Suspension of Disbelief

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PhilHealth benefit package for people with HIV under review

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VERA Files | 01 December 2015

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PhilHealth HIV - ARV Bottles

ARV Bottles

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

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

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

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

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

DOH National Epidemiology Center

DOH National Epidemiology Center

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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PhilHealth clarifies OHAT coverage

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Outrage Magazine | 29 August 2015

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

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

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

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

READING THROUGH

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

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

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

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

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

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

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

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

ACTUAL COVERAGE

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

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

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

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

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

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

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

PROPER MANAGEMENT

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

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

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

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

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

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

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

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

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

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

WAY FORWARD

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

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

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

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

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

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

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

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

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

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PLHIVs ask PhilHealth to reconsider HIV response

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Outrage Magazine | 14 August 2015

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

PhilHealth-on-San-Lazaro1

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

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

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

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

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

CONFUSING DISPARITY

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

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

PhilHealth-on-San-Lazaro3

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

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

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

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

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

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

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

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

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

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

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

RAISE THE ISSUE

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

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

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

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

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

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

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

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

*NAME CHANGED TO PROTECT THE PRIVACY OF THE INTERVIEWEE

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

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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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Paolo: Being HIV-positive as a personal struggle

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Outrage Magazine | 25 May 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.

POZ2

He was standing on the balcony of one of the coffee shops in Tomas Morato, puffing his cigarette before he spotted, and then waved at me.

“Hi, I’m Paolo, patient H42007XXX*,” he said to me when we were face to face, introducing himself as he reached for my hand.

Several weeks back, I received an email from an unfamiliar sender, asking if I wanted to write about the “real deal of being a PLHIV in the Philippines”. Having written about the issues facing the HIV community in the Philippines, including the ARV stockout, this was not exactly uncommon.  Outrage Magazine also has a campaign – “More than a number” – that aims to give a human face to those affected by HIV.  But the following day, the same sender sent another email; and this time, it seemed more… convincing.

Dear Mr. Pascual,

I came across your contact details while browsing Outrage Magazine.

I am reaching out to you for an interview. I want to give firsthand details and experiences on what it’s like to be a PLHIV. I want to share my perspective. We can set a meeting so you can listen to my story.

Don’t get me wrong, I’m not asking anything in return, I just want to share what I know and what I have been to in the last eight years; probably, to help and inspire other PLHIVs and to educate members of the LGBT community.

Hoping for your favorable reply.

Regards,

Patient H42007XXX

WAKE-UP CALL

“I remember the time when I found out that I am HIV-positive. It was the summer of 2007. My friends and I usually get ourselves tested every six months because of the kind of lifestyle we were practicing,” Paolo recalled.

Before being diagnosed, he spent most of his nights in different LGBT places in the metro, including clubs and bathhouses. He admitted to partying, drinking, and taking recreational drugs like there was no tomorrow.

He did go to “San Lazaro to register and submit my test results. I felt that it was the right thing to do,” he said.  Paolo also admitted his status to his closest friends, even if kept it from his family.

Even after he tested positive, Paolo’s lifestyle remained as wild as usual.  “I was out every night. Because whenever I’m sober, when I’m alone and the surrounding is quiet, that’s when depression kicks in. Yes, I’m okay. Yes, I already accepted my status. But, things are not that easy. I always need a distraction to take my mind off things,” Paolo said.

After his few initial visits to the treatment hub, he stopped going for four years and only returned in early 2011, when one of his friends also tested positive and asked for his help.

“My CD4 count at that time (in 2007) was 582; it was high enough. But when I went back to the hospital in 2011, it was already 327. I was really worried,” Paolo said.

STARTING TREATMENT

When his CD4 count reached that level, he was advised by the doctors to start taking antiretroviral medications.

Paolo was willing to start the trial period of the treatment, but one of the hub’s policies at that time was for a patient to have a treatment partner before they allow and give them the medicines.

“I have no one to ask,” Paolo said.

He was living on his own that time.

“And although my friends knew my status, I didn’t want them to go through the endeavor I was going through,” he recalled.

So he convinced the doctors to allow him to start the treatment on his own and assured them that he would comply with all the requirements of the hub.  Paolo was made to sign a waiver, indicating that whatever happened to him, the treatment hub or attending doctors will not be held liable.

“I was given two weeks’ worth of Lamivudine/Zidovudine and Nevirapine. The doctors also gave me a list of allergy-causing food and was asked to avoid them for three months,” Paolo said.

During the first few days of intake, Paolo started feeling pain and was feverish.

“The doctors explained the possible initial side effects of the ARVs; but to actually feel it first hand, it was like hell. Two days in, my whole body was in pain. My fever was rising every day. I wasn’t allowed to take Paracetamol. I wanted to stop taking the medications, but I know it wouldn’t do any good,” Paolo said.

He lost almost 30 lbs after one week. His fever played from 39°C to 43°C, and patches of red marks also started to appear in different parts of his body.

“I was very weak. I called the treatment hub and told them about my condition. I was asked not to stop taking the ARV meds and finish the two-week trial. But before I was able to reach the 14thday, I was experiencing unbearable headaches and muscle pain, it felt like I was going to die,” he said.

The first thing the following day, he went to the hub and waited for the doctor.

He was injected with a high dose of Iterax.

“That morning, the antihistamine that was given to me was really strong. I took the train on my way home. It was really difficult. It was a mix of headache, nausea, and muscle pain,” Paolo recalled.

After one week, he was asked to go back to the hub. He was given another set of ARVs.

“Good thing they shifted my medication to Efavirenz. Even if I feel groggy every time I take it, it’s more tolerable than Nevirapine,” he added.

FEELING LOW

“I remember when I lost weight and when red patches started to appear on my skin, I felt so low. I couldn’t see myself anymore. I wore a jacket all the time so people would not see how ugly I WAS becoming,” Paolo said.

He was also making every possible effort to act and look normal at work, even if it was close to impossible.

“In the office, I was always blank and not functioning normally. Some of my officemates even started teasing me when they noticed the red patches on my skin. I felt really down, I almost felt suicidal,” he said.

Though his friends communicated with him everyday to check his condition, for Paolo, it was not enough.

“Even if I have friends who were there for me, the feeling was so impalpable. It was unexplainable. No one can really gauge what PLHIVs feel except themselves. At the end of the day, after you separate with the people who listen to you, the depressions would start to kick in. And every time I’m alone in my room, that’s when the tears start to fall – not because I have HIV, but the struggle I experience everyday in dealing with this,” Paolo shared.

He also joined different organizations that cater to the needs and welfare of PLHIV, but that didn’t help him either.

“Those support groups, yes, they’re doing a superb job, no doubt about that. But in reality, it’s not them who can and will help you because they don’t really know what you’re feeling, HIV is really a personal thing. Support groups… I have been involved with three of them, and they have not really offered enough support particularly when you’re experiencing a chronic type of depression. Sometimes, crying all by yourself while you’re drunk is better than repeating your story over and over again to a group of people,” Paolo ended.

*EXACT PATIENT CODE WAS REMOVED AS REQUESTED BY THE INTERVIEWEE TO PROTECT HIS 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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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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