"What is happening to Persons Living With HIV as the pandemic continues to ravage our land?"
The COVID-19 pandemic has had a profound effect on our way of life. We have had friends, acquaintances or even family members infected with the virus. Many have lost their jobs or scaled down their business. Schools have shifted to online classes. Hospitals have been overwhelmed.
But there are less obvious or pronounced effects of the pandemic on specific sectors of the population. One of these sectors is the PLHIV – People Living with HIV – community.
Prior to the pandemic, the HIV-AIDS problem in the Philippines had been getting worse. The number of new infections per year had been steadily increasing, from 4,300 in 2010 (almost 12 per day), 10,500 in 2016 (almost 29 per day), 12,300 new cases in 2017 (almost 34 per day), 13,900 in 2018 (almost 38 per day) and 15,200 in 2019 (almost 42 per day), according to information from the Department of Health’s Epidemiology Bureau.
This growing number is a double-edged sword, according to Danvic Rosadiño of Love Yourself, a Mandaluyong-based organization composed of volunteers helping PLHIV. “It’s a testament that numbers are increasing, but it may also be attributed to the increased availability of testing provided by the government and other community-based organizations.”
Treatment in the form of anti-retroviral drugs, provided free by the government, is now available. The ARV, however, is not like ordinary medication one can purchase from one’s friendly neighborhood drugstore. Because of the sensitive nature of the illness, the medicine has to be obtained through a discreet delivery network often facilitated by volunteer groups.
The Philippines has set a 90-90-90 target to combat HIV. According to UNAIDS executive director Winnie Byanyima, in a Zoom interview in May, this means that 90 percent of people who have HIV should know their status, 90 percent of those living with HIV should be on treatment, and 90 percent of those on treatment should be virally suppressed – meaning, the virus cannot anymore be seen in their blood, therefore making them unable to transmit it further. At the end of 2019, the Philippines was a long way from the 90-90-90 target.
And then, without warning, COVID-19 came to our shores.
Falling numbers, same risky behavior
Recent DOH data showed that because of mobility restrictions imposed to contain the spread of COVID-19, the number of HIV tests conducted in 2020 dropped by 61 percent to 480,285 from 1.2 million in 2019.
As a result, the number of newly diagnosed cases fell 37 percent to 8,058 from 12,778 in 2019. New ARV enrollment fell by 28 percent to 8,429 from 11,654 in 2019.
According to Robert Figuracion of Iloilo-based Rajah Community Center/ Family Planning Organization of the Philippines, many of the treatment options available to PLHIV are hospital-based. With the pandemic, those hospitals have become off-limits because their resources have been stretched and because PLHIV have weak immune systems to begin with. Many PLHIV were not able to get their supply of medicine for up to six months, seriously compromising their immune systems and making them susceptible to drug-resistant HIV.
Because of this, the Philippines continued to miss targets. As of December 2020, only 68 percent of the estimated PLHIV population have been diagnosed, and among those diagnosed, just 61 percent were on treatment. Viral load suppression among those tested was at 94 percent – but this is misleading, since among PLHIV on medication, just 17 percent were tested.
To make things worse, Figuracion says, people’s risky behavior did not necessarily change even after the onset of COVID-19. While hookups became less common in March to May 2020 because of quarantine/ curfew restrictions, the concerned population went back to how things were, facilitated by the Internet, as soon as these restrictions were relaxed. There was minimal change in the behavior of men having sex with men (MSM) and transgender women (TGW), according to the DOH; in 2019, the percentage of those engaging in anal sex was 79 percent; in 2020, it was 78 percent. There has also been an average of two sexual partners in both years.
Communities step up
Figuracion’s and Rosadiño’s groups have done many things to cope with the effects of COVID-19 on prevention, testing and treatment for HIV. “Our efforts have been a mix of online and offline,” Figuracion says, citing MSM, TG, LGBTQIA+, faith-based groups and civil society organizations as their partners.
For prevention, they provide access to condoms and post-exposure prophylaxis. They have also stepped up their information campaign on safe sex and behavior modification, encouraging people to at least stick to only one sexual partner.
Under the SelfCare program, meanwhile, Danvic’s group has been providing self-test kits to those who may wish to get tested but do not want to go out or do not know where to go.
“We enabled innovations so that we will be able to offer vital services despite difficulties in addressing them,” he says.
Figuracion’s group has done the same, but says that while self-test kits have been available for a while even on online stores, those using it will still need guidance in properly using them, interpreting results, or knowing what to do after they get a positive diagnosis.
Facilitating tele-consultations for the many health problems encountered by PLHIV is another service. Love Yourself has its iCON service while FPOP puts patients and doctors together through the Internet or, in the absence of good signal in the province, traditional mobile calls. Figuracion also laments that doctors who had themselves been struck with COVD-19 would have been able to offer tele-consultation to anywhere between five and 10 patients a day. His group tries to reach out to younger patients in Iloilo and Western Visayas, or those between the ages of 15-24 who may have no idea how to deal with their situation. This age group is crucial, since 47 percent of projected new infections in 2021 comes from this group.
They have also been working with local governments for the COVID-19 vaccination of PLHIV, who rightfully belong to the A3 category – those with co-morbidities. For obvious reasons, PLHIV cannot simply walk into the vaccination centers and declare their situation, so Rajah/FPOP has arranged with LGUs to conduct vaccinations in its own center.
Finally, to ensure that PLHIV still get the treatment they need, Love Yourself has Xpress, a courier-based delivery service where anti-retroviral medication is delivered to clients right at their doorstep or a location of their choice.
The usual networks have been disrupted, so they have to be creative – as well as discreet – in their delivery, says Figuracion.
Despite these efforts, the pandemic remains a massive roadblock to the attainment of our goals to cover all PLHIV with treatment, and eventually bring down the number of new PLHIV cases.
A health and a human approach
Byanyima of UNAIDS underscores the importance of a human rights approach in dealing with HIV. “Unless the people living with HIV or those who are at risk are treated with respect and without stigma, they will be driven underground and will not come out to get help. In turn, they will transmit to others.”
She says the main driver for the spread is inequality, but COVID complicated the situation.
Figuracion talks about the macho culture that might be responsible for a higher incidence of sexual abuse among young males, by their neighbors and relatives, during the lockdown. “The thinking is that nothing will be lost since they are male, anyway.”
What, then, could be done when we are still grappling with COVID-19, especially since the DOH itself projects that new HIV infections can increase by 21 percent between 2020 and 2021, after a 10-percent increase in the actual number of PLHIV (based on various models and not from testing data)?
Byanyima says both COVID and HIV could be addressed and one does not have to be dropped when fighting the other. “This is possible by being agile and innovative in finding solutions, using digital platforms and online spaces to spread information to young people.”
Rosadiño has practical advice to those who wish to access HIV services. “There are other options where our community can access HIV testing even though they cannot (or don't want) to go out of their homes because of the situation that we are in. There are friendly community-based screening (CBS) motivators that are always available online they can access it if they want to have screening to be done at their place. Alternatively, they can also access our SelfCare service, where they can do the testing themselves. In our SelfCare service, they will just enter a few details of their delivery location and other assessment questions, and we will be sending a test kit to them.”
For Figuracion, the pandemic is proving to be a win-lose situation. There were many people affected by the pandemic, and not just those who were actually diagnosed with it. But he chooses to look at the bright side and says COVID-19 also opened up areas of learning for his group. “We gained new skills and tested new mechanisms. We learned how we could expand our reach even after this pandemic,” he says. COVID exposed weaknesses and highlighted the need for all stakeholders – the public and the private sector – to work together rather than blame one another.
The fight continues against discrimination and stigma.
“The solution to HIV is not only medical but psychosocial,” he adds. “There has to be an understanding of why a person does this or that, why he engages in transactional sex, etc.”
All these should help normalize coming out to get tested, and, if positive, seek treatment. Figuracion says they must help not only the person concerned, but indirectly family members living with the PLHIV who must know how to be there for them, make them feel empowered and loved unconditionally.