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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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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DOH: HIV virus infects 16 Filipinos every day

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VERA Files and Yahoo Philippines | 10 May 2014

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HIV-on-the-riseCases of HIV (human immunodeficiency virus) infection continue to rise in the Philippines.

Data from Department of Health (DOH) shows that HIV is now infecting 16 Filipinos every day, up from last year’s average of seven new patients daily.

Latest DOH data showed that 498 new cases were reported in March this year — the highest recorded in a month since the DOH started tracking HIV cases in the country in 1984.

Of this number, 380 involved MSMs (men who have sex with men); 54 were contracted because of drug use (through injecting); 63 were OFWs (overseas Filipino workers) who had unprotected sex; and one case of mother-to-child transmission.

Since January this year, 1,432 HIV cases have been recorded, 146 of which developed into full-blown AIDS (Acquired Immune Deficiency Syndrome) and 434 resulted in death.

The DOH also listed the most prevalent areas in the Philippines where new HIV cases were reported: the National Capital Region, Central Luzon, Southern Luzon, Cebu and Davao.

Assistant Health Secretary Eric Tayag said that the DOH is working closely with local governments to help address the problem. He added that the numbers may continue to rise in the coming months since not all persons at risk “are responsible enough” to get themselves tested and that based on their projections, there are still many undetected cases.

“We have continuously informed the public about this, and we are also reminding everyone that they need to be extra careful and conscious about their health,” Tayag said. “We are also appealing to those who are at risk to get themselves tested immediately.”

Those who get infected with the HIV virus remain asymptomatic up to 10 years. They will only have flu-like symptoms which would later disappear.

If an infected person continues to practice a reckless and unhealthy lifestyle, it won’t be long before the virus matures into AIDS and complications would start to manifest. It would be harder for this patient to recover and respond to medications.

The Philippines is currently using the traditional confirmatory test, called the Western blot, to detect if the HIV virus is present in the blood.

If the initial blood test (which is normally done in a hospital or laboratory) turns positive, the result will then be forwarded to the DOH for confirmatory tests. It normally takes 15 to 30 days before the DOH releases its findings and confirmations.

Health Secretary Enrique Ona said the department is exploring the possibility of making the process faster by making rapid HIV test kits available.

“The only problem we see with this rapid testing is that anyone can have it, just like the pregnancy test kits,” Tayag said. “We won’t be able to properly monitor the numbers. The people who will buy these kits will not be counselled by peer educators before they take tests, just like what the hospitals are doing and HIV/AIDS counselling is essential so you’ll know what to do.”

DOH-Assistant-Secretary-Eric-TayagAlthough in recent months the number of people who voluntarily took the test has increased, there is still a great number of people at risk who are not making the effort to know what their status is.

“Secretary Ona would want to shift from voluntary testing to something that’s compulsory,” Tayag said. “We’re working out the details and how this is possible. We want health providers to screen adults who may have a risk for HIV so that they can be properly counselled on what to do next.”

He continued: “In the Philippines, HIV testing is not done like how they’re doing it in other countries. Only some get themselves tested. The only way it can be done is when it is being offered, especially to people who are at risk.”

PLWHAs (persons living with HIV and AIDS) are currently protected by Republic Act 8504, or the Philippines AIDS Prevention and Control Act. All government agencies, medical institutions and individuals are mandated to keep all information regarding PLWHAs confidential. A person or institution found violating this law faces penalties that include imprisonment from two months to four years, and revocation of their licenses and permits.

There is still no permanent cure for HIV and AIDS, but there are ARVs (antiretroviral drugs) available to help slow down the growth and spread of the virus.

The Philippine government is providing free access to ARVs to PLWHAs. PhilHealth allots P30,000 per year for its PLWHA members to cover diagnostics, medications and other hospital needs.

“Some people may think that it’s [sort of] okay to have HIV since the government is giving free medications and that these medications will prolong their lives,” Tayag observed. “Don’t ever think that because for these medications to work, you have to religiously take them for life… all of these have side effects if you do not adhere to the correct ways of how to take them.”

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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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DOH eyes to make HIV testing mandatory

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Outrage Magazine | 07 May 2014

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Confronting-HIV

As the Department of Health (DOH) issued the latest data on the number of HIV and AIDS cases in the Philippines, DOH Assistant Sec. Eric Tayag said in an interview by ANC that the government agency is working out details for making HIV tests compulsory.

This is because although, in recent months the number of people who have been responsibly taking the test to know their status have increased, there reportedly remains a great number of people at risk who are not making the effort to know their status.

“(DOH Sec. Enrique) Ona would want to shift from voluntary testing to something that’s compulsory. We’re working out the details, how this is possible, and all. 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 said.

As per DOH data, in March 2014, there were 498 new HIV cases recorded, a 35% rise from the same month last year.  Specifically, 381 of the 498 cases were men who have sex with men (MSM), 54 were because of drug use (through injecting), 63 were overseas Filipino workers (OFWs) who had unprotected sexual relations, and one case was from a mother-to-child transmission. Since January 2014, there were already 1,432 cases that have been recorded; 146 of which developed to full blown AIDS, and 434 resulted in death.

“We have been reminding everyone since last year to be more careful and conscious about their health. It won’t be long until we reach the all-time high of 500 new cases,” Tayag said. “We’re also appealing to those who are at risk to get themselves tested, and that’s just the tip of the iceberg.”

He added that the numbers may continue to rise in the coming months, since not everyone at risk are that “responsible enough” to get themselves tested.  Also, based on their projections, “there are still many who are still undetected.”

WHAT THE LAW SAYS

Making HIV testing compulsory is actually a violation of the existing law concerning HIV and AIDS in the Philippines.

Section 3: Declaration of Policies of the Republic Act No. 8504 (or “Philippine AIDS Prevention and Control Act of 1998″) specifically states that “compulsory HIV testing shall be considered unlawful”.

In a statement, the Network to Stop AIDS (NSAP) lambasted the DOH proposal to enforce mandatory HIV testing, saying that it “demonstrates that among those involved in addressing the HIV epidemic in the Philippines, the health agency is by far the most backward and the most out-of-tune.”

Added NSAP: “The current legal framework allows for various modes of HIV testing, but they have to be voluntary and confidential. This is clearly rights-based, but this is also premised on existing evidence that coercive modes of HIV testing actually result in a decrease in the coverage of testing – those who need to get tested fear discrimination and abuse, so they hide underground once authorities require HIV testing. This fear is not unfounded, as HIV-related stigma and discrimination remain unaddressed in the Philippines. Imposing compulsory testing is operationally problematic (also unnecessarily costly) and it encourages human rights abuses.”

This was seconded by Michael David C. Tan, editor of Outrage Magazine, the only lesbian, gay, bisexual, transgender and queer (LGBTQ) publication in the Philippines, which also conducts HIV-related projects.  He stated that forcing people to get tested will not deal with the spread of HIV, and could – in fact – only worsen the situation. “‘Witch hunt’ easily comes to mind,” he said, “particularly since the idea of having compulsory testing will specifically target populations that are deemed at higher risk for HIV infection. By saying ‘compulsory’, we actually only aim at making specific groups of people get tested; as such, we’re abetting in the unnecessary stigmatization of members of these groups.”

Members of the LGBTQ community (particularly men who have sex with men, including gay and bisexual men), overseas Filipino workers (OFWs), and those working in the business process outsourcing (BPO) industry should be wary, said Tan, because they are “only some of the people who have been stigmatized to be at higher risk for HIV infection at certain points in time.  Their plights could only worsen with making HIV testing mandatory.”

NSAP also added: “Even DOH possesses evidence that show the complexity of Filipino sexual 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 community. By definition, this sexual behavior includes any man who engaged or engages in sexual acts with other men – the heterosexual partners of transgender people; those who do not consider themselves as gay but engages in sex with other men; even the heterosexual ex-congressman whose life story was featured in a TV show a few years ago where he admitted to engage in transactional sex with a ‘bakla to support his schooling. Would DOH require all of them to get tested? The agency is also in possession of data that shows that a significant portion of men who have sex with men and transgender people have female sexual partners – would they be required to get tested, too?”

BETTER RESPONSES

Tan believes that the current responses of the government remains lacking, which – in turn – affects the continuing fear of HIV.

“In (HIV) advocacy, we say that no one should die from HIV anymore at this time and age because treatment is available, and the disease can already be managed,” he said.  “But working at the grassroots, among HIV-related issues we’ve come across include the shortage of the antiretroviral (ARV) medicines in the Philippines, employment-related discrimination encountered by people living with HIV (PLHIV), and cases when PLHIV are kicked out of their homes after family members find out their HIV-positive status. You can’t even ensure that PLHIV live just as good a life as non-reactive people, and you expect them not to be fearful?”

Tan added that “if services are bettered, then no forcing needs to be done.  HIV, after all, is not just a health concern, but a complex social issue.  Deal with the connecting issues, too. That’s the only way for people to know for sure that there is nothing to fear.”

The DOH is supposedly also exploring the possibility of making the testing process faster by acquiring rapid HIV test kits.

“The only problem we see with this rapid testing is that anyone can have it, just like the pregnancy test kits in the drug stores, (and) we cannot properly monitor the numbers. The people who will buy these kits will not be counseled by peer educators before they take tests, just like what the hospitals are doing, and HIV/AIDS counseling is essential so you’ll know what to do,” Tayag said.

He added that “in the Philippines, HIV testing is not done like how they’re doing it in other countries, (so) only few people get themselves tested. The only way it can be done is when it is being offered, especially to people who are at risk. But if the person still refuses to take the test after it was offered, it will not be forced to them.”

Tayag said that the DOH is already working with local governments to address high HIV cases in several areas in the Philippines, including in the National Capital Region, Southern Luzon, Central Luzon, Cebu, and Davao, to double their efforts to lessen the continuous growth of the people who get infected.

“The only sure way to protect yourself from getting HIV is abstinence, but who can really abstain for so long? So the next effective way to protect yourself is to use condoms. Sec. Ona wants to push for more efforts when it comes to HIV, and we have to do our part so we can ensure the success of the plans,” Tayag said.

WORK TOGETHER

For NSAP, there are alternatives to compulsory testing, including community-led HIV testing. In fact, in the last years, collaboration between community groups and government-run HIV testing facilities has intensified, accounting for the increase in the uptake on HIV testing.

“A recently conducted review by international and local HIV experts of existing HIV interventions being implemented in the Philippines has cited this model as an effective approach in a concentrated epidemic. Incidentally, the same review, which was already accepted by the Philippine National AIDS Council (PNAC) that Sec. Ona himself chairs, has already warned authorities against coercive HIV measures, including mandatory testing,” NSAP stated.  “Yet Sec. Ona seems to be blind to what the situation is, what the evidence says, and what needs to be done. It’s not a question of knowledge or awareness – he has had several interactions and dialogues with community groups where various issues were discussed, from stigma to gaps in testing and other services. But he refuses to listen.”

Outrage Magazine‘s Tan calls for the government to “focus, really focus on your services – what you should be doing to better what are currently being offered,” Tan said. “Because the continuing worsening situation only highlights that the existing efforts are currently wanting.  We need long-term human rights-based solutions to a huge problem that will just continue to worsen right under our noses if we continue having only knee-jerk reactions.”

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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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Project Red Ribbon: Responding to a growing need

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Outrage Magazine | 04 December 2013

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Project Red Ribbon logoIt started as a blog in 2011. with the author calling the Website Living with HIV in the Philippines.  And its first article, I Have AIDS!, told the story of Pozzie Pinoy, the HIV-positive advocate behind the blog, where he narrated how he overcame this ordeal when he was diagnosed with bilateral pneumonia and was tested HIV-positive.

And so this also served as the foreword of the Website, a precursor of what the readers should expect in its posts.

“The intention of the blog is to give information about HIV and AIDS in the Philippines. It aims to provide information about the importance of prevention, early detection through HIV testing, and treatment of HIV and opportunistic infections. It provides a venue for social interactions and discussions about the disease,” Pozzie Pinoy said.

In its two years run, Living with HIV in the Philippines has served as a go-to of some sort for many, responding to questions and inquiries from its readers with the help of Dr. Rosanna Ditangco of the Research Institute for Tropical Medicine (RITM).

The blog now also serves as a channel in promoting current events and trainings for the benefit of the general population.

Eventually, Pozzie Pinoy also started The Love Fund, an attempt to provide indigent people living with HIV (PLHIV) with medical assistance for laboratory tests and treatment.

Eventually, too, with the continuing success of Living with HIV in the PhilippinesPozzie Pinoystarted other efforts for the benefit of PLHIV – particularly, Project Red Ribbon.

“The blog became an area for us to answer questions, but we felt the need to establish other programs that can help and support PLHIV. And since there’s no care management program in the Philippines, we established the Red Ribbon,” Pozzie Pinoy explained.

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.

“What we do in Red Ribbon is we deal with PLHIV directly. We have support groups, we have outreach programs, online support group talks where PLHIVs gather to share their stories and their journey with each other,” Pozzie Pinoy said.

Compared to other organizations that have efforts for PLHIV, Project Red Ribbon “focuses solely on supporting PLHIV.” Notably, “99% of our managers are PLHIVs, so we know our concerns, we know our needs, we know our problems. We can support other PLHIVs properly,” Pozzie Pinoy stressed.

Project Red Ribbon also organizes: monthly outreach programs – where they visit different treatment hubs to educate new PLHIVs and give inspirational advice; monthly support group gathering; sportsfest; and outings, among others.

And as Pozzie Pinoy said many times over on his Website and during his talks: “No PLHIV is alone with his or her struggle with HIV! We are all in this together!”

For more information, visit http://pozziepinoy.blogspot.com/ or email Pozzie Pinoy at pozziepinoy@yahoo.com.

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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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