Ending HIV exceptionalism

Every third Sunday of May, the world remembers people living with HIV/AIDS (PLWHA) who have passed on after putting up a fight against infections caused by HIV. Advocacy groups and bereaved family members of PLHWA will hold a candlelight memorial on May 17 at the Quezon City Memorial Circle.

It’s been a year since then Health Secretary Enrique Ona drew flak when he proposed mandatory HIV testing for at-risk groups. His name will leave its mark as a reminder of activist groups’ victory over the “witch hunt” and the power of lobbying to oppose human rights violations.

Lost lives also encourage us never to forget revisiting the question: What are we fighting? Simple: stigma.

Like other annual social activities, memorials tend to offer plain answers to originally complex questions that fired the imagination and zeal of their pioneers. Through time, the institutionalization of subversive outcry offers a less than sterling alternative to the stereotype it fights. Painless to the brain, slogans are bumper-sticker philosophies.

The problem with Ona, in my opinion, is not that he proposed the unpopular move for mandatory testing or the purchase of P800 million worth of pneumococcal conjugate vaccine (PCV 10) over PCV 13. I agree with Inquirer columnist Winnie Monsod that his problem is hard-wired: “Ona is not, never will be, a politician.” His fall from grace parallels that of PLWHA—they wade through philistinism.

The annual total of reported HIV cases last year numbered 6,011. According to HIV/AIDS and ART Registry of the Philippines (HARP), the age group with the biggest proportion of cases has become younger. Fifteen years ago, it was 30-39 years old. By 2010, it has scaled down to 20-24 years old. Of the 646 cases reported in February 2015, 181 individuals belong to the 15-24 age range. While the Philippine AIDS Law (Republic Act No. 8504) is a rights-friendly legislation, why can’t it stave off the epidemic? We must rethink it by going back to its legal roots.

RA 8504 was highly influenced by the US civil rights movement, which privileged individual rights and protection against state interference. While the US AIDS experience began among upwardly mobile gays, the earliest cases in the Philippines were reported among women forced by poverty to engage in sex work. Not merely a viral transfer, HIV also involves cultural mutations. For example, Japan retains its skewed image of HIV as a disease among females who flout traditional domesticized femininity, but the Philippines imagines it as a “gay disease.” Therefore, a cultural translation of causal and preventive measures does not guarantee a perfect fit to a different country.

Today HIV is a chronic yet manageable ailment. Despite the development in HIV treatment, AIDS advocacy remains locked in rights discourse and, its unwitting consequence, internalized stigma. This has bred an entrenched HIV exceptionalism—an attitude of treatment and handling of HIV as a different and “extraordinary” case compared to TB, diabetes, or hypertension, among others—to the detriment of collective public health rights.

As early as 1998, Kevin de Cock and his colleagues already criticized the limited applicability of the individual rights framework to HIV treatment in Africa. Campbell and Nair’s ethnographic study also confirmed the low “purchase” of women’s rights to battle HIV in rural South Africa. De Cock proposed normalization by “treating HIV/AIDS like other infectious diseases for which early diagnosis is essential for appropriate therapeutic and preventive measures, within the requirements of informed consent and respect for confidentiality.”

I do have reservations with the semantic crudeness of “mandatory” testing proposed by Ona. However, I regret that the lobbyists did not perceive it as an opportunity to rethink the legal paradigm so as to brainstorm alternatives toward an existing solution. Mandatory testing may not be the appropriate alternative; neither is the current opt-in approach. Both the Department of Health and the activists shared a common goal to curb virus spread and promote early diagnosis and immediate enrollment in antiretroviral treatment. This commonality could have been a productive springboard for innovative thinking. They could have assessed and learned from the favorable reception of routine HIV testing in Botswana and opt-out practices—also in Botswana—and antenatal clinics in Canada, the United States and the United Kingdom. The point is: Move out of the rights rut.

The rights approach has won for us many battles. And I don’t argue for its repeal in HIV treatment. However, we must acknowledge its Western legal provenance and the complexity of cultural translation. Indeed, May 17 is a day of mourning for we have come to bury Ona, not to praise him.

Cyril Belvis is a PhD student of the Philippine Studies program at the University of the Philippines Diliman. He teaches literature at De La Salle Araneta University, Malabon City.