Dr Rosanna Ditangco of the Research Institute of Tropical Medicine (RITM) and Mr Chris Lagman of Love Yourself, a nongovernmental organization, have been working together to provide HIV testing, counselling and treatment to men who have sex with men (MSM).
An evolving epidemic
For many years, Dr Ditangco’s HIV patients at the RITM in Manila were mostly overseas Philippine workers who contracted the virus abroad. In 2006, Dr Annie–as she is popularly known–began to notice a change.
“We started seeing more and more HIV positive men who have sex with men, they were getting younger and younger, a profile very different from MSM in the past,” said Dr Annie. “We had to conceptualize a clinic customized for the new patient profile. We realized we also had to address the big discrepancy between the numbers of those diagnosed and those accessing treatment. That’s how we started our RITM Clinic situated in Malate, Manila’s gay enclave at the time.”
Online expression and engagement
Also in 2006, Chris Lagman began a blog: Manila Gay Guy. “I was deeply closeted but needed an outlet to express myself, so I wrote under a pseudonym about many different subjects primarily through the experience of being gay…Very soon I had a huge readership, 40 000 unique visitors a month. I became a sort of celebrity online, but I remained terrified of coming out.”
Then, in 2010, everything changed. “I got the very first email from a reader who disclosed he had HIV. It was my very first time communicating with anyone who was positive. Then more and more people with HIV wrote in. I’d never had an HIV test myself, I had a huge fear of being tested. Then one of my very good friends tested positive. It all came together, the online sharing by strangers and then someone in my own circle.”
In June 2011, Lagman took his first HIV test. “It was a milestone for me. Fortunately I was negative. Being the drama queen that I am, I started bawling after receiving the result, I was so relieved and yet so emotionally drained. I realized that even though my experience turned out well, there were so many gay men for whom the situation was so difficult. Something had to be done, not only through my blog, but what? I didn’t really know. That same month, a friend and I organized a dinner of six gay friends, a very mixed group, where we discussed this crisis facing our community, and from that dinner conversation Love Yourself was eventually born.”
Love Yourself, Lagman’s nongovernmental organization, initially sought to offer HIV counselling and support to the MSM community. Shortly after, a friend introduced Lagman to Dr Annie.
Working together to save communities
“It was serendipity,” said Dr Annie. “RITM needed a strong partner in the community to reach young MSM. Love Yourself needed a strong project to focus on.”
Lagman agreed. “It was a good match. I was among the very first peer educators to be trained in the very first batch of what we came to call ‘change agents’.”
Almost 200 change agents or peer outreach workers have since been recruited. All are clinic-based volunteers and all are HIV negative, supporting the key message that you can be sexually active and HIV negative.
Unlike traditional peer outreach workers, the RITM clinic and Love Yourself’s change agents do not visit hotspots where MSM congregate. “Our hotspots are online,” said Lagman. “We’ve teamed up with the MSM networking sites Hornet and Grindr, and we’ve got our own popular website and Facebook page through which we reach thousands of people as well.”
Achieving results
The RITM clinic uses a continuum of care model, explains Dr Annie. “We do two rapid same-day HIV tests. If the first one is reactive, we do a second one. If that’s reactive too we do patient counselling there and then, after which we send the client to the RITM Hospital for CD4 testing. Our counsellors either accompany their clients there, or provide clear directions and even maps to ensure the clients can’t say they couldn’t find the place. We also ensure that those who need to begin medical treatment do so quickly, minimizing the gap between diagnosis and treatment – we have an 85% to 90% success rate in this.”
The RITM Satellite Clinic in Malate sees 20 to 40 clients a day. From June 2011 to June 2014, 14 442 men were tested and 2286 (almost 16%) were HIV positive. “HIV among MSM is significantly increasing in Manila and the Philippines,” notes Dr Annie. “Yes, our services are by now widely known and so you would expect to find more HIV positive individuals because of the demand for services. But even independently of the number of people being tested, the actual rate of infection is rising fast.”
It is a complex situation, says Lagman. “So many gay men in our society remain deeply closeted, without support or anywhere to turn to, and the risk therefore increases in terms of them having sex furtively, secretly, without taking necessary precautions. There’s a psychological factor as well. Sex provides much-needed intimacy, a feeling of belonging, a kind of external validation that the person is valued–it boosts one’s sense of self-worth. Many gay men, stigmatized by society, internalize this stigma and feel worthless inside, and need the validation which sex provides, however fleetingly. In such a situation, high-risk behaviour is common. That’s why we named our organization Love Yourself. Our mission is to embrace and nurture our self-worth and create positive change in our community. Our vision is a model MSM community that empowers the self-worth of young people and MSM so that HIV prevention is achieved.”
Pride, self-respect and love in HIV management
This approach to HIV prevention has received positive feedback from the Philippine government. “We’re replicating our model bit by bit in local government units” said Dr Annie. “We need to encourage our clientele to avail of local services more and more. We cannot handle everyone in our little clinic alone, we’ve outgrown our space and are searching for a larger facility now. We’re training other clinics to adopt our approach – Klinika Bernardo in Quezon City is a good example of this.”
“We may not be able to change the world and its stigma towards gay men in the short run, but we can and should change how we think about ourselves,” concludes Lagman. “Love Yourself’s I’m Worthy campaign has our motto incorporated in it: Dare, care, share. Dare to embrace who you really are, dare to know your HIV status. Take better care of yourself whether you are HIV negative or positive. And share your sense of self-worth and your HIV status with others to be truly responsible to yourself and to those you love.”