The cemetery is both a place of solace and work for Alice (not her real name). Her family even asks why she wants to be around death all the time. More than giving her a peace of mind, the private memorial park near the business district of Cebu City is where Alice earns by asking visitors to let her clean the areas around the graves of their loved-ones. Sometimes, she gets paid assisting undertakers prepare their burial services.
Alice, too, jokes about her work in the cemetery but there seems to be an uncanny truth to her proximity to death. In 2018, Alice was hospitalized due to vomiting and abdominal pains. Laboratory tests revealed that she was HIV positive. She started to imagine how her family would react to her death but, in truth, she really wants to live longer.
For the last 20 years, Alice, now 43, had been living her life without any care for the future. After separating from her husband and with a toddler to care for, she turned to drugs and alcohol to deal with her depression. For more than 15 years, Alice had been a person who inject drugs (PWID). It was through this practice of sharing used and contaminated needles that she contracted HIV.
According to UNAIDS, every four minutes, one person who injects drugs becomes infected with HIV. People who inject drugs are 28 times more likely to be infected with HIV than the general population.
Sharing needles among injecting drug users
Data from the HIV/AIDS Registry of the Department of Health (DOH) for January 2019 recorded 1,249 new cases of HIV. This brings to 63,278 the number of HIV cases reported in the Philippines since 1984. But 74 percent of these cases or 46,802 were reported over the last five years from January 2014 to January 2019. Dr. Louie Ocampo, Country Director of UNAIDS Philippines says that there are 38 new infections of HIV in the Philippines every 24 hours.
The spike in monitored new infections over the last five years can be attributed to an increasing awareness about HIV and AIDS, resulting in more people volunteering to get screened and tested.
In Cebu City, as of January 2019, there are 3,828 people living with HIV (PLHIV). Majority of those infected are young people (73%) between ages 15-34. However, half of all HIV cases in Cebu City were transmitted through sharing of infected needles.
Alice says that she could spend P150-200 pesos per day on drugs and she would need her shots four to five times a week. Most times, she says that she’ll be desperate for a shot but she doesn’t have money. That’s why she’ll find others to share the cost. A bottle and one needle set would cost about P90-100 that can be split among three to five people.
Data Source: Cebu City Health Department
The struggle to keep on living
Alice is one of a group of former PWIDs being monitored and assisted by the Department of Health and Bisdak Pride, a Cebu based non-profit organization. It is a daily struggle, according to Alice. Being poor makes it worse, she says. How can one eat right and keep healthy when she sometimes don’t even have transportation fare to the nearest clinic? She’s embarrassed but feels fortunate to get the support of her family, particularly her mother and only daughter who is now 23 years old. They would make sure that she was eating right and that she is able to get her supply of anti-retroviral therapy (ARTs) from accredited social hygiene clinics in Cebu City. But the thought of dying haunts her, terrifies her.
She says that it’s in the cemetery where she is able to clear her head. She thinks that if she wasn’t living with HIV, her family would not question her choice. For now, she is used to hearing them say “nahadlok”, “murag lain” and “talagsa-on” – frightening and weird choice for her. But she is more afraid of how people would treat her if they found out that she’s HIV positive. She believes that even with the strong campaign of government and NGOs, people would still be afraid of her or avoid her. In time, she says that she’ll be ready to tell more people about her situation. For now, she jokes that aside from her family, the only ones she talks to about being HIV positive are the strangers whose graves she helps maintain.
Care and support for people living with HIV
Alice is grateful for this second chance at life. She wants to live longer for her daughter and grandchild. She wants to be able to help take care of her mother. But many PLHIVs like Alice are living in poverty. She says that while treatment is free, it’s the daily survival that affects their recovery. She says there are days when she would skip meals because she doesn’t earn if there are no clients to hire her. They tell her to keep healthy and eat nutritious foods but this costs money.
On December 20, 2018, President Rodrigo Duterte signed Republic Act 11166 or the Comprehensive Policy on HIV/AIDS Prevention, Treatment, Care and Support. This new law repeals RA 8504 or the AIDS Law passed in February 1998. Among its many provisions, the new law strengthens the role of concerned government agencies into ensuring the PLHIVs are given the medical, social protection and social assistance they need. Senator Risa Hontiveros is the principal author and co-sponsor of the RA 11166.
Like all new laws and programs of government, implementing and funding the new AIDS Law remains a challenge for a country with the highest rate of new infection in the world. Filipinos still bear most of the costs and burden of health with 54 percent of out-of-pocket spending going into payment for medicines, according to the Philippine Statistics Authority.
For Alice, getting her ARVs is the least of her concerns when she struggles to access the basic necessities of life like nutritious food and water. While she tries to stay positive about her situation, she doesn’t know how long she could keep it up.#