Wednesday, September 28, 2016

HIVisions - We’ll Need More than Apples: Medical professionals on the continuum of HIV services in the Philippines

By Jan Gabriel Castañeda

The HIV crisis has gone on for four decades, and for four decades the world has struggled against it. Doctors, scientists, educators, policy makers, writers, artists -- people of all walks and all colors have, in their own ways, sought to make sense of this crisis and its relationship with society. From citizens to states, from medicine to prayer, from cures to cries for reform, people’s visions of how to respond to the crisis are as diverse as the people who bear its scars. The goal of this series is to give you a glimpse of these visions: the roles people of different passions and disciplines have played in this crisis that, as of March 2016 as recorded by the Department of Health’s Epidemiology Bureau, is infecting 25 Filipinos daily.

The phrase "An apple a day keeps the doctor away" is a troublesome one. Besides being an adage to a complicated colonial heritage, it's not even that good (native fruits like langka and durian are far more nutritious and patriotic alternatives). And when it comes to HIV services, spanning the whole gamut from testing to treatment, apples aren’t much of a solution either. The powerlessness of the colonial fruit is especially pronounced in the Philippines where, despite our successes, the reality is still mostly bad news -- a far-cry from when, just a little over a  decade ago, health experts puzzled over why HIV infections were so uncommon here.

Apples aside, there’s something else we need to puzzle over: what will keep the doctor away? If the country's HIV services were to come in for a full check-up, what would be the prescription? Despite their busy schedules, two doctors spoke with us about their work and to give us their diagnoses and prescriptions.

Doctor Jon Fontilla, a full-time consultant for the National HIV Monitoring and Evaluation Team, explained that his work was motivated by a personal tragedy. "During the course of my career in the HIV program, I had friends who died from AIDS related causes," Doc Jon shared, his experience a motive many of us in the community know all too well. "This pushed me to stay with the program."

Doctor Winlove Mojica, who recounts a similar shock in another interview, currently works as a Clinical Associate Professor at the Philippine General Hospital's Section of Dermatology. In 2014, he was granted a scholarship by the National Skin Centre Singapore, during which he saw an average of 30 to 50 patients daily in his one-month stay at their Department of Sexually Transmitted Illnesses (STI) Control.

Dr. John Fontilla

Dr. Winlove Mojia

The diagnosis

While they work under different circumstances – Doc Jon in program management and Doc Winlove in dermatology – both doctors converge on the fact that people have cultivated a whole constellation of fears around HIV, what we generally refer to as “stigma”. And stigma, as we now know, drastically impacts our ability to deliver HIV services effectively.

"The most pervasive issue that I encountered is stigma. Many people shy away from talking about HIV because of its mode of transmission," Doc Jon explained. "People generally don’t want to talk about very personal things such as sex and drug use."

Doc Winlove on his end, talked about how people were scared "away" – sometimes by the doctors themselves. "People with HIV also have other STIs and they do not know where to go to avail of quality services," Doc Winlove shared. "Most of my patients tell me that they are either ashamed to disclose their other conditions to their primary doctor or their doctor does not know or refuse to provide them treatment especially for conditions manifesting on the skin."

Asked what the contexts of these refusals were, he clarified that doctors want HIV testing to be done before performing an invasive procedure. “In a lot of provinces, doctors refuse to do life-saving operations because of fear of getting infected with HIV for those suspected to have the virus,” Doc Winlove lamented. “The lack of understanding of how the virus is transmitted among health professionals is saddening and sickening at the same time.”

But even when one zooms out from the individual case study, the bigger picture does not offer much comfort either.

"There are so many gaps in the national HIV program: lack of facilities, lack of trained professionals, hesitance of people getting services," Doc Jon laments, citing curious instances of dishonesty. "And it's not just a matter of whether they have it or not: it’s functionality. There are sites with equipment, but they’re not functional. It's declared by the social hygiene clinic, but they have no counselors or testing kits. There’s a Local AIDS Council on paper, but they do nothing.”

And while the past five years have seen improvement, the reality remains a work in progress at best. Doc Jon offers a blunt reflection: "If there is not enough investment in HIV prevention programs, expect much higher incidence rates in the future. This means the cost of medicines for people living with HIV will also escalate. I don't know if the government will still afford to provide free medicines in the future." Although the government has worked to make sure medication remains available, Doc Jon’s worry coincides with broader issues pertaining to the economic impact of HIV/AIDS medication. Recall, for example, the scandal that broke out in 2014 regarding a supposed nationwide shortage of vital HIV medication.

Doc Winlove offered his own timeline: "With a biased focus on testing and treatment of HIV and the neglect of the prevention of other STIs, the epidemic could continue for at least the next ten years."

The doctors' prescriptions

But to say that a situation is bleak is not to say it is impossible. As the past five years have showed, creating better HIV services is actually doable. The doctors offer a few suggestions for how we can do it better.

Doc Winlove tells us that collaboration, in HIV/AIDS as in any field of interest, is a key component in addressing the issue. "It is hard to encourage different medical specialties to work together to fight these infections. But the good news is a younger generation of doctors are starting to collaborate to provide comprehensive and efficient STI-HIV services."

And since STIs and HIV often go together, Doc Winlove asks us (which is the practice elsewhere) to provide these services together. "Because of the focus on HIV, preventive aspects for other STIs are not given equal emphasis. I have learned that these services must be colocated. A one-stop-shop facility that provides management for STIs and HIV not only improves infection control but also reduces stigma."

And for his fellow doctors, Doc Winlove offers this advice: "As a doctor you have to have a high index of suspicion for possible HIV infection. You must not be afraid to ask sensitive questions. But you must do so in a non-stigmatizing manner." This might sound like novel advice, but to any doctor who takes their code of ethics seriously (and to all of us who understand the heavy price of stigma), this ought to be obvious.

Another key component to any kind of medical practice is clarity and consistency. On this point, Doc Winlove turns to HIV counselors: “Not all HIV Counselors have a medical background. Even if they do, it is not standardized. There is no regular monitoring and evaluation if the key messages are delivered during counseling services. Several times  when I went for HIV testing  and the counselor knew I was a doctor, the counselor stopped and told me, ‘Alam mo na 'yan doc’. No, it shouldn't be that way.”

“Each encounter must be effective and consistent,” Doc Winlove tells us. “To use an analogy: if you teach a group of students about a topic, it should not be assumed that they understand it. That's why we evaluate through oral and written exams. Counselors should have regular skills evaluation.”

Doc Jon, turning to the efforts of other countries and the overwhelming evidence supporting them, emphasized the need to take comprehensive sex education seriously: "Start young. Habits are formed at a young age, including sexual practices. People in DepEd, for example, still think that it’s wrong to talk about sex for fear of enticing kids to start having sex. Hello: they will have sex whether they talk about it or not." Places like the United States, for example, have learned this the hard way.

That is not to say that everyone in our schools are against it. For those who know better, their hands are often tied by institutional politics. "We had some teachers in our peer education trainings. They did change their perspective but the problem with schools is systemic. Some want to start a school-based program but school officials prevent them from doing so." But this dilemma is nothing new. Organizations like Human Rights Watch have observed this before, and even back in 2004 reported that “attempts by AIDS educators to teach comprehensive HIV prevention in schools were met with stiff resistance from teachers and principals opposed to birth control.” 2016 is the same old story.

But Doc Jon, focused as he is on programs, is deeply concerned with the budget. "The only way to improve the program is to increase the investment. We are so far from the four billion peso annual cost of a comprehensive HIV program." This number comes from the Department of Health's own calculations in their AIDS Epidemic Model, published two years earlier.

So the doctor's orders are clear so far: institutionalize prevention through comprehensive education, strengthen existing services, encourage collaboration among medical professionals, address the culture of fear, and get a bigger budget. Apples are optional.

Tuesday, September 13, 2016

LoveYourself Welcomes its New Batch of Volunteers, "Bahandi"

Last September 10, Batch Bahandi’s Sarimanok graciously soared to take part in Love Yourself’s roost. They are the 37 new recruits who underwent a thorough screening process to complete this year’s 3rd set of volunteers.

This 2016, LoveYourself kick-started the assimilation of concepts from the three main island groups of the Philippines (LuzViMinda) in coming up with batch names for the new volunteers. This rebranding reflects LoveYourself’s intent to promote patriotism and tolerate diversity among its volunteers. This trend took off with Kinaadman (Cebuano for “wisdom”) to represent Visayas, followed by Magayon (Bicolano for “beautiful”) to embody Luzon and finally capped by Bahandi to signify Mindanao.

Bahandi, the chosen batch name for the new set of volunteers, actually came from Pamahandi, a lower god of the Higaunon people of Northern Mindanao, who is believed to have dominion over treasures and properties. From Pamahandi came the word Bahandi, a Cebuano term, denoting treasure, riches or fortune. From this concept, LoveYourself aims to highlight its volunteers, who are considered as its priceless treasures in creating positive ripples of change.

Soaring High

The Sarimanok, the popular fowl of legendary origins, was chosen as the representation for Batch Bahandi. It comes from the words “sari”, which is a garment of assorted colors and “manok”, which means a chicken. With its multi-colored wings and plumage, the sarimanok is often depicted with a fish in its beak or talons, which it considers as its prized possession, its treasure. The Maranao people of western Mindanao consider this fabled bird to represent good fortune, linking the logo with the batch name Bahandi. Its colourful feathers also depict the individuality of its volunteers, noting that each one is talented in their own right and that every bit of contribution complements the various colours in the whole picture that is LoveYourself.

Safety in Numbers

With the addition of 37 recruits, LoveYourself has increased its numbers to over 600. And just last August, 17 volunteers completed the trainings to become full-fledged HIV counsellors, pushing the total number to over 300. Batch Bahandi will be given the opportunity to undergo training to become counsellors and then to move further up as life coaches by taking the NEX+ CHAP+ER program.

Volunteers, old and new alike, are encouraged to help man its 2 clinics (LoveYourself Anglo at Shaw and LoveYourself Uni at Taft) and to engage in the various committees of the organization. As LoveYourself aims to widen the scope of its advocacy, the organization looks back and highlights the importance of its volunteers. It aspires to fortify the bond between the volunteers to further solidify its foundation for a stable expansion. For LoveYourself volunteers throughout the years will all agree, “Alone we can do so little, together we can do so much.”

Wednesday, August 31, 2016

Volunteer Spotlight: Jay Fernando - Manunulat, Tagataguyod

Ni: Ruben Jay Alvarez

Mamulat tayo sa mga kulay at talinghaga ng mga karanasan ng isang manunulat, tagapagsalaysay, alagad ng sining, at LoveYourself volunteer na si Jay Fernando.

Sinong mag-­aakala na ang isang batang nangangarap maging dalubhasa sa siyensya ay magiging isang alagad ng sining sa kasalukuyan?
Habang hinihintay ko ang aking kapapanayamin, umupo muna ako sa isang bakanteng silya sa tapat ng aking kasamang si Mickey at nagisip ng kung ano ba ang dapat kong itanong sa kanya. Maulan ang hapon ng Martes at wala masyadong tao sa Detoxify Bar kaya naman yun ang napili naming pagdausan ng aming panayam.
Pagdating ni Jay ay umupo na agad siya sa tabi ko at kapansin­-pansin ang pulang scarf na nakabalot sa kanyang leeg. Tipikal kay Jay ang magsuot ng maluluwag na kasuotan dahil mas komportable siya sa ganitong istilo ng pananamit.
Si Jay ay isa sa mga volunteer ng Love Yourself at kasalukuyang manunulat ng mga teleseryeng pinapalabas sa ABS­-CBN.
Ang Mahirap Na Panimula
Parehong nagkaroon ng karamdaman ang mga magulang ni Jay at ito ang naging dahilan kung bakit nahirapan ang pamilya nila sa aspetong pinansyal. Dahil sa kanyang mga dinaranas, minabuti na lang ni Jay na manatili sa silid-­aklatan ng Philippine Science High School (Pisay) at magbasa ng mga librong hindi madalas nababasa gaya ng mga librong tungkol sa Literature at Philosophy. “Halos wala ako masyadong kaibigan at dahil sa mga hirap na pinagdaanan namin sa buhay, lagi akong nasa silid-aklatan ng Pisay,” wika niya.
Hindi naging madali ang paglaki ni Jay bilang isang bata lalo nang pumanaw ang kanyang mga magulang. Dito siya nakaramdam ng matinding lungkot at pangungulila. Kaya mga libro ang naging kaibigan ni Jay at nahilig siya sa pagbabasa.
Pakiramdam niya may mga totoong katauhan sa mga kwentong kanyang binabasa at nagkakaroon siya ng kakaibang ugnayan sa mga ito.

Naging malaking impluwensiya ang pagkahilig ni Jay na magbasa sa pagkapukaw ng kanyang interes sa pagsusulat. Bata pa lang siya ay mahilig na siyang magsulat at gumawa ng kwento dahil ito ang naging takbuhan n’ya tuwing nakaramdam ng lungkot. “Ang pagsusulat ang tumulong sa akin upang lagpasan ang mga hirap na dinanas ko sa buhay.”
Pero biro nga niya, mahilig din siyang gumawa ng mga kwentong barbero o gawa-gawa lang n’ya na may mga naniniwala.
Mula sa Agham patungong Sining
Sa Pisay nag­hayskul si Jay at isa sa mga patakaran ng paaralan upang maipagpatuloy ng mga mag­aaral ang kanilang scholarship pagtungtong ng kolehiyo ay dapat kumuha sila ng kursong may kinalaman sa agham or Science courses gaya ng Engineering, Biology, Chemistry at iba pa. Ilan sa mga napupusuan ni Jay ay ang Robotics Engineering, Physics, at Forestry.
Nakapasa si Jay sa kursong Forestry sa UP Los Baños, ngunit naisip ng kanyang nakatatandang kapatid na baka mahirapan siya sa layo ng paaralan.
Napag­desisyunan niyang kunin na lamang ang pangalawang kursong pinili niya at ito ay ang Malikhaing Pagsulat sa Filipino sa UP Diliman. Hindi lingid sa kaalaman ni Jay na mawawala ang scholarship niya mula sa DOST (Kagawaran ng Agham at Teknolohiya), ngunit pinili pa rin niyang ipagpatuloy ang kursong sa tingin niya ay magbibigay sa kanya ng kaligayahan.
Aminado si Jay na nag­-excel naman siya sa kursong napili. Sa edad na labing-siyam, nakamit ni Jay ang unang pwesto para sa “Future Fiction in Filipino” ng Palanca Awards. Sumali rin si Jay sa mga National Writing Workshop at ito ang nagbigay ­daan sa kanya upang makapag­trabaho sa ABS­-CBN sa edad na dalawampu. Naging una niyang proyekto ang “Mangarap Ka” na pinagbidahan nina Piolo Pascual at Bea Alonzo at hanggang ngayon ay nasa parehong kumpanya pa rin sya at kasalukuyang Creative Manager ng iba’t-ibang teleserye na napapanuod gabi­-gabi.
“Kung ako ang tatanungin kung ang mga manunulat ay nilikha o isinilang, sa tingin ko ang mga manunulat ay talagang isinilang.” Naniniwala siya na ang talento sa pagsusulat ay nakatanim sa puso ng isang tunay na manunulat; hindi lamang manunulat kundi isang tagapagsalaysay o alagad ng sining.
Si Jay, Ang Kanyang Madla, at ang Kanyang Tungkulin.
Habang hinihigop ni Jay ang kanyang fruit shake, binalikan niya muli ang kanyang ugnayan sa kanyang mga naging kaibigan – ang mga aklat na kanyang nabasa sa Pisay. Sa pagbabasa, alam niya na may mga taong nagkaroon ng karanasan na tulad ng sa kanya, na nagdaan sa parehong emosyon at pagsubok o kaya’y nakahihigit pa.
“Kahit hindi ko sila kilala, nagkakaroon ako ng ugnayan sa kanila dahil nagdaan kami sa halos parehong pagsubok at landas sa buhay.”
“Ang aking madla o panauhin ay mga taong handang makinig at may pakialam sa aking kwento,” dagdag pa niya.
Naniniwala si Jay na kung sinuman ang kanyang mga tagapakinig, handa siyang maging gabay ng mga ito sa pamamagitan ng kanyang mga isinulat.
Naramdaman ko ang dedikasyon ni Jay sa kanyang obra, at natuklasan kong mas binigyan niya ng diin ang kanyang tungkulin sa kanyang sining kaysa sa kanyang manunuod. Ngunit hindi niya winawaksi ang katotohanan na may tungkulin rin siyang dapat gampanan para sa kanyang taga­subaybay.
“Alam ko ang tungkulin ko sa aking audience, ngunit ang tungkulin ko talaga ay more on my material, towards the story that I am telling. Dapat ito ay totoo, walang kasinungalingan, emosyunal, at naisulat nang may pagmamahal.”
Naninindigan si Jay sa kanyang obra, kaya naman alam niya kung kailan ito totoo at hindi. Hindi niya hinahayaan na manipulahin ninuman ang kanyang isinusulat, dahil naniniwala siya na dapat ang kwento ay magkaroon ng sariling buhay.
Kadalasang tema ng mga sinusulat ni Jay ay buhay at pag-­ibig na umiikot sa pamilyang Pilipino. Mga kwentong sumasalamin sa pagsasakripisyo sa ngalan ng pagmamahal. “Naniniwala ako na sa buhay ng tao, pagmamahal ang isa sa pinakamahalaga. Pag nagmahal ka, doon mo mas makikilala ang sarili mo,” ani Jay.
Nais niyang maisabuhay ng mga bida sa kanyang kwento na kaya ng sinuman ang magtaya ng lahat para sa pag­ibig, sapagkat ito ang katotohanan sa labas ng telebisyon.
Ang Pagsulat at ang Adbokasiya
Dumadaloy sa dugo ng pamilya ni Jay ang pagiging makabayan at likas na matulungin sa kapwa. Ibang kaligayahan ang  naidudulot nito sa kanilang magkakapatid. Ang kanyang ate ay isang Project Manager sa Ayala Foundation na tumutulong sa mga guro na mas maging epektibo sa pagtuturo lalo na sa mga liblib na lugar. Ang kanyang bunsong kapatid naman ay ang Lead of Implementation ng CHED para sa K-12 Program.
“Pag naguusap-­usap kami, sila, they share yung mga ginagawa nila para sa ibang tao, ako ang tangi ko lang nasasabi ay ‘marami akong kilalang artista.’ So parang nainggit ako. Gusto ko rin gumawa ng mga bagay para sa lipunan,” aniya. “Bilang manunulat, hindi ko direktang naapektuhan ang aking madla. Maaari kong ma-­influence yung pananaw nila sa pag-­ibig, pamilya, buhay pero walang direct physical connection kumpara sa mga karanasan ng mga kapatid ko,” dagdag pa niya.
Gaya ng maraming volunteer ng Love Yourself, si Jay ay mayroon ding mga kaibigan na PLHIV (people living with HIV). Napagtanto ni Jay na isa sa kanyang moral na obligasyon ang tumulong bilang ito ay napapa-lapit na sa kanilang tahanan. Para sa kanya, isang imoralidad ang pananahimik sa isang krisis na alam niyang lumalala at pumapatay sa lipunang kanyang kinabibilangan. Sa kadahilanang ito, naghanap si Jay ng isang organisasyon upang makapag­bahagi siya ng panahon upang tumulong.
Sa pamamagitan ng dalawa niyang kaibigan, natagpuan niya ang Love Yourself. Nang marinig pa lang niya ang pangalan ng organisasyon, alam na niya na ito na ang hinahanap  niya, dahil sa ideya ng “loving yourself”. Ayon sa kanya, sa lahat ng love stories na kanyang naisulat, ang pagmamahal sa sarili ang naging puno’t dulo ng mga kwentong ito.
If there’s an underlying message other than the virus, it is more of like loving who you are and accepting who you are and maybe that is where the real healing happens.
Ang TV at ang Adbokasiya ng HIV
Malaki ang papel na kayang gampanan ng TV at midya sa pagpapalaganap ng impormasyon tungkol sa mga bagay na napapanahon. Subalit ayon kay Jay, ang TV (drama) ay wala masyadong ambag padating sa usaping HIV sa kadahilanang hindi pa handa ang madla sa ganitong uri ng paksa. “Yung madla kasi na pinagsisilbihan natin, hindi naman natin maikakaila na masyado pang konserbatibo kaya hindi pwede ang forced entry. Though I have tried pitching [stories about PLHIV] pero [it seems that] the market is very niche.”
Ayon kay Jay, may nagagawa naman ang midya pagdating sa pagpapalaganap ng impormasyon tungkol sa HIV at ito ay makikita sa mga balita. Bukod dito, naniniwala siya na marami pa ang magagawa at pwedeng magawa. “Makapangyarihan kasi ang teleserye lalo na sa pamilyang Pilipino kaya umaasa pa rin ako na balang araw magkaroon ng karakter na PLHIV sa mga teleserye upang mabawasan at tuluyang mawala ang stigma”.
Ayon sa kanya, may kakayahang mag­sibol ng panibagong kaalaman at ideolohiya ang teleserye at kung magkakaroon ng karakter na PLHIV, magiging malaking hakbang ito sa mundo ng telebisyon. Ang nakikita na lamang niyang balakid ay ang kahandaan ng mga manunuod sa ganitong pagganap.
Bilang parte ng creative team, handa raw ang management na magkaroon ng ganitong paksa ngunit isa sa mga pagsubok nila ay kung sino ang magsasabi na handa na ang madla. Isa itong madugong proseso pero hindi nawawalan ng pag­-asa si Jay na sa hinaharap ay magiging katanggap-­tanggap sa pamilyang Pilipino ang istoryang tumatalakay sa HIV. Naniniwala rin si Jay na ang HIV ay isang collaborative effort na dapat ay napag­-uusapan sa paaralan at iba pang institusyon upang maging handa ang mga manunuod sakaling ito ay ipalabas na sa telebisyon.
Buhay Volunteer

Sa mahigit isang taon ni Jay bilang isang volunteer sa Love Yourself, pakiramdam niya ay natupad niya ang kanyang adhikaing makatulong sa kapwa. Sa palagay niya ay nagkaroon siya ng pagkakataong makipag­ugnayan sa ibang tao. Nasubukan na rin naman niya ang magpa­test kaya alam niya ang nakakakabang proseso nito, kaya ang maging gabay ng ibang tao ay isang pribilehiyo para sa kanya. Ang magkaroon ng pisikal na koneksyon sa ibang tao ay isa sa mga gustong gawin ni Jay ngunit hindi lang iyon ang tangi niyang magampanan. Nais niya rin maging instrumento sa pamamahagi ng kaalaman tungkol sa HIV.
Miyembro rin si Jay ng Communications Committee ng Love Yourself at naniniwala siya na marami ang mga hakbang na kailangan pang tahakin. Para sa kanya, ang HIV at AIDS ay isang communications issue. Ang pagbibigay ng tamang impormasyon sa mga tao sa pamamagitan ng counselling and education gamit ang social media ay isa sa mga tinututukan ni Jay.
Malaki umano ang papel ng social media sa pagpapalaganap ng impormasyon at ang organisasyon ay mas nagiging popular sa pagtaguyod ng adbokasiya. Gamit ang social media, kinakailangan ng organisasyon na maging mas responsable sa mga aksyon na gagawin nito at matugunan agad ang mga pa-bagu­bagong pangangailangan ng kasalukuyang lipunan.
Masaya si Jay sa natatamong pagtanggap sa Love Yourself sa pagsulong ng HIV advocacy sa bansa, ngunit alam din niya na mas malaki ang magiging responsibilidad ng organisasyon,di lamang sa mga taong gusto malaman ang kanilang HIV status, kundi sa lipunang ating kinabibilangan.

Kaya naman, tinatanaw na utang na loob ni Jay ang pagkakataong ibinigay sa kanya ng Love Yourself upang makapag­lingkod at makatulong sa kapwa.

Litrato: Mickey Jamias

Ang LoveYourself Volunteer Spotlight ay isang feature na linlalathala kada buwan tungkol sa taglay na volunteerism ng mga miyembro ng LoveYourself. Makakapanayam namin ang mga samu’t saring volunteers na may iba’t ibang mga pinanggagalingan at kuwento, ngunit nagkakaisa sa isang layunin. Mangyaring balikan kada buwan ang aming mga kuwento upang makilala ang mga mukha ng LoveYourself.

Kayo ba’y napukaw sa tapang at pagtataya ng aming mga volunteers? Hinihikayat namin kayong mag-like sa aming Facebook  page at tulungan kami sa paglaganap ng mensahe ng optimismo at self-worth (o kaya’y pagmahahal sa sarili) sa sarili niyong mga komunidad upang makatulong laban sa paglaganap ng HIV.