Tuesday, April 13, 2010

Dealing with HIV and AIDS

published April 5, MST

Filipinos have been familiar with HIV and AIDS since the 1980s. Remember movies made about Sarah Jane Salazar and Dolzura Cortez? Even so, the knowledge of the existence of this condition did not alarm most people at the time. The Philippines was thought to be a low-prevalence country, compared to other countries especially in Africa. Many attributed this to the fact that most Filipinos are Catholic—devout, faithful, never promiscuous.

Imagine thus the public’s reaction when no less than the Department of Health announced an almost-fantastic increase in the number of reported cases in recent months. In December 2009 alone, there were 126 reported cases, bringing the full-year 2009 total to 835, from the 2007 total of 343 and 2008 total of 628. Hardly a consolation were the January 2010 figures, which reflected 143 new cases.

To be more dramatic about it, there was an average of one case per two days reported in 2000. In 2007, this became one case per day. In late 2008 to 2009, there were two cases a day. Using the January 2010 numbers, there are four to five cases reported per day.

Ferchito Avelino, executive director of the Philippine National AIDS Council secretariat, says there is a host of reasons for the alarming surge in numbers. First, because of the support of The Global Fund, there has been a more widespread information and intervention program that has also improved access to HIV testing procedures.

Then, too, the Integrated HIV Behavioral Serologic Surveilance, performed in 23 sites all over the country, confirms increased risky behavior among some Filipinos.

The survey, done every two years, includes obtaining blood samples from certain segments of the population deemed “at risk”—people in prostitution, men having sex with men, and people who inject drugs. Extensive interviews are also conducted to get to know respondents’ behavior and lifestyle. The latest survey, done last year, yielded that newer cases being reported are those of people under 30, mostly young urban professionals. Reasons for acquiring the virus were poor knowledge of HIV and AIDS, having multiple sex partners and the low level of condom use.

The 2009 survey also reflected a great increase in transmission among people who inject drugs, leading authorities to link HIV infection and Hepatitis C, a blood-borne disease.

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The council (www.pnac.org.ph), a creation of Republic Act 8504 and composed of more than 20 government and non-government bodies, is the central coordinating agency for the national response to the threat of HIV and AIDS. But what IS the national response? Avelino says they are focused on the prevention, treatment, care and support of Persons Living with HIV.

By prevention, the council works on information and education campaigns to prevent the spread of HIV and AIDS. Risk reduction is key, Avelino says. Abstinence and mutual monogamy are always fool-proof ways. But the truth is that neither the government nor the Church can impose on people what lifestyles to lead. “Different people do behave in so many different ways,” Avelino adds. “The way to help is to ensure they have options.”

This brings us back to the controversial condom, evil incarnate for the Catholic Church. Remember how much flak Health Secretary Esperanza Cabral got from the church hierarchy for distributing condoms at a bus station on Valentines Day? The bishops even reportedly advised Cabral to reflect on her advocacy during the Holy Week just past. The Catholic Church says condoms do not help prevent the spread of HIV and even increase risks as they offer a false sense of security.

Avelino adds that the Church’s position—that condoms offer only 85 percent protection, and this protection decreases with repeated use—just does not make sense. The 15 percent risk, he says, comes from incorrect and inconsistent use. “This is why mere distribution is not enough. We also have to teach people how to use it correctly.”

The council is also involved in conducting awareness campaigns in the workplace, both in the private and public sectors. Numerous corporations have recognized the need to educate their manpower on the consequences of risky behavior. Fortunately, the Civil Service Commission’s chairman, former Health Secretary Francisco Duque, needs no further convincing on the merits of the campaign.

As for treatment, there are now Anti-Retro Viral drugs, prescribed to a patient whose CD4 count (CD4 is a kind of white blood cell that leads the attack on infections) falls below an ideal level. But once a patient starts the ARV treatment—a mix of three drugs, when before there were 10—he has to take them every day, at the same hour, unfailingly, for the rest of his life.

The treatment is costly. The medicines will cost a patient anywhere between P1,500 and P2,000 a day. Remember that the drugs have to be taken every day. The government does provide ARV treatment for free in selected treatment hubs—but this is made possible by the help of The Global Fund. It’s aid, and it will not last forever. The Global Fund rounds last for five yeas and the one currently in force will end in 2012. The Philippines will then have to apply for the next one.

Avelino points to the “burning house” syndrome as what is responsible for the escalation of the number of reported cases. “The problem in this country is that an issue has to be a sensation first in the media before we realize how important it truly is.” In the past, HIV and AIDS were not deemed serious threats to the country. For the most part, there was no decisive, sustained and aggressive effort to prevent its spread. The threat was conveniently swept under the rug.

Now that the situation has been likened to an epidemic, everybody is hysterical—laying blame on others, branding certain industries as “breeding grounds” for HIV, taking the moral high ground, debating over what to do and how exactly to do it, advancing and then receding in the fight because of the fear of offending certain sensibilities. In the meantime, many more people remain uninformed of their options, and more are consigned to a battle with the dreaded virus. The persistent social stigma, from a deadly mix of ignorance and bigotry, makes things worse.

“We cannot afford to be lukewarm anymore in the fight against HIV and AIDS. Tama na ang pagpapa-cute. It’s time for serious action,” Avelino says. He is worried, and with reason. We all are. His current boss, Cabral, has shown admirable gumption in doing what she has to do even as she only assumed the health portfolio in January. She has not yet even made her zeal contagious in the Executive branch. For how long will she stay in her post given that this administration is almost done?

And will the next national leader recognize the threat or keep on waffling to court favor from the almighty church?

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