Department of harm

This is my column today, May 20, 2014.

It’s as if the last four decades have not happened; as if we haven’t learned anything at all about HIV and AIDS and how best to manage the pandemic.  It’s as if the gazillions of money the world has poured into understanding the many psychological, social, and cultural factors that hamper prevention of infections have not produced any valuable lessons that we can learn from, as most other countries have.  

The Philippine government, through the Department of Health, plans to implement mandatory HIV testing so that those who “may have risk for HIV...can be properly counselled on what to do.”  Health Department spokesperson Eric Tayag confirmed in a television interview that government is now working out the details as to how to make compulsory testing possible.  According to rumours, mandatory HIV testing will be initially imposed among specific “target populations” a move that should ring alarm bells everywhere as it is an open invitation for human rights violations and for institutionalization of prejudice against certain communities and individuals.  Mandatory testing was the knee-jerk reaction in the eighties and the nineties when very little information about the pandemic was available and leaders were reacting from fear and panic. 

As can be expected, there is massive objection to the plan.  First, because it is against the law!  Mandatory HIV testing is not allowed in the country by virtue of the National HIV/AIDS Prevention and Control Law that was passed in the nineties.  

There are many reasons why mandatory HIV testing is dangerous.  But I will leave it up to the experts, the activists who have been working on the ground for many decades now to explain why.  Below is an abridged version of the statement of civil society groups involved in anti-AIDS advocacy work called Network to Stop AIDS Philippines.     

The Department of Health proposal to enforce mandatory HIV testing demonstrates that among those involved in addressing the HIV epidemic in the Philippines, the health agency is by far the most backward and the most out-of-tune.

The problem lies with the agency’s leadership. Within the agency, there are units and officials who stepped up, owned the problem, and pushed for evidence-based initiatives that are on the right track. But these efforts are severely undermined by Secretary Ona’s obstinate and incomprehensible obsession with archaic and stigmatizing proposals.

Compulsory HIV testing is one of them. It’s wrong in many levels: it is illegal, ineffective, ignorant, and dangerous.  The current legal framework allows for various modes of HIV testing, but they have to be voluntary and confidential. This is clearly rights-based, but this is also premised on existing evidence that coercive modes of HIV testing actually result in a decrease in the coverage of testing - those who need to get tested fear discrimination and abuse, so they hide underground once authorities require HIV testing. This fear is not unfounded, as HIV-related stigma and discrimination remain unaddressed in the Philippines. Imposing compulsory testing is operationally problematic (also unnecessarily costly) and it encourages human rights abuses. Even DOH possesses evidence that show the complexity of Filipino sexual behaviour. In a concentrated epidemic among men who have sex with men (MSM) and transgenders, who do you actually require to get tested?

This population does not conveniently fit whatever stereotypical images that Sec. Ona may have about the community. By definition, this sexual behavior includes any man who engaged or engages in sexual acts with other men - the heterosexual partners of transgender people; those who do not consider themselves as gay but engages in sex with other men; even the heterosexual ex-congressman whose life story was featured in a TV show a few years ago where he admitted to engage in transactional sex with a ‘bakla’ to support his schooling. Would DOH require all of them to get tested? The agency is also in possession of data that shows that a significant portion of men who have sex with men and transgender people have female sexual partners—would they be required to get tested, too?

Given this complexity, how does Sec. Ona intend to find those who’ll be required to get tested? This could easily be translated into a witch hunt, and going by the statements made by some LGU officials, that’s precisely what this will result into. There are alternatives to compulsory testing, one of which is community-led HIV testing. For the last four years, collaboration between community groups and government-run HIV testing facilities has intensified, and this accounts for the increase in the uptake on HIV testing. A recently conducted review by international and local HIV experts of existing HIV interventions being implemented in the Philippines has cited this model as an effective approach in a concentrated epidemic. Incidentally, the same review, which was already accepted by the Philippine National AIDS Council (PNAC) that Sec. Ona himself chairs, has already warned authorities against coercive HIV measures, including mandatory testing.

 Yet Sec. Ona seems to be blind to what the situation is, what the evidence says, and what needs to be done. It’s not a question of knowledge or awareness—he has had several interactions and dialogues with community groups where various issues were discussed, from stigma to gaps in testing and other services. But he refuses to listen. He refuses to acknowledge that as Chair of PNAC, he should be leading the HIV response; he has, unfortunately, been a delinquent chair. There is also an ongoing anti-retroviral stock out issue, one that he is probably unaware of; if it were not for the initiative of a community group to import medicines, supplies for May would have been severely inadequate. There are requests for him to talk to Mayors to encourage them to fund local HIV programs, or for DOH to launch a stigma reduction campaign on HIV testing, and yet he refused to act on these proposals.

The problem is not simply about increasing uptake of HIV testing. There’s a more fundamental issue: it’s Secretary Ona himself.