How Quezon City in the Philippines is leading the fight against Southeast Asia's new HIV-Aids epidemic
A young man wearing a striped red T-shirt and faded blue jeans enters a popular bar in downtown Quezon City. He starts speaking to the owner and is soon joined by several other young men. They blend in seamlessly with the other bar customers, but even though it’s 10pm, they are here to work not relax. They are peer educators and health workers employed by Quezon City’s health department.
“You just get used to it,” said Mai. “The night is to us what the day is for others. It’s the job.”
Outside, a street lamp casts an orange glow on a city ambulance which purrs softly, parked and waiting unobtrusively for clients. The group of men have come here to conduct HIV counselling and testing with bar patrons and staff, who are mostly gay men or other men who have sex with men (MSM). On this steamy night they provide HIV testing services to around 50 people.
With nearly 3 million residents, Quezon City is the Philippines’ most populous urban centre and has made stopping a burgeoning Aids epidemic a top priority. Mayor Herbert Bautista has encouraged city residents to know their HIV status and he has taken an HIV test in public.
“Quezon City is unrelenting in its effort to pursue and sustain its programme of zero new infections, zero discrimination and zero Aids-related deaths. We remain committed to providing preventive intervention, treatment, care and counselling to ensure our people receive a better quality of life,” said Mayor Bautista.
In 2007, an HIV-Aids registry published by the Philippines’ Department of Health indicated that HIV transmission was shifting from sex between female sex workers and their male clients to same-sex relations between men. UNAIDS found there were 6,400 new HIV infections last year in the Philippines, making it one of the fastest growing epidemics in Asia. The picture is even worse in Thailand, where more than 7,600 new HIV cases were recorded last year.
In Quezon City, HIV prevalence among MSM increased from less than 1 per cent in 2007 to nearly 7 per cent in 2013.
In 2012 the city became the first in the country to open a clinic providing services to MSM and transgender people.
Klinika Bernardo, popularly known as the Sundown Clinic, is a community-friendly facility located on a busy highway.
“We cater to MSM from all over the Philippines,” said Dr Leonel John Ruiz, head physician at Klinika Bernardo. “Only 40 per cent of our clients are from Quezon City.”
While same-sex sexual relations are legal in the Philippines, there is a high degree of social stigma and discrimination towards gay men and MSM. Fear of being outed and ostracised prevent many MSM from accessing traditional health services. Studies by city health officials show that two-thirds of MSM in Quezon City have never had an HIV test.
With its row of potted plants and bright green decor, Klinika Bernardo exudes a cheerful atmosphere. It has 10 staff members with four peer educators, who include MSM and a transgender woman. Clients are free to choose the educator, who best suits their needs. Personal information is kept confidential. Instead of documenting and calling clients by their name, the clinic maintains their anonymity by giving each person a number. Staff are skilled at reassuring jittery clients visiting the clinic for the first time.
“This is my first HIV test. I don’t know what to expect,” said one young man while filling out registration forms. “It took me awhile to gather the courage to come here.
“The pre-test counselling was very helpful,” said the young man. “It made me realise that my fear is mostly about ignorance.”
If a person tests positive, they receive counselling and antiretroviral medication, which is free in the Philippines.
From the start, demand for the Sundown Clinic’s services was high. By the end of last year, the clinic had conducted more than 2,500 tests of which 200 were HIV positive. The success of Sundown prompted the city to open a second clinic earlier this year.
“My favourite part in working in Klinika Bernardo is that you get to meet a lot of people,” said Jayson, a peer educator. “And that you become friends, you get to know them, and you get to help them. That is the best part. Helping others help themselves.”
Quezon City shoulders the cost of the clinics’ operations and has increased investment in HIV services significantly, from less than 5 million pesos in 2012, to 24 million pesos (Bt18.3 million) last year. The city’s efforts to encourage HIV testing are paying off. The number of men being tested has increased fourfold since Klinika Bernardo opened.
“In the three years that we have been operating, the perspective has definitely changed,” says Doctor Ruiz. “Before, we would have a hard time inviting people for testing. Now, most of our clients are walk-ins. People are personally and actively seeking information.”
Several other local city governments are now adopting the Quezon City model and establishing their own Sundown Clinics.
“We are proud that we are helping to shape the Aids response in the Philippines,” says Doctor Ruiz. “We hope the Sundown Clinics will help dim the lights on an epidemic which has claimed too many lives.”
While the clinic staff are proud of their achievements, the day the Sundown Clinic can close up shop is the day they will really celebrate.
“I pray before sleeping,” says Adel, the only woman Peer Educator at Klinika Bernardo. “I pray that there will come a day when no one needs our services. That’s what I am working for.”
Saya Oka is regional communications adviser, UNAIDS Regional Support Team for Asia and the Pacific.