PROTECTING prisoners’ health safeguards public health.
With prevalence of human immunodeficiency virus (HIV) higher in prisons than in the general population, prisons are ideal settings for HIV testing and treatment. In 2020, the United Nations Office on Drugs and Crime reported an estimated global HIV prevalence of three percent among prisoners.
Part 1: Special Report: Ex-inmate leads charge for HIV awareness in Cebu
Beyond the risk to the community, the well-being of inmates must be considered as well.
Vengie Mendoza, a former inmate and a person living with HIV (PLHIV), emphasized the need for improved food, proper nutrition, and access to mental health programs for prisoners with HIV.
“Yes, we wear yellow and we’re prisoners, but we deserve proper care and adequate food, especially since we’re taking medication,” he said in Cebuano.
SunStar Cebu received Mendoza’s permission to be identified in the article, along with a signed confidentiality waiver, signed by a notary public.
Prisoners have the right to receive healthcare equivalent to that provided to the general population. This right is guaranteed under Article 25 of the United Nations Universal Declaration of Human Rights.
However, this is not the case in the country. Despite efforts by jail management to provide proper nutrition to inmates, most jails are overcrowded and constrained by limited budgets.
Jail Senior Insp. Jay Ylanan, chief health officer of the Bureau of Jail Management and Penology in Central Visayas (BJMP 7), said the bureau is actively collaborating with the Cebu City Health Office to ensure the availability of HIV testing and treatment supplies.
Ylanan also said that persons deprived of liberty living with HIV (PDL-PLHIVs) receive monthly replacements of their antiretroviral therapy (ART) to ensure continuous treatment and management of their condition; however, he acknowledged the shortage of nurses in regional jails.
They also face budgetary constraints for meals, which is challenging for prisoners on medication who require higher nutrition. Ylanan said they need the support of prisoners’ families to meet these needs.
There is also the challenge of preventing discrimination against PDL-PLHIVs in such close quarters.
“Sometimes, naa gyud silay idea…As much as possible ato sa gyud gihapon nang gi practice ang confidentiality. Ang uban per cell lang sila makagawas. Didto na sila i-testing. At least naa mi area pod didto…ngadto ra specific mag replace sa medicine, counseling,” Ylanan said.
(Sometimes the inmates would really get an idea…As much as possible, we still practice confidentiality. Some are only allowed out of their cells one at a time. That’s where they are tested. At least we have a specific area there where we handle medicine replacement and counseling.)
Congestion
Ylanan said BJMP 7 jails can experience congestion levels of 100 to 200 percent, as with other jails nationwide.
The Commission on Audit reported in 2022 that “of the 478 jail facilities nationwide, there are 323 or 67.57 percent, which are congested with occupancy rates ranging from 101 to 2,739 percent.”
It said the total jail population of 127,031 as of December 2022 exceeded the total ideal capacity of 46,702 “resulting in unhealthy living conditions for the Persons Deprived of Liberty.”
In Central Visayas, 36 out of the total 43 jails are congested. From a total ideal capacity of 5,039, the total jail population in the region reached 19,126 in 2022.
Ylanan said with only 89 nurses for 43 jails across the region, each nurse is responsible for 200 persons deprived of liberty (PDLs).
The Talisay Jail Male Dormitory, for instance, has 1,194 inmates with only four nurses, while the female dormitory with 184 inmates has only one attending nurse.
The BJMP, however, has ongoing plans to establish its own accredited HIV hub, enhancing its capacity to provide comprehensive care on-site.
General population
Central Visayas remains to have the highest number of HIV cases outside Metro Manila, according to the latest HIV and Aids surveillance report of the Philippines.
However, these are just estimates based on the current data the Department of Health in Central Visayas (DOH 7) has—from data that has been captured.
“These figures are from those who actually got tested. We don’t know if the actual numbers should be higher or lower,” said Dr. Lui Miguel Balbuena, Regional Medical Coordinator of the National HIV/Aids, STI Prevention and Control Program of the DOH 7.
Transmission modes
Based on the 107 new cases recorded in the region in April 2024, sexual contact, particularly male-to-male sex, remains the primary mode of HIV transmission, accounting for 101 cases, with 66 of these involving male-male contact. This is followed by needle sharing, which accounted for five cases.
While no cases of vertical transmission (mother-to-child) have been reported in April, it is still a recognized mode of HIV transmission.
Meanwhile, males continue to represent the majority of new diagnoses in a particular context, based on recent data.
The 25-34 age group also still has the highest number of new cases.
Meanwhile, the 15-24 age group, the young key population, is showing a notable increase in new diagnoses, reflecting a shift in trends.
“When we are talking about this age group, there is called the age of vulnerability and the age of exploration (sexually),” Balbuena said.
“We need to focus our attention on the younger generation because we don’t want them to be the ones filling these statistics in the future. We have to address this issue as early as possible,” he added.
The goal was to identify 95 percent of all HIV-positive individuals, ensure that 95 percent of those diagnosed receive antiretroviral therapy (ART), and achieve viral suppression in 95 percent of those undergoing treatment by 2030.
As of December 2023, the DOH reported that the percentage of PLHIV who know their status is still at 63 percent, while 63 percent of those diagnosed are on life-saving ART, and 36 percent of those on established ART are virally suppressed.
“When we are talking about HIV, it is the same as cancer. There is no cure. The messaging is U equals U. Undetectable = Untransmittable,” Balbuena said, noting the importance of testing and early treatment.
Barriers
Aside from fear of stigma and discrimination, the Filipinos’ poor health-seeking behavior, due to several factors such as poverty, and the gaps in legislation serve as barriers to health services.
Balbuena said the country’s Philippine HIV/Aids Policy Act is “very restrictive.”
Under Sec. 29 of the Philippine HIV/Aids Policy Act, if the person is 15 years old and below 18, consent to voluntary HIV testing shall be obtained from the child without the need of consent from a parent or guardian.
“Any young person aged below fifteen (15) who is pregnant or engaged in high-risk behavior shall be eligible for HIV testing and counseling, with the assistance of a licensed social worker or health worker. Consent to voluntary HIV testing shall be obtained from the child without the need of consent from a parent or guardian,” the law said.
However, in all other cases not covered by the cases above, “consent to voluntary HIV testing shall be obtained from the child’s parent or legal guardian if the person is below 15 years of age or is mentally incapacitated.”
“We cannot do mandatory testing. Everything is voluntary…How can we stop stigma and discrimination?” Balbuena said.
“I think we can even have it mandatory because it (HIV) has been an epidemic for 40 years (already),” he added.
Balbuena also said that Filipinos have the tendency to delay or avoid seeking medical help. This could be attributed to financial constraints and cultural or personal beliefs, among other factors.
Interventions
To break these barriers, Balbuena said the DOH is increasing its HIV information, education and communication campaign, along with increasing testing and treatment.
The DOH is also developing an online HIV platform through a user-friendly app. This app will streamline information on prevention, testing, treatment, and care, offering a comprehensive and responsive resource tailored to the needs of its users.
The DOH is also working on expanding the Rapid HIV Diagnostic Algorithm that decentralizes testing and expanding treatment hubs.
“Before, our confirmatory testing was done in Manila, so it typically takes three months to be sure if you have HIV. Currently, our turnaround time is at best the same day, and at most, up to one week,” Balbuena said.
Central Visayas currently has 10 HIV treatment hubs and eight primary HIV care clinics.
Balbuena emphasized that, with access to proper testing and health services, HIV is not a death sentence.
People living with HIV can lead happy and normal lives with appropriate medication and care.