pinoy stressed.

The UP Student Council, for its part, expressed its intent to make HIV awareness more apparent.

“We want to bring the issue of HIV/AIDS here in UP, because the number of cases among the youth have been increasing continuously, and we also hope that other universities will do the same. The issue of gender and health awareness is very important, and everyone should be involved in this,” Julian Tanaka, councilor of the UP Student Council, said.

Working-together-to-enlighten-those-in-the-dark-about-HIV.Julius Elorpe, HIV program coordinator of Pilipinas Shell Foundation, said they have several HIV programs that seek to provide correct HIV information to the business sector through HIV 101 lectures. Elorpe described the programs as “the Philippine Business Sector’s response to the growing HIV/AIDS cases in the Philippines.”

“We encourage the business sectors, especially the private businesses, to have an HIV policy in the workplace… in line with RA 8504 or the HIV/AIDS law, which mandates each of the private companies to give basic information about HIV to their employees, as well as provide linkages to support HIV testing,” he said.

There is still no cure for AIDS, but over the years, the status of PLHIVs has improved because of ARVs (antiretroviral medicines) used in the treatment of HIV infection.

It has been reported that the Department of Health (DOH) has been experiencing a “delay in deliveries” of ARVs but it has kept mum on the issue to avoid unnecessary panic among the PLHIV community. Instead, the DOH has been focusing on other issues like the proposed mandatory HIV testing of those who are at risk of the disease.

“We feel that they [in the DOH] don’t listen to us. We feel that with the shortage of ARVs – they are not doing anything… and because of the delay, some PLHIVs are switching their ARVs from one to another, which is so hurtful to one’s health,” Pinoy said.

“We want transparency and open communication from our government. The PLHIV community has been panicking for the past three months now, and the DOH has not been that transparent with its programs when it comes to ARV supplies,” he added.

The Philippines is currently receiving support from the Global Fund’s Transitional Funding Mechanism to help fight HIV/AIDS, tuberculosis, and malaria.

PhilHealth, on the other hand, has come up with Outpatient HIV/AIDS Treatment (OHAT) package for persons with HIV/AIDS, which entitles them to a P30,000 insurance package every 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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Are the efforts of the Phl gov’t enough for PLHIV?

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Outrage Magazine | 26 May 2014

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HIV

“They should continue talking to different LGBT organizations and different HIV advocacy groups so they will know the real problems.”

That, in a gist, was the plea echoed during the observance of the International AIDS Candlelight Memorial (IACM) this 2014.

IACM is an annual international gathering that commemorates those who passed on because of AIDS. Over the years, it has transformed from being just a memorial to an event where people can also be educated about the HIV pandemic. It’s also a time for different organizations to pledge their support for the PLHIV community.

This year’s gathering, attended by PLHIV from all over the country, different LGBTQ organizations and foundations, was spearheaded by the Project Red Ribbon.

“We did a different twist with the memorial. We wanted to do something more current; we wanted it to be more dramatic. Over the years, other organizations have hosted the event, but it has been just mainly a memorial, and we wanted to change that. We wanted to inspire other PLHIV and the rest of the community that there is still hope and that we need to continue fighting,” said Pozzie Pinoy, founder of the Project Red Ribbon.

As of today, the Department of Health (DOH) remains unsteady when it comes to its programs for PLHIV. The resources that have been allotted to sustain the care and management of PLHIV are lacking, if not fluctuating.

This is even if – when the DOH released its March update on the number of HIV cases in the country – it showed a significant increase in the number of new HIV cases in the country. It seems like the increasing number is (still) not that alarming for the DOH, and so its efforts are (still) wanting.

The same sentiment was shared by the attendees of IACM 2014.

“I think what the government is not doing well is targeting the response to where the epidemic is and that is men who have sex with men. We still need a lot of change in terms of messaging the advocacy and the campaign,” said Benedict Bernabe, CARE officer of Yoga For Life, said.

Yoga For Life is a community-based organization that provides free yoga and meditation classes to PLHIV and to organizations who support PLHIV.

As for the student council of the University of the Philippines, the amount of information being released by the DOH is not enough.

“They should definitely do education first. Information, information, information. Awareness is the key in solving any problem. It’s always the first step in bigger things. Kapag ‘yung information dissemination became successful, we won’t be needing mandatory HIV testing. Kusang darating ang mga tao kapag alam nila kung anong information ang kailangan nila,” said Julian Tanaka, head of USC’s gender committee and councilor of USC.

And of course, there’s the issue of fluctuating supply of ARVs in the country, an issue denied by the DOH several times.

“Ang ARV supplies natin ay wala naman talagang problema. Nagkaroon lang tayo ng abnormal situation because nagkaroon lang ng miscalculations in ordering. Pero hindi nagkaroon ng shortage dahil walang pambili or walang budget. There’s no need to cause unnecessary panic among PLHIV,” Dr. Rosanna Ditangco, research chief at the Research Institute for Tropical Medicine-AIDS Research Group (RITM-ARG, one of the treatment hubs in the country), explained.

At the grassroots, though, this is not what’s coming across.

“The PLHIV community has been panicking for the past three months now. The DOH has not been that transparent with its programs when it comes to antiretroviral medicines. The Project Red Ribbon itself has already purchased ARVs to support the community, so if there’s no problem, why is it that we are buying from other countries to supplement the problems with the stocks?” Pozzie Pinoy stressed in dismay.

Specifically, Project Red Ribbon purchased four boxes of Lamivudine and Tenofovir, a two-in-one mix of the two drugs.

“We were able to release it from the Customs in just one week. So it’s easy to purchase from other countries as opposed to what other people are saying that it’s hard to release it from customs,” Pozzie Pinoy added.

And so the questions remain unanswered:
Are the efforts of the government, especially the DOH, enough to cover the needs of PLHIV?
Are they doing what they are supposed to be doing to control the spread of the virus?
Are they really all talk, with no tangible outputs?
And are they even listening to PLHIV to know what’s really lacking in their existing efforts?

“The DOH should be more transparent about what’s really happening and with their programs. And they should have a continuous dialogue with the PLHIV community before they embark on something drastic that will affect PLHIV significant,” Pozzie Pinoy said.

The IACM event ended with all the attendees gathering around the huge red ribbon cloth while they hold the commemorative candles and as they recite their pledges for the PLHIV community. It was a moment to be remembered, when members of different organizations gathered together to remember those who passed on. But it was also a reminder to everyone that there is still so much more that needs to be done.

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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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