Even though better medications against the Human Immunodeficiency Virus (HIV) are now mostly distributed for free, some people are still having a hard time availing them due to accessibility issues and the long-standing stigma attached to being sexually active.
Gab, a resident of Pangil, Laguna, has to travel for more than two hours and pass by 10 towns to reach the closest treatment hub dispensing HIV-preventive pills like post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) in their province.
While both are proven effective in decreasing the risk of HIV infection, the medicines vary in terms of how they are taken. PrEP is regularly used by those who are still negative for the virus. Meanwhile, PEP shall be taken within 72 hours after potential exposure to HIV.
“I don’t know if offered ba siya sa mga [rural health units]. So far, wala akong alam kung saan siya pwede i-avail,” Gab said. “If magkakaroon ako ng oras to go to Calamba, or kung magkaroon ng mas malapit na options in the near future, kukuha ako ng PrEP talaga.”
At present, access to both HIV-preventive medicines is centralized within Metro Manila and its neighboring cities.
According to a March 2023 report by the Department of Health, 102 out of 191 HIV treatment facilities are concentrated across the National Capital Region, Central Luzon and Calabarzon.
However, 43% of the total HIV cases last April were recorded outside these regions, suggesting the need for more treatment facilities in provinces as well.
Even without taking PrEP, the 20-year-old Gab confessed that he still engages in unprotected sex. He says he only relies on the HIV status and sexual history that his partners disclose, holding faith that “no one will fake their information.”
Further, Gab also refrained from availing HIV tests and PrEP because of the fear of being judged and talked about.
“Nandoon ‘yung takot na baka mabuko ka na involved sa [sexual] activities. Baka mag-jump into conclusions na once you get PrEP or an HIV testing, you have [the virus],” he said.
Meanwhile, Cjim, a student from the University of the Philippines (UP) Diliman has only used PrEP consistently since May when he moved out from Bulacan for face-to-face classes.
“Hindi rin ako super out pa sa parents and relatives ko, so once they see me with the meds, baka itanong pa nila ‘Hala ano to?’. I can’t say naman na it’s PrEP, baka i-investigate pa nila kung para saan yun,” he explained.
Cjim tried using PrEP before, but a prerequisite blood chemistry test that was not free of charge stopped him from pushing through with the treatment’s course.
He also recounted that in Malolos, Bulacan, private hospitals are already the most accessible source of PrEP.
“Sa Malolos need pa rin magbayad, pero if free, need mo magpa-schedule and it will take you months before mo makuha,” he said.
While PrEP is mostly dispensed by treatment hubs without charge, the free use of PEP, meanwhile, is mostly reserved for select emergencies like when healthcare workers are accidentally exposed to HIV.
When requested for personal use, however, the cost of PEP would range from P3,500 to P7,750 in some clinics.
Current guidelines
According to the HIV/AIDS & ART Registry of the Philippines, 32% of all the HIV cases recorded last May were individuals aged 15 to 24 years old.
Despite this, the amended version of the Philippine HIV and AIDS Policy Act of 2018 still does not have any provision for the nationwide rollout of PrEP and PEP, let alone its distribution among the youth.
For patients aged 15 to 17, there are certain guidelines that DOH-certified HIV counselors must follow in prescribing PrEP and PEP. When minors are concerned, the consent of a parent or a guardian is not required so long as a social worker is involved.
Meanwhile, a non-reactive HIV test result is required for everyone before taking PrEP.
Although there is no available data on the number of PrEP users in the Philippines, DOH-certified HIV counselor Aremm Castrillo estimates that the consumption of PrEP among the youth is relatively lower compared to those who get tested for HIV.
The HIV counselor affirmed that logistics is one of the factors that hinder the distribution of PrEP in certain areas of the country.
“Ang alam ko kasi sa [province], hindi ganon karami unlike sa Metro Manila, like every city may clinic at community based people who do it,” she said.
Apart from being an HIV counselor, Castrillo also volunteers for the HIV and AIDS Support House (HASH), a community organization that builds partnerships with private entities to give free HIV screenings and PrEP outside Metro Manila.
“Meron kaming partnerships with applications like Grindr. We tap into them, and kapag nag-open ka noong application, may ads for programs like free PrEP distribution” she explained.
Castrillo also mentioned that the lack of conversation on sex discourages youth from recognizing the importance of HIV-preventive medicines.
“Kung nahihiya pumunta sa facilities, may community-based screenings. Kami na ‘yung lumalapit sa community, pero wala kasi yung proper information [on HIV] . . . With the youth meron tayong ‘bawal’ i-tackle kasi raw sex is considered taboo,” she said.
Community-based screenings (CBS) are one-on-one consultations, wherein health counselors personally go to those who requested their service. Castrillo said these were designed to work around the stigma of going to clinics related to sexual health.
“It’s a discussion and a conversation. With the normalization of [talking about sex], people become responsible. If we as a society would be more open, magco-correlate siya sa pagbaba ng HIV cases,” Castrillo explained.
EDITORS’ NOTE: An earlier version of this story was submitted as a final requirement to Journalism 102 (Researching and Reporting the News) class under Instructor Janvic Mateo.
