HIV in Palawan is continuing to spread and we are not doing enough to prevent further infections.
Two of my Roots of Health colleagues attended a Local AIDS Council meeting yesterday and updated me with some very troubling developments.
1. HIV is here and it is stronger than it was before.
HIV and AIDS are thriving in Palawan. Half of all Puerto Princesa’s 66 barangays have at least 1 confirmed HIV case. Many people test positive for HIV, but never come back for their results so currently don’t even know they are positive. And many more people have HIV but have not been tested yet.
Currently, 94 cases of HIV in Palawan have been linked to care. Almost all of them were diagnosed late. Troubling patterns are emerging that show an HIV virus that is more aggressive and that is destroying immune systems faster than in years past. Previous patterns of HIV showed that someone would often live with a normal immune system for 5-10 years after being infected with HIV. At the Provincial Hospital, doctors are now seeing the characteristics of “full-blown AIDS”, or extremely weakened immune systems only 2-4 years after someone is infected, and even among young people whose immune systems and health are generally stronger. We need to catch cases earlier.
2. Young people are particularly at risk.
At the moment, a staggering 94% of Palawan’s people living with HIV (PLHIV) are in the age bracket of 16-34 years old. This is not surprising when you consider that in the Philippines, most young people begin having sex, usually unprotected, at 14 years old. Currently, young people need parental consent to access contraceptives and HIV testing if they are below 18 years old and this is a huge hurdle for them. We know that young people are engaging in risky behavior from the time they are 14 and we are not protecting them or offering them testing until they are 18. Those 4 years without protection and support put young people at risk, and the HIV infection age range shows that. (As an aside, we are very fortunate that Provincial Hospital has staff on duty at the testing center who are authorized to give parental consent if the young person has reason to believe that they have been exposed to the virus).
Young children are also at risk. Palawan has cases of mother to child transmission (MTCT) of HIV. Puerto Princesa recently diagnosed its first child case of HIV. The child is 4 years old. To try to prevent further MTCT HIV cases, the City Health Office has been proactively encouraging pregnant women to be screened for HIV as part of their routine prenatal check ups. We must continue to push for this as MTCT is preventable. If HIV is diagnosed early enough in a pregnancy, the pregnant woman can take antiretroviral medication, still have a vaginal delivery, and avoid breastfeeding her newborn so as to prevent the likelihood of the baby having HIV. If a woman is diagnosed late in her pregnancy, she must have a caesarian section birth, which can lead to more complications. When HIV in a pregnant woman is undiagnosed or diagnosed too late, it increases the chances that the baby will also have HIV.
3. Men AND women are getting HIV.
A lot of people are in denial about who HIV can affect and like to think of HIV as a “gay disease”. While the majority of the earliest diagnosed cases were predominantly among men who have sex with men (MSM) and transgenders, this is not the case anymore.
There was recently a case of a young man who was bisexual – he had sexual relationships with both men and women. He was infected with HIV and had several girlfriends. All 3 of his previous girlfriends now have HIV. One is only 18 years old, and was infected when she had sex with him at age 16. He is the only man she has ever had a sexual relationship with. Perhaps these women will be able to survive because they are accessing care. The man has already died.
We must not treat HIV like an illness that only certain populations get. We are all at risk whenever we engage in unprotected sex or reuse needles.
4. Stigma and discrimination are alive and well in Palawan.
Many people still do not understand HIV and are scared of the virus, leading many to behave in discriminatory ways towards people living with HIV. Many people who have been diagnosed with HIV are disowned by their families and friends. Some of the patients accessing care at Provincial Hospital do not have adequate money for food and nutrition. They do not have any support from loved ones because they are often too afraid to disclose their status. The 4 year old I mentioned earlier does not have enough milk because no one in the family is lending support, so hospital staff have had to donate funds for milk from their own pockets.
It is important to note that the emotional and psychosocial state of HIV patients is incredibly linked with their ability to thrive and survive. Patients who are also undergoing emotional devastation can have faster deterioration of physical health. Literally, your discrimination and bad treatment of someone living with HIV could kill them.
Discrimination is not just among personal relationships – it is also structural. Some business establishments in Puerto Princesa have fired or refused to hire otherwise qualified and capable workers because of their HIV status.
Recently, 2 HIV patients died, and funeral homes in Puerto Princesa refused to embalm the bodies because they were scared of getting infected. A doctor from the city had the opportunity to explain to the funeral homes that the virus would not survive without a living host, and that they would not be at risk of infection while handling the blood. But instead the doctor told the funeral homes it was their decision. This is disappointing. Doctors should be sources of accurate, scientific information. Doctors should not perpetuate bias and discrimination especially when these are based on faulty understanding of an illness. Because those funeral homes refused to embalm the bodies, their families were forced to cut their wakes short. They had less time to grieve and mourn their losses just because of some people’s unfounded discrimination.
We must address these issues in order to prevent further escalation of HIV infection in Palawan. We must educate ourselves. We must educate each other. We must practice safe sex. We must get tested for HIV. If positive, we must access treatment. We must show compassion and step up efforts to end the stigma and discrimination associated with HIV.
We were disappointed that the officers of the Local AIDS Council from the City Government did not attend the Local AIDS Council meeting. We hope that this is not an indication of their commitment levels to fighting HIV. The Committee is set to meet again on May 11. We hope the whole Council will be in attendance so we can move forward united in the fight against HIV.
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