The Philippine Government is Powerless to Stop the Rise of HIV

This article originally appeared on Tonic.

"Suck. Fuck. Test. Repeat" is an unlikely campaign slogan for a free clinic in the largely Catholic Philippines, where deeply conservative values, stretching from Congress to the breakfast table, keep talk of sex taboo. But LoveYourself—a not-for-profit offering no-cost HIV tests in the heart of steamy, gridlocked Metro Manila—is making waves amid the silence surrounding the country's HIV epidemic with edgy tag lines like this one.

HIV/AIDS is growing faster in the Philippines than anywhere else in Asia. The Philippines Department of Health estimates about 28 new cases of HIV are diagnosed every day. LoveYourself, with just two HIV testing centers run mostly by some 600 volunteers, diagnoses about half of those cases.

In dramatic comparison, there are 26 social hygiene clinics across Metro Manila that test for HIV/AIDS supported by paid staff and government coffers. Regardless of these many hospitals in the city that test for HIV, LoveYourself prides itself in offering a judgment-free zone—and the small organization's high HIV detection rate shows that a non-discriminatory approach with in-your-face campaigns targeted to young, sexually active males is more effective.

"Ever since the HIV epidemic started here in the Philippines, [the government] has had the same interventions," says Ronivin Pagtakhan, LoveYourself's founder, adding that the organization has been overwhelmingly more successful that the government at diagnoses and support. Pagtakhan says social hygiene clinics have low detection rates because the government rarely bothers to target the population vulnerable to contracting HIV.

One of LoveYourself's testing centers sits in traffic-choked Mandaluyong City, on the third floor of a hardware and paint center. But inside, LoveYourself looks more like a busy spa than a free clinic. Beyoncé and Lady Gaga hits play on a swank set of speakers while a volunteer reads birth dates, instead of names, to call in clients. The hallway is tastefully decorated and smells like expensive bath salts, and there's a backdoor exit for clients concerned with their privacy.

"I feel comfortable here," John* tells me inside one of the center's private rooms while waiting on a blood test. At 27 years old, he works as a nurse abroad in Dubai—but fearing potential deportation, he won't get tested there. When he returns to the Philippines about every six months, he instead gets tested at LoveYourself—and also sees a free counselor to discuss both safe sex and living abroad as a young homosexual. "At the social hygiene clinics, there's discrimination, especially with HIV and STI tests," John says.

John represents LoveYourself's typical patient profile: Pagtakhan says that clients tend to be homosexual males in their early twenties to early thirties. But clients younger than 18 often walk through the door too—and despite the Philippines AIDS Law, which prohibits testing minors without parental consent—LoveYourself (unlike hospitals) will go ahead with the HIV test.

"We accept anyone," Pagtakhan tells me on a plush couch at the Mandaluyong center. "We follow the 'captain of the ship' policy that the doctor can decide [to test for HIV] on behalf of the client, which we call implied consent."

Testing minors isn't the only maverick move coming out of the grassroots organization: Also unlike hospitals, the centers will offer treatment for HIV/AIDS patients no matter how high or low their T-cell count is. Hospitals in the Philippines will only prescribe medicine to HIV/AIDS patients when the T-cell count is low, because of provisions in the national health insurance program, PhilHealth.

"The earlier the better: We don't follow the Philippines protocol," Pagtakhan says. "We're dealing with lives here, and it's not illegal what we're doing—it's the WHO recommendation."

LoveYourself is now treating more than 1,000 clients in Metro Manila with HIV/AIDS; last year, out of 10,731 clients tested for HIV, LoveYourself diagnosed 1,046. Funding for the organization comes from the government's Research Institute for Tropical Medicine—"They're on the more open side of the political spectrum," as Pagtakhan puts it—and also the Dutch aid organization HIVOS.

But to tackle HIV/AIDS transmission at the roots, Pagtakhan and his team remain dedicated to awareness with creative interventions. The TestMNL campaign—which hammered in the slogan "Suck. Fuck. Test. Repeat" both online and offline at school campuses—drew outrage from older generations, but college students were quick to defend it. There's LoveYourself Platinum, a service where a client can order an HIV or STI test to his or her home; the organization asks for a voluntary donation in return. LoveYourself has also brought mobile testing centers to universities, where students often for the first time get screened for HIV.

"The stigma in the Philippines is still strong—not only with HIV, but also against LGBT. That's why people are either afraid of having themselves tested or even just afraid of talking about what HIV is," says Mark De Castro, a peer HIV counselor at LoveYourself.

Like most other volunteers, De Castro has a full-time day job—he works as an office assistant. As a young gay man, he felt the need for advocacy when he saw Twitter increasingly become a local source of underage, gay pornographic content, and solicitation. In Metro Manila, it is not uncommon for homosexual teenagers to seek out anonymous sex by posting graphic photos and videos with the hashtag "Alter."

"That was my turning point, when I saw MSMs engaging in unprotected sex—and they're getting younger and younger," De Castro says. He adds that from his experience in counseling clients, "Men tend to not practice safe sex because in the Philippines, it [a condom] tends to be used only to prevent pregnancies. Also, [they say] that not using a condom feels better."

Pagtakhan has ambitious plans for expanding LoveYourself. Having struck a partnership with the government and WHO, the organization is now offering free Truvada to 250 clients over the next three years, as part of demonstration research on PrEP treatment in the Philippines. LoveYourself will use this time lobbying the government for the rigid PhilHealth plan to subsidize PrEP as part of the national healthcare package.

LoveYourself also plans to expand with the country's first ever transgender focus center, Victoria Health and Wellness Center. While it has already opened, the center now only offers HIV testing—by next year, LoveYourself plans to scale it up to include STI testing, hormone replacement therapy, and transitioning assistance.

Back at the center in Mandaluyong City, Angelo*, a young working professional, waits on results from his HIV test. When he cheated on his wife for the first time, he didn't use a condom: "She wasn't the type of girl I thought she was," he tells me. He's felt sick for about two months and he knows something isn't quite right.

Angelo is quick to admit that he wouldn't have known about LoveYourself if his social group of other young professionals hadn't told him about it. Among Metro Manila's urban poor, far flung from social media campaigns and university campuses, the government is yet to scratch the surface of HIV awareness.

"I hear a lot of news about HIV, especially here in Metro Manila… but the poor community isn't very aware of it," Angelo tells me. "They don't have much information about testing centers."

*Names changed to protect sources' identity