Beyond the new HIV and AIDS law

The newly signed Philippine HIV and AIDS Policy Act of 2018 (Republic Act No. 11166) is a welcome piece of legislation. Although the absolute number of documented cases of HIV in the country (61,152 as of late 2018) is still relatively low, the rate of increase (a staggering 140 percent over the past six to eight years) is alarming — more so because the registered cases are very likely just the tip of the iceberg. Clearly, the current situation calls for updating the 20-year-old RA 8504.

Perhaps the most important provision of RA 11166 is allowing teenagers from 15 to 18 — or even younger if they are pregnant or engaged in high-risk behavior — to undergo HIV testing without parental consent. This is a more realistic policy in light of the fact that, per the Young Adult Fertility and Sexuality 2013 data, 25 percent of males and 22 percent of females in the country are having sex before the age of 18.

Other highlights of the law include the removal of RA 8504’s language against birth control and framing HIV services as part of the “right to health.”

Kudos, then, to Sen. Risa Hontiveros, Rep. Kaka Bag-ao, all the lawmakers and advocates who pushed for the law, and to the Duterte administration for continuing to support progressive (even if imperfect) health legislation. I hope the signing of the universal health care bill is next, alongside the enactment of more tobacco taxes.

Laws, however, are not magic bullets, and RA 11166 is only as good as its actual implementation. Moreover, while it is certainly a big legal (and moral) boost, with or without it, there are steps that need to—and can—be done if we are to adequately deal with the HIV crisis.

First, increasing access and ensuring adherence to medicines. Although the Department of Health (DOH) has denied there is a shortage of antiretrovirals (ARVs), reports to the contrary need to be taken seriously, both in the short term and in the long run, given that the Global Fund support for free medicines will not always be around. There are also newer ARVs with more convenient dosing regimes; we need to make these available and affordable (if not free) if we are to ensure compliance. Preexposure prophylaxis should also be an option for those who engage in high-risk behaviors.

Dr. Bryan Lim, an infectious disease specialist, told me that he is especially concerned about drug resistance: “Unfortunately, we have patients who, despite the free medicines, are noncompliant, especially once they notice an improvement. As with TB, this will lead to drug resistance, which will complicate efforts to deal with HIV.”

Secondly, we need to scale up testing and other services. One notable omission in RA 11166 is a provision for needle exchange program. Despite the laudable efforts of some civil society organizations and local government units, we still have too few testing centers and treatment hubs. Moreover, as longtime reproductive health advocate Chi Vallido told me, RA 8504 already mandated the formation of local HIV councils (which would have helped promote and supervise these hubs), but compliance has been uneven.

The quality, not just the quantity, of clinics is also an issue; some have no proficient med techs, and many have limited or inconvenient office hours. There are also issues of privacy: I have heard “horror stories” of health staff gossiping about their clients’ HIV status, thus dissuading other people from getting tested or treated.

Thirdly, we need to boost communications and education efforts, including the promotion of condom use. This may sound elementary (education is always emphasized in laws, including the reproductive health law and RA 11166), but owing to political (and ecclesiastical) pressures, condom use is not emphasized in DOH’s health promotions, and health promotions themselves have not been a DOH strong point. We need practical sex education—one that will inform our youth on how to effectively prevent HIV and sexually transmitted infections, as well as strategic communications, including in social media, to reach both the general public and high-risk groups.

Addressing these concerns will rely on the leadership of DOH and the reconstituted Philippine National AIDS Council, the involvement of the private sector, and active engagement with people living with HIV and other concerned communities. The HIV epidemic is one that we can effectively manage, but we can only do so if we act now, and if we act together.

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