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A new legal framework to combat HIV and AIDS


(Below is a position paper submitted by Jonas Bagas to the House Committee on Health on August 24, 2011, on the proposed amendments to the Philippine AIDS Prevention and Control Act (RA8504. Mr. Bagas is vice chair of TLF Share and a member of the Philippine National AIDS Council) This is a well-timed initiative considering the alarming rise in HIV incidence in the Philippines, one of the only 7 countries worldwide that is experiencing a spike in HIV infection. The total number of HIV cases has already gone past 7,000 since the first case was recorded in 1984. By 2007 it was already clear that the Philippine HIV situation is no longer “low and slow,” and the increase since then is immensely alarming. The total new cases that the Department of Health recorded in 2010 is in fact more than the cumulative new HIV cases that were reported from 2001 to 2005. The July data have just been released, and 204 new cases were reported, the record highest in the history of our monthly HIV surveillance report. By 2015, government epidemiologists expect the HIV incidence to reach 45,000. What has gone wrong? If there’s any compelling reason why the law should be reviewed, amended, or overhauled, it’s the fact that HIV infection is rising, and is rising exponentially. Some segments of our population are already facing a concentrated epidemic. As a gay man, I come from one of the so-called most-at-risk populations, and the gay, bisexual, and transgender community and other men who have sex with men have witnessed HIV creeping into our lives. Dolzura Cortez and Sarah Jane Salazar are no longer the faces of HIV; they’ve been replaced by the faces of friends, ex and present partners, our gay co-workers. Our own community is full of murmurings of HIV-related deaths, of stories of friends of friends who died of AIDS-related complications, cases that are not reported, making the impact of the epidemic invisible. We feel disheartened and outraged every time we hear complacent public officials say that HIV is not a problem in our country. We must disabuse ourselves of the notion that the status quo is not alarming, and the effort to review the law must be acquainted with the current shape of the epidemic and address the gaps in our legal framework. More than a decade ago, the law was touted as a model legislation. We can no longer say the same now; the growing epidemic has revealed the severe inadequacy of the existing law. In short, the spike in HIV prevalence may be attributed not just to the failure of some government agencies to implement the law or enforce their mandate on public health, education, and social welfare, it should also be traced to the law and its failure to provide a clearer and a more flexible design to stop the spread of the virus. 4 key flaws For the past few months, various HIV and AIDS civil society groups, including organizations of people living with HIV and AIDS, initiated a civil society process to review the law and consolidate key legislative reforms that must be instituted. HIV has been with us for three decades now; we have all the evidence, information and knowledge on how we can effectively stop the epidemic from growing. If other countries were able to control their own HIV epidemic, or least slow down new infections, I see no reason why we can’t do it. In our consultations, we have identified key flaws in our HIV and AIDS prevention and control law. For one, the law no longer reflects the current reality. It was enacted in a period where HIV was mainly affecting overseas workers, and it therefore did not contemplate the possibility that epidemic would dwell on pockets of at-risk populations such as men who have sex with men, sex workers, injecting drug users. No single design fits all epidemics. Flexibility must be allowed, for what works among women and children wouldn’t be effective among men who have sex with men, or adolescents. But common sense dictates that to stop the epidemic, and to stop it cost-effectively, we must scale up on prevention. Focusing on treatment alone won’t stop the virus. Evidence also tells us that we must target most-at-risk populations, because ignoring the HIV epidemic among men who have sex with men, sex workers, and drug injectors creates a climate that makes it easy for the epidemic to jump to the general population. Some men who have sex with men actually have sex with women, who would in turn have sex with husbands who buy sex from women who could be sharing needles with other injecting users. Human sexuality and behavior cannot be put in a box, and our response must be flexible to take into account the fluidity of human behavior. The law is also in conflict with many recent laws, among them the Anti-Trafficking in Persons Act and the Dangerous Drugs Act. The anti-prostitution provision of the anti-trafficking law is being abused by law enforcers to conduct raids and extort money from gay men, and the so-called evidence that they use to claim that prostitution is happening in an establishment is the same weapon that we use to prevent the spread of the virus: condoms. Our law on drugs makes it hard for public health officials, NGOs, and outreach workers to reach injecting drug users. The other issue is governance. Who implements the response? Not enough The DOH believes that its mandate on HIV and AIDS is limited only to testing, surveillance, and treatment. Who should be working on prevention, especially in doing the nitty gritty work of educating populations that are at-risk of infection? It is not enough that government agencies send out regular media advisories, our education work must help in changing consciousness about safer practices

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and safer sex. We’ve decentralized healthcare, so by law this should be funded by local governments, who have neither the resources nor the political will to implement a politically sensitive program. The last major concern is public funding. HIV and AIDS is a public health concern, and yet government spending on HIV and AIDS has been declining: beginning 2009, or while the epidemic is rapidly growing, the allocation of the Department of Health has been going down.[1] It is certainly baffling. The existing law has many provisions that needs to be operationalized but has granted explicit funding for the operation of the secretariat only. Every five years, various government agencies and non-governmental groups collaborate to establish a national plan, the HIV and AIDS Medium Term Plan (AMTP). But that plan is always unfounded—it is always unclear who should be funding the plan – and thus it is hardly implemented. That the epidemic is growing is therefore hardly surprising. What these issues mean is that a simple collection of line-item amendments to the law is insufficient. It would only extend the same inefficiency, the same gaps, that we are experiencing under the current legal framework. We need to think out of the box, continue and strengthen spirit of collaboration between government agencies and civil society groups but make the legal framework a tool that enables effective, gender sensitive, evidence-based and rights-based prevention, treatment, care and support services and interventions. In short, the law needs to be overhauled.                                

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  1. nature’s way of decongesting the world, aside from war and natural calamities.

  2. Johnny Lin says:

    HIV and AIDS are prevalent among:
    1. Homosexual, gay lesbian community.
    2. Women and men with multiple partners not necessary prostitutes.
    3 drug users, oral and parenteral.
    The other infectious diseases associated with HIV/AIDS that should be included in the screening are Hepatitis B&C, Herpes and genital warts. Funding and government regulations,aside from education, are the two most important parameters on the success of the program. There are available funds from UN and USA for international prevention,control and eradication. Before the funds could be availed, it is necessary that regulatory measures have been properly set up.DOH should be actively involved in implementation with cooperation of NGO supporting entities. DSW should also be utilized in accessing the high risk communities. In my experience as head of a Latino health program, we relied heavily from city and federal human services in developing and promoting HIV/AIDS prevention and treatment. The biggest problem, and I suppose in the Philippines too, is how to bring people to come for testing because of the stigma associated with the illness. We devised a method to bring the service to the concerns with utmost privacy. This requires extra funding though. Another aspect of our advocacy was mandatory testing of all prisoners because high risk individuals are very common in this population. If OFWs are targeted,then mandatory testing of returning OFWs should be instituted. Early identification is the key to success. Accessibility to the high risk communities and addressing privacy issues are the drawbacks of early identification. Solving these 2 problems should be primary aspects of the program. Public education is also important tool to success.

  3. Johnny Lin says:

    Agreed, war and calamities are nature’s way of decongestion without collateral damage. In HIV/AiDS, unborn children are innocent victims which could be prevented.

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