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INTRODUCTION

In this Chapter the researcher will tackle the following areas:

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 Study on HIV/AIDS and it’s causes

 HIV/AIDS treatment in the Philippines

 Review of Related Literature for HIV/ AIDS in the philippines

 Local Case Study of treatment Hubs in the country

 Foreign Case Study of treatment Hubs

“HIV” stands for Human Immunodeficiency Virus. To understand what that means, let’s

break it down:

H – Human – This particular virus can only infect human beings.

I – Immunodefeciency – HIV weakens your immune system by destroying important cells

that fight disease and infection. A “deficient” immune system can’t protect you.

V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host.

HIV is a lot like other viruses, including those that cause the “flu” or the common

cold. But there is an important difference – over time, your immune system can clear most

viruses out of your body. That isn’t the case with HIV – the human immune system can’t

seem to ged rid of it. That means that once you have HIV, you have it for life.

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We know that HIV can hide for long periods of time in cells of your body that it

attacks a key part of your immune system – your T-cells or CD4 cells. Your body has to

have these cells to fight infections and disease, but HIV invades them, uses them to make
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more copies of itself, and then destroys them.

Over time, HIV can destroy so many of your CD4 cells that your body can’t fight

infections and diseases anymore. When that happens, HIV infection can lead to AIDS, the

final stage of HIV infection.

However, not everyone who has HIV progresses to AIDS. With proper treatment,

called “antiretroviral therapy” (ART), you can keep the level of HIV virus in your body

low. ART is the use of HIV medicinces to fight infection. It involves taking a combination

of HIV medicines every day. These GIV medicines can control the virus so that you can

liv ea longer, healthier life and reduce the risk of transmitting HIV to others. Before the

introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a

few years. Today, a person whos diagnosed with HIV and treated before disease is far

advance can have a nearly normal life expentancy.

No safe and effective cure for HIV currently exists, but scientists are working had to find

one, and remain hopeful.

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What is AIDS?

“AIDS” stands for Acquired Immunodeficiency Sysndrome. To understand what that

means, let’s break it down:

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A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS

afterbirth.

I – immune – Your body’s immune system includes all the organs and cells that work to

fight off infection or disease.

D – Deficiency – You get AIDS when your immune system is “deficienct”, or isn’t working

the way it should.

S – syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a

syndrome, rather that a single disease, because it is a complex illness with a wide range of

complications and symptoms.

As noted above, AIDS is the finals stage of HIV infection, and not everyone who

has HIV advances to this stage. People at this stage of HIV disease have badly damaged

immune systems, which put them at risk for opportunistic infections (OIs).

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HOW IS HIV TRANSMITTED?

According to the “Department of Health” virus is passed on to another person

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through infected blood like blood stained needles/medical instrumentations, sexual

contacts between casual acquaintances or with strangers/multiple partners, or partners of

infected OFW, sharing of needles among drug users or accidental needle pricking or trauma

among health professionals. HIV infected individuals can infect unsuspecting contacts

because of their normal looking physique. Spread of the disease happens before

identification of the disease is the most treacherous of all possibilities.

Activities That Put You At Risk for HIV Infection

Sexual contact that involves semen, pre-cum, vaginal fluids or blood.

Direct blood contact, particularly through sharing injection drug needles or 'works' (cotton,

cookers, etc).

Infections due to blood transfusions, accidents in health care settings or certain blood

products. This is possible, although extremely rare, in the United States.

Mother to baby (before or during birth, or while breastfeeding through breast milk)

Sexual intercourse (vaginal and anal): Unprotected anal and vaginal intercourse are

high-risk activities. In the penis, vagina and anus, HIV may enter through cuts and sores

(many of which would be very small and hard to notice), or directly through the mucus

membranes.

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Oral sex (mouth-penis, mouth-vagina): Oral sex is considered a low risk practice, but

it’s not completely risk-free. The virus can't survive well in the mouth (in semen, vaginal

fluid or blood), so the risk of HIV transmission through the throat, gums, and oral
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membranes is lower than through vaginal or anal membranes. Having an STI, cuts or mouth

sores, recent dental work or bleeding gums may increase risk for HIV infection during oral

sex.

Sharing injection needles or works: Sharing needles or other materials used for injecting

is considered a high-risk practice. Injection needles can pass blood directly from one

person to another if you share them. If a person with HIV injects with a needle then shares

it with another person, the second person is at very high risk for getting HIV.

Mother to Child: Mother to child transmission is now rare in the U.S. and other high-

income countries because pregnant women who are HIV-positive are normally given

medications to prevent the fetus from getting infected. However, it is possible for an HIV-

infected mother to transmit HIV before or during birth or through breast milk. Breast milk

contains HIV, and while small amounts of breast milk do not pose significant threat of

infection to adults, it is a risk for infants

Bodily Fluids that are NOT infectious:

 Saliva / spit

 Tears

 Sweat

 Feces / poop

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 Urine / pee

HOW TO GET TESTED: HIV TESTING IN THE PHILIPPINES

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One of the most important thing to do to prevent transmission is knowing your status. HIV

is a very controllable disease as long as it is detected early and has not yet done major

damage to your organs most specially the Liver, Kidneys and the Brain. There are many

ways of getting tested for HIV in the Philippines. We will discuss each of them, one by one

including their advantages and disadvantages.

Hospitals

Testing by going to hospitals is one of the most common means of getting tested.

There are 5 hospitals in our country that specializes with HIV counseling and testing as

well as referrals in case you tested positive and needing further treatment. In no particular

order: RITM, San Lazaro Hospital, St. Lukes Medical Center both in Quezon City and

Global, Makati Medical Center and Medical City in Ortigas. Do take note that the cost for

HIV testing is around 1,100 to 3,800 in the private hospitals I mentioned.

PROS: If done correctly, results are very accurate. This is also the only results

acknowledged in various employment and immigration requirements.

CONS: There is always an issue with regards to privacy and confidentiality getting

tested in any hospital. Though privacy is protected by our health care professionals, there

are many incidents of information leakage caused by poor protocol with regards to transfer

of information such as students getting free access to medical records without permission

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or a slip of tongue during a conversation of one of the member of the health care team

handling the HIV case. Hacking is another risk when it comes to electronically stored

medical information and records of medication being dispensed from the Pharmacy and to
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whom.

When it comes to public hospitals, though uncommon, there are recorded cases of

results being switched between patients. It is not unheard of that a certain person tested

positive though in reality, he is negative simply because a specimen sample was incorrectly

labeled with his name. Lapse in judgment and concentration of our overworked and

underpaid medical professionals is the main culprit in most cases

Free tests done by Volunteer groups

We have friendly, volunteer groups that do testing for free. You can call them and

schedule a visit and let them know that you are interested in getting tested.

LOVE YOURSELF ANGLO HUB

Pinoy Plus Association is the pioneer organization of PLHIV in the Philippines. It

is a support group dedicated to the welfare of PLHIV in the country.

Pinoy Plus as an organized community of positive individuals, answering to the needs of

peer HIV positive is the pioneer national organization of Filipinos living with HIV and

AIDS in the country. Fighting for the rights of positive individuals. PPA are now in the

forefront of further enriching the organization, documenting violations, evaluating access

to every available services including all kinds of treatment, care and support. Gone beyond

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Metro Manila, creating chapters all over the country to address the needs and offer support

to individuals in need either directly or indirectly affected by the epidemic. They have

learned to teach one another on how to live with HIV and how to fight for their rights.
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Babae Plus

Babae Plus, the first and only existing support group of women living with HIV in

the Philippines was established in 2004. Their vision is to create An Independent Lead

Organization of Empowered and Supportive Women Living with HIV/AIDS.

United Western Visayas Incorporated (UWVI), is a community-based group (CBG)

of people living with HIV based in Iloilo and operating in Panay and Guimaras areas with

Ilonggo members across the country. The organization is active in both prevention of HIV

and promotion of treatment and care among its members who are HIV positive as well as

affected families. It strives to address stigma and discrimination in order to build

confidence among the newly diagnosed to access services at the local treatment hub based

in the Western Visayas Medical Center.

The growing number of PLHIV in the region is driven by the large number of

OFWs particularly seafarers in the region which host the highest number of Maritime

Schools in the country and the flourishing – yet hidden sex industry and trafficking enroute

the striving nautical highway as entry and exist points for the tourism super region in the

Philippines.

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The organization has a rich history since its inception in 2005 during the global

fund round 5 project. The strong membership and advocacy of the group has helped the

Western Visayas Medical Center to have its own CD4 machine, the first outside Manila
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and a half-way house based in Santa Barbara in Iloilo

PROS: Free and they offer counselling as well. Staff are very friendly, professional and

trained.

CONS: Privacy and result confidentiality are concerns when it comes to free and public

testing. Though trained, innocent conversations could lead to information leakage both

consciously and unconsciously. There are cases wherein a Volunteer saw a recently

positive patient in the mall and told his friend that “That guys just tested positive yesterday.

HIV testing kits

Testing kits are widely used as the main method in HIV detection in some hospitals

and hygiene clinic. All free testing done by volunteer groups uses HIV test kits. HIV testing

hubs also uses HIV kits. Medical missions and workplace testing will usually use HIV

testing kits. They are easy to use with result at 99.9% accuracy seen in mere 10 minutes.

The common brands in The Philippines are Fujibio and SD Bio. Fujibio is Japanese made

while SD Bio is Korean made. Both should give an accurate result with 99.9% certainty

similar to that of hospital based testing. Only Fujibio HIV test kits are the only one you can

buy online.

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PROS: Very easy to use and results are very accurate. I would personally

recommend testing using test kits first as to give you an accurate idea of your status before

going to the hospital. That way, you will know that you will test negative or positive in
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advance privately. It is also very convenient and you are assure that only you will know

the result. Fujibio hiv test kits being sold online also offers free counseling.

CONS: Since the person that bought the kit will usually test himself or herself, Anxiety

could lead to testing delay. Some people will contemplate for weeks before using the test

kits and then eventually forgets that he bought one.

HIV and AIDS Treatment Care and Support in The Philippines

In support of the United Nation’s Millennium Development Goal Number 6 to halt or

reverse the incidence of Human Immunodeficiency Virus (HIV)/Acquired Immune

Deficiency Virus (AIDS) by 2015, PhilHealth through Board Resolution No. 1331, series

of 2009 has approved die implementation of an outpatient HIV/AIDS treatment package.

This benefit aims to increase the proportion of the population having access to effective

HIV/AIDS treatment and patient education measures.

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HIV treatment here in the Philippines.

1. Antiretroviral medicines (ARV’s) are FREE in the Philippines. This is subsidized by the

Department of Health and will be soon part of the Philippine Health Insurance (PhilHealth). Page | 35

2. HIV consultation in treatment hubs:

a. FREE only in government treatment hubs

b. Out of pocket payment in private hubs

3. HIV Baseline Tests or initial tests in treatment hubs

a. Some offer free baseline tests

b. Discounted in most treatment hubs: total price ranges from P5,000-P10,000

c. Private Hubs: total cost ranges from P5,000-P15,000

4. Treatment of AIDS-related infections

a. Hospitalization is not free

b. Medicines are not free (unless government hospitals have available FREE medicines)

c. Ambulance service is not free.

5. Frequency of treatment:

a. ARV’s are prescribed for refill:

i. Initially 2 weeks

ii. 1 month (during first month)

iii. every 3 months

b. Semi-annual check up and laboratory tests in treatment hub

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RELATED LITERATURE
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Manila hospital soon to be HIV treatment hub

According to “The Manila Times Newspaper” The Santa Ana Hospital in Manila

will soon be turned into a human immunodeficiency virus (HIV) treatment center. Mayor

Joseph Estrada said the hospital will not only serve Manila residents but also HIV patients

from other cities or municipalities. “This will be a modest contribution of the city

government to measures implemented by national government as well as international

agencies and organizations to curb the spread of HIV, which, if left untreated, can lead to

acquired immune deficiency syndrome or AIDS,” the mayor said. The 500-bed, 10-storey

hospital, one of the six public hospitals in the city that underwent a P500-million

renovation, is classified as a “level II” medical facility. Dr. Jesus Sison, Jr., the hospital

director, said the medical personnel have completed their training on how to handle HIV

cases in partnership with the Department of Health (DOH). He added that they have

complied with the basic requirements of the DOH such as a laboratory for treatment and

analysis of HIV-infected blood, trained personnel for counseling of patients, obstetricians

and surgeons, highly-trained nurses and the upgrade and procurement of facilities. “We

expect DOH to approve our accreditation as an HIV treatment center by January. We just

have to submit some other documentary requirements,” Sison said, adding that Health

officials inspected the hospital early this month. The facility will cater to Manilans as well

as non-Manilans. Based on the HIV/AIDS Registry of the DOH, 841 new HIV cases were

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reported in June 2016 and 103 of these cases developed into full-blown AIDS. This number

was the highest ever recorded in a single month since 1984, when HIV was first detected

in the country. Of the 841 cases, 92 percent were acquired through sexual transmissions,
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mainly through MSM (men having sex with men).

CASE STUDIES

About LoveYourself

Self-worth is a powerful determinant of one’s quality of life. It is the self-

perception of one’s right to achieve happiness and be given respect, of one’s ability to

understand and solve problems, and to triumph in the small and big challenges of life.

LoveYourself believes that self-worth is key to building an empowered community. We

exist to ignite in each one an active desire for a healthy and vibrant self-worth, especially

among the youth and males who have sex with males (MSMs).

Through awareness, education, counseling, fun social interactions, and activities that

weave these elements into a unity, we take delight in spreading our message of the value

of self-worth and the critical importance of loving oneself.

Services

LoveYourself is a community of volunteers that aim to reach out to others to propagate

ideas, attitudes, and practices that encourage loving oneself -- to DARE to be oneself, to

CARE for oneself, and to SHARE oneself as a way to multiplying joy.

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HIV counseling, testing, treatment and life-coaching

Through our three community centers -- Anglo in Mandaluyong, LoveYourself Uni in

Pasay and Victoria by LoveYourself (RITM Satellite Clinic) in Manila -- we provide HIV
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screening, counseling and education to prevent the spread of the epidemic among the youth

and key affected populations.

HIV awareness for Men who have Sex with Men (MSM) and Youth

We conduct HIV/AIDS awareness campaigns and education seminars in schools,

companies and regional communities. We take delight in promoting the value of self-worth

and the critical importance of loving oneself as a core intervention against the spread of

HIV/AIDS.

LoveYourself in Numbers

Figure 3.1 Love Yourself number of clients

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Research Institute for Tropical Medicine (RITM)

RITM is the premiere and the leading facility in The Philippines when it comes to

antiretroviral drug distribution as well as treatment for HIV patients. This should be your Page | 39

first choice in obtaining confirmatory results and further treatment if the initial testing

result was positive. RITM is more specialized than San Lazaro and could deal with serious

HIV related complications such as Mycobacterium Bovis infection as well as cryptococcal

infection of the brain.

Hospital Facilities

True to the mandate of the Research Institute for Tropical Medicine, the Clinical

Research Division (CRD), serves to link the institute to the patients and other stakeholders

in need of its clinical expertise, diagnostic facilities and research capabilities. Driven by its

three main thrusts, namely, research, training, and service, the division aims to improve

health outcomes among Filipinos afflicted with infectious, tropical and dermatological

diseases. RITM, through CRD, provides inpatient hospital services and outpatient clinical

services including HIV Clinic, TB DOTS Clinic, Animal Bite Clinic, and General

Infectious Disease Outpatient Clinic. With the threat of emerging and re-emerging

infectious diseases, the institute has gathered a much deserved attention having been

designated as a referral center for the management and isolation of these novel diseases of

interest not only to the medical community, but to the general public.

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Laboratories

RITM, through its Laboratory Research Division (LRD), provides technical

expertise in the laboratory diagnosis and characterization of infectious agents in the Page | 40

country. LRD is ably supported by competent researchers, well-equipped facilities, and

highly-proficient lab staff. We are guided by policies and procedures that give premium to

quality and timely results.

RITM hosts National Reference Laboratories and World Health Organization

(WHO) – recognized laboratories. These lead centers are tasked with performing

laboratory research, monitoring of disease occurrence and spread (surveillance), and rapid

outbreak response.

RITM extend expertise by helping other laboratories in the country. They conduct

training programs and provide guidance documents and technical assistance. They also

have programs to ensure the quality of testing of other infectious disease laboratories.

Isolate Bank

RITM Biological Bank is the central storage facility for specimen, isolates and

biological materials. The entire facility houses 30 Medical Deep Freezer and three – 25⁰C

Walk-In Freezer units. It could store more than 3.5 million primary container vials

containing specimen, isolates and/or biological materials for research surveillance and

diagnostic purposes. The facility is equipped with enhanced CCTV surveillance camera

and controlled access system.

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Training Center

The RITM Training Center was built in 1989 with the goal of becoming the Center

for Training in Infectious Disease—including trainings of medical and paramedical Page | 41

personnel within the Institution, from other health agencies in the country, and from other

developing countries in the region. The Training Center also aims to establish network

between RITM’s research scientists and health professionals and potential research

workers from outside the Institution, locally and internationally.

The Training Center houses an auditorium, lecture rooms, laboratories, and offices.

The Auditorium has a 188 seating capacity and a projection room complete with audio-

visual, LCD and overhead projectors, sound units, and projection screen. There are 3

lecture rooms in the building, with each rooms accommodating at least 25 to 30 persons.

Vaccine Storage

The RITM, through its Storage and Distribution Department of the Biologicals

Manufacturing Division (BMD-SDD), receives, rejects, quarantines, stores raw materials

for vaccine production, and distributes local and imported vaccines such as BCG, DTwP-

HepB-Hib, Hepatitis-B, Measles, Measles-Mumps-Rubella (MMR), Measles-Rubella

(MR), Rotavirus, Human Papillomavirus (HPV), Oral Polio Vaccine (OPV), Inactivated

Polio Vaccine (IPV), Pneumococcal Conjugate Vaccine (PCV13), Tetanus Toxoid (TT),

Tetanus diphtheria Vaccine (Td), Pneumococcal Polysaccharide Vaccine (Pneumo 23) and

Influenza Vaccines procured through UNICEF and local bidding by the Department of

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Health for the Expanded Program on Immunization (EPI) / National Immunization

Program (NIP) and Rabies Prevention and Control Program.

Research Activities Page | 42

RITM serves as the research arm of the Department of Health for infectious and

tropical diseases of public health importance. With our multidisciplinary study groups, we

conduct clinical trials, epidemiologic research, surveillance research, basic research, and

laboratory-based research.

To be of utmost relevance to the national health policy and strategy, our research

efforts are directed towards the development of effective and efficient strategies for the

control of infectious and tropical diseases including new diagnostic techniques.

RITM Research Groups include:

• Acute Respiratory Infections Research Group

• AIDS Research Group

• Dengue and other Arboviruses Research Group

• Diarrhea and other Enteric Viruses Research Group

• Emerging Infectious Diseases Research Group

• Filovirus Research Group

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• Leprosy and other Dermatological Diseases Research Group

• Malaria Research Group

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• Medical Research Group

• Rabies Research Group

• Schistosomiasis Research Group

• Tuberculosis Research Group

Clinical Training

Through its Clinical Research Division (CRD), RITM conducts capacity-building

and training activities to enhance the clinical skills of the country’s medical workers.

They conduct regular trainings on the management of various infectious and

tropical diseases such as rabies, HIV-AIDS, leprosy and common skin diseases, and

emerging infectious diseases such as the Ebola Virus Disease and Middle East Respiratory

Syndrome. We also train healthcare workers on infection control, intravenous therapy, and

basic life support.

In support of continuing education, we organize postgraduate courses on

dermatology and infectious/tropical diseases. RITM is also an avenue for subspecialty and

rotating residency training in infectious/tropical diseases as well as residency training

program in dermatology.

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FOREIGN CASE STUDIES

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St. Michaels Hospital (Canada)

For many people living with HIV, the stigma associated with their illness is itself a

health risk. It impacts their mental health and wellbeing, their social interactions, even how

closely they follow medical advice, adhere to their therapies, and get connected into and

stay in care.

To identify the sources of HIV stigma, and find ways to reduce and eliminate them,

a research team from St. Michael's Hospital is leading the HIV Stigma Index in Canada.

Led by Dr. Sean Rourke, a scientist with the hospital's Centre for Urban Health

Solutions, and Dr. Francisco Ibáñez-Carrasco, a researcher who has lived with HIV for

more than 30 years, the team will conduct up to 2,500 surveys and interviews across

Canada, using a unique method developed in Europe and already used in dozens of

countries around the world.

The People Living with HIV Stigma Index tool requires all of the interviews to be

conducted people who are HIV positive, with people who are HIV positive, and be done in

person. The results will be used regionally to promote changes in policy, health care as

well as individual awareness and behavior of Canadians.

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An estimated 75,500 people in Canada live with HIV, according to the 2014

national HIV estimates. This represents an increase of 9.7 per cent since 2011, which Dr.

Rourke said was discouraging, especially since rates of new HIV diagnoses have been
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declining in many other Western industrialized countries.

"HIV-related stigma refers to the negative attitudes, beliefs and actions directed

towards people living with HIV," Dr. Rourke said Friday, World AIDS Day. "Stigma is

perceived and often internalized, and when this happens, people living with HIV often are

forced to surrender to silence, because of the judgmental language and actions of others."

Dr. Ibáñez-Carrasco said that experiencing HIV-related stigma contributes not just

to poorer health outcomes but to discrimination in housing and in the workplace.

"As a result of experiencing this stigma, some people may engage in behaviors that can

make them vulnerable to coercion, shame, anxiety, depression and the use of substances,

in order to cope" he said.

Because of stigma - "People living with HIV can lose employment and housing,

their status can be disclosed without consent, intimate partners may reject them or accuse

them of trying to infect them, and families shun them. HIV stigma is the last barrier to the

social equality of persons living with HIV - it affects prevention efforts, access to

treatments and support services, schooling, and success in the workplace."

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THE LONDON CANCER HUB

The London Cancer Hub will create a vibrant community of scientists, doctors and

innovative companies, intended to deliver real benefits for cancer patients and drive
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economic growth. They plan to deliver an exceptional environment for cancer research that

enhances the discovery of new treatments and their development for patients. The London

Cancer Hub will be a living, breathing community with research buildings, hospital

facilities, a school, restaurants, cafes and hotel accommodation for visitors and patients.

The transformational design has the potential to deliver around 280,000 square metres of

modern facilities in beautiful green space, making the most of the campus’s unique location

within London - a global city - but in reach of the outstanding Surrey countryside. The

campus will provide attractive work and leisure space for researchers and clinicians and an

outstanding healing environment for patients.

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