Wednesday, December 28, 2016

HIVisions: Getting the Story Out

By Jean Natividad
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.



In his 1963 book, The Press and Foreign Policy[1], American political scientist Bernard C. Cohen likened journalists to cartographers: they influence, with the “maps” they draw, how the public comes to see the world. "The press may not be successful much of the time in telling people what to think,” Cohen writes, “but it is stunningly successful in telling its readers what to think about.”[2]  Maxwell McCombs and Donald Shaw, in a 1972 issue of Public Opinion Quarterly[3], found a real-world example. Studying the 1968 presidential campaign in Chapel Hill, North Carolina, they came to what is now an obvious conclusion: that mass media shapes voter beliefs about what are important issues. They were not the first to say this, of course. The idea surfaced as early as 1922 by newspaper columnist Walter Lippman[4] and others.


No debate here: the media can set the agenda[5]. Frequent reporting of select issues, prominent story placement, additional inches on a newspaper column, extended airtime -- the media’s strategies are subtle and many. But as much as this power can direct the public, it can also alienate them.
HIV: An underreported issue
Independent journalist and sexual health advocate Ana P. Santos works with the Pulitzer Center on Crisis Reporting[6], an institution that supports journalists working on underreported issues. A two-time grantee, she has reported on migrant mothers as well as HIV (Human Immunodeficiency Virus) in the Philippines. Her stories have been published in various international titles, including The New York Times, The Washington Post, The Los Angeles Times, IRIN News, and The Guardian.
Santos believes interest in HIV has not waned, but she admits there are challenges, even for independent journalists like her, to getting these kinds of stories published. "I'm an independent journalist, so I have to focus on issues that are important to me and balance them out with issues that my editors from overseas want me to focus on,” she explains. “And the editors overseas, they all want a story about the president.” True enough, local newsrooms haven't had a slow day since the presidential campaigns. Since President Rodrigo Duterte’s election, more and more political stories have been produced, from the president's war on drugs to his controversial pronouncements, the state visits, Senate hearings, the Marcos burial -- the list goes on. "There's been a lot of unprecedented moments in this new administration,” Santos tells us. “It is a real challenge in terms of getting your stories out there and also getting people to pay attention." Internationally, it is the same challenge. Other issues, such as the refugee crisis, the rise of violent extremism, and the looming shadow of climate change, simply have more traction than HIV/AIDS.
But Santos has found a way to write about HIV despite these editorial interests. In "Philippines' war on drugs affecting fight against HIV"[7], her September 2016 report for the German publication Deutsche Welle (DW), she angled the story to satisfy both her editors’ requirement to deliver news on the president and her personal advocacy. The result is a riveting investigative piece that delved deep into the rising number of HIV infections among people who inject drugs (PWID) in Cebu, and how the government's criminal approach[8,9,10] to its anti-drug campaign has crippled HIV intervention programs. "First, it was the drug war, and then it has now become a geopolitical issue. These are increasingly important. Yes, they're important, but so is HIV." Santos mentioned geopolitics because the president’s often controversial statements concerning international relations[11,12] are top news for editors too, and these also tend to overshadow other issues like the HIV epidemic.
Humanizing the epidemic
Anna Santos talking to a patient at the Halfway House run by Cebu Plus

A published story with all “news values” (such as timeliness, impact, conflict, proximity, and prominence) is good, but it's the storytelling that makes it great. “Treatment trumps topic,” as the American Press Institute puts it.[13] For a reader, storytelling can become more important than the story itself. “The best story is a well-told tale about something the reader feels is relevant or significant.”[14]
For sensitive topics like HIV, well-written human interest features (or people-focused stories told with an emotional angle) fit the mold of a great story. These great stories can resonate with readers because they showcase real people with real struggles and real victories. But even then, journalists face roadblocks. "There's less resistance to HIV stories on children[15] and mothers[16],” Santos explains. “When you talk about HIV in terms of, for example, PWID, sex workers, and people in prison, people think, 'Who cares about these people?' So there's always that challenge." One solution is, somewhat ironically, to make the subject human: "I think the way that journalism can address that is to frame it around people. This isn't a prisoner; this is someone like you and me. This isn't a person who injects drugs; this is a person like you and me."
But journalists aren’t just journalists either: they’re people like you and me, and like most of us aren’t immune to the emotional toll stories like these have[17,18,19]. In Santos’ case, it was meeting children living with HIV that weighed heavy on her: “When we were doing the drug den story in Cebu…we found children who are living with HIV. And that bothered me the most. One 9-year-old girl said that she would, at times, be the one to buy the drugs for her mother. She didn't realize it, and she was sometimes at the shooting galleries.” Santos’ advice is to “detach”, to take a step back and to “detoxify”. This means moving away from the stressful situation and letting the strong emotions pass before continuing the legwork.
There’s a need for journalists reporting on HIV to go beyond the numbers if they want a wider readership. In an article for the Center for Health Journalism[20], Jon Cohen writes: "The best HIV/AIDS coverage delves beyond the latest statistics of how many people are infected, the publication of a new national plan, or the results from a study of a promising new treatment or preventive intervention. It tells the stories of the vulnerable people who took part in that study and offers different perspectives about the results. It airs debates that took place behind closed doors while the new policy was being formed. It explains the complex, confusing forces that drive how an epidemic changes shape over time." In short, quality coverage is comprehensive: it probes for information, provides context, and offers perspective.
In the Philippines, where HIV remains a touchy subject, putting a face on the epidemic can be daunting. People living with HIV (PLHIV) could fear estrangement from their communities because of their condition and refuse to become sources for journalists. And for Santos, the first rule is to do no harm: “the safety and the dignity of PLHIVs should be your paramount concern.” This means protecting sources and reporting their stories with utmost care, getting informed consent, honoring requests for anonymity, getting in touch with the right people (like experts and reputable organizations), disclosing all details about the story (like the angle, and where and when it will be published), and so on. She recalls: “We were in a drug den… My photographer, Veejay [Villafranca], because he had a camera, they [PWID] were asking, ‘What's that?’ Veejay asked, ‘Sir, could we take some pictures? We won't show your faces.’ And then he [Veejay] would show them the photos, so they eased up. But no one wanted to talk to me at first, and I was the only woman in the room. Finally, somebody came up to me and asked, ‘Ate, what do you need?’ I said, ‘No one's talking to me. I just need to get an interview. Is it alright?’ She said, ‘Okay, but let me inject first, okay?’ Will you be able to wait? Are you in a hurry?’ I said, ‘No, no, no. I'll wait for you. Promise, I'll talk to you.’”
Learning the science, getting the support
Part of the job is to stay on top of the beat or the subject. For those reporting on HIV, this means being up-to-date on the latest social and medical advancements. In the Philippines, for example, journalists need to learn how to report on Pre-exposure Prophylaxis (PrEP)[21], a pill that, with correct and consistent use, was demonstrated by clinical research to lower the risk of HIV transmission by up to 92%[22].
According to Santos, a shift from 'awareness' to 'understanding' is necessary. It’s not enough for readers to know there’s an HIV epidemic in the country[23]; readers need to know about the epidemic’s beginnings, its present state, and where it’s headed. "There's a lot of reporting, but let's move beyond awareness already... You need to go beyond creating awareness to now establishing understanding and then creating positive conversations and dialogues." Going beyond awareness also means journalists need to go beyond the figures. While solid research is the foundation of any good report, presentation matters. This means translating medical jargon and complicated statistics into clear stories that are readily accessible to readers unfamiliar to the subject[24,25,26].
"HIV, when you report on it, you need to be sensitive to the realities of the people that you report on,” Santos says. “You also have to be scientifically accurate. That's what I rely on the government for, especially with new things like PrEP. It's technical again. Now, there's something new again to understand. And I think that's where the partnership of journalists and the government should come in because we have to be accurate." One example is the Department of Health (DOH), which releases the HIV/AIDS and ART Registry of the Philippines (HARP)[27] every month. Note however that reporters must be extra critical when dealing with technical data: closer inspection could at times reveal gaps in official reports, which should be addressed[28].
Aside from community sources and government data, journalists can tap other entities for support. For Santos' story on PWIDs in Cebu, she enlisted the help of a known non-government HIV testing and support organization in the province. "In Cebu, we had the support of Cebu Plus[29]. Cebu Plus is one of those organizations that are trusted. We also had the support of the city health department. So we talked to them. We told them what the story's going to be about. We engaged them. We also got a briefing from them about what to expect. And we were granted access. But you never go in there without someone who's known in the community.”
LoveYourself[30] also works with members of the media to help them get HIV stories out. Volunteers have served as resource persons for news and investigative reports, and the organization has connected journalists with other sources for their stories. LoveYourself also regularly shares content through its website[31], the Rappler X page[32], and other social media channels[33,34,35], which can be sources of reliable information for readers and story ideas for reporters. Santos tells us: “I look to you [LoveYourself] for support groups and guidance. If I were to write a transgender story now, for example, and I have to look for an expert on transgender issues, I would ask somebody from LoveYourself.”

With adequate support, the journalist’s job of producing quality reports on HIV is made easier. And while making HIV the headline story of the day remains a big undertaking, journalists can turn to tested strategies to get their stories the attention they deserve. But once the story is out, its value rests solely in the hands of the readers. Because while journalists might be the cartographers, it’s the readers who do the traveling.


Photos by Ana Santos and Veejay Villafranca


Tuesday, December 20, 2016

LoveYourself and the Senate: Battling the modern-day HIV epidemic

By: Mark de Castro

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In commemoration of the World AIDS Day observed every 1st of December, Senator Risa Hontiveros, head of the Committee on Health and Demography, partnered with LoveYourself last November 29 in spearheading an HIV Testing campaign for the employees of the Senate of the Philippines. Together with the help of the Pasay City Social Hygiene Clinic, the testing was conducted from 9:00 AM to 5:00 PM at the Jose P. Laurel Hall.

Hontiveros recognizes the need to decrease, if not obliterate, discrimination and increase the level of health consciousness and solidarity in the general public[1]. With aims to raise awareness about the disease and emphasize the importance of early detection, this partnership between LoveYourself and the senate is a good leap towards the battle against HIV.
The Senate for the Youth

Senator Hontiveros voiced out her concern for the youth and emphasized that they are now part of the key affected population of the HIV epidemic. “This is highly important for our youth because they are at the forefront of the vulnerable key affected population”, said the Senator.  (Higit na mahalaga ito para sa ating mga kabataan dahil yung atin pong mga young Filipinos ay nasa forefront ng vulnerable [na] bahagi ng ating populasyon.) This can be reflected in the latest data from DOH where 27% of the newly reported cases of persons infected with HIV are youth aged 15-24 years[2].

With the latest trend that the large portion of the newly diagnosed cases has become younger, there has been notions to lower the age limit of individuals undergoing voluntary HIV testing. Once approved, individuals, as young as 15, will be allowed to undergo voluntary HIV testing without the need to secure his or her parent’s consent. This, coupled with counseling and early treatment will open a lot of opportunities in the battle against HIV.
Pushing for Improvements

A public hearing at the senate on the same day was conducted for the bills filed seeking to amend R.A. 8504, otherwise known as the Philippines AIDS Prevention and Control Act of 1998. As per Hontiveros’ opening remarks during the senate hearing, there is a growing consensus among policy makers, program implementers and advocates that the R.A. 8504 “will not deliver an end to the HIV epidemic in the country.” The government’s response and initiatives are still based on a legal framework from the past where HIV cases were still low[3] and HIV was considered as a terminal condition.

Back in 1998, the number of reported cases of people living with HIV is at 189, which is a far cry from the 7,756 reported cases by the end of the third quarter of 2016, which affirms that a lot has already changed, and that the provisions of the current law may no longer be applicable to modern-day situations. There are now modern pharmacological advances and HIV prevention approaches available that we could benefit from which were not yet available during the time of the passage of the said bill.

As stated by Hontiveros, all five bills filed this year seeking to repeal R.A. 8504 have a lot of commonalities. The proposed amendments highlight the need to reinforce the existing mechanisms of the government in suppressing the HIV epidemic, with strong considerations in the observance of human rights, abating discrimination, eradicating stigma and uplifting the welfare of the community, especially the key affected population.

Another First For LoveYourself

Being the first advocacy organization to have been invited by the current administration to conduct testing at the Senate, the event is a milestone for LoveYourself as an organization and an honorable recognition of the efforts it has made over the past few years. Last December 12, the organization’s founder, Vinn Pagtakhan, was awarded as one of the country’s Ten Outstanding Young Men and Women (TOYM) for founding an organization leading the fight against the HIV crisis.

The non-government organization comprised of volunteers has steadily made its mark as the leading HIV advocacy group in the country. Earlier this year, it has expanded its range of services from HIV testing to include life coaching and PLHIVs[4]. Furthermore, it has launched a unique line of service centered on counseling for couples, known as LoveYourself Purple. Finally, in partnership with PrEP Pilipinas, LoveYourself will be the pioneers of PrEP, a revolutionary intervention method for preventing the spread of HIV[5], administration of which will be carried out through its two clinics, Anglo and Uni.

Photos by: Mark de Castro

Wednesday, December 14, 2016

STATUS -- The FIFTH HIV Status

By Reiner “Meow” Grospe

Everyone has talked about a particular status in his or her life, be it their relationship status, their financial status, and heck people talk about their problems on their Facebook status all the time! But one thing that’s rarely talked about is one’s HIV status. Despite its relevance today it is still greatly stigmatized and has been thought of as taboo by many. This monthly column aims to help facilitate discussion on issues surrounding HIV testing and living with HIV.


“Single”, “In a Relationship” and “It’s Complicated” are some of the usual relationship statuses we hear of. As social individuals, all of us have a relationship status - we’re any of the three just mentioned. Similarly, everyone has an HIV status. HIV status is usually a sensitive issue, kept confidential most of the time. Most people are mum about this topic due to the repercussions it entails - much of it due to stigma.

In any case, there are four types HIV status a person may have, namely: nonreactive, negative, reactive and positive. These types are not permanent and may change. Let us know more about the four types of HIV status mentioned:

Nonreactive

A  person who has undergone HIV screening and has had a “nonreactive” result means that their blood samples did not react to test procedures determining the presence of an HIV antigen or antibody. This person’s status is therefore “nonreactive”.

Though undetected, we should also consider the fact that the presence of HIV antigens and antibodies in the blood changes in different phases or time frames after the infection. This time frame is called the window period, and the duration of the window period depends on what screening or testing procedure one will submit themselves to.

Aside from the procedures, another thing to consider is how fast the body will produce HIV antibodies, a factor which is reliant to the strength of our immune system. Upon contracting HIV, the body will take some time to produce antibodies in response to the infection. At this point the viral load is at its highest and the person is at his or her most contagious phase. A person may show symptoms of illness such as fever, diarrhea, chronic weight loss, and fatigue. It is also possible that a person will be completely asymptomatic. After some time,  the body will produce antibodies to suppress the infection.  A person with a weak immune system will generally take more time to produce HIV-antibodies.

Some tests may detect antigens within two weeks after exposure, however it usually takes six to twelve weeks post-infection for HIV antibodies to appear[1]. These mentioned time frames are what the term “window period” refers to. Since the presence of antigens and antibodies depends on the disease process and health status of individuals, LoveYourself follows the prescribed 3 months  window period to ensure a more accurate test result.

A person with a nonreactive status but underwent testing within the “window period” (the client had unprotected penetrative sex within three months when he had the test) must be tested again for the presence of HIV after the completion of his or her window period.


Negative

Having this status after practicing safe and satisfying sex confirms the absence of HIV in his or her body. LoveYourself’s paradigm of self-care, the “Triangle of Self-Care”, is a three-point guide to staying negative. This can be achieved through timely testing and treatment, safe and satisfying sex, and correct and consistent use of condoms and water-based lubricants.

However, being negative is not an excuse to become complacent and engage in otherwise risky sexual behaviors. Risky behaviors such as not wearing condoms and engaging in sex under the influence of drugs and or too much alcohol must be avoided as it predisposes people to do things that might put them at greater risk of being infected. You may get helpful information and support from LoveYourself counselors or other registered HIV counselors. You can also cultivate love for yourself and surround yourself with friends who will enhance your self-worth.


Reactive

This status is yielded when screening and test results reveal the presence of HIV antigens and or antibodies in one’s blood sample. At LoveYourself, we are using HIV Rapid Screening Kit which is 99.98% accurate and approved by the World Health Organization (WHO), the Food and Drug Administration (FDA), and the Department of Health (DOH).

A person with a reactive status will be informed that his or her blood sample will be sent to DOH SACCL (STD and AIDS Central Cooperative Laboratory) for confirmatory test. Similar to those who tested nonreactive or negative, those who test reactive are urged to practice the triangle of self care.

It is possible for a person with a reactive status to worry unnecessarily. While the situation can indeed be difficult, we would like to assure you that there is a community of volunteers and experts who are here to give you the help and support you need. We encourage you to speak with our LoveYourself counselors to receive more accurate information and at the same time talk about what you feel while waiting for the confirmatory test result to know if you are really Positive.

Positive

This means that you have HIV in your body. It neither means that your days are numbered nor you may die anytime soon. With advancements in medical care, science and technology, HIV is no longer a death sentence. Moreover, it doesn’t necessarily mean you have AIDS. With this status, a person will be given clear instructions to acquire baseline tests, lifestyle modifications and then treatment using medication.

The goal of antiretroviral treatment (ART) is to keep a person living with HIV healthy. With consistent and proper treatment,  the progress of HIV into Acquired Immunodeficiency Syndrome (AIDS) can be averted.

It was mentioned earlier that HIV status may change. This is true even with a Positive status. If a person living with HIV will take his or her medications and other prescribed treatment regimen, his or her status may go back to nonreactive, but will never be HIV free again. This means that the virus is undetectable because of the effectiveness of treatment, but HIV is still there. Failure to continue the treatment will still facilitate progression of the condition to AIDS. A 25-year old accountant living with HIV told me, “With the help of treatment and by taking care myself  I live normally;  more so by being knowledgeable about my condition and being optimistic.”

This Positive status carries a saddening social stigma but there are people who keep an open mind. A female administrative employee at an airport said she knows someone who is PLHIV and still finds him to be the same person he was before. A 26-year old Law Firm Secretary told us that “Yes, I know someone who has HIV, and he is normal just like us.” Truly, much has been done to dampen the social stigma related to HIV and AIDS but much work needs to be done.

Jerome, a 16-year old student and a member of the LGBT community said that he is afraid of PLHIVs. He believes that he may contract the virus even just by eating and watching movies with them inside the cinema – of course, this is not true. There are more like Jerome out there who are misinformed. Jerome, like a lot of other people,  share the fifth status.

The Fifth Status: Unknown

Unknown is actually the fifth HIV status. If you know your status, you can do something significant about your condition and also prevent worse things from happening such as spreading the infection and developing AIDS. Having an unknown HIV status will not give you the power to have control over the medical condition or your life.

Raymond Rinoza, a movie actor said, “Each person should be aware that this is not an issue specific to some demographic and that it is incumbent upon all of us to be educated about this in order to minimize or even eliminate its propagation.”

Visit us at our LoveYourself clinics located at Anglo and Uni, Wednesdays through Saturdays from 12pm-7pm and during Sundays from 9am-2pm. Our friendly LoveYourself counselors will be happy to assist you.

We all have an HIV status. Do you know yours?

Illustrations by: Christian Watson Vergara