What's Behind the Philippines' Youth HIV Epidemic?

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 literally save one of them.

One of the boys tested positive for HIV. When he and his boyfriend broke up, he stopped taking his medicine and started destroying his tablets and pills instead. Kahel, 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—31-year-old Kahel was the only adult there to guide as he tried to fight the virus.

"I did not order him or force him to take his medicine. Instead, I tried to understand first why he's doing it, why he's crushing his meds. That was the only way I was able to get to him," he said.

Kahel often serves as the guardian, friend and the counselor of people living with HIV, or otherwise known as PLHIV. He's worked with about 1000 people fighting HIV, many of them are minors who cannot tell their parents about their condition. Kahel 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 will give them the consent. If they test positive, Kahel will help them access treatment and make sure that they stay with it, love problems be damned.

Social workers and life coaches like Kahel fill an important gap in addressing the growing rate of HIV prevalence in the Philippines, since the law forbids people under 18 years old from getting themselves tested unless they have written consent from their parents. The law is leading to deaths and lack of proper treatment, according to health advocates.

"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 that age, 16, there's already a two-year gap before they learn their status. By that time they get tested at 18, their body has already experienced a big difference—their health could have already deteriorated," Kahel said.

The Philippines has the fastest-growing rate of HIV cases in Asia Pacific, with a 140 percent jump in the number of new infections. In 2016, there were 10,500 Filipinos who 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 involved Filipinos aged between 15 and 24. A report from July this year expects this rate to go higher at the end of 2017. The National Youth Commission has declared the phenomenon as a "youth epidemic" in 2016 as out of the 29 Filipinos who get infected daily, 19 of them are 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, 14 year olds are able to test themselves for HIV without parental consent. The new bill would allow minors as young as 15 years old to take an HIV test without consent if they can prove that they have no contact with their parents or guardians or are pregnant. In January, Senator Risa Hontiveros filed a bill to remove any restrictions from minors aged between 15 to 17 to take an HIV test. Parental consent would only be required for those younger than 15 or who are mentally incapacitated. If they have no parents or guardians, consent can be extended by licensed social workers. The Department of Health (DOH) has supported these proposed amendments since 2015. However, the bills calling for the scrapping of parental consent for minors have yet to gain traction. The DOH has also pushed for "proxy consent," where social workers, peer counselors and even teachers can give minors permission to taken an HIV test. This is usually done during community-based screening. "Our hands are tied because of the law," DOH Assistant Secretary Eric Tayag said. "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, has taken proxy consent and community-based screening to another level.

"We tried to work with 'clans' or groups formed by teenagers," said 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 meetup. Inside the bar, aside from the usual kegs of beer and flashy lights, was a DOH representative who spoke about HIV, the importance of safe sex and taking an HIV test. Pinoy Plus also set up booths where minors can take the test via proxy consent from social workers.

Franco said they plan to increase HIV testing among minors and spread safe sex education one clan at a time.

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 in the apps and inviting them for a screening. "There are some who don't want to go to social hygiene clinics to take the test because they're scared, 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," said Franco.

The counselors at LoveYourself clinic has also used the same dating apps to spread HIV testing invites, a timely innovation as young Filipinos use apps and social media to meet other people not only for dating but also for casual sex. "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," Kahel said.

Even though proxy consent has helped many Filipino youth, health advocates still want a law that lowers barriers for HIV testing for minors and makes proxy consent a legal mechanism for enabling testing.

"We need a law because without it, we can be stopped anytime. [As] social workers, we can be barred from helping minors take the test and receive treatment," Kahel said.

While a proposed bill in the Senate moves at a slow pace, an administrative order is being pushed by the DOH. 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.

It doesn't just stop there. Once minors are allowed to take the 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, those under 18 years old cannot be a member of Philhealth or Philippine Health Insurance Corporation. This deprives minors with HIV of the Outpatient HIV/AIDS Treatment Package, which include anti-retroviral treatment that suppresses the growth of the virus, laboratory exams and a PHP30.000 ($587 USD) coverage for expenses incurred by 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 said.

Franco said it's important for both minors and parents who are 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 can have money to play Defense, a computer game. He had himself tested and it's a good thing his mother allowed him to take the HIV test," he said. "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."