HIV在菲律賓:為什麼必須如倡導團體所引領之方向迅速地採取行

 

HIV在菲律賓:為什麼必須如倡導團體所引領之方向迅速地採取行動以控制日益增長的流行疫情

資料來源:南海早報;出版時間:201913日星期四,上午8:20;財團法人台灣紅絲帶基金會編譯。

•雖然許多國家,包括東南亞國家,愛滋病毒新感率已經下降,但菲律賓仍急劇增長

•官僚體制、保守社會和天主教會是有效行動的主要絆腳石

這是根據聯合國愛滋規劃署6月份發布的2018年全球愛滋更新資料,然而,聯合國愛滋規劃署發現,愛滋新感率下降得並不夠快,愛滋的預防服務仍未提供足夠之規模或達足夠的強度。

東南亞的情況是不一致的,在觸及「關鍵人群--尤其是聯合國愛滋規劃署所指1524歲的年輕人」所持續之努力,已導致泰國、越南、柬埔寨和緬甸的新病例大幅減少。

然而,菲律賓是該地區的一個國家,新病例數卻正在增加- - 而且速度驚人。聯合國愛滋規劃署表示,自2010年以來,該國青少年新感染人數增加了170%。

該機構發現,菲律賓從2008年的每天平均一例新病例,到目前每天平均新發病例數則為26個。

沒有跡象顯示這種趨勢很快就會放緩。截至2017年的七年間,菲律賓的年度新感染人數增加了一倍以上,估計為12,000人。菲律賓國家愛滋委員會的第六期HIV/AIDS中期計畫(2017年至2022年)指出,截至20166月,愛滋病毒感染總人數已達到34,999人,這些更新的數據目前均已可取得。

該計畫列舉了許多促成這一趨勢的因素:疾病的傳播方式從過去主要是異性戀轉變為大部分為同性戀接觸;靜脈注射藥癮者透過針頭傳播;在對未成年人進行愛滋病毒檢測前需父母同意- - 這些都阻礙了早期發現和治療。

為了控制此一流行,民間組織正針對疾病認知之傳播、提供支持和消除歧視上扮演其角色。

其中一個組織就是「珍愛自己」(LoveYourself),這是一個愛滋預防倡導組織,其使命是透過諮詢、測試、治療和生活指導來「擁抱和培養自我價值並激勵他人做同樣的事情」。

它還在不同的學校、公司和各個社區中開展HIV/AIDS疾病意識宣傳活動和教育研習。

LoveYourself的宣傳部副主任Raybert Domingo表示,同理心是一種有效的方式,可以讓人們做出健康的生活選擇,打破文化歧視羞恥感。

 「除非我們採取合乎科學或正義之方式提出議題,否則民眾並不會被促使針對健康採取行動」他說。「如果我們以如同真實一般人在體驗性生活、也會在生活上做出錯誤的決定、甚至可能對事物一無所知之認知關係上與人們互動,那麼幫助就會是在這裡並更能被突顯」。

「在這個社會中仍有些人會願意在理解的立場且注重隱私地關心和關注您的健康需求」。

LoveYourself的宣傳部主任Paul Victor Junio表示,該組織在馬尼拉大都會區的五個診所- - 一個由16個城鎮和一個都市所組成的區域,所通報的愛滋病例佔該國的80--提供所有人開放且免費的諮詢和檢測。

LoveYourself治療計畫由衛生部和政府所擁有的保險公司PhilHealth認證。

聯合國愛滋病規劃署區域主任EAMONN MURPHY表示,菲律賓可以抓住一個小小的機會,以迅速採取行動阻止愛滋病毒的重大流行。

Junio表示在倡導上的一個重大挑戰是當地文化:菲律賓是一個保守的社會。

「仍有一個令人畏縮的因素,這絕對是一個問題」,他說。「我們只能在性的情境中談論愛滋病毒;但如果人們對討論性感覺不舒服,那麼他們對討論愛滋病毒亦會感到不舒服」。

有關討論生殖和性健康的問題在菲律賓很普遍,可能是因為大約83%的菲律賓人自稱是天主教徒。天主教會仍然在菲律賓社會中發揮著巨大的影響力,並一直堅決反對人為的計劃生育和補貼節育計畫等政策。

天主教徒生殖健康倡議團體執行長Bic Chua表示,大量的反對派來自羅馬天主教的階層制度,包括神父、主教和樞機主教-- 他們將避孕政策譴責為道德邪惡。 Chua在最近的一次採訪中表示,儘管事實上「超過70%的菲律賓天主教徒真的想要一個計畫生育之計畫」。

 

就政府而言,衛生部已在全國各地建立了一些愛滋病治療中心,提供拯救生命的抗反轉錄病毒藥物,並敦促愛滋病毒感染者利用免費治療。

 

在馬尼拉大都會區,地方政府已經撥出專項資源並啟動了愛滋病預防服務。

 

例如,在奎松市已開設了三家“日落診所”,並在非標纖歧視的環境下為男同性戀者、男男性接觸者和跨性別的民眾提供快速的愛滋病毒檢測和諮詢服務。

 

2012年以來,該市還增加了九次愛滋防治之資助,並敦促其他地方當局也這樣做。

 

此外,衛生保健界正在倡導聯合國愛滋規劃署的90-90-90策略,其中“到2020年,90%的愛滋病毒感染者將了解其感染狀況,且其中90%的人將被安置於高效能抗轉錄病毒藥物治療中(抗反轉錄病毒藥物或藥物可以防止病毒的生長),並且90%接受治療的患者會達到病毒被抑制的程度,馬卡蒂醫療中心的傳染病研究員Nonoy Marella博士說。

 

有一個理由仍可能對該國的各種提高疾病認知運動抱有希望:Marella認為菲律賓所報告的愛滋病例之增加「可能是由於早期發現了愛滋病毒感染者」。

 

不過,該國對健康威脅的反應仍存在著差距。 9月份發表的參議院政策簡報中指出了包括,過時的、具有20年歷史的HIV/AIDS預防和控制法律架構;疾病有關的公共信息不足;保險套取得上的障礙和保險套使用率低;以久外部資金支持的下降等。

 

一些可以減少愛滋病毒傳播的減害措施倡議可能無法被制定,因為它們違反了某些法律。例如增加靜脈藥癮者使用清潔針具設備的可近性和利用率,即被2002年所訂頒的「全面性危險藥物法」所禁止。

 

還有一個令人畏縮的因素,這絕對是一個問題......如果人們對討論性感覺不舒服,那麼他們對討論愛滋病毒亦會感到不安,「珍愛自己」機構的PAUL VICTOR JUNIO表示

 

另一個法律障礙是1998年的菲律賓愛滋病預防和控制法案,其中有一節要求未成年人在接受愛滋病毒檢測之前得獲得父母或法定監護人的同意。

 

值得讚揚的是,眾議院和參議院承認更新該國愛滋病法規架構的重要性。在2018年,兩院均批准對其各自版本的法案進行第三次和最終解讀,尋求修改1998年法案的關鍵條文。

 

Faustine Luell Tupas Angeles Jnr是參與制定第六期HIV/AIDS中期計畫的愛滋病倡議組織Pedal的創始人,他表示許多靜脈藥癮者因杜特蒂總統對毒品宣戰的強硬立場而害怕尋求治療。

 

他說,在12月初期間,他正在製作一部紀錄片,即ChemSex(一個關於在性行為時使用藥物者的名詞)的複雜性,兩名穿著警服的演員在重演期間被捕。他把這些歸結於當局「試圖掩蓋毒品宣戰情勢」。

 

衛生部表示,該國正處在與愛滋病鬥爭的關鍵時刻,該國將該項疾病視為國家發展問題,而不僅只是一個嚴重的健康問題。只有在所有相關部門的充分承諾下,菲律賓才能有效地解決問題並扭轉目前的趨勢。

 

聯合國愛滋規劃署亞太地區主任Eamonn Murphy也對此表示贊同。墨菲說,「菲律賓有一個小小的機會,可以迅速採取行動,阻止愛滋病毒的重大流行」,「如果能由這個疾病流行已經帶來重大衝擊的城市帶頭,這種承諾將是可以實現的」。

 

 


 

HIV in the Philippines: why it must act fast to control growing epidemic, as advocacy groups lead the way

  • While many countries, including in Southeast Asia, have seen a fall in new HIV infections, the Philippines has seen a sharp rise
  • Bureaucracy, a conservative society and the Catholic Church are the main stumbling blocks to effective action

PUBLISHED : Thursday, 03 January, 2019, 8:20am; South China Morning Post

 

表單的底部

That’s according to the 2018 Global Aids Update of UNAids, released in June. However, the rate of new infections is not falling fast enough, the United Nations agency found. HIV prevention services are still not being provided on an adequate scale or with sufficient intensity.

The picture in Southeast Asia is patchy. Sustained efforts to reach “key populations” – which UNAids describes as young people aged 15 to 24 – has led to a significant fall in new cases in Thailand, Vietnam, Cambodia and Myanmar.

The Philippines, however, is one country in the region where the number of new cases is on the rise – and at an alarming rate. UNAids says the number of new infections in the country among young people has risen 170 per cent since 2010.

 

From an average of one new case a day in 2008, the country now clocks an average of 26 new cases daily, the agency found.

There is no indication that the trend will slow down any time soon. Annual new infections more than doubled in the Philippines in the seven years to 2017, to an estimated 12,000. The sixth HIV & Aids Medium Term Plan (2017 to 2022) of the Philippine National Aids Council states that as of June 2016, the number of people living with HIV had reached a total of 34,999. There are updated figures available.

The plan cites a number of factors as contributing to the trend: the shift in the disease’s mode of transmission from mainly heterosexual to largely homosexual contact; the spread via needles among intravenous drug users; and the need for parental consent before HIV testing of minors – which hinders early detection and treatment.

To get a grip on the epidemic, the private sector is playing its part in spreading awareness, offering support and erasing the stigma of the disease.

 

One organisation doing its part is LoveYourself, an HIV prevention advocacy group with a mission of “embracing and nurturing self-worth and inspiring others to do the same” through counselling, testing, treatment and life coaching.

It also runs HIV/Aids awareness campaigns and education seminars in schools, companies and various communities.

Raybert Domingo, LoveYourself’s deputy head of communications, says that empathy is an effective way to enable people to make healthy life choices and break cultural stigmas.

 “People are more encouraged to take action about their health if we don’t present the topic in a way that’s scientific or righteous,” he says. “If we relate to them like real human beings who experience sex, make wrong life decisions and can even be ignorant of things, then we would be able to show that help is here.

“There are people who are willing to give care and attention to your health needs in an understanding and private space.”

Paul Victor Junio, LoveYourself’s head of communications, says the organisation’s five clinics in Metro Manila – a cluster of 16 cities and one municipality that account for 80 per cent of reported HIV cases in the country – are open to everyone for free counselling and testing.

 

The LoveYourself treatment programme is accredited by the Department of Health and government-owned insurer PhilHealth.

The Philippines has a small window of opportunity to act fast and stop a major HIV epidemic from taking hold.

EAMONN MURPHY, UNAIDS REGIONAL DIRECTOR

Junio says that one big challenge in advocacy is local culture: the Philippines is a conservative society.

“There is still that cringe factor and that’s definitely an issue,” he says. “You can only talk about HIV in the context of sex. If people are uncomfortable discussing sex, then they’ll be uncomfortable discussing HIV.”

Qualms about discussing reproductive and sexual health are widespread in the Philippines, possibly because roughly 83 per cent of Filipinos profess to be Catholic. The Catholic Church still wields enormous influence in Philippine society, and has always been steadfastly opposed to policies such as artificial family planning and subsidised birth control programmes.

Bic Chua, executive director of advocacy group Catholics for Reproductive Health, says a great deal of opposition comes from the Roman Catholic hierarchy, including priests, bishops and cardinals – who decry contraception policies as a moral evil. That’s despite the fact that “more than 70 per cent of Filipino Catholics actually want a family planning programme”, Chua said in a recent interview.

 

For the government’s part, the Department of Health has established a number of HIV treatment hubs across the country that provide access to life-saving antiretroviral drugs, and is urging those living with HIV to take advantage of the free treatment.

In Metro Manila, local governments have earmarked resources and initiated HIV prevention services.

Quezon City, for example, has opened three “Sundown Clinics” that provide speedy HIV testing and counselling in a non-stigmatising environment for gay men, men who have sex with men, and transgender people.

The city has also increased its HIV funding nine times since 2012 and has been urging other local authorities to do the same.

Moreover, the health care community is advocating UNAids’ 90-90-90 strategy, wherein “by 2020, 90 per cent of persons living with HIV will know their status, 90 per cent of them will be placed on ARVs [antiretrovirals, or drugs that prevent the growth of the virus], and 90 per cent of those on therapy will have viral suppression”, says Dr Nonoy Marella, an infectious diseases fellow at Makati Medical Centre.

There may be one reason to be hopeful about the various awareness campaigns in the country: Marella believes that the increase in the reported HIV cases in the Philippines is “probably due to the early detection of individuals with HIV”.

 

Still, gaps exist in the country’s response to the health threat. A Senate policy brief published in September pointed to the outdated, 20-year-old HIV/Aids legal framework for prevention and control; inadequate public information about the disease; barriers to condom access and low condom use; and a decline in external funding support.

Some harm reduction initiatives that could reduce HIV transmission could not be enacted because they run counter to certain laws. Increasing the availability and utilisation of sterile injecting equipment among intravenous drug users, for example, is prohibited under the Comprehensive Dangerous Drugs Act of 2002.

There is still that cringe factor and that’s definitely an issue ... If people are uncomfortable discussing sex, then they’ll be uncomfortable discussing HIV.”

PAUL VICTOR JUNIO, LOVEYOURSELF

Another legal impediment is the Philippine Aids Prevention and Control Act of 1998, which has a section requiring parental or legal guardian proxy consent before a minor can be tested for HIV.

To their credit, the House of Representatives and the Senate acknowledge the importance of updating the country’s legal framework on HIV. In 2018, both houses approved a third and final reading of their respective versions of the bill, seeking to amend key provisions of the 1998 act.

Faustine Luell Tupas Angeles Jnr, founder of Pedal for HIV, an advocacy organisation involved in formulation of the Sixth HIV and Aids Medium Term Plan, says many intravenous drug users are afraid to seek treatment because of President Rodrigo Duterte’s tough stance on the war on drugs.

He says that in early December, during filming of a documentary he is producing, Complexities of ChemSex (a term for people who use drugs during intercourse), two actors wearing police uniforms were arrested during a re-enactment. He puts this down to the authorities “trying to cover up the drug war situation”.

 

The country is at a critical point in its fight against HIV, says the Department of Health, which regards the disease as a national development issue rather than just a serious health concern. Only with the full commitment of all concerned sectors can the Philippines tackle the problem effectively and reverse the current trend.

That sentiment is shared by Eamonn Murphy, UNAids regional director for the Asia and the Pacific.

“The Philippines has a small window of opportunity to act fast and stop a major HIV epidemic from taking hold,” Murphy has said. “This commitment is achievable if cities where the epidemic is having a big impact take the lead.”