Human Rights during COVID-19: Battling Stigma and Discrimination

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is an international mechanism that mobilises and invests more than US$4 billion a year to support programmes that fight the three diseases, and has been investing in HIV, TB and Malaria responses in the Philippines since 2003 and has so far disbursed US$492,103,086 for responses for the three diseases.

In the Philippines, the Global Fund has:

• • Contributed towards 24,800 people put on anti-retroviral treatment for HIV in 2017;
  • Treated 400,000 people with TB in 2019; and
  • Distributed 596,000 mosquito nets in 2019.

Global Fund investments have not only contributed to provide lifesaving treatment and health commodities to people affected by and living with HIV, TB and malaria in the Philippines but have made significant improvement in the Philippines health systems to ensure access to available HIV, TB and malaria health services and have also supported communities and civil society in the Philippines to advocate for community, rights and gender concerns of the HIV, TB and malaria responses.

Technical assistance provided by the Global Fund’s Community, Rights and Gender (CRG) department has supported communities in the Philippines to identify and articulate their priorities for removing human rights- and gender-related barriers to access to health services to be included  in the country’s Funding Request for HIV for the next three years. Philippines is also part of the “Breaking Down Barriers initiative” of the Global Fund which provided intensive support, including US$45 million in additional funds in 2017-2019 and another US$41 million in 2020-2022, to 20 countries to vastly scale up evidence-based programming to reduce human rights-related barriers to HIV, TB and malaria services.

Mara is the Executive Director of Action for Health Initiatives, Inc. (ACHIEVE) – a non-stock, non-profit organisation based in Quezon City, Philippines that focuses on the development and implementation of programmes, projects and policies addressing HIV and AIDS, gender, sexuality, human rights and migrant issues. ACHIEVE works closely with communities of migrant workers and their families, young key affected populations, people living with HIV, people who use drugs, as well as government agencies, international institutions, and other civil society organisations.

ACHIEVE has continued supporting communities who are the hardest hit by the lockdown in the Philippines through repurposing grants of the organisation. Food and basic necessities assistance support has been provided to more than 49 families by ACHIEVE, and additional support for laboratory diagnostics, medicines and access to ARV was provided to 21 people living with HIV, and referrals to relevant COVID-19 services, such as COVID-19 testing. During the lockdown, ACHIEVE also facilitated a debriefing and counselling support for 17 staff and members of the community to help them deal with the stress brought about COVID-19 pandemic and related lockdowns.

Mara’s engagement with the Global Fund and its mechanisms started 16 years ago in 2004. She has provided technical support to implementers of project activities in the Philippines from 2004 to 2009, and from 2017 – 2018, ACHIEVE became a sub-recipient (SR) of a multi-country regional grant of the Global Fund – “Sustainable HIV Financing in Transition (SHIFT)”. As the project manager she engaged with national stakeholders advocating for the sustainability of the HIV response in Philippines, including sustained engagement of key populations. In 2019, Mara became a member of the Communities, Rights and Gender (CRG) Advisory Group of the CRG Department of the Global Fund. More recently, Mara was involved in the process of developing Philippine’s funding request to the Global Fund for 2021 – 2023 for the HIV component, and particularly with regards to the development of Matching Funds for the human rights strategic priority area which aims to reduce human rights related barriers to HIV, TB and malaria services and use country allocations towards the right mix of human rights programmes targeted to the right people.

As of 13th October, Philippines has 342,816 confirmed cases after seeing 3,564 daily cases on Monday 12th October, the highest in more than 20 days, and 6,332 deaths. It is one of the three countries from the Asia-pacific of the twenty countries currently most affected by COVID-19 worldwide, and sees  deaths per 100,000 population of 5.93 and 1.9% observed case-fatality ratio.

When COVID-19 started impacting countries worldwide in March 2020, Mara and her colleagues in ACHIEVE had to adjust to lockdown conditions in Metro Manila while continuing to serve its communities that sought legal support and assistance virtually. Various cities in the Philippines underwent strict lockdowns from March 14, 2020. Mara like the millions of others in Metro Manila abided to the lockdown measures by staying home during this period, whilst her flatmate who is a police officer involved in providing free transportation for other front liners.

On 16th April 2020, Mara’s flatmate tested positive for COVID-19, and Mara was requested to be quarantined for 14 days and underwent the SARS-CoV-2 diagnostic test 2 days later on the 18th April 2020.

When COVID-19 started impacting countries worldwide in March 2020, Mara and her colleagues in ACHIEVE had to adjust to lockdown conditions in Metro Manila while continuing to serve its communities that sought legal support and assistance virtually. Various cities in the Philippines underwent strict lockdowns from March 14, 2020. Mara like the millions of others in Metro Manila abided to the lockdown measures by staying home during this period, whilst her flatmate who is a police officer involved in providing free transportation for other front liners.

On 16th April 2020, Mara’s flatmate tested positive for COVID-19, and Mara was requested to be quarantined for 14 days and underwent the SARS-CoV-2 diagnostic test 2 days later on the 18th April 2020.

On the 12th day of the quarantine, Mara’s test result came back negative for COVID-19. Mara remembers, “I was concerned about getting a positive result. My immediate worry was not having any family members living even remotely near to me as they are all living in other provinces and my flatmate was already in hospital, how was I going to survive my self-quarantine?”

For Mara, who has been working for many years on addressing stigma and discrimination faced by communities living with and affected by HIV and TB, the self-quarantine was a very personal encounter she faced first-hand with COVID-19 stigma and discrimination.

Mara recalls that even with the knowledge on COVID-19, she experienced self-stigma herself and even after receiving her negative results for COVID-19, was unable to make up her mind to leave her apartment for two days.

“I felt that the moment I step out, people will know. I wanted so much to go out of my apartment, walk my dogs and feel free. But I felt that the moment I step out, people will know, and I allowed my own stigma to get the better of me. Waiting for the test results reminded me of the countless “Wildfire” exercises I’ve conducted in my HIV trainings to simulate the HIV testing process and the impact of the test results. I have been tested several times for HIV, but I was more anxious waiting for the COVID test result,” shared Mara.

Mara acknowledges that experiencing and reacting to stigma differs from person to person. During her home-quarantine, she had to struggle to get the management of her apartment building to attend to an electricity fluctuation in her apartment unit and it was only after the electricity died, did the management attend to the matter. She later found out that the person who initially received her complaint did not want the apartment unit checked as her unit was the “Unit with COVID”.

Mara was also not allowed to leave her apartment even though the management of her apartment building received a copy of her negative COVID-19 test result and she had to wait till the management secured a clearance from the local government unit of her municipality or the “Barangay”. She, however,  doubts whether this was part of the Philippines COVID-19 protocol or the management of her apartment building was too scared to let her out.

“Self-quarantine and the related experience of waiting for the test results was a wake-up call. A medicalized approach cannot alone address a pandemic such as COVID-19 or epidemics like HIV, TB or malaria sustainably. It is crucial that we address related social issues such as stigma, discrimination, and lack of awareness which at times lead to dehumanizing affected people and communities,” stressed Mara.

The story that was faced by Mara is not unique in Metro Manila as she feels that she is much more fortunate than others with support provided to her during her quarantine from some member of the management of her apartment compound, including security personnel.

Yet the reality is that seven months after the world is hit by COVID-19 still sees the daily struggles faced by the majority of communities vulnerable to, affected by or living with HIV due to stigma, discrimination, violence and criminalisation further compounded by COVID-19.

The Global Fund has continued to play its part to support Philippines in fighting COVID-19 with financial support of almost US$15 million, with over US$13 million approved under the Global Fund’s Grant Flexibilities for COVID-19 responses and over US$1.5 million approved through its COVID-19 Response Mechanism (C19RM).

However, funding alone is not sufficient to resolve the issues that are created by COVID-19 in the country, and Mara is critical of the lack of coordination of the country’s administration six months into the epidemic, and the militarised approach taken by the Philippines government to control the spread of the pandemic leading to further violations of human rights, not dissimilar to its approach on the “war on drugs” which has seen killings in Philippines up 50 percent during the pandemic.

Moreover, survival is a daily struggle faced by majority of communities vulnerable to, affected by and/or living with HIV/TB due to stigma, discrimination, violence and criminalization and this reality is further pronounced during the spread of the COVID-19 pandemic. Access to essential requirements and services such as food and healthcare for the most vulnerable and impacted communities is further challenges, and many who may not have family and/or social support have become the furthest left behind.

Having the trepidatious experience of awaiting her COVID-19 test results, Mara contemplated on the necessity for community-based organisation to develop systems that are able to provide regular updates and contingency plans in emergency situations to ensure that vulnerable and key populations are not left behind. She highlighted the importance of reimagining the delivery of organisational activities in an unfamiliar context of social distancing and other COVID-19 pandemic related rules and regulations given that physical meetings, gatherings and workshops have been the norm for communities and populations living with and affected by HIV, TB and malaria.

She reflects that poor connectivity in Philippines has been an insurmountable barrier as the world turns online with the absence of a meaningful internet connection, especially in unserved and underserved communities. Mara is adamant on the fact that being able to conduct business in the world’s “new normal” needs to factor in the realities of key, vulnerable and criminalised populations of men who have sex with men, transgender people, people who use drugs, sex workers, migrants, internally displaced people, the poor, women and girls and many more in terms of being able to access and more importantly afford these new technologies and the tech literacy needed to operate them.

Mara is concerned on how Philippines will be able to come out of the COVID-19 pandemic, and how it is delivering against its health and related targets according to the Sustainable Development Goals. According to the Sustainable Development Report 2020, Philippines ranks 99 of 166 countries, and only sees one goal (SDG Goal 12 – Responsible consumption and production) achieved, with major challenges remaining for Good Health and Well-Being (Goal 3), Zero Hunger (Goal 2), Reduced Inequalities (Goal 10), Peace, Justice and strong Institutions (Goal 16) and Industry, Innovation and Infrastructure (Goal 9).

Philippines also has an outstanding external debt at US$87.5 billion as of end-June 2020 and has recently been approved a US$600 million loan by the World Bank to support the efforts of the government to sustain social protection for the poor and most vulnerable families amid the COVID-19 pandemic. A country that has been in a vulnerable position since the beginning of the COVID-19 pandemic that is affected by pre-existing social, economic, health and financial factors.

Mara is perturbed how communities and populations will be impacted by the lack of political will in addressing these challenges. The latest scandal where the Philippine Health Insurance Corporation (PhilHealth) which has been helping finance COVID-19 testing and treatment in the country, has been rocked with allegations of fund mismanagement and pricing.

“It is extremely crucial that we address the social and economic inequalities as part of pandemic responses and resolve these inequalities and ensure that the human rights of all individuals are respected and protected so that no one will be left behind in achieving Universal Health Coverage”, concludes Mara.