Public health and HIV

SO FAR the pronouncements on public health coming from the camp of presumptive President-elect Rodrigo Duterte sound appealing. He has personally said he would push for a nationwide ban on liquor and smoking, following similar ordinances that he successfully implemented in Davao City.

The prohibition on lighting up has been in place in Davao since 2002; it bans smoking in public buildings, public outdoor spaces, partially enclosed public spaces, in government-owned vehicles and entertainment establishments, and during concerts, rallies and other public gatherings. Certain open smoking areas are designated. Duterte has justified his plan to implement this prohibition nationwide by saying he recognizes the addictive, cancer-causing nature of nicotine, and the risks it poses to the larger population: “I have to protect those who are not smoking.”

The sale of liquor after 1 a.m. has also been prohibited in Davao for the past 14 years, but Duterte’s camp recently said the nationwide ban could begin at 2 a.m. The ban applies to drinking in public places. “When you go home, you can drink to your heart’s content in the privacy of your homes,” clarified Duterte spokesperson Peter Laviña.

During the election campaign, Duterte also promised a number of things designed to make healthcare more accessible to ordinary Filipinos—for one, a requirement that all hospitals establish and maintain a facility that would handle the poorest patients, whose medical bills would then be shouldered by the government, and, for another, further expansion of PhilHealth, ensuring universal healthcare and “zero billing” for its members. Every barangay should have its own doctor and team of nurses, said Duterte; the government should also build more regional specialty hospitals so patients need not bear the additional expense of traveling to Manila for treatment.

Public health, in fact, would be his third budget priority after agriculture and education, Duterte said on the campaign trail. Which appears to be a sound plan, given that, according to the Department of Health, more than 30 percent of Filipinos fall ill and die without seeing a doctor. A report in this paper states: “Many hospitals in the provinces are poorly equipped and staffed, and lacking in services, the result of the devolution of responsibility for health services from the central government to the local governments in the 1990s.” And, tying up the current healthcare situation with the pervasive poverty afflicting the nation, Duterte has said he would “insist on family planning”—presumably the full and effective implementation of the Reproductive Health Law—to help alleviate poverty and ease the burden on public health.

But unmentioned so far in Duterte’s planned healthcare program is anything that would address one of the most explosive developments in the Philippines today: the rapid rise of reported HIV cases, which, this year, come up to 25 newly diagnosed cases a day from only one daily in 2008. The March 2016 figure of 736 new persons living with HIV is 10 percent higher than the number from the same period last year. From January to December 2015, 7,289 cases were reported; in the first three months alone of 2016, 2,291 more were added. In most of the cases, the virus was contracted through sexual contact; the next most prevalent mode of transmission was the sharing of needles among drug users. Most alarmingly, about 28 percent of these cases are said to be young people aged 15-24.

If Duterte makes good on his promise to fully implement the RH Law, he has to push Congress to allot a bigger budget for its core programs, among them the distribution of condoms, more widespread education and awareness campaigns on safe sex, and HIV testing. Despite being upheld by the Supreme Court, the RH Law has been hamstrung in the implementation by the continued objection of the Church and other sectors; last year it suffered greatly from being defunded in the last round of budget deliberations in Congress.

Duterte’s vaunted bullheadedness when it comes to pushing for policies he thinks are right, no matter the opposition that might be generated, should encourage the DOH to include a bold, comprehensive program to arrest the public-health crisis posed by the rise of HIV cases in the new healthcare agenda it is mandated to present to the incoming administration. This is nothing less than a national emergency that requires the 9-11 mindset that Duterte has, from reports, implemented in Davao.