Immunocompromised, afraid: HIV treatment tails off amid COVID-19

Delia, 33, who has been fighting the human immunodeficiency virus (HIV), thought the Luzon-wide Enhanced Community Quarantine (ECQ) implemented in March 2020 would only last a couple of weeks.

After both her sons, 6 and 12, were diagnosed with HIV in 2016, she has made sure her family would not miss a dose of their antiretroviral (ARV) drugs. Delia, who requested to hide her full identity, would have their medicine supply refilled every one to three months at the Research Institute for Tropical Medicine (RITM) treatment hub in Alabang, Muntinlupa City. ARV therapy helps PLHIVs keep their viral load low as they await the virus’ cure. 

Little did she expect that their maintenance drugs would run out long before the ECQ ended. Missing out on ARV treatment for the first time, Delia feared contracting COVID-19 because of being immunocompromised. 

“Madali kaming mahawa ng ubo [at] sipon. Nung nalaman ko na ‘yun ang unang sintomas ng COVID natakot talaga ako, bawat konting ubo ng mga anak ko parang ninenerbyos ako,” Delia told TNP. 

Delia and her sons are among the millions of people living with HIV (PLHIV) whose treatment had to take a backseat as COVID-19 limited their mobility. Extreme lockdowns blocked PLHIVs from lifesaving ARV drugs, putting them in danger of not only contracting COVID-19 but other deadly diseases as well.

“Nung nalaman nga namin yung tungkol sa COVID pati mga anak ko natakot. Hindi nga rin sila lumalabas ng bahay,” Delia added.

ARV treatment disrupted

Commuting from Trece Martires, Cavite to RITM in Alabang now costs her P400, around three times higher than the P140 she used to spend before movement restrictions were in place.

READ: How far must QC residents go for healthcare?

Delia said she had to borrow money from neighbors just to make ends meet.

“Walang-wala talaga kami ‘nun […] maski pang-data para sa check-up kasi hindi nakakapaglako yung asawa ko ng tinapay. Eh yun lang yung source of income namin,” she said. 

Delia had plans of working abroad before the pandemic, but HIV soiled her medical examinations. Unemployed, she struggled to keep up with her Philhealth insurance contributions.

A Philhealth membership made Delia eligible for free HIV medications and consultations. But Delia is required to pay a P600 quarterly contribution to remain an active Philhealth member.

“Nababayaran ko siya kung may extra kami o kapag nakakakuha ako ng medical or financial assistance dito sa local government namin sa Cavite,” she said. “Pero depende pa ‘yun. Every six months [lang] kasi pwede mag-file for medical assistance at depende rin sa budget ng LGU.”

The pandemic halted the P5,000 biannual medical assistance she used to receive from her local government unit (LGU).  

RITM allows regularly paying Philhealth members to stock up on ARV drugs worth one-to-three months. But because Delia was unable to settle her contributions, she had no choice but to come back to Alabang monthly.

Naging mabait naman yung RITM ngayon [na may pandemya]. Pumapayag sila ngayon na pang-three months na ang refill,” she added. 

Civil society stepping up

A 2020 Department of Health (DOH) memorandum ordered health facilities to “collaborate with existing networks of community-based organizations in promoting HIV services.”

This is to ensure uninterrupted access to ARV therapy, such as setting up telemedicine services or availing courier services or government vehicles to deliver medicines to PLHIVs.

While the COVID-19 pandemic has blocked patients from accessing HIV treatment, it also hinders concerned agencies from reaching out to PLHIVs.

Philippine National AIDS Council (PNAC) Chairperson Alvin Feliciano said that although they continued working amid the lockdown, the council’s delays were unavoidable. 

“Nagkaroon ng mga budget cut para sa COVID-19 response. So marami ring naantala,” Feliciano said.“Nagtulong-tulong yung mga civil society organizations [na] parang bayanihan—na yung iba, sila yung nagdedeliver ng mga gamot sa isang PLHIV and they communicated through their networks.” 

When Delia and her sons were unable to take their medicines from June to September 2020, a civil society organization reached out to them by sending medicines via courier service.

Project Red Ribbon Care Management Foundation’s Pamela Magdaluyo felt that the HIV response was sidelined during the COVID-19 pandemic.

Hindi nila nakita na aside from COVID-19, meron tayong isang virus [HIV] na dapat continuous [ang pag-address] para mabawasan ang bilang,” said Magdaluyo.

Aside from sending Delia her maintenance drugs, the organization also taught her family how to use RITM’s telemedicine service. 

Ronald Bugarin, a volunteer counselor from community organization LoveYourself Inc., said they also had to find ways to “innovate” in the new normal, such as hiring public transport drivers to deliver ARV drugs to far-flung clients.

A PLHIV himself, he and other PLHIV volunteers feared contracting COVID-19 and wore full personal protective equipment during their work. “It definitely takes a toll on one’s mental health. We’re anxious not just [about] acquiring the virus but also for our loved ones.” 

They had to limit the number of walk-ins and impose strict by-appointment consultations for their clients as part of new precautionary measures. 

We’re here to help, but we had to figure out how to protect each other—not only the clients but also us, volunteers, while still helping the community,” said Bugarin.

‘HIV epidemic’

Despite having a “strong and community-led response,” the Philippines has one of the fastest-growing HIV epidemics in the world, reports UNAIDS Executive Director Winnie Byanyima. UNAIDS estimates a 237 percent change in new HIV infections in the country since 2010.

The HIV/AIDS & ART Registry of the Philippines (HARP) records 88,108 HIV-positive individuals for 2020, majority of whom were diagnosed between 1984 and 2019. Among them, 58% are currently enrolled in ARV therapy.

The Calabarzon region, where Delia lives, has the second-highest number of regional HIV cases, with 13,705 tallied as of June 2021. 

But the actual number of Filipino PLHIVs could be higher, as UNAIDS reported a 61% drop in HIV testing in 2020 compared to 2019. During the 2020 ECQ, the country only detected a daily average of 22 cases, as mobility restrictions led to a halt in HIV testing.

The number has since gone up to 31 from January to March this year.

“Marami [kasi ang] na-lockdown, maraming hindi nakakagalaw or hindi nakaka-acccess sa mga point of services ng HIV,” Feliciano said.

Feliciano notes that inaccessible HIV testing could lead to late testing and treatment. In fact, HARP recorded that 17% of PLHIV showed symptoms of advanced HIV infection or Acquired immunodeficiency syndrome (AIDS) during their diagnosis in April 2021.

Once na mabigyan [sila] ng gamot at an early stage mas mabilis na nagagamot—malaki yung effect sa [quality of life ng] PLHIV,’ Feliciano added.

Lagging behind

The UNAIDS has set the 90-90-90 global target in 2016, where 90% of PLHIV must know their status, 90% of them are on treatment, and 90% of people receiving ARV treatment are virally suppressed. Not once did the Philippines meet these targets.

“Malaki ang chance natin na mameet itong bagong magiging target natin na 90-90-90 kasi meron tayong bagong batas the Philippine HIV and AIDS Policy Act,” said Feliciano.

Republic Act (RA) 11166 or the Philippine HIV and AIDS Policy Act of 2018 strengthens the country’s policy on HIV and AIDS prevention, treatment and support. Feliciano believes that the law puts “more teeth” into the country’s HIV/AIDS response.

“Mas detalyado kung ano yung mga responsibilities ng bawat government agency and ano yung magiging role ng civil society organizations and other stakeholders,” Feliciano added.

He also stressed that RA 11166 would provide a much-needed budget to local government units (LGUs), whom he called ‘frontliners’ in the country’s fight against HIV. The law secures an HIV budget in LGU wallets, itemized in General Appropriations Acts.

But with the pandemic disrupting the law’s implementation, Feliciano believes that the country will only get back on track in two to three more years.

Nowadays, Delia and her sons have been continuously taking their ARV drugs. Since the COVID-19 pandemic, her family has learned to toughen up their precaution, as they now battle two viruses at the same time.

“Yung panganay ko naiintindihan niya na [na may HIV siya] pero yung bunso ko wala pa siyang alam. Nung nagka-COVID, naintindihan nung panganay ko na kailangan naming mag doble ingat talaga,” she told TNP. 

While her husband has returned to selling pastries, she still hopes the pandemic will end soon—for her sons to live a life as normal as possible.

“Sana matapos na ito[-ng pandemya], kasi wala namang may gustong mamuhay na laging takot at nangangamba ‘di ba?” she said.

NOTE: This story was originally written for a J195 Pandemic Reporting class under Prof. Theresa Reyes.

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