A limp AIDS law in an HIV epidemic

A young person who jumped on the tracks of a rail transport was reported in the news as an act of suicide. Had it been known that he had HIV, the news stories would have been different. 

When a young man’s family learned that he has HIV, he was asked how he got infected. When he revealed that he had sex with other men, his family disowned him. He stayed with friends, remained quiet about his medical condition, and later died of pneumonia, an ensuing complication from AIDS, in a hospital that never knew that he had AIDS.

A woman sought an HIV test for her and her baby after her husband died of AIDS. When they both tested positive, a hospital staff warned through the public address system of the “presence of a mother and infant who have AIDS”. On her way out, the mother had to walk past people who have lined up to see her and her baby.

When two employees disclosed their HIV status, one was forced to go on sick leave without pay while the other was denied payment of insurance by his company.

A student’s name and photo were put on Facebook, identifying him as HIV-positive who intentionally infected people. It was shared by users of the social networking site. An organization whose name and phone numbers were used in the post without its permission contacted the student and offered to help. It reported the case to the police. The organization also facilitated the student’s HIV test, which gave a negative result.

These incidents happened in different years after 1998 when the AIDS Prevention and Control Act, the AIDS Law or Republic Act 8504 was passed and, over the years, became a model of legislation for other countries. HIV cases in the country were then a trickle of numbers recorded in the HIV Registry, the government’s official data handled by the Department of Health – one new infection every 7 days, mostly female sex workers and male overseas contract workers.

Fifteen years hence, the epidemic has taken a different profile. The July 2013 HIV registry listed 449 new cases, 90% consisting of males who have sex with males (MSM). Populations of injecting drug users contribute a huge spike of infections. The DOH now reports a staggering one Filipino newly infected every hour.

Human rights violations

There is no sign that the epidemic would wane. By 2015, the DOH estimates around 50,000 more Filipinos with HIV who will need anti-retroviral treatment to slow the progression of HIV infection to AIDS. Over P500 million will be needed to finance their treatment. This alone will disturb the state of resources meant for other communicable but preventable illnesses.

Respect for human rights is a vital provision of the law that placed a high consideration to social stigma and discrimination attached to HIV infection and its consequent disease, AIDS. The pervasiveness of stigma 27 years after the country reported its first AIDS case in 1984 is such that most people living with HIV choose not to disclose their medical status after they test positive.

Many violations of the rights to privacy, confidentiality, proper medical care, support, education, and employment against persons living with HIV (PLHIVs) have been reported in the last 15 years, but no case has reached a court. Again because of stigma, PLHIVs do not want to file a case and be exposed and subjected to legal proceedings.

While the United Nations recently predicted that AIDS will no longer exist by 2030, the Philippines is one of only 9 countries in the world that continues to experience rising infections above 25%. A host of government, civil society and PLHIVs’ organization who work on HIV awareness and prevention now operate in the midst of a tenfold rise of infections since 2007, with sudden increases occurring on the 15 to 24 age group, and an early initiation to sex and drug use among those aged 14 to 19. At least four government AIDS medium term plans have been implemented, with the fifth and current one ending in 2016.

These realities that advocates have to work in to be able to catch up with the epidemic that expands faster than any response to it is more troubled because of the scourge of stigma that hampers prevention efforts – stigma attached to HIV infection, sexual orientation, and intravenous drug use.

Outdated law

Clearly, an outdated law is not the answer, according to Dr. Jose Narciso Melchor Sescon, president of the AIDS Society of the Philippines, who lauds “the very well written law but whose implementing mechanisms have never been in place.” He said there is a glaring lack of redress mechanisms in the law. “A PLHIV who is discriminated on does not even know where to lodge complaints. What agency is entrusted to handle grievances?” he said.

Sescon said the law also did not clarify rules on specific penalties and sanctions for people with known HIV status who intentionally inflict other uninfected individuals. Related to this is the dissemination of wrong information on the HIV status of people to malign persons and organizations, such as the Facebook case.

Currently, the community of non-government and civil society groups is awash with incidents of mishandling of persons with HIV, including isolated instances of committed and attempted suicides despite their being with a “support group,” so called because they are usually exclusive or combined infected and uninfected members who accept persons with HIV for moral support as they undergo treatment and continue living normally. 

Sescon questioned if the law speaks on mishandling or negligence. “There is more harm done on a person with HIV than being taken care of,” he said.

Dr. Gerard Belimac, program manager of the DOH National AIDS Prevention and Control Program, acknowledged these incidents as “occurring but not validated and documented” and is a “growing concern” of the government. “We recognize that the law and government policy are vague on accrediting organizations. What is happening now is that anybody can set up a group and have their own standards, and this is not right.”

Belimac said the government is also aware of groups that provide testing and counseling but lack professionalism, ethics, and quality in their services. Counseling is a crucial part of health and psychosocial services provided prior to and after a person’s HIV test. He said the departments of social welfare and interior and local government have accreditation standards for non-government organizations, but these are not clear for HIV support groups.

Karl Reiner Agbulos, a peer educator, said the law does not allow compulsory and mandatory testing because it should be voluntary and anonymous, meaning that testing centers should, for instance, assign numbers or codes to a person getting tested. A counselor must explain to a client when the name or identity is needed, such as for health insurance purposes if the person is diagnosed as positive and wishes to avail himself of insurance. 

Sescon and Agbulos said no testing and counseling center should operate without accreditation by a central body such as the DOH, which should also regulate counselors and the content and quality of their counseling, requiring only qualified and trained counselors to be allowed to do this task.

Further, Agbulos added that discriminatory acts are often committed by medical professionals, the most widespread of which are sharing information of positive tests to other people beside the person who got tested. He also said people with HIV are singled out in testing centers, clinics and hospitals and are treated differently from other patients, often isolated.

No platform for grievances

He said there must be an institution that handles HIV-related forms of discrimination where people who feel criminalized or discriminated upon because of HIV can report cases. He suggested that the Philippine National AIDS Council, an advisory body to the President, should be empowered to implement, investigate and provide sanctions on violations, but these are nowhere in its responsibilities.

Agbulos said confidentiality should not be limited to health workers but to all individuals. Unfortunately, “for violations of confidentiality under the AIDS law, one can still file a case of slander but does not address issues of people living with HIV,” he said.

Belimac acknowledged that there are gaps in the mechanisms for addressing confidentiality. “There is no clear platform for grievances.”

Sescon and Agbulos also noted the AIDS law’s conflict with other laws such as the Comprehensive Dangerous Drugs Act of 2002 (RA 9165) that criminalizes the possession and distribution of drug paraphernalia such as needles and syringes, which is what health workers do in populations of injecting drug users to curb the impact of needle use and sharing in the light of the rising number of infections in this group. They said conflicting laws need to be reviewed and ratified to complement the needle and syringe health program, called “harm reduction.”

Sescon said close to 2,000 PLHIVs are on antiretroviral treatment for life, but as the numbers grow rapidly, the government’s health insurance provider, PhilHealth, has yet to adopt a comprehensive benefit package. Agbulos said there are also health maintenance organizations (HMOs) who deny services to persons with HIV.

But Belimac said “measures will be in place within the next three years” even if amendments to the AIDS law have been forwarded in both houses of the 15th Congress.

The bottom line, said Sescon, is that “even if we have a well written revised AIDS Law, implementation and enforcement is vital, so who will call the shots?” – Rappler.com