A new law to reverse PH’s HIV epidemic

The HIV epidemic in the Philippines has been characterized as the most explosive worldwide: While new HIV rates are going down globally, the number of new HIV cases in the country has continued to rise dramatically in the last 10 years.

The overall HIV prevalence remains relatively small, but there is an undeniable concentrated HIV epidemic among men who have sex with men and people who inject drugs, especially in urban areas. In a decade, the number of Filipinos living with HIV will exceed a quarter of a million.

There are many reasons behind this rise, and a lesser known but a significant problem is the country’s outmoded HIV law (Republic Act No. 8504).

Enacted two decades ago, when the country’s epidemic was still deemed “low and slow,” the law is now severely inadequate; it’s like using tabo to put out a raging village fire.

The law’s prevention measures are too granular in some areas and designed for a generalized epidemic, but not concentrated epidemics.

It has good human rights provisions for people living with HIV (PLHIV), but lacks the teeth to enforce them. It has a messy governance structure, which is muddled further by decentralization and devolution.

The Philippine National AIDS Council (PNAC), the country’s main multisectoral policy-making and coordinating body for HIV, is too weak to be relevant. Finally, there’s no funding provision for the HIV response.

But, on Oct. 10, the House of Representatives and the Senate finally ratified a bill that overhauls the Philippine legal framework on HIV.

It is a progressive measure that will upgrade the Philippine response to the epidemic. It introduces reforms to the PNAC and improves the HIV-related programs within the Department of Health (DOH).

It clarifies the roles and mandates of various government agencies and institutionalizes the country’s national strategic plan to fight HIV, which lays down multiyear strategies and interventions to reverse the epidemic.

It has a comprehensive provision on primary prevention, and gives the country the latitude to pursue evidence-based interventions to prevent the spread of HIV.

It guarantees access to HIV treatment and ensures free HIV medicines, including medicines to treat HIV-related infections. It provides for care and support programs for PLHIVs.

It also integrates HIV services into the country’s universal health coverage framework, including PhilHealth.

It removes barriers to HIV services, such as age-related restriction to HIV testing and discrimination in healthcare settings. It has an expansive language on human rights, and establishes redress mechanisms and similar programs for PLHIV and communities that are at greater risk of getting infected with HIV.

Finally, it has an appropriation provision, and identifies sources of funding for HIV programs, a vital reform in light of declining donor support for HIV and other health programs for middle-income countries like the Philippines.

The bill, for sure, still has certain gaps. Harm reduction, which would have supported HIV-related evidence-based risk reduction measures for people who use drugs, was taken out due to the government’s war on drugs.

The prevention package still includes the promotion of sexual abstinence and fidelity, two inept and unrealistic approaches that do not contribute to HIV prevention.

But the bill provides an abundance of policy guidance and legal arguments to steer HIV programming away from ineffective strategies (such as the coercive models for HIV testing and the recently concluded beauty contests that the DOH organized) toward effective, evidence-supported and human rights-based HIV interventions.

While the bill faced challenges from quarters that wanted to introduce backward measures such as mandatory HIV testing, it took unwavering advocacy from groups like the Network to Stop AIDS-Philippines, support from a few allies within the government, and the leadership of its champions in Congress, especially of Dinagat Rep. Kaka Bag-ao and Sen. Risa Hontiveros, for this landmark measure to secure congressional approval.

Now, 10 years since its drafting, the bill is just a heartbeat away from enactment. Far too many Filipinos with HIV have died in silence, killed by a disease that in medical terms is no longer a death sentence, but still carries with it the weight of shame and stigma.

If only to give dignity and justice to our friends and loved ones who died because of this epidemic, and to give hope to those who are still living, President Duterte should waste no time signing this bill and implementing its vision.

* * *

Jonas Bagas is a Filipino HIV and LGBT rights advocate working for Apcaso, a Bangkok-based regional network of NGOs engaged in health and human rights. Follow him on Twitter: @jonasbagas.