To live and love: The importance of Community Based HIV Screening

Having to go to clinics to get tested for HIV can be daunting for some. Getting tested is a time of vulnerability in which most people would like to keep private as much as possible. 

Began during the height of the pandemic, Community Based HIV Screening gives access to people seeking HIV tests within their community through digital means. Likewise, this has made its way into the Los Baños community.  

What is Community Based HIV Screening (CBS)?

Recognizing the HIV epidemic in the country,Community Based HIV Screening involves trained volunteers or health workers within the community to provide accessible counseling and HIV screening to people seeking these services. 

According to Jules, who volunteers for HIV and AIDS Support House, Inc (HASH), this initiative is a coordination between the NGO, UNAIDS, and the Department of Health (DOH). 

Jules, based in Los Baños, Laguna, has been a volunteer for seven months starting in November. He usually advertises his services through Grindr, an online dating app for typically catering to gay men.

He says not all volunteer screeners use Grindr to advertise their services, some use Telegram, Twitter, and other social media platforms or dating apps. It is up to the volunteer where and how they want to advertise their services. He also mentions that they coordinate with LGBTQ+ organizations making them official screeners for an event and some are even on courtesy-call for local government units. 

“To be honest, yung means para i-promote ito at para ma-contact yung CBS motivators –  sky is the limit for this depending kung gaano ka creative or kung gaano ka sociable at kung gaano kalaki yung network noong CBS Motivator dahil doon yun yung pinaka-puhunan dito, yung network mo,“ he adds.  

How does this work?

Clients contact them through the account in which they state their availability such as the time and place of testing. The session usually lasts 20 to 30 minutes. 

“Sa testing proper, when they come over here, mayroong pre-motivational counseling and post-motivational counseling that sandwiches yung mismong testing. So kaming mga CBS (Community-Based HIV Screeners) motivators, we’re like a hybrid of HIV counselor and HIV tester.”

Pre-motivational counseling usually includes asking the clients about their basic knowledge of HIV, transmission, and prevention. Testing is drawing blood using a lancet which is a small tool that pricks the finger. The blood is then transferred to the HIV strip using a capillary tube.  

Post-motivational counseling depends whether the result is positive or negative. If the result is negative or non-reactive, clients are usually referred to PrEP or Pre-Exposure Prophylaxis to reinforce their safety and reproductive health. And if the result is positive or reactive, they let the client process their feelings since the experience can be personally grueling for the clients. 

“It can take a lot for a lot of people na especially medyo malakas yung pagiging empathetic to clients. It’s a necessary process to let the client process what they are feeling and afterwards, when they say they are ready, we go on to the battleground, we explain what happens next and we assure that we’ll be there all along the process until they get used to it,” he adds

They have a fixed 40 tests per month quota, but he sometimes exceeds or  fails to meet that quota, hence, he tests at around 30-40 people per month within the Los Baños area and those nearby. 

Pros and Cons

Compared to health hubs and clinics who offer free HIV screening, Community-based HIV screening has its advantages and disadvantages from the former. 

With the current health protocols, this surely has more of an advantage in accessibility and flexibility.It is easier since the test is done in their own home or some place nearby. In Jules’ case, he offers his apartment to clients who do not have their own place to get tested, which is usually the same proximity as the client. In some cases, tests are done in a public place as long as the client is comfortable with the venue. 

Another advantage is privacy and convenience. Though as mentioned before, this can be done publicly with the client and motivator’s discretion, privacy is still an advantage because it takes away the daunting task of having to go to a clinic or medical facility. 

 One reason why people forgo regular HIV testing is fear or shame. Fear that they might get discriminated against. Having to go to medical venues and interact with people can be daunting for some. Volunteers are also bound by RA 11166 which covers confidentiality with regards to HIV and AIDS.

This method however, is not a replacement for health hubs or clinics but an option for those who want to opt for it. Because in reality, there are still people who have limited access to the internet hence access to social media and/or dating apps. People may also have difficulty accessing safe and private places to get tested because some might not be comfortable getting tested in public places. 

In retrospect, testing in health facilities and community-based testing have similar protocols when it comes to the testing proper; pre-motivational counseling, testing, and post-motivational counseling however, the latter is immersed within the community where the motivators can develop a network within the community. The clients can develop a relationship with the motivators eliminating the fear and stigma when it comes to HIV testing. 

HIV epidemic in the country

According to the Department of Health-Epidemiology Bureau (DOH-EB), the Philippines has the fastest growing HIV epidemic in Asia and the Pacific Region. From 2010-2020, there has been a 237% increase in annual infections. With an estimated total of 115,100 of HIV cases in 2020, it could reach 330,000 by 2030 if the rapid increase of new infections is sustained. 

Similar to Jules’ screening clientele, 90% of new infections come from males who have sex with males (MSM). One of the reasons, is that a young demographic of MSMs as well as transgender women (TGW), show that only 38% of them use condoms.  

According to the National Center in HIV Epidemiology and Clinical Research, the country has had a low and slow increase of HIV infections since 1984. Possible main reasons for this steady increase are low condom use and injectable drug use. But the former is more prominent since most HIV infections in the country happen sexually. The Philippines has the lowest documented rates of condom use in Asia with 20-30% in 2010. 

According to De Torres of the University of the Philippines College of Nursing, “barriers to condom use were discomfort and displeasure on condom use, low parental communication, lack of sex education, social stigma, and the high price of condoms. 

The Philippines’ low condom use is caused by social, political, and structural barriers, according to the study. Roman Catholicism as the dominant religion in the country, has had a strong resistance against the use of condoms. Apart from religion, there are restrictive policies on condom purchase like the RH Law which prohibits condom purchases by individuals under the age of 18 without parental consent. And lastly, sex education is still an issue in schools where institutions are still bound by sexual conservatism which hinders sexual positivity among individuals. 

Destigmatizing HIV and AIDS

There is still a knowledge gap among Filipinos when it comes to HIV and AIDS. A big reason for this is the stigma that’s around the topic of HIV and AIDS. 

Through accessible testing and counseling, open discussions occur among community members through the networks created by Community Based HIV screening. CBS helps create relationships between the motivator and their clientele which integrates education and sexual positivity within the community. 

Community testing helps take away the stigma by creating a comfortable space for people to get tested easily as well as having support within the community when it comes to taking care of one’s reproductive health. 

Getting to know one’s status is one thing. Living with HIV is another. Once we reach the hurdle of testing and knowing one’s status, it can be difficult for those who are positive. 

There is a misconception that having HIV is a death sentence but it doesn’t have to be. With recent treatments such as the antiretroviral treatment (ART), the concept of “Undetectable Equals Untransmissible (U=U)” is being popularized. This concept helps destigmatize HIV/AIDS by  encouraging people to get treated, hence, policies should make treatments and professional help accessible to people living with the virus. 

Knowing that one can be positive yet stay non transmissible, is a boost for one’s dignity. It is also proof that living with HIV does not have to suck the life out of a person which should encourage people to become more aware and supportive of those living with the virus.  

Getting tested for HIV can mean the difference between life or death. But it is the first and necessary step to prevention or treatment. That’s why it can be a daunting task for some. With the fear of being shamed or discriminated against, it is imperative that safe spaces, digitally or physically, should be accessible for people looking to assess their reproductive health which can be a very vulnerable time for them. [P]