The senile “HIV/AIDS” Law in the Philippines

12.13.2017

So I was asked to answer a key informant interview (written) and I found myself writing down some articles from the 1998 law.  I noted some sections are “limiting barriers” and a lot of the other sections as not having been implemented or enforced.

Most of us would know that the proposed amendment has passed the lower house more than a week ago, but the 2nd reading at the Senate has been postponed to January 2018.  The proposed amendment had a lot of new clauses, hence the need for a new law.

I noted some issues below on the  1998  AIDS law, Some were:

Issue Section
Enforcement RA8504 Article 1, Section 4

All teachers and instructors of said HIV/AIDS courses shall be required to undergo a seminar or training on HIV/AIDS prevention and control to be supervised by DECS, CHED and TESDA, in coordination with the Department of Health (DOH), before they are allowed to teach on the subject.

 

Limiting Barrier RA8504 Article 1, Section 4

no instruction shall be offered to minors without adequate prior consultation with parents who must agree to the thrust and content of the instruction materials.

Enforcement RA8504 Article 1, Section 5

The knowledge and capabilities of all public health workers shall be enhanced to include skills for proper information dissemination and education on HIV/AIDS.

Enforcement RA8504 Article 1, Section 6

All government and private employees, workers, managers, and supervisors, including members of the Armed Forces of the Philippines (AFP) and the Philippine National Police (PNP), shall be provided with the standardized basic information and instruction on HIV/AIDS which shall include topics on confidentiality in the workplace and attitude towards infected employees and workers. In collaboration with the Department of Health (DOH), the Secretary of the Department of Labor and Employment (DOLE) shall oversee the anti-HIV/AIDS campaign in all private companies while the Armed Forces Chief of Staff and the Director General of the PNP shall oversee the implementation of this Sec..

 

Enforcement RA8504 Article 1, Section 8

Informational aids or materials on the cause, modes of transmission, prevention, and consequences of HIV infection shall be adequately provided at all international ports of entry and exit.

 

Enforcement RA8504 Article 1, Section 9

Local government units, in collaboration with the Department of Health (DOH), shall conduct an educational and information campaign on HIV/AIDS. The provincial governor, city or municipal mayor and the barangay captain shall coordinate such campaign among concerned government agencies, non-government organizations and church-based groups.

Enforcement

 

 

 

 

 

 

RA8504 Article 1, Section 10

Information on prophylactics. – Appropriate information shall be attached to or provided with every prophylactic offered for sale or given as a donation. Such information shall be legibly printed in English and Filipino, and contain literature on the proper use of the prophylactic device or agent, its efficacy against HIV and STD infection,

 

“as well as the importance of sexual abstinence and mutual fidelity.” *Note: update needed

 

 

Limiting barrier

 

Limiting barrier

 

(Limited to tri-media(radio, tv and print); many social media claims and misleading information need to be sanctioned)

RA8504 Article 1, Section 11

Penalties for misleading information– Misinformation on HIV/AIDS prevention and control through false and misleading advertising and claims in any of the tri-media or the promotional marketing of drugs, devices, agents or procedures without prior approval from the Department of Health

 

 

Limiting barrier

Enforcement

 

(No known guidelines have been issued specially on surgery. “Universal precautions” have always been used but no specific guidelines have been issues to shut down issues on mandatory pre-surgery testing)

RA8504 Article 2, Section 13

The Department of Health (DOH), in consultation and in coordination with concerned professional organizations and hospital associations, shall issue guidelines on precautions against HIV transmission during surgical, dental, embalming, tattooing or similar procedures. The DOH shall likewise issue guidelines on the handling and disposition of cadavers, body fluids or wastes of persons known or believed to be HIV-positive.

 

Enforcement

 

Example:  Philippine Airlines, KCC mall Zamboanga

RA8504 Article 3 Section 13

Compulsory HIV testing as a precondition to employment, admission to educational institutions, the exercise of freedom of abode, entry or continued stay in the country, or the right to travel, the provision of medical service or any other kind of service, or the continued enjoyment of said undertakings shall be deemed unlawful.

 

Enforcement

 

 No QA set for counselors who finished the counsellor’s training. No Client KII, no any form of quali check is in place, or have been reported

RA8504 Article 3 Section 20

 

Pre-test and post-test counselling. – All testing centers, clinics, or laboratories which perform any HIV test shall be required to provide and conduct free pre-test counselling and post-test counselling for persons who avail of their HIV/AIDS testing services. However, such counselling services must be provided only by persons who meet the standards set by the DOH.

 

Enforcement

A lot of cities still don’t have partner CSOs to intensify community-based services (i.e., Malabon, Navotas, Valenzuela, Paranaque, etc)

 

RA8504 Article 4 Section 23

Local government units, in coordination and in cooperation with concerned government agencies, non-government organizations, persons with HIV/AIDS and groups most at risk of HIV infection shall provide community-based HIV/AIDS prevention and care services.

 
Enforcement

 

Where’s the study? Is this in reference to the OHAT?

RA8504 Article 4 Section 26

 

The Secretary of Health, in cooperation with the Commissioner of the Insurance Commission and other public and private insurance agencies, shall conduct a study on the feasibility and viability of setting up a package of insurance benefits and, should such study warrant it, implement an insurance coverage program for persons with HIV. The study shall be guided by the principle that access to health insurance is part of an individual’s right to health and is the responsibility of the State and of society as a whole.

(NON-RA8504 RELATED)

Enforcement

While the insurance commission has come out with a general order to cover PLHIVs for life insurance, no specific implementations have been rolled out at the insurance company-levels.

 

Insurance commission circular order 2017-11

GUIDELINES IN THE LIFE UNDERWRITING OF APPLICANTS WITH ACTUAL, PERCEIVED OR SUSPECTED TO BE WITH HUMAN TMMUNODEFICIENCY VIRUS (HIV)

Here:  https://www.insurance.gov.ph/wp-content/uploads/2017/07/CL2017_11.pdf

 

 

Limiting Barrier

*I do not know where the proxy consent stands on the release of the results for minors

RA8504Article 6 Section 32

Section 32. Release of HIV/AIDS test results. – All results of HIV/AIDS testing shall be confidential and shall be released only to the following persons:

(b) either parent of a minor child who has been tested;

Enforcement  

RA8504 Article 7 Section 39

 

I am almost sure that the Philippine National AIDS Council is aware of these.  So…. let me end this with another “Oh well….”

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July to August 2017, HIV AIDS REGISTRY OF THE PHILIPPINES

11.27.2017

There was a delay in the national report for the HIV / AIDS registry, so here you go

Some “notable noted” points were:

  • 1962 new cases for July to August, 2017. No, that’s not my birth year =)
  • That brings us to 7,363 year-to-date total number of cases
  • 250/1962 were reported as AIDS cases, either diagnosed with OI or CD4 lower than 200 ( and maybe both)
  • 89 females /1962 new cases
  • 512 (28.3%) of the 1810 males reported having sex with both males and females
  • 118 reported deaths for the two months mentioned
  • 610 cases from our young key population (15 to 24).  Majority came from the 25 to 34 range (1,009 cases)
  • 18 pregnant women were reported to have been confirmed with HIV
  • 27% came from the National Capital Region, followed by Region 4A (18%), 2nd runner is Miss Jamaica, I mean, Region 3 with 7% of the 1962 cases
  • August actually had 1104 of the 1962 cases.  This is again, a new record high for the Philippines
  • A total of 98 adolescent cases (10-19 yo) were reported of the 1962 new cases. 96 of 98 cases were sexually transmitted.
  • There were 7 children aged 10 years and below, all mother-to-child or vertical transmission.
  • 8% or 154 cases were reported as overseas foreign workers (OFWs)

Here’s a copy:    HARP July to August 2017

FOR COMMUNITY-BASED HIV SCREENING, PLEASE MESSAGE US AT FACEBOOK.COM/HASHPilipinas or send an SMS to 0927-806-REDx (8669)

 

 

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It’s Not Right, But It’s Okay

11.03.2017

You committed to attend to a patient, and then you didn’t show up. You’re a volunteer and people don’t pay you to do these things. It’s not right, but it’s okay

You attended a training class, and then you didn’t use your skills to serve the community.  You’re a volunteer and people don’t pay you to do these things. It’s not right, but it’s okay

You intentionally bash other programs to promote your own projects.  It’s a free country.   It’s not right, but it’s okay

You make up stories to make yourself more popular online.  It’s not right, but it’s okay

You dated someone and led him on for weeks, months even– only to let him go because you cannot disclose your HIV status.  You have your reasons.  Personal, but it’s your life. It’s not right, but it’s okay

You bash people online.  It’s your account,  you say it’s your prerogative.  Fine.  It’s not right, but it’s okay, I guess

Mind you, shit happens.

It’s not right, but it’s okay.

 

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Rainbows

10.11.2017

While counseling a new CBS reactive client, these came out. 

It’s a sign, a promise. 

I have a feeling you’re going to be fine.

He said, “I will be. I have to be. I need to be.
#fortilocandia

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Turn Time Back

10.10.2017

Ever thought of turning back time?

Maybe lingered in that one long unending moment of pain?

Or lived in the past where things were a lot better?

Instead of making the most of the time you have.

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An overnight at Gigantes

07.09.2017

We got to the first island (Balagon Island) at around 1130am yesterday. Boom! A girl friend got stung by a big jelly fish. We were frightened that we had to bring her over to the nearest island where an e.r. is set up, we didn’t had to. She didn’t waste a tear and manned up. She was involuntarily trembling but yeah, she was fine after a few hours.

Lunch was served at MJ’S in the Island of Gigantes where we were checked in. We were served grilled scallops and pork with monggo beans. 

It was a pleasant lunch although the flies around us were bothersome. We ate at a cottage outside the resort. 

Around 2, we went on to 4 other islands.  Tanque island where a seawater lagoon was located in the middle of the island. Unfortunately, the water (tide) was not high enough to reach the lagoon. We went on to Cabugao island where we went up around a 30ft high hand-made stairs by the side of a mountain—to take pictures. After Cabugao, Bantigui sand bar but the tides covered the sand bar. We proceded to antonia beach but there wasnt much to do there, we transferred to Puting baybay (white shores) but the boat stayed around 20-30 meters away from the shore, the group just jumped into the water and tried to enjoy, of course everyone was paranoid about a possible jelly fish invasion.

(Top pic taken at the tanke saltwater lagoon. Bottom pic from Bantigui)

Last island was Puting baybay Where as always, I was able to get a good shot of the sunset. 

We got back to MJ’s before 6. Dinner was served.  Crabs were fresh and meaty. The stir fried squid was a tad overcooked but well seasoned.

We got up around 6am for breakfast. Hotdogs, Scallops adobo and Rice.  Nothing fancy but good enough to start a day off. We headed back out to Tanque island and the lagoon was nice, t’was a bit high tide and the place was filled with water. We also went back to the sand bar where the sand lined the sea, as if a 4-6feet wide (100-200 meters long) sand was floating in the middle of the sea.

Back at MJ’s at 1130sh for lunch. We were served Chicken Binakol and Breaded scallops (unfortunately the locals didn’t had tartar sauce dips).  It would have been a nice lunch had it not for the flies. 

We left around 130 for a 40min boat ride back to the port.  Before we left, I approached the TG supervisor and gave my card, told her if she has time, come over to ilo-ilo for HIV testing. She was interested and I felt guilty because I opted not to offer HIV screening the night before–knowing I had a few kits with me (and the ghost of laziness took over me)

MJ’s offered unlimited soda and coffee, staff were nice and cute kids helped serve food and clear table.  We paid 1,699php (around 34dollars) per head for the entire island hop package, boat rides, accommodation and food. Not bad. 

The islands were nothing special. The water was better, clearer at Bohol.  Food was good, but better in places like Cebu and Boracay.  People were definitely friendly. Boatmen were funny. 

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A Hell of a Day

09.07.2017

Septembet 6. 10am. Went to Antipolo to see a client, diagnosed 2015 but he never sought treatment.  We talked, talked, had lunch, and talked some more.

4pm. Went back to Quezon City,  further north of the city, to see a client diagnosed 4-5months ago and has been symptomatic for the past two months. We talked, talked, talked, had dinner, and then talked some more.

Between  10am and 7, I had to make several stops to respond to emails, take and make calls, and reply to text messages.

Got home around 830pm,  and someone wanted to get tested. I wanted to reschedule but he’s very anxious so I said yes. He said we can meet around midnight. I told myself, “rest, baby!”

11pm, I got an endorsement for another client for screening, drove out to his place 10 minutes away.  And then off to my midnight schedule who arrived late 130am.  

215am. I was on the way home and a call came in. “DON’T ANSWER THE EFFING PHONE!” I told myself, but after three missed calls, I parked and called back. Another lost to follow up from last 2016, wanting to seek treatment.

3am. I craved for some burger machine only to stand in queue for 15minutes, and I decided to drive thru Jollibee.  I asked the cashier if the burger I wanted was available, she said yes.  After taking my cash, she went like, “Sir, 5 minutes, ok lang?”. I took a deep breath and said, “Yes.” with a smile (YES!!!!! WITH A SMILE). I went on to the next window and the next girl handed me my soda,  fries and then, “Sir, 10minutes….”  

I was like, the girl said 5minutes.

She said, “ay, OK, 5minutes”

And from behind, the guy shouted, “Out!” 

And the girl told me, “ok na, sir”

340am. I had my Amazing Aloha- a quarter pounder with bacon and pineapple. 

Yes…saved. The long day was was all worth it. 

Now, who will debrief me?

Thanks to Grey’s Anatomy and The Catch,  and my Amazing Aloha Burger, I’m okay. And as Dr. Derek Shepherd said…

It’s a beautiful day to save lives.

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Latest Health Dep’t Order Moves Us Forward

09.22.2017

We have for so long been waiting for this to come out.  Finally, a week ago, the Department of Health signed an administrative order (2017-009) with the subject:

Policies and Guidelines  in the Conduct of HIV Testing Services in Health Facilities

Click here for the file:2017 DOH_AO_2017-0019

Some highlights of particular interest to the community are:

  • Community-based HIV screening is defined as “Non-laboratory  rapid HIV screening procedure done outside a health facility by a trained member of community-based organizations or groups”
  • ALL pregnant women and confirmed TB Patients will be routinely offered HIV testing
  • Community-based HIV screening…”shall be offered to key populations. Trained and supervised lay providers can independently conduct safe and effective HIV screening using rapid diagnostic kits.”
  • Health care workers (doctors, nurses, medical technologists, midwives) are allowed to perform the procedure (in reference to HIV screening, section VI.B)
  • rHIVda or Rapid HIV diagnostic algorithm is in the same document.  This essentially addresses the 3 weeks (or more) of waiting time for patients who got tested reactive awaiting treatment.   Of course,  clients may be link to care without the confirmatory in  accordance to  Section VI.F (Connection to care) with reference to the Department Circular  2016-0171.

So what does this mean?

It doesn’t mean shit if our social hygiene and health offices won’t respect the order from the Secretary.   It means the world for the hard-to-reach community finally with options to access screening at the comfort of their own home, or car, or shop, or wherever.

It means more and more people can access HIV screening, especially those who don’t want to go to clinics.

It means more and more organizations get to engage in the program. It also means more capacity building is needed.

It means someone has to mapped municipalities and cities without HIV testing services since ALL TB patients and pregnant women will have to be suggested to undergo HIV screening.

It means midwives, especially the private ones,  will and can have the ability to do screening to reach more women.

It means the community will have to partner with their local units.

It means the local government will have to partner with the community counterparts for community based screening to happen, and to be successful.

It means more investments around training and quality assurance.

It means a lot, lot more beyond this page.

Above all, it means saving more lives.

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When Pozzies Gather

 

09.13.2017

A few nights ago, we had the pleasure of meeting a few members of the positive community in Cebu.  It was a  fun night. We were laughing and @cebur14m was particularly funny.  Stories were shared.  Laughter filled the hallway where we were seated.

cebupz

me, standing at the back (sorry for the icons). Others in the pic: 

 

 

Serious moments were inevitable.   Issues were shared. The lack, or absence, of CD4 for some time now, and viral load.  The death of a someone at the shelter. The condition at the shelter.  Sharing about Philhealth came up. Information about baseline labs were asked.

Then the goddess of fun cast a spell yet again. Jokes flew across the room, er, the table.  It was a fun night.

It was a good support group. A real support talk. With peers. By peers. No resource speaker. No trainer. No hidden agenda.  A talk over coffee not driven by any funding agency. No minutes of the meeting. No documentation.

T’was a nice evening.

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Wil’s Road That Kept Winding

09.13.2017

road

CD4 = 5

You first came to me asking for help, you skipped treatment and wanted to come back for your ARVs.  I referred you to Ed. It took sometime before you eventually did.

CD = 3

You came back and this time, your condition was worse. You were given the basic labs and was found to have CMV, your left eye was going blind.  You were thin.  Very thin.

CMV Bout

You had to process PCSO assistance to secure your CMV meds since they cost a lot, too much even for a middle class citizen.  But you were unable to sustain the efforts of going to the charity office to secure assistance, you were on and off with your valcyte.

Cebu

We eventually decided to bring you to Cebu, where gancyclovir would be more available and where you can be housed temporarily in a shelter, for free.  We raised money for your plane ticket.  It took more than a month before you had your first gancy, and then your succeeding gancy.  But shortage came, and you had to stop.  The plan with your sister was to bring you back to Manila for treatment, again.

Silence

We never heard from your sister.   Until a few days ago when we were in Cebu with a group of pozzies and they mentioned you in passing. We were surprised.  They said you were gone. They said you died.  In disbelief, Ed checked the facebook posts of your sister. And yeah, you’re gone.  You left last June. It’s been three months. You left.

Memories

As with the others, you are now just a memory. “Just”.  It’s sad,  Do people even remember you?  Like when you attended the rooftop (er, a.k.a. penthouse) gathering where I thought you were doing better. Like when you came to Quezon City to get some money for fundoscopy.  Like whenever you would come in to the clinic for your labs, or refills.  Like when you used to work before your body came down with complication.  Do people still remember you?

Questions

I was left with questions:

  • Why was it too difficult to secure PCSO assistance especially for someone with no family to help him out, and who’s physically challenged to go through the queue at 3 in the morning?
  • Was I wrong to send you to Cebu thinking you would get the much needed treatment and attention there?
  • Was I wrong to send you to Cebu having heard that the shelter was depressing and sad for people who lived there?
  • Was I wrong to assume you were doing okay?
  • Do you hate me?

Answers

  1. Your never-ending winding road ended. You’re okay now. Better than ever.
  2. I’m sorry.

 

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