ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Living in Dangerous Times
Presentation by Maria Dulce Natividad
Maria gave a disturbing presentation about the current state of HIV prevention work in the Philippines. There has been a frightening shift in the landscape since President Duarte took the reins in June 2016.
Between 2010 and 2016 the Philippines has seen a doubling of HIV infections from 4300 to 10500. Maria noted that prior to that time progress on HIV prevention in the Philippines was “low and slow”. While most of the rise is seen to be amongst young MSM, there is also concern for those who inject drugs. Prevention for this group under the current Government will be very difficult.
After taking office President Duterte declared a ‘war on drugs’ , which has been marked by harsh condemnation of drug users and Presidential ‘permission’ to punish and kill drug users. Maria presented several quotes from the president, which including the words “free to kill idiots” (IV drug users). The impact on the ground was the beginning of extra judicial killings which have led to an estimated 13000 deaths. Maria described this as a “shoot first, ask questions later” approach.
She noted that the political message represented a harnessing of fear and social discontent, with its roots in social inequality. It has enabled the institutionalisation of fear through promises of cleaning up society. Maria argued that for Duterte it has led to a consolidation of political support.
The resulting discrimination means that drug users have been driven further into the shadows, with people avoiding health care because they fear for their safety. Harm reduction has become much more difficult. Programs such as clean needle distribution have been discontinued, drug use is poorly documented, and activists/advocates are afraid to get involved.
Drug use and HIV interventions are treated separately, so there is no cross linking.
The situation in prisons is very concerning, with greater overcrowding and a subsequent rise in health issues, which is likely to include blood borne infections.
Overall it appeared to be a grim picture which does not present much room for optimism, however Maria discussed some areas of hope. While dialogue is not possible nationally, change may be initiated at the community level. Some communities and smaller organisations are stepping in to help despite the risks.
IV drug users have the most to fear in the current climate. Perhaps Australian health workers and their peak bodies can find ways to support those communities which are brave enough to help people affected by these depressing government policies, and through this keep alight the flame for HIV prevention.