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Health

Many Filipino Teens Can't Get Tested For HIV

And yet of the 29 Filipinos who contract HIV daily, 19 of them are between 15 and 24 years old.
NOEL CELIS / Getty

A version of this article originally appeared on VICE Indonesia.

Kahel Jay Sta. Maria was no love guru, but on that day, he needed to be one. He had to intervene between two 16-year-old Filipino boys whose relationship had gone awry in order to save one of their lives.

One of the boys had tested positive for HIV. When he and his boyfriend broke up, he stopped taking his medicine, destroying his tablets and pills instead. Jay Sta. Maria, a "life coach" at LoveYourself clinic, an HIV testing and treatment hub in Manila, had to step in. The boy's parents didn't know that he had HIV—and 31-year-old Jay Sta. Maria was the only adult there to guide him as he tried to fight the virus. "I did not order him or force him to take his medicine. Instead I tried to understand why he's doing it, why he's crushing his meds. That was the only way I was able to get to him," he says.

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Jay Sta. Maria often serves as the guardian, friend, and counselor of people living with HIV. He's worked with about 1,000 people who the disease, many of whom are minors who can't tell their parents about their condition. Jay Sta. Maria would first provide pre-counseling to minors to ease their fears about taking an HIV test. If they fail to obtain their parents' required approval for the test, social workers provide consent instead. If they test positive, Jay Sta. Maria helps them access treatment and make sure that they stay with it, love problems be damned.

Social workers like Jay Sta. Maria fill an important gap in addressing the growing rate of HIV prevalence in the Philippines, since the law forbids people under 18 years of age from getting tested unless they have written consent from their parents. That law leads to deaths and lack of proper treatment, according to health advocates.

Illustration by Diedra Cavina

"I hope the law can be revised because it makes it harder to treat minors with HIV. At the age of 14 to 16, they already have experience with sex. From [age 16], there's already a two-year gap before they learn their status. By the time they get tested at 18, their body has already experienced a big difference—and their health could have already deteriorated," Jay Sta. Maria says.

The Philippines has the fastest-growing rate of HIV cases in Asia Pacific, with a 140 percent jump in the number of new infections between 2010 and 2016. In 2016, 10,500 Filipinos tested positive for HIV, a big leap from the 4,300 cases of infection in 2010. And since 2015, 30 percent of the newly-recorded cases have involved Filipinos between the ages of 15 and 24. A report from July this year expects this rate will increase by the end of 2017. The country's National Youth Commission declared the phenomenon a "youth epidemic" in 2016 since, of the 29 Filipinos who contract HIV daily, 19 of them are between 15 to 24 years old. But in 2015, Senator Miriam Defensor Santiago moved to amend the law, citing that HIV testing in nearby countries is way more accessible for young people. In nearby Laos, for example, 14-year-olds are able to get tested for HIV without parental consent. The new bill would allow minors as young as 15 to take an HIV test without consent—if they can prove that they have no contact with their parents or guardians, or are pregnant.

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In January, Senator Risa Hontiveros filed a bill to remove any restrictions from minors between the ages of 15 and 17 to take an HIV test. Parental consent would only be required for those younger than 15 or who were mentally incapacitated. If they had no parents or guardians, licensed social workers could provide consent. The country's Department of Health (DOH) has supported these proposed amendments since 2015. However, the bills have yet to gain traction in the Senate. The DOH has also pushed for "proxy consent," which would allow social workers, peer counselors, and even teachers to give minors permission to take an HIV test. This is usually done during community-based screening. "Our hands are tied because of the law," says DOH Assistant Secretary Eric Tayag. "We have doctors, however, who are looking for ways to convince parents to let their children take the test."

In order to reach more minors, Pinoy Plus, a treatment and support group for people living with HIV in the Philippines, has taken proxy consent and community-based screenings to another level. "We tried to work with 'clans,' or groups formed by teenagers," says Owie Franco, president of Pinoy Plus.

In July, Pinoy Plus rented a whole bar for a clan in Cubao, a red light district in Quezon City, for a meet up. Inside the bar, aside from the usual kegs of beer, was a DOH representative who spoke about HIV, and the importance of safe sex and HIV testing. Pinoy Plus also set up booths where minors could take the test via proxy consent from social workers. Franco says the organization plans to increase HIV testing among minors and spread safe sex education one clan at a time.

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Pinoy Plus has worked with dating apps for gay men such as Grindr, Hornet, and Blued to undo the stigma around HIV testing by talking to minors on the apps and inviting them to get screened. "There are some who don't want to go to social hygiene clinics to take the test because they're scared, [and] there's a stigma against those who take the test—even if they tested negative, people will think they're already HIV positive just because they're in a clinic," says Franco.

"Minors now engage in risky behavior for the simplest of reasons. There was a 16-year-old boy who engaged in paid sex so he [could] have money to play Defense of Ancients, a computer game."

Counselors at the LoveYourself clinic have also used the same dating apps to spread HIV testing invites. It's a timely approach, as young Filipinos use such apps and social media to meet other people for dating and casual sex alike. "Technology has made it easier for minors to engage in sexual activities—at the age of 14, 15, they already start to explore. When you open apps—even if they have age requirements—you can easily lie and join them," Jay Sta. Maria says.

Even though proxy consent has helped many young Filipino people, health advocates are still calling for a law that lowers barriers for HIV testing for minors, and makes proxy consent a legal mechanism for enabling testing. "We need a law [like that] because without it, we can be stopped anytime. [As] social workers, we can be barred from helping minors take the test and receive treatment," Jay Sta. Maria argues.

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While a proposed bill in the Senate moves at a slow pace, the DOH is pushing a new administrative order. At the same time, the Philippine National Aids Council, an advisory body to the executive, has asked President Rodrigo Duterte to issue an executive order allowing testing for minors.

But it doesn't stop there. Once minors are allowed to take an HIV test, the government must also refine its health packages and services in order to make treatment more affordable and accessible to young people living with HIV. Currently, anyone under 18 can't be a member of Philhealth (Philippine Health Insurance Corporation), the country's universal health coverage. This deprives minors with HIV of the Outpatient HIV/AIDS Treatment Package, which includes anti-retroviral treatment that suppresses the growth of the virus, laboratory exams, and a PHP30.000 ($587 USD) coverage for all expenses incurred through accessing treatment hubs and medicine.

"There's a suggestion that the package should be changed to accommodate minors. For one, if your guardian or parent is a Philhealth member, you must be allowed to use Philhealth to access hospitals," Franco explains.

Franco says it's important for both minors and parents alike to be aware of the necessity of HIV testing and prevention. "Minors now engage in risky behavior for the simplest of reasons. There was a 16-year-old boy who engaged in paid sex so he [could] have money to play Defense of Ancients, a computer game. He [got] tested, and it's a good thing his mother allowed him to take an HIV test," he says. "But what about other minors? If they don't know their status, they could still go on with their risky behavior. I think that ignorance is the one driving force behind the youth epidemic."

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