1-U=U at government/national level

Philippines saw a late adoption of U=U. Government decided to run a combination prevention, which includes U=U. This could be a good advocacy for the government to purchase more viral load machines, so more PLHIV have access to it. Right now, focus is mostly on prevention strategies.

 

2-Sensitization/ Training of ​PLHIVs, community advocates, service providers and/or CBOs ​

Different CBOs from different part of Philippines are forming a coalition. This network is geared to be involved in promoting the U=U principle.

 

3-Incorporating U=U messages in relevant community outreach, education info and social media campaigns

There are yet to be standard strategies and messages for CBOs to promote U=U. Some organisations promote U=U through facebook and are planning on involving the health care sector to participate in the campaign. One organizations is working on key messages for social media and will go with it post September once they have finalised viral testing protocol.

 

3-Country challenges and barriers

In the Philippines, though there does not seem to be a vehement pushback against PreP, it still has several obstacles in its way before it can become ubiquitous. Besides availability and high costs, the stigma attached to HIV is still one of the biggest problems with overcoming the epidemic.

In general, there are concerns regarding the legal and policy environment, low rates of linkage and limited available treatment in the existing health system in Philippines. 

Current national policy demands that HIV testing be carried out by a laboratory technologist specifically trained for HIV testing and that only individuals 18 or older may buy condoms or consent for testing (with minors requiring the consent of a parent or guardian) (Republic Act No.8504). Overall, the level of provider-initiated counselling is low except among overseas workers and entertainment workers based in establishments. Many local governments have enacted ordinances whereby condoms are seen as proofs of prostitution, an illegal activity.

Two sections of the Republic Act No.8504 (HIV/AIDS Prevention and Control Act of 1998) could be a challenge for implementing self-testing, namely (a) pre and post-test counselling by an accredited counsellor, and (b) the requirement that HIV testing can only be conducted by a medical technologist. However, the promotion of HIVST as a screening program as opposed to testing could lift these restrictions since in the Philippines, testing guidelines from 2017 draw a distinction between screening and testing. While testing is only performed by trained medical technologist, screening is seen as an additional procedure prior to testing that can be performed by lay trained provider, midwives, nurses and physician using rapid diagnostic tests.

The Philippines’ AIDS Prevention and Control Act of 1998 also makes it necessary to disclose one’s status – albeit (unlike in other countries) it is mum on the possible criminal liability of those who fail to disclose. Section 34 (under Article VI, which deals with confidentiality) mandates disclosure to sexual partners – i.e. “Any person with HIV is obliged to disclose his/her HIV status and health condition to his/her spouse or sexual partner at the earliest opportune time.”

 

Desirable characteristics of HIVST kits in the Philippines*

Over half of MSM and TGW participants preferred blood-based to oral fluid HIVST kits as they felt it would be more accurate.

“Blood is better, because you'll know if you have HIV, because it's blood-to-blood” TGW FGD 1

They felt the kit should have instructions in Tagalog, access to a video demonstration and telephone hotline to aid those with literary difficulties.

All key informants, MSM and TGW felt that a high price would restrict access of HIVST, but this was especially so among participants from poor urban areas. MSM participants from low socio-economic groups were willing to pay up to 200 pesos. Whilst MSM from middle to high economic groups and TGW suggested paying between 50 and 875 pesos and 300 pesos respectively.

Our study showed a preference for blood-based kits, which is similar to findings from studies in the USA, Malawi and Zimbabwe... Also our findings of preferences for a low or no cost to the user for HIVST kits, resonate with studies conducted in a wide range of settings (high to low income) and within general and key populations … These characteristics provide an inclusive HIVST program that increases access for testing particularly for those belonging to a low socio-economic group. 

*Excerpt from Is the Philippines ready for HIV self-testing? (Gohil J, Baja ES, Sy TR, Guevara EG, Hemingway C, Medina PMB, Coppens L, Dalmacion GV, Taegtmeyer M. BMC Public Health. 2020 Jan 9;20(1):34. doi: 10.1186/s12889-019-8063-8. PMID: 31918706; PMCID: PMC6953179.

 

According to a 2018 editorial of Outrage Magazine, the only LGBTzine in the Philippines, three key challenges to TasP and U=U are the following:

  • After people get tested, no one really knows what to do next.
  • Baseline tests are not covered by PhilHealth. 
  • Many medical practitioners in HIV advocacy continue to not know much about HIV. Or even if they do, they continue to be sources of HIV-related discrimination.

 

REFERENCES

  1. prepwatch.org
  2. fpasrilanka.org
  3. avac.org
  4. lawsandpolicies.unaids.org
  5. https://cnnphilippines.com/
  6. Get PrEP Done! Strategies for raising awareness, acceptability, uptake and effective use of PrEP, webinar of the WHO Global PrEP Network, 7th July, 2021
  7. https://www.unaids.org/en/resources/presscentre/featurestories/2021/may/20210511_philippines
  8. WHO, Unitaid, and UNAIDS meeting on HIV self-testing and innovative testing approaches in Asia and the Pacific Region: Country progress and plans, December 2020 (https://unitaid.org/assets/PrEP-innovation-and-implementation-in-Asia-and-the-Pacific-Meeting-Report-2020.pdf)
  9. Guidelines on HIV Self-Testing and Partner Notification: Supplement to Consolidated Guidelines on HIV Testing Services, World Health Organization, 2016 (https://www.ncbi.nlm.nih.gov/books/NBK401666/)
  10. PrEP innovation and implementation in Asia and the Pacific: Meeting Report, UNAIDS, Unitaid and WHO in association with the Institute of HIV Research and Innovation (IHRI), December 2020  (https://unitaid.org/assets/PrEP-innovation-and-implementation-in-Asia-and-the-Pacific-Meeting-Report-2020.pdf)
  11. Asia-Pacific Regional Expert Group Meeting on Reviewing Implementation of Commitments from the Asia-Pacific Intergovernmental Meeting on HIV AIDS Beyond 2015, ESCAP, 2018 (https://www.unescap.org/events/asia-pacific-regional-expert-group-meeting-reviewing-implementation-commitments-asia-pacific) 
  12. HIV Self-Testing Strategic Framework A Guide For Planning, Introducing And Scaling Up, WHO, October 2018 (https://apps.who.int/iris/bitstream/handle/10665/275521/9789241514859-eng.pdf)
  13. HIV and AIDS in Asia & The Pacific: Regional Overview (https://www.avert.org/professionals/hiv-around-world/asia-pacific/overview#HIV_testing_and_counselling_(HTC)_in_Asi)
  14. UNAIDS Data 2020 (https://www.unaids.org/sites/default/files/media_asset/2020_aids-data-book_en.pdf)
  15. WHO and partners urge countries to fast-track implementation and scale-up of HIV self-testing and other innovative HIV testing approaches in Asia and the Pacific, March 2021 (https://www.who.int/news/item/16-03-2021-who-and-partners-urge-countries-to-fast-track-implementation-and-scale-up-of-hiv-self-testing-and-other-innovative-hiv-testing-approaches-in-asia-and-the-pacific)