CEBU, Philippines – When night falls, Paulino Bongcaras starts packing. He fills a square plastic box with analgesics and ointment repacked from large tubes pumped into small plastic bags. He scoops up red sachets of condoms, lubricant, and packs of crackers, then stuffs them all into a messenger bag that he slings over his shoulder.

Bro. Paul, as he is more commonly called, is a teacher at the University of San Carlos by day and an outreach worker by night. Dressed in knee-length shorts that extend just below his knees, a t-shirt and sneakers, Bro. Paul is a familiar and welcome sight in Cebu’s dumpsites, slums and dark corners where the hardest to reach but most in need of health services live and sometimes hide.

“It makes a big impact if people know you – if the sex workers, drug users and persons living with HIV all know you…Because if we talk about the people living with HIV, (having) HIV is hard to talk about.  But if you are close, then they can share that with you,” the 69-year-old said about his nightly walks that extend until the wee hours of the morning.

Bro. Paul’s nightly outreach is a simple but key intervention. It is during these walks that conversations are started and friendships are made.

“Through friendship, people will open up tell you what they need,” he said. Sometimes such need goes beyond the condoms and lubricant Bro Paul gives out – like an HIV test or enrollment in life-saving anti-retroviral therapy (ART) that the Department of Health (DOH) provides for free.

Bro. Paul does not do this alone. He works with the city health office, charity birthing clinic Glory Reborn, and non-government organizations that offer HIV care and support like Cebu Plus.

Fast growing epidemic

Two decades after 1984 when the first case of human immunodeficiency virus (HIV) was reported in the Philippines, HIV infections had been managed and maintained in the low hundreds.

That began to change around 2008 and 2009 when the first major spikes in HIV infections were noticed. It was to be the start of an upward trend of rising infections.  

Out of the total 30,356 HIV infections reported at the end of 2015, more than 20,000 were reported from 2010-2015, catapulting the Philippines to the position of having one of the fastest-growing HIV epidemics in the Asia Pacific region.

More than 70% of the total HIV infections cluster around men having unprotected sex with other men, usually in the 25-34 age group.

UNAIDS estimates indicate that while new HIV infections have fallen in recent years globally, the Philippines is among a small group of countries that have bucked this global trend.

In 2015, a nationwide study conducted by the Department of Health (DOH) showed that in some areas, infection rates among at risk groups were higher than 5%.

“That 5% threshold is like a tipping point,” said Dr Genesis Samonte, head of the department’s HIV/AIDS monitoring and tracking unit.

“There is already a large base of people who have the virus, so the rate of infection will be exponentially faster.”

If this current trend continues, the DOH predicted that HIV infections could reach 133,000 by 2022. 

PH Gov’t fuels HIV epidemic

In a report released earlier this month, Human Rights Watch (HRW) slammed the national and local governments in the Philippines for its failure to address the growing HIV prevalence among men who have sex with men. HRW listed factors such as the absence of a national HIV prevention education program as well as outdated laws that prohibit minors (those under 18) from accessing condoms and HIV testing without parental consent as contributing to the worsening epidemic.

“The Philippine government is fueling a rising HIV epidemic among men who have sex with men through policies that restrict interventions proven to prevent transmission of the virus,” HRW said in its report, “Fueling the Philippines’ HIV Epidemic: Government Barriers to Condom Use by Men Who Have Sex With Men”. 

Cebu has seen one of the biggest explosions in infection rates, specifically among people who inject drugs (PWID) and share needles.

In 2014, the Cebu HIV/ AIDS Registry reported that 74% of the city’s 1,366 recorded HIV infections were due to needle-sharing. The DOH estimated that more than 50% of the roughly 6,000 intravenous-drug users in Cebu and its neighboring cities are positive for HIV.

The Duterte administration’s crackdown on illegal drugs has driven people who use and inject drugs farther into hiding, making it more difficult for them to access regular HIV testing, treatment, and harm reduction interventions like needle exchange programs. 

Ending the stigma

For Jerson See, executive director of Cebu Plus, HIV is personal. See tested positive for HIV when he was 18. Discriminated against and treated as an outcast, See felt isolated and alone.

“I was infected at a very young age. It was emotionally draining, it was physically draining because I was having a lot of infections. I lost a lot of friends. My other friends will say, ‘Hey, get away from Jerson because he is HIV positive.’”

Now, as director of Cebu Plus, See makes it his personal mission to save others from going through the same ordeal.

Like Bro. Paul, See’s nights are busy especially on Friday and Saturday when he and volunteer counselors go to clubs and cruising sites to conduct free HIV testing and counseling. 

Together with Asilo de Milagrosa, Cebu Plus runs a shelter where people living with HIV can stay for free. For those who live outside Cebu, the shelter is their home away from home when they go for HIV treatment in the city. For thƒose abandoned or shunned by family because of their HIV status, it is a refuge.

“I don’t take it against people who discriminated against me for being HIV positive. I took it as a challenge to provide them with the right information to finally end stigma and discrimination,” said See. 

Through their shared advocacy, Bro. Paul and See hope to heal the stigma of HIV.›

“I am hoping that more people will become aware and not be afraid of people with HIV,” Bro Paul said, stressing that “the principle that we are using is ‘observe without judging’ – just being there. In one word – acceptance.” – Rappler.com