Publicly unveiled last February 16 of this year, the web-based QuickRes.org aims to help clients access testing and treatment services for the human immunodeficiency virus (HIV).
The project, developed by the non-profit group Family Health International (FHI) 360, is a cherry to the cake that was the “Free to Be U” Campaign. The latter being the Meeting Targets and Maintaining Epidemic Control (EpiC) Philippines’ push to break the stigma plaguing people living with HIV (PLHIV), and to help bring an end to the HIV epidemic come 2030.
But for Joven Santiago, EpIC Philippines’ Technical Advisor for Social and Behavior Change Communication, QuickRes.org is more than just a booking app or an extension of a campaign. For him, this is also a means to popularize the concept of “Undetectable Equals Untransmittable (U=U).”
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), this refers to an idea that PLHIV can have safe sexual contact without transmitting the virus to their partners. That is if the virus would remain undetectable as long as the host continuously undergoes antiretroviral treatment or therapy (ART), among other preventive measures.
When asked about the significance of U=U, Santiago told Yahoo Philippines that “for the longest time, there is a stigma that HIV is a death sentence. Once you get HIV, parang (it’s like) it’s a matter of years [before] some people die, but this [only happened a] long time ago already.”
This was because, according to him, science had already paved the way for different types of treatment.
“We have lifesaving antiretroviral drugs that are available so kapag (if) they take that religiously and they are adherent to it, hindi lang sila mag-live ng (they won’t just live a) long and productive life,” he continued.
However, a 2015 policy brief from Global Forum on MSM and HIV (MSMGF) revealed that there are factors that can hold people back from accessing and affording medicine. These include high prices, as well as the government’s role in maintaining the products’ local availability and overall quality. Issues that can be compared to the Philippines’ lack of proper funding to support PLHIV in terms of medical and medicinal coverage.
But Santiago maintained that there are indeed free services in the country. “It’s only a matter of accessing them,” he said.
Scientific basis for U=U
When asked about U=U’s authenticity, Santiago recalled UNAIDS’ and FHI 360’s citation of three unspecified studies that covered HIV transmission through sexual contact between couples, and took place from 2007 to 2016. In the EpIC Philippines official’s words, it was discovered that “they can no longer pass the virus through their partner through unprotected sex.”
He, however, said that “the virus is still [within] the person living with HIV’s blood because right now, wala pa tayong (we still don’t have a) cure for HIV. It’s still a lifelong condition, but since the person is adherent to his or her antiretroviral drugs, the [detection] level of virus in the blood is so low that it can no longer be transmitted sexually.” He also noted that the tests did not account for other means of transmitting the virus such as blood transfusions.
Santiago added that HIV can be undetectable within the first three to six months of treatment. Related to this, the National Institute of Allergy and Infectious Diseases (NIAID), one can be considered undetectable only six months after their treatment began.
Although neither Santiago, UNAIDS, nor FHI 360 provided the exact studies, scientific reports online did verify U=U’s authenticity.
One was from a research team led by Prof. Giorano Madeddu (from University of Sassari in Italy), whose tests took place from 2010 to 2019 led them to confirm U=U’s importance in reducing stigma surrounding HIV. This was after observing having almost no transmissions among 8,241 participants who underwent ART. Around 97% of the testing period, their viral load was below 200 (where HIV is said to be untransmittable).
2019 tests funded by the National Institutes of Health (NIH) would also show that there were no sexual transmissions between their sample of serodifferent couples (i.e. one partner is HIV-positive, while the other tests negative for the virus). This was again only said to be possible if the host devoutly sticks to their ART.
Emphasizing that popularizing U=U “brings back the dignity of people living with HIV,” Santiago said that it empowers PLHIV to have themselves treated without fear of being discriminated against.
“We have this parang (like) success stories right now, because parang it’s a manifestation, parang isang evidence na (that is) normalizing ones’ status, and normalizing HIV services can actually lead to having health positive outcomes [for] people living with HIV,” he said, adding that U=U allows other people to be “better allies” to PLHIV.
Bridging the gaps
On how QuickRes.org will support the U=U cause, Santiago said that the app will help clients gain easier access to necessary services.
“QuickRes is just an app, but its aim is to facilitate [...] the delivery of HIV services to those who need it. [...] There is a list of clinics providing treatments for people living with HIV on QuickRes.org, and hopefully we can facilitate [them] to [PLHIV and other clients in] accessing treatment. Once they are adherent to that treatment [the virus] would become undetectable,” Santiago hoped.
The timing of QuickRes.org debuting in the Philippines was perfect, as Santiago noted how HIV advocacy groups and organizations were learning to adapt online applications in light of the COVID-19 pandemic. Some of these groups that EpIC Philippines partnered with include HIV and AIDS Support House (HASH), Love Yourself, Inc., the Tropical Disease Foundation (TDFI), and The Library Foundation Sexuality, Health and Rights Educators Collective (TLF Share) among others.
He added that EpIC Philippines focusing on the Mega Manila areas, which comprises the National Capital Region (NCR), Region-III (Central Luzon), and Region IV-A (CALABARZON) was due to their desire to tend to the 62% of HIV cases in the Philippines (who he said are all located in the aforementioned regions). Although Santiago did not mention it, Region IV-B (MIMAROPA) is also a part of Mega Manila, though he did not mention any plans for that region in the interview.
This, however, excludes Geographically Isolated and Disadvantaged Areas (GIDAs), with Santiago commenting that EpIC Philippines working on online initiatives was only a “fraction” of what they’re doing.
He then explained how the app works: it doesn’t diagnose users, and instead provides “tailor fit” recommendations based on how clients answer a specific set of questions; all the while respecting the user’s privacy and confidentiality. These in-turn determine how vulnerable one is to contracting HIV.
As the questions are based on how medical experts would assess HIV risks in-person, Santiago said “in terms of accuracy, it’s accurate, in a sense [that it] is able to calculate someone’s risk for the person to be able to qualify or to need an HIV test, but it is never to diagnose because we can only diagnose HIV through testing.” He added that a disclaimer was included to remind clients that the results are not to be treated as diagnosis.
QuickRes.org also includes features such as a quiz that recounts a clients sexual contact and testing history, as well as options to reach-out to experts and counselors. Adding that EpIC Philippines gets in-touch with or refers clients to their desired services, Santiago believed that there is a need to further “capacitate” experts in adjusting to online means.
“For example, the facilities have HIV workers. We have to make sure that they also use social media, for example, to do outreach for HIV and to respond, so parang (like) capacity building to training modules [are the things that we need],” Santiago continued, elaborating on the importance of “centering” on their stakeholders’ needs, such as case management and motivational counseling.
He hopes that EpIC Philippines would be able to support said facilities, “for that whenever clients message yung mga (those) facilities, they [will be] able to provide the information that they need and makapag-access sila ng (gain access to) whatever HIV service na kailangan nila (that they need).”
What’s next for QuickRes.org?
As the technology was developed by groups outside of the Philippines, Santiago said that the country merely “inherited” QuickRes.org. As such, he believed that in the long run, the Philippines needs to develop its own app like Quick Res.org.
“You know, parang (like) sort of ‘bridging the gap,’ kasi (because) it’s not enough that you know where to get tested. You also need to have the technology to be able to access that, but we did not develop it in the Philippines. [...] [QuickRes.org’s] globally shared among this country, so kumbaga (basically), we are one of the countries that are currently using it across the world where EpIC as a project is existing,” the EpIC Philippines official said.
He saw this as a form of “developing” communities and facilities, saying “we need to make sure that the idea [is] responsive to [stakeholders’] needs, and at the same time, EpIC as a project works closely with the Department of Health (DOH) to make sure that investments moving forward are gonna be there as soon as the innovations are scaled of.”
He added that “in the next two quarters (as of the interview),” EpIC Philippines would continue pilot testing in “select sites,” assessing what else can be improved and what worked with the current version of the app. Santiago also said that their group is aiming to work with DOH beyond their initial partnership with the app, and with groups in tackling comprehensive sex education in schools.
Santiago said that EpIC Philippines will be launching 10 clinics across Mega Manila, including “six in Quezon City, one in Bacoor City, [and] one in General Trias City.”
Free at last?
Near the end of the interview, Santiago reflected on the local misconception that HIV testing is expensive, saying that “I think it is a [form] of cultural [thinking] of the Filipinos, yung (those) health seeking behaviors natin (of ours). Mas takot tayo sa gastos kesa sa effect nung health issues natin (we’re more scared of the costs than the health issues), but at least for HIV, we hope that people would be aware na (that) most services are free.”
Free services that he elaborated include government-funded testing, as well as condoms and lubricants from social hygiene clinics and treatment hubs (who also provide testing opportunities). Pre-exposure prophylaxis (PrEP) pills, which are taken to prevent getting HIV by those who do not have the virus but may be prone to it, are also available for free from Love Yourself, Inc. and PrEP Pilipinas among other sources.
Acknowledging that the Philippines is still conservative when it came to sexual health and other related matters, Santiago credited advocacy groups for normalizing talks concerning HIV and AIDS.
“It’s important [that] we are not just introducing QuickRes as a platform, because it's just a platform. It cannot do so much. It just allows you to book. It is important that there is a campaign that comes with it and there are organizations that sort of [enable] it or [sell] it to the people parang (like) “hey, it’s okay to get tested. You don’t need to be embarrassed about your HIV status.’ Regularly, it should be normalized [sic],” he hoped.
In wrapping-up his thoughts, Santiago once more invited PLHIV to try QuickRes.org. He added that the HIV epidemic “disproportionately impacted” the health of different members of the LGBTQIA+ community, promising that EpIC Philippines will help make services more accessible.
“There is a whole community of service providers and organizations that are here for them and we here for them so that they can access the services free from stigma and discrimination and through accessing this we are free to be themselves,” Santiago swore.
In the end, Santiago also urged those who do not have HIV or those who are not part of the LGBTQIA+ community to educate themselves and be more considerate to what the latter two endure.
“Be better allies to the people living with HIV, and those [who] are vulnerable [by] making [yourselves] more knowledgeable about HIV, making [yourselves] more aware about what HIV is, how this affects the person, what are the interventions for people living with HIV, for people who are not living with HIV,” Santiago concluded.
Clients may book their needed services by visiting QuickRes.org through this link.
Reuben Pio Martinez is a news writer who covers stories on various communities and scientific matters. He regularly tunes in to local happenings. The views expressed are his own.
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