AIDS Care Watch

Monday, October 16, 2006

The missing picture of Aids

"ANO ang mangyayari sa mga batang hindi nabibigyan ng gamot at tulong," asked a high school girl in the open forum during the first day of the 8th Philippine National Aids Convention held at the Royal Mandaya Hotel the other week.

A hush fell on the huge crowd gathered in the Lantawan Hall for a few seconds, many in the audience shifted on their seat, the reporters gathered in one group stared at the resource speakers, probably wondering who would be brave enough to speak up.

If the situation were to be described, it was as if the whole hall was whispering, "Uh-oh!" under its collective breath, and it was a fitting close to the morning session during the opening of the congress, as it drove the point of the whole congress: the children with Aids...

"One child below 15 years of age dies of an Aids-related illness every minute of every day. One person between 15-24 contracts HIV every 15 seconds. And, as I speak before you today, at least three children would have died of Aids," United Nations resident coordinator Nileema Noble said as she addressed the congress earlier on.

Yes, HIV-Aids does not only affect the bad guys and the perverts, as we would have wanted to believe and the Unicef and UNAids are even more concerned because in the fight against HIV-Aids, the children are regarded as the missing picture.

In the "10 fast facts on Filipino children affected by HIV-Aids", it's said that most Filipino children whose parents are living with Aids don't know about their parents' affliction.

"Filipino parents living with HIV are reluctant to tell their children about their status because they want to protect their children from HIV-related stigma and discrimination. Even infected children aren't being told about HIV," the fast facts said.

The fast facts further pointed out that there is a "deafening silence on Filipino children affected by HIV-Aids.

"The National HIV-Aids Registry lists only know cases of HIV. If most of the 9,000 estimated people living with HIG (PLH) in the Philippines have children, that could mean thousands of children are affected," it said.

Dr. Nicholas Alipui, country representative of Unicef said that when he arrived in the Philippines in 2004, the National Registry of HIV-Aids has already documented 29 children infected since 1984. The Remedios Aids Foundation Inc.'s website reports that from January 1984 to April 2006, there has already been a total of 36 children below ten years old, and 46 more between 10 and 19 are listed in the HIV-positives nationwide.

Whether its still steady at 29 or has already risen to 82, however, is not the major point of concern, rather, it's whether the health sector and government are reaching enough children living with HIV-Aids, Dr. Alipui pointed out.

"The response so far is small and timid," he said.

"There is a long, long, long way to go. What we are happy with is that we have made the first few basic steps," he added, "But concretely, children have to be brought forward for testing."

The problem is, even adults are not coming forward to be tested because of the stigma attached to the disease, and the denial of the general population that they are as vulnerable to the disease as any other person, and cultural taboos in openly discussing sex and HIV-Aids prevention, especially with the young and the youth.

In the fast facts, it notes that young people know very little about the disease and yet are exhibiting risk behaviors.

The 2002 Young Adolescent Fertility and Sexuality Study showed that 23 percent of young Filipinos aged 15-24 practice pre-marital sex, up from 18 percent in 1994; and that nearly half of sexually active young males have had multiple partners.

Further, the study showed that only half of those aged 15-19 know that condom use can reduce transmission of HIV and many believe that they could not contract HIV.

"Most still believe that Aids only affect adults and that they have Aids because they have done something wrong and thus they are being punished by God," Dr. Alipui said.

There is silence, there is denial, and there are very limited tests being taken, and, thus the trend that HIV-Aids in the Philippines is indeed low and slow as reflected in the National HIV-Aids Registry may in fact be deceiving us into complacency.

Prevalence rate in the Philippines is still at .01, said Teresita Marie P. Bagasao of the UNAids Regional Support Team for Asia and Pacific in her presentation. This means that less than one percent of the adult population are infected.

The first recorded HIV-Aids cases in the Philippines was in 1984; there were two, both Aids-positive. The following year, there were ten cases reported, of which four were Aids cases and the six were asymptomatic, or HIV. The numbers has since grown, 29 in 1986, 38 in 1987... and have been hitting the hundreds since 1993.

For 2005, there has been a total of 210 HIV-Aids cases recorded. While from January to April 2006, 89 have already been added to the registry, of which nine are Aids-positive.

"The average of 10 new HIV cases being reported each month doubled from 2003 and over the last few months, reports show the number of cases more than doubled. For this reason, the Philippine National Aids Council voices its concern that the epidemic in the country may be taking a new direction moving from a low and slow to a hidden and growing epidemic, with majority of cases reported having contracted HIV through unprotected sexual contact," Ms Bagasao said.

Of those affected, current records show overseas workers account for 35 percent compared to 28 percent in year 2000. OFWs are thus listed as among the high-risk groups. But this increase in reported cases may be because OFWs have to show a clean bill of health for them to be deployed, and voluntary HIV-Aids testing is thus higher in this sector than any other sector of the population.

Prevalence is also highest in the 30-39 age group, accounting for 932 (629 males, 303 females) of the total 2,499 recorded between 1984 and April 2006. Next is the 20-29 age group with 737 (362 males, 375 females), then the 40-49 age group accounting for 497 (393 males, 104 females).

These age levels are the productive ages -- and also the making-a-family-ages; meaning, while there are only 82 recorded cases of HIV-Aids among the population aged below 19, there can be many more; the unrecorded ones, the children hidden because of the "deafening silence" on Filipino children affected by the disease.

This already alarming possibility is made worse by the fact that while there is a significant increase in recorded cases in the 2000s, spending for the disease has not followed the same trend.

"In the Philippines, the cumulative Aids spending by 2004 declined to levels below 2000, even as the number of reported cases continues to rise, implying the level of response is not keeping up with the epidemic, despite the milestones in the country's response," Ms Bagasao said.

The country's response to the disease is getting more comprehensive, but this is not matched with corresponding increase in spending, both for medication and care for the affected and prevention for those who are not.

All throughout these contradicting pictures is the missing one -- the children living with HIV-Aids: where they are, how they are coping, who are taking care of them, and how many are they?

Contributing to this missing picture are similar questions: Where are their parents, how they are coping, who are taking care of them, and how many are they?

Clearly, the gap between the known and the huge unknown is made wider because of the low uptake on free HIV-Aids drugs and services, as well as, voluntary testing, a state Dr. Alipui would want to break so that the silence about this toned down threat will also be broken.

"When you know your HIV status, it affects your attitude," he said in his speech during the convention.

Those who test positive can seek medical assistance and counseling, and those who test negative will make conscious actions to remain negative.

Dr. Alipui added that people should not even wait until more children are infected or for more children infected to be recorded. There should instead be a conscious move to ensure that children remain Aids-free, and this can best be done by ensuring that adults are, and that the adults who are infected are aware of their status.

But because there is a general denial even among those who are engaged in risky sexual behaviors, the sense of invincibility prevails among the Filipinos; and for as long as this general denial will show that HIV-Aids remain low and slow in this part of the globe, then assistance to what is considered as a global threat may soon decline.

This early, available anti-retrovirus (ARV) drugs may be pulled out from the country's ready supplies because these expensive drugs that were brought in to help the country deal with the disease have expiration dates; and out there worldwide, millions of poor people are in dire need of these.

"Unless we have an increase in the uptake, clearly we need to bring the drugs to where they are most needed," Dr. Alipui said.

ARVs are available for free in regional health offices, Health Undersecreary Ethelyn Nieto said. And because there are very few recorded children with HIV-Aids, pediatric formulations are available only in three hospitals in the National Capital Region where the recorded children are.

Where are the others, how are they coping and whose taking care of them, no one can tell; for all we know, many of them may have already died.

"At the end of the day all of us have to lean in and give our fair share in the response if we aim to stop the increase in number of infections, illness and deaths," Ms Bagasao said.


Source: Stella A. Estremera, The Sunstar, October 15, 2006

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