The current state of the HIV/AIDS epidemic in the Philippines has been characterized as low and slow. For a highly populous country of 80 million, there are only 1,776 HIV/AIDS cases recorded in the National Registry of the Department of Health as of October 2002. The current total of HIV/AIDS cases is a cumulative tally beginning the time when HIV/AIDS was monitored by the Philippine government in 1984.

Current estimates by the WHO place the number of infected between 10,000-30,000. There are many factors that account for the low number of actual cases. Many sectors agree that there are many cases that remain unreported, due to 1) a weak surveillance system; 2) absence of comprehensive treatment and care facilities; and, 3) stigma and discrimination faced by PLWHAS. The third factor is critical in determining the actual state of the epidemic in the Philippines. For as long as PLWHAs remain discriminated and stigmatized and there is no enabling environment that will facilitate positive disclosure of their status, they will remain hidden and invisible.

In 1998, the Philippine HIV/AIDS Control and Prevention Act of 1998 or Republic Act (RA) 8504 was enacted into law. RA8504 was hailed as a landmark legislation, not just in the Philippines, but also in the whole of Asia, as it was a clear manifestation of the Philippine government's will to legally address the issue of HIV/AIDS. Indeed, the law is strong in its language to protect PLWHAs. There are specific provisions protecting their right to privacy and confidentiality, and the right not to be discriminated against.

RA 8504 is critical as it sets the framework within which discrimination against PLWHAs is defined in the local context. RA 8504 lists specific sites and situations where violations may occur: e.g. in the health care system such during the process of HIV Antibody testing or treatment of PLWHAs; workplace or employment; the education system; the family and the community, among others. It also provides punitive measures in reference to specific provisions. RA8504 is a vital instrument, which PLWHAs have been able to use as a reference to their concrete realities and experiences. In particular, they use it as a basis to identify discrimination and invoke their rights.

In August 2001, Pinoy Plus Association began the conduct of a research entitled "Human Rights Peer Documentation Project: A Multi-City Participatory Action Research on Social Stigma, Discrimination and AIDS". This study was part of the regional research on HIV/AIDS-related stigma and discrimination being undertaken in three other countries in Asia (Indonesia, Thailand and India) by the Asia Pacific Network of People Living with HIV/AIDS (APN+). This regional study is significant because it is the first of its kind to be undertaken by people living with HIV/AIDS. Though there was technical assistance and support provided by NGOs and private individuals working on HIV/AIDS, this project was principally managed by PLWHAs.

II. OBJECTIVES

The objectives of the study were:

• To understand the range of discriminatory attitudes and actions.
• To understand the pathways of AIDS-related stigma and discrimination.
• To review and understand the nature of AIDS-related stigma and discrimination in the Philippines.
• To train people living with HIV/AIDS on how to recognize human rights violations and how to document these.
• To document actual violations of human rights faced by Filipinos living with HIV/AIDS.
• To identify the need for full implementation of the R.A. 8504, also known as the "Philippine AIDS Prevention and Control Act of 1998."

III. METHODOLOGY

The study was conducted using both quantitative and qualitative methods. The quantitative study entailed the conduct of a survey involving a total of 82 respondents. All four countries used the same questionnaire, which was translated into the local language. Pinoy+ employed the services of PLWHAs as researchers/ interviewers in both studies. The selection of the researchers/interviewers was based on the criteria that they were willing to work on the project and that they had contacts who were willing to be interviewed. The selection of respondents was based on two factors: they were known by or referred to the researcher/interviewer and they were willing to be interviewed.

The researchers/interviewers underwent a basic training on research, especially in the area of data gathering, which included administering guided interviews, conducting in-depth interviews, and facilitating focus group discussions. The researchers also underwent basic orientation on data clustering and analysis so that they would ably support the analysis that was undertaken by two independent consultants.

The second study entailed the conduct of seven in-depth interviews with identified respondents. The respondents were also participants of the survey and were purposely chosen and identified because their responses in the survey revealed that they had experienced some form of discrimination. Thus, the interviews were meant to probe into their specific experiences and conducted separately from the survey.

IV. RESULTS

1. The Survey

1.1 Introduction

This study was conducted from August 2001 to January of this year in Metro Manila. It has two parts: the survey and the case studies. This section will discuss the findings of the survey part of the research. It will also present some problems encountered in the conduct of the survey as well as some recommendations that arose from the findings.

The survey looks at the stigma society has placed on HIV/AIDS and how this affects the lives of PLWHAs. It also looks at the experiences of discrimination of people living with HIV/AIDS (PLWHAs) as a result of this stigma.

1.2 Methodology

At the beginning of the study, 12 PLWHAs were trained as researchers. These researchers were selected based on three factors: those who had networks with non-government organizations working with PLWHAs, those who personally knew other PLWHAs, and those who were willing to conduct the survey and interview other PLWHAs.

The respondents were selected with the main consideration being their willingness to be part of the survey. The interviewers contacted these respondents through their contacts with NGOs working on HIV/AIDS issues and hospitals providing services for PLWHAs. Majority of the respondents are known personally to the interviewers.

Upon agreeing to participate in the survey, the respondents were also asked to sign a consent form stating that they were willing to participate in the survey. The researchers were all under a protocol that ensured the confidentiality of the identity of the respondents as well as the detailed data provided by the respondents.

The researchers then interviewed the respondents using a structured questionnaire. This questionnaire was developed by APN+ for all the research sites. It was translated in Tagalog for purposes of the Philippine study. While the respondents answered the questions, the researchers ticked the appropriate boxes in the questionnaire. Follow-up interviews were done with respondents which had answers that needed more explanation and clarification.

1.3 The Respondents

The survey was conducted among 82 respondents. The age of the respondents range from 17 to 58 years old and the average age of the respondents is 38. Among the respondents, there are 40 males, 39 females and 3 self-identified transgenders.

Of the 82 respondents, 57 have children. Thirty-three of those with children have only one child. There was one respondent with 5 children and one respondent with 7 children.

The highest educational attainment of the respondents was also asked. More than half of the respondents, i.e., 44 have reached college, while 30 were able to finish high school. One respondent finished a technical course. One reached post-graduate education. Only one of the respondents was not able to have any schooling.

When the research was conducted, 32 of the respondents were jobless. The jobs of those who were working are summarized in the following table:

The categories of occupations in the above table are those present in the questionnaire. The respondents simply chose from among these categories. The seven respondents who answered 'Others' are all volunteers in non-government organizations working with people living with HIV/AIDS. One respondent did not give any answer.

1.4 Results and Discussions of Findings

The following presentation and discussion of results are divided into sections based on the questionnaire.

1.4.1 Right to Health

During the time of the interviews, the respondents described their current health condition as 'just ok' (34 respondents) and 'good' (32). Sixteen respondents answered that they were not feeling well. Of the 82 respondents, 32 are currently taking medication for HIV infection. Seventeen of them are taking anti-retroviral drugs, seven are taking herbal medication, two are presently taking prophylaxis and another three are taking medication for opportunistic infections. There were four respondents who were taking other types of medication: one was for diabetes and the remaining three stated they were taking vitamins.

Forty or 49% of the respondents have stated that they have experienced some form of discrimination by health care workers. Of those who experienced discrimination, 70% say that they seldom experienced it, whereas 10% say that they experienced it very often.

The specific forms of discriminatory acts and the corresponding number of respondents who experienced them are summarized below. It should be understood that the following figures are those that the respondents believed were done due to their HIV+ status.

Generally, it cannot be determined from these figures how many of the respondents have experienced more than one of the discriminatory acts enumerated above. But since there were 40 respondents who stated that they have experienced discrimination by healthcare workers, it is safe to assume that there are respondents who may have experienced more than one of the acts mentioned in the table.

Of those who were advised not to access healthcare services, 2 were advised by a family member. One was advised by a friend, the other by a healthcare worker. It is not, however, clear in the survey why they were advised not to seek medical care.

It is very significant that 21% of the respondents have experienced a delay in the provision of healthcare services. Delay may not only mean a time delay in the provision of treatment. It is also important to consider delay of services in the context of availability of appropriate healthcare services. Though it is not apparent in this particular study, it is interesting to note that in the case of the Philippines, healthcare service is generally expensive and presently, there are only two hospitals specializing in the treatment and care of PLWHAs. Even medicines are sometimes not available in these hospitals. When they are available, they are often too expensive. With such limited options, it is very difficult for PLWHAs to cope when on top of this; they have to contend with healthcare workers who discriminate against them.

Another aspect of violations in the context of Health Rights is in the area of clinical trials. Thirty-one (38%) of the respondents say that they have participated or are currently participating in clinical trials. Sixteen out of the 31 respondents were involved in clinical trials for six months. One respondent was involved in these trials for 60 months, another for 30 months. However, it is not clear if they were involved in one trial continuously for the duration they stated or whether in the span of 30 or 60 months they were involved in several different trials.

During the conduct of the trials several violations were identified and the 31 respondents who participated in the trials stated which of the violations they went through. The results are summarized below:

From these figures, it can be inferred that majority of the 31 respondents who were involved in clinical trials were informed regarding the various aspects of the trials. However, the figures above are still very significant. It is alarming that eight out of 31 respondents were not aware that there were risks involved in the trial. Seven out of 31 respondents were not even aware of what the study was for before they agreed to participate in it. Majority of the respondents were not offered treatment at the end of the trial. These are ethical issues that need to be addressed to ensure the safety and well being of PLWHAs who want to undergo these trials in their hope of finding a cure for HIV/AIDS.

In terms of private health insurance and benefits, five respondents stated that they were denied membership because of their HIV+ status. Three other respondents also reported that they lost their existing private health insurance after having been diagnosed with HIV. The figures may be small relative to the total number of respondents in this survey but they nevertheless show actual cases of discrimination in the area of health insurance and benefits. It must be worth noting though, that many Filipinos in general, do not have health insurance. There is an existing policy among health insurance companies in the Philippines that PLWHAs are not allowed to apply for private health insurance. They will automatically be disapproved, anyway. This creates a big problem for PLWHAs who are marginalized from obtaining a service that would very much benefit them. Although there is a law in the Philippines on HIV/AIDS, the Philippine HIV/AIDS Prevention and Control Act of 1998 or RA 8504, there is no clear policy regarding access to private health insurance.

1.4.2 Privacy

Sixty respondents were tested for HIV in the 1990s. Two were tested in 1986 and 1987 and the others were tested either in the year 2000 or 2001. Thirty respondents (37%) were tested as a requirement for a job. The other reasons are summarized in Table 4.

Those who answered 'Others' have stated a range of reasons for having been tested for HIV. Three were tested before donating blood. One had to be tested before he was able to sell blood. Two respondents said it was a requirement for going abroad. It was not clear whether these two were going abroad to work or not. The others were tested after seeking treatment for other illnesses like cough, lumbar paralysis, pneumonia, and asthma and for having mouth sores.

There is a provision in the RA 8045 stating that mandatory HIV-Antibody testing is prohibited in the Philippines. Therefore, it should not be a requirement for employment. However, this law only covers local employment. The high figure shown in the table above pertains to those who were applying for overseas work. The law is unclear in cases where HIV testing is administered for purposes of overseas employment. Testing positive for HIV means losing the opportunity work abroad.

In the conduct of HIV-Antibody Testing, RA 8504 specifically states that testing should be voluntary and that it must include pre-test and post-test counseling. The law also guarantees the confidentiality of the results of the test. The survey results show that these requirements had been violated. The following table summarizes these violations:

There is a dramatic decrease in the number of those who did not receive pre-test counseling to those who did not receive post-test counseling. This may be attributed to the fact that all confirmatory tests for HIV are done in the two hospitals specializing in HIV/AIDS. These institutions provide the post-test counseling. The high number of respondents who did not undergo pre-test counseling may also be due to the fact that they were not aware that they were being tested for HIV anti-bodies. In another study being undertaken by Action for Health Initiatives (ACHIEVE), Inc./CARAM-Philippines on Mandatory HIV Anti-body Testing of Migrant Workers, it was found out that migrant workers were not told that they were being tested for HIV anti-bodies. Medical tests have become a routine requirement before they could work abroad but though they are aware that blood tests are also required, they are not informed what the blood tests are for. This is another violation in the course of the testing, however, this was not specifically asked for in the survey.

Eighty-three percent of the respondents said they got their results from medical personnel (doctors, nurses, medical technician). This is not a guarantee, however, that the rights of the PLWHAs were protected. After all, only 61% received post-test counseling when they were given their test results. It is important to note that the remaining respondents got their results from persons who had no business knowing the results ahead of the concerned person. Three respondents said that it was their employers who gave them their test results; one respondent said that his fiancée gave him the results. One respondent even said that he did not know who the person was that gave him his results.

The respondents who answered that other people were told of their test results without their consent identified the latter. Six respondents answered that other healthcare workers were informed of their results. Another six stated that members of their families were told without their consent. There were four respondents who found out that their co-workers knew of their status. Another said that government personnel and NGO personnel were informed without their consent.

Fifty-nine percent of the respondents stated that they informed other people of their status. Sixty-three percent of them told their families or relatives, while 17% told their friends. Also, 45% of the respondents reported that their status is known exclusively within their immediate family only. Twenty percent said that their status is known to their families and close friends. Nine percent of the respondents answered that absolutely no one else knew of their HIV status.

In relation to this, 12 of the respondents reported that after being diagnosed with HIV, they had been excluded in family activities. Six of them said this seldom happened, while three said this happened often.

Twenty-two respondents felt that their friends had discriminated against them after their diagnosis. Five respondents said that they were excluded from social functions due to their status.

Disclosure is a big issue for people who are living with HIV/AIDS. The question of whom to tell, when to tell and how to tell people about their condition is a struggle the moment they learned of their status. The problem of not being accepted by those who find out about their condition, especially family and friends, may push a PLWHA to isolate himself or herself. It is difficult for them to come out because of the prevailing stigma in society. This hinders them from seeking support, on the one hand, and also makes it difficult for service providers to reach them. These results clearly show the gravity of violations perpetrated against those who underwent HIV testing, but especially those who tested positive for HIV and decided to come out with their condition. This would serve as a challenge for the government and the NGO community to advocate for and create policies or programs to ensure that the rights of those who undergo HIV testing are protected.

1.4.3 Liberty and Security of Person

This part of the survey looks at the treatment given to those who are known to be HIV+. The succeeding table shows that a significant number of respondents had been harassed because they were known to be positive of HIV. What aggravates this situation, according to PLWHAs in one consultation by Pinoy Plus Association, is the fact that the aggrieved PLWHAs are decided to not file charges against their perpetrators because the nature of the justice system in the Philippines makes it difficult for them to protect their identities. They fear that their status will be known widely. There are no mechanisms by which they could pursue redress while at the same time protecting their privacy and security. So the perpetrators go unpunished.

One respondent cited a specific incident where he went to a popular fastfood store with another PLWHA who was widely known to be HIV+ because she appeared in the media. They were told to leave the store.
Some of the entries in the above table were not explained. Six respondents had to change residence because of their status and one among them had to change residence four times. One respondent explained that she was confronted by a neighbor and was told to stop spreading the disease. She was accused of being a sex worker when her HIV status was known. For the others, it is not apparent whether those who were forced to change residence did so because there was pressure from their communities or they did so because they were afraid that their status would be known to their communities. In either case, the situation reflects the impact of stigma on the affected people. The social stigma on HIV/AIDS creates a very disempowering environment that marginalizes PLWHAs or forces PLWHAs to isolate themselves.

A number of respondents who endured harassment or ridicule cited their experience of hearing people around them whispering about "AIDS" and laughing at them when they passed. There were those who were bodily dragged or pushed while being laughed at for having "AIDS". Another experienced having her hair pulled by another member of her Bible study class.

Some respondents talked of being ridiculed by their families. One respondent said that relatives would not sit on a chair that she previously occupied. They separated her clothes and the glasses, plates and spoons she used.

Also related to how PLWHAs are treated differently, 13% reported that they have been denied of services or privileges available to others. The questionnaire, however, does not explain what these privileges are.

One of the two respondents who answered that he was sued based on an offense related to his status explained that he was involved in a brawl with another person who was making fun of his being HIV+. When this happened, the respondent decided that he couldn't simply sue the other person because he might have to disclose his status. Instead, he challenged the person to engage in a fistfight. The other person lost and filed charges against him. The respondent sought help from a government hospital. There was no further elaboration as to the result of the charges against the respondent.

1.4.4 Right to Employment

It was established earlier that 37% of the respondents were tested for HIV as a requirement for work. It is shown in the following table that 27 (33%) of the all respondents lost their jobs after being diagnosed positive with HIV. The study, however, does not make any direct correlation between the kind of employment that the respondent had when the violations occurred. It must be pointed out that a number of the respondents were former migrant workers. Thus, not all acts refer to those who are locally employed.

Summarized in Table 7 are the acts perpetrated against PLWHAs in the line of work.

Only four respondents answered that they were able to seek redress for what was done to them. They also stated that they were satisfied with the outcome of their complaint. Only it was not specified what act was committed against them or how their case was resolved.

Forty percent of the respondents stated that their capacity to earn was decreased after having been diagnosed with HIV. This may be due to the fact that most of these respondents were migrant workers who have spent their most productive years outside the country. They were diagnosed relatively later in their career lives. Most of them are already too old to find lucrative jobs locally. Although this part is not mentioned in the survey, it is nevertheless a reality in the Philippines

1.4.5 Right to Marry, Found a Family, and Form Significant Relationship

Out of the 82 respondents, two respondents said that they were forced to undergo HIV testing during pregnancy or because of their child's illness. On the other hand, 27 of the respondents were advised not have a child because of their HIV status. Of the 27, only 19 were given enough information regarding mother-to-child transmission.

Three respondents answered that they were abandoned by their partners because of their status. Three respondents also said that their children were separated from them due to their status. There is no explanation as to who took their children and whether they still have contact with them.

One respondent elaborated that she lost financial support from her family after they found out about her condition. She explained that the reason for this is because her family thought that the Government and the NGOs were supporting her financial needs. When she tried to ask her family for assistance to cover hospital expenses, they told her to seek help from the Government.

These experiences of PLWHAs have adverse psychological impacts that can in turn affect their physical health badly. On top of the trauma of dealing with their status, they were further burdened with these experiences of violations.

1.4.6 Right to Association and Self Determination

This section is concerned with the access of the PLWHA to support groups and institutions where he or she can belong to and be able to air his or her concerns as a PLWHA.

Seventy-four percent of the respondents stated that they were referred to self-help groups for PLWHAs. They were referred by healthcare workers, mostly by the health worker who gave them post-test counseling. Eighty percent of the respondents also said that they know of existing self-help groups for PLWHAs. A lower percentage of 77% stated that they wanted to join these groups. It is also very significant that 56% of the respondents have been able to participate in decision-making committees that tackled the issue of HIV/AIDS. This is a very positive outcome because it reflects that although there is much to be done and a lot of issues to address, the PLWHAs are able to voice their opinions and ideas regarding how their situation can be improved.

One respondent answered that he did not want to join organizations of PLWHAs because associating with other PLWHAs keeps reminding him of his own condition. He said that by staying home, he could pretend that there's nothing wrong.

Another respondent who also did not want to join existing organizations reasoned that his refusal is because he feels that joining would not improve the situation for him. Instead, he would just be sacrificing his privacy.

1.4.7 The Impact of HIV Infection

As mentioned in the earlier part of the report, a law was enacted in 1998 to protect the welfare of people living with and affected by HIV/AIDS. This is the Philippine HIV/AIDS Prevention and Control Act of 1998 or the Republic Act 8504. But even with the enactment of such a law, discrimination and human rights violations among people living with HIV/AIDS still happen. In this survey, about 62% of the respondents were tested before the law came into existence. However, the survey also showed that even those who were tested after the law was enacted experienced the same forms of discriminatory acts experienced by those who were tested before 1998. It appears that the law has not prevented the prevalence of discrimination against PLWHAs.

The experience of the respondents show that even those in the healthcare institutions are not aware of the issues related to and faced by PLWHAs. Half of the respondents experienced discrimination committed by healthcare providers. Some of them were denied treatment and others experienced delays in their access to treatment. These kinds of experiences can result in the lack of trust and confidence of PLWHAs on the healthcare system in the country. Although there are government hospitals that are presently catering to the needs of PLWHAs, their resources are not enough to answer the need. The alternatives, which are the private hospitals, are too expensive. Majority of the respondents attested that HIV infection meant a decrease, if not, loss of income. They simply would not be able to afford the costly medicines and treatment they would need when infections kick in. This is further compounded by their exclusion from health insurance benefits.

The adverse economic impact of HIV infection is perhaps the hardest blow to PLWHAs in the Philippines. Being HIV+ means they lose their opportunity to find gainful employment. Greatly affected are the former migrant workers who have come to depend solely on their income overseas. Though they can still be productive, they are hindered from fully participating in the economic arena because of restrictions placed by receiving countries on entry and stay of PLWHAs.

Stigma and discrimination continue to marginalize PLWHAs. They are seen as "carriers" of a deadly disease. They are regarded as "immoral" persons who deserve to have such a dreadful disease. They are shunned, treated with disgust and isolated. Those who have experienced human rights violations are forced to keep quiet for fear of being publicly humiliated due to their condition. Even with the existence of the RA 8504, there is still a lot of work to be done in terms education, awareness raising and advocacy. What is clear is that the present situation has to be improved; an enabling environment, created so PLWHAs will be able to fully practice their rights and live harmoniously in their communities.

2. QUALITATIVE STUDY

2.I Introduction

The qualitative study undertaken by Pinoy Plus Association looked at specific instances of discrimination as identified by seven purposely chosen respondents. Particular attention was given to information about the nature of the discriminatory act, the identity of perpetrators and the institutions they belonged to, the time and place the discriminatory acts happened, and the impact of the experience on the PLWHA. A number of the respondents experienced multiple forms of discrimination in one just one setting or situation.

2.2 Methodology

The original design of the case studies involved having respondents elaborate on answers that they provided to specific questions in the survey. However, this did not happen as there were very few respondents who were probed by the interviewers on the responses they gave. Instead, separate interviews with seven respondents were undertaken. Such interviews were not in-depth and only focused on one or a few experiences that were known to the interviewer. The responses to the interviews were transcribed, clustered and written up as individual case studies (see Appendix).

2.3. The respondents

The seven respondents of the in-depth interviews were chosen from among those who responded in the quantitative survey. Specifically, they were chosen from those who had positively identified instances of discrimination. The interviews had two major overlying assumptions: 1) the respondents had some degree of awareness and knowledge about their rights as PLWHAs and; 2), the incidences they recounted in the interview constituted discrimination. Indeed, almost all of those who were interviewed were involved in existing organizations, e.g. Pinoy Plus Association, and had some degree of involvement in various activities of the organization and of other HIV/AIDS NGOs. Most of them also had some knowledge about the Philippine HIV/AIDS Control and Prevention Act of 1998 or RA 8504 and in fact, a number had invoked RA 8504 in reference to their specific experiences. It must be said that the research process did not attempt to probe deeper into the respondent's understanding of discrimination. Rather, it asked the respondents to identify specific acts that they deemed to constitute discrimination, using the questions that had been asked in the survey as a take-off point.

Almost all the respondents knew little or nothing about HIV/AIDS at the time of their diagnosis. They were also not aware of their rights as PLWHAs. This fact is important, given that most of the violations that they encountered happened during the time that they were tested and initially diagnosed with HIV. Because they lacked information about HIV/AIDS and they had no awareness of their rights, they suffered from the impact of their experience. However, the research also showed that having the knowledge and awareness did not also exempt them from being discriminated and stigmatized. It also did not mitigate the anxiety and distress that they experienced. But, they were able to turn the experience around and use it as a forum to bring about a discussion on HIV/AIDS, thus contributing to the education work being done on the issue.

2.4. Results and Discussion of Findings

2.4.1 Testing Issues

HIV Anti-body testing is one area, which the respondents identified as a site of discrimination. There are many aspects in testing which are subjected to violations. Foremost is the manner in which the tests were conducted.

• Coercive and/or deceptive manner of testing

  It is not uncommon for PLWHAs to be subjected to blood testing for reasons other than HIV/AIDS. Thus, when their blood is also tested for the presence of HIV Antibodies, this often happens without their knowledge and consent. In this research, a number of respondents did not know that they would be undergoing HIV antibody test. This disregard for the patient's right to be informed about any matter concerning his or her body is also a result of power dynamics that occur between the patient and the doctor. Often doctors proceed and do what they deem is "best" for the patient, even though the patient may not necessarily concur with their decision or proposed action.

  One respondent (AR-17) was compelled to undergo HIV Antibody test by her employer and immediate supervisor. Because she was working in a club, the latter deemed it necessary to find out what her status was as this could affect the business. Thus, the testing was not meant to help her in knowing what her status was and subsequently providing her support and care. It was conducted for the benefit of her employer.

  Another respondent (MA-02) noted that when her husband was hospitalized, the doctors wanted to draw blood from him so that they could conduct a blood test. Because her husband knew that he was HIV+, he refused. However, the respondent noted that the hospital staff had managed to get a sample of his blood after they told him that they were only going to get his blood pressure.

  "They were extracting blood from him for examination. He refused because he didn't want them to draw blood from him. So (they said) it was (just for) blood pressure. Then I just saw, I didn't notice how it happened, I just saw that they were bringing out a tube (with blood)."

  The respondent believes that her husband's rights were violated on two grounds: 1) blood was taken from him through deceptive means and 2) he was not given any information or counseling on HIV/AIDS. This deception would have tremendous repercussions when the hospital later found out that that her husband was HIV+ (see section on treatment). It need be said that the hospital staff acted in an unethical manner when they willfully deceived the patient and subjected him to testing without his consent.

• Absence of pre-test counseling

  Coercive or deceptive modes of testing go hand-in-hand with another violation: absence of pre-test counseling. Under the law, HIV/AIDS testing must include pre-test and post-test counseling. This means that information must be provided to the person before he or she is about to take the test and during the period when he or she will get the test results. A number of the respondents stated that such counseling did not take place. One respondent (AR-17) said that she was asked to take the test by her employer when news broke out that her former live-in partner had died of AIDS. She was brought to a house, which was allegedly owned by a doctor. Blood was extracted from her but she was not told anything about HIV/AIDS. What made the testing irregular was that it was not conducted in a clinic or hospital but in the private residence of a doctor whom the respondent was not familiar with.

  Another respondent (GE 07) noted that when he got sick in the hospital, blood was taken from him but he was not informed what it was being tested for. This incident happened to him twice because the next day, his doctor took another blood sample from him after telling him that they found something in his blood. In both times that blood was drawn from him, he was not given any information about HIV/AIDS.

  "I was admitted into a private hospital in our province in Tarlac…Blood was extracted from me. I was at the payward and there were ten of us in the room. The next morning, the doctor came and he told me, "something was seen in your blood". But he didn't say what it was. What he said was the test will be repeated. After that, blood was drawn from me again. The next day he came back and he told me I was HIV+." (GE 07)

  Because of this gap in the testing process, many had a hard time accepting the reality of their eventual diagnosis. A number of respondents rued that has they been informed of the procedure and the implications of them being subjected to testing, they would have been better prepared to deal with their HIV+ status.

  In both instances, the HIV/AIDS law had already been enacted. But, it must be noted that all the incidents happened at two different provinces where there is presumably less information and awareness on HIV/AIDS. And although the law has been enacted, it is still a relatively recent piece of legislation that has yet to be popularized, especially outside the Metro Manila area.

• Absence of Post-test counseling

  Just as pre-test counseling was not conducted during the testing process, a number of respondents did not get post-test counseling when their test results were released to them. One respondent who did not know that he was tested for HIV antibodies received the news from his attending physician. However, he was not given any other information.

  In the case of another respondent (AR-17), she found out that she was HIV+ from her employer. She was not given any information about HIV/AIDS, nor was she provided any support and care thereafter.

  The repercussions of not having pre and post-test counseling are quite severe for most of the respondents. Because some of them had no prior knowledge about HIV/AIDS, they experienced undue suffering just by thinking about the possibility that they were going to die soon after. A number of them became depressed and suffered from anxiety and fear (see section on impact).

  "When I found out that I was HIV positive, I didn't want to believe. I wanted to cry, but my tears wouldn't fall. And then, I just realized that this was indeed true. When I was alone in my room, I felt that I was going to die. I didn't know what to do, I was so confused. They should have informed me first that they would administer a test. I should have known beforehand." (GE 07)

  The respondents believed that had they known what they know now about HIV/AIDS, they would not have suffered unnecessarily. They could have also helped in educating the people that they were dealing with at the time of their diagnosis, e.g. doctors and medical personnel.

2.4.2 Unwarranted disclosure of HIV status to others

Following the initial violations that the respondents experienced in the area of testing, a number of them experienced further problems when their status was revealed to other people. In some cases, these happened in private hospitals in the provinces. MA-02 had to endure humiliation when the entire hospital found out about her husband's HIV+ status. The nurses who previously attended to her husband refused to attend to him anymore. Even non-medical personnel such as hospital cleaners refused to enter her husband's room. The people in the hospital avoided her presence and whenever they would see her, they would talk in whispers about her. The hospital even went to the extent of telling the owner of the house that she rented about their HIV+ status. She was eventually asked to leave by the owners of the house, even though she had signed a contract with them. In this case, the doctors that handled her husband's case acted irresponsibly in revealing his HIV+ status. Because this incident happened at a time when there was still very little public awareness about HIV/AIDS, the respondent and her husband provided a first-hand experience to the hospital in dealing with PLWHAs. Their experience has become a test case, which HIV/AIDS activists use to illustrate how horrific lack of education or information can get.

"It was a big private hospital in Bacolod, in my province…that was in 1993 in May… It really happened at the hospital itself…I felt that everyone was looking at me. I was very angry because they were sickened (by my status). When they passed by you, they would walk sideways, they didn't want to be touched by me. They would pretend as if they were walking towards another direction. I saw that clearly and I would cry and cry. I was mad at them. The counselor of the hospital herself told the owners of the house we were staying at that we had AIDS. She had wanted to tell them. I said, not now, because I still cannot handle it. Maybe my family will help out. Isn't that our decision to make? What happened was, we were still at the hospital, I was told over the phone that we had to move out." (MA-02)

GE 07 found out that his doctor had told all the other doctors in the hospital about his status. All 20 of them came to his room to speak to him and ask him questions. The respondent became the subject of an unplanned and unwarranted medical inquiry. He was treated like a specimen that had to be examined and scrutinized, not for his benefit, but for the hospital doctors who may have not yet seen a person living with HIV. He was compelled to respond to their questions even though by law, he was not obliged to do so.

AR-17 experienced isolation and ill treatment from her co-workers and housemates when her status was revealed to the community. She avers that she only told her immediate supervisor about her positive status but the information quickly spread to the club where she was working. She was eventually banned from working in the club.

The above examples constitute a violation of confidentiality of the test results. The negative experiences of the respondents happened immediately after their HIV antibody test results came out. What appears to be appalling in these cases is that the perpetrators of the violations are doctors or medical practitioners. It is worth mentioning that in this country, most people see doctors as authority figures who can seemingly do no wrong. Thus, patients put their complete trust on them. The implications are therefore serious when the doctor breaches this trust.

All three examples show that Philippine society is not a stranger to the culture of gossip, One's life situation or status is a common fodder for the rumor mill. Ordinary conversations are laced with stories of other people's lives and there is a tacit license to talk about other people, especially if it concerns ill fate or misfortune. This predilection for gossip, coupled with a lack of knowledge about HIV/AIDS is a deadly combination that fuels acts of discrimination. Even though RA 8504 contains a specific provision that mandates confidentiality of a person's HIV status, it will take time before any consciousness on the value of confidentiality is realized and understood by many people in this society.

2.4.3 Treatment Issues

The issue of treatment of PLWHAs covers the period prior to and after their diagnosis. Thus, some of them those who did not know they were HIV+ experienced differential treatment immediately after they were revealed to have HIV+ status. Others had gone to hospital knowing that they were HIV+ and received ill-treatment from the hospital. There are many forms of ill treatment and these include:

• Refusal of Treatment

  In 1996, one respondent (GG03), was about to give birth to her second child. The private hospital she went to in Fairview, Quezon City refused to admit her. She was made to sign a paper that stated she could not give birth in the hospital. When she asked for the reason why she was being refused, the hospital personnel told her that she knew the reason.

  "That time, I was about to give birth. I went to Fairview because that was the hospital I knew. When my record was read, and there was nothing that said 'HIV', what I was told, though I knew that I was about to give birth because I couldn't close my legs anymore, I was told by the frontline personnel, she said, "this is a document, sign this, you cannot give birth here." I asked, "Why?" "Don't ask, you cannot be admitted here, you're not fit to give birth here." I asked, "What's the reason?" "Nothing, you already know that," she told me." (GG 03)

• Physical and Social Isolation

  GE 07 revealed being isolated as soon as he was found out to be HIV+. While he was previously occupying a bed in the ward section, he was transferred to a separate room. Nurses and other attending medical personnel started avoiding him and refused to attend to him, prompting him to lock the door to his room. Because hospital patients are forbidden to lock their doors, he had to eventually face questioning from his doctor.

• Ill-treatment

  A number of respondents reported being given ill treatment in the hospital they sought treatment in. One respondent (AR-04) revealed that when the doctor at a premier government hospital found out about her husband's HIV+ status, they were asked to move out otherwise his condition would be divulged to the entire ward. They were also berated for not having informed the hospital of his actual status. In these instances, instead of the hospital and the medical personnel becoming sympathetic and understanding of the patient's conditions, they do the exact opposite and reject the patient and the illness.

  These incidences clearly demonstrate that HIV/AIDS is not a mere health or bio-medical condition. It is a condition that defines and influences a person's social, economic and political status. It also exposes the biases and pre-conceived notions that people have when they come face to face with a PLWHA.

• Violation of confidentiality

  Keeping confidentiality of a patient's HIV+ status in hospitals remains a major issue among PLWHAs. One respondent (KR-03) noted that when she had to undergo operation in the same hospital as that of AR-04, a big sign that read "universal precaution" was placed beside her bed. This prompted other patients in the room to ask her what the sign meant. MA-02, who gave birth in the same government hospital, reported that a big piece of red paper was put on top of her bed. The irony of posting a sign or any other symbol to identify the patient as HIV+ is that exercising universal precaution is not meant solely for PLWHAs or patients with other infectious diseases. The reason why it is termed "universal" is that it applies to any situation or condition, whether the patient is sick with a minor ailment or a major life-threatening disease. Such consciousness about universal precautions appears to be alien in the Philippines, given the apparent lack of advocacy on the issue, as well as the resources to actualize it. Indeed, if many big hospitals, request their medical interns to bring their own gloves and surgical masks, it would take many years before each and every nurse or medical attendant will have access to free and clean gloves and masks.

Experiencing discrimination in the health care system, especially in hospitals and clinics, is particularly traumatic for PLWHAs because their very condition necessitates them to constantly visit and/or stay in such settings. Thus, they face the risk of experiencing it repeatedly, in various forms and ways. It is therefore understandable when PLWHAs refrain from disclosing their HIV status, and thus end up at the receiving end of inaccurate or incomplete diagnosis of their health. In a relatively safe and enabling environment, PLWHAs would willingly and voluntarily seek medical care. This however, is not yet the case in the Philippines, where only two government hospitals are known to specialize in the management of HIV/AIDS cases. It must be noted that most of the discrimination reported in the case studies happened outside these two hospitals. As the case studies have shown, private and provincial hospitals still need a lot of orientation and education in handling HIV/AIDS cases. Also, it must be emphasized that the continued lack of facilities and services for the care and treatment of PLWHAs remains to be a major gap that needs to be immediately addressed.

2.4.4 Clinical Trials

Respondent GE-07 noted that he was invited to join two clinical trials: one was for herbal medicine administered by a private doctor and another was one being administered by the San Lazaro Hospital. However, he was not given any prior information about the trials and therefore could not make a decision whether to join them or not. The issue of clinical trials was not explored in the research but anecdotal information suggests that there are many violations that have happened in the conduct of such trials. This area needs a more serious documentation.

2.4.5 Rejection, Social Isolation and Ostracism by Community

Respondents whose HIV+ status was revealed without their consent had to endure being ostracized and rejected by the communities in which they lived. Respondent AR-17 was prevented by her housemates to use cooking and dining facilities for fear that she might infect them. Respondent GG-03 experienced various forms of discrimination when she went back to her home province after coming out in TV about her HIV+ status. She shared that when she got to their community, she almost got stranded as no public transportation would take her and her brother to their parent's house, even though it was already late at night. When word came out that she was home, she noticed that people were avoiding her and would only speak to her from a distance. She had difficulty going anywhere because no public transport would take her. When her family went for an outing at the beach, she was forced to swim far away from everyone else because her relatives and friends all thought that she had germs that would infect anyone she came in contact with. While she wanted to stay longer, her parents could not take the discrimination she had to endure. Fearing that she would suffer more, they asked her to leave town at midnight and disguised as a man, so that she would not be seen by the community.

"What they know is AIDS. (I was told) to never come near them. My sweat, the seat I occupied, my saliva, (they all thought) these were infectious… Before I got diagnosed, every time I go to Samar, so many people would greet and meet me because they would be asking for presents. When I arrived and they knew that I was already infected, not even one person came to greet me. They would speak to me from the street and I would be at the terrace of our house. (They would stay) far away from me." (GG-03)

The rejection of the community was most strongly felt by two respondents who had to transfer residences because they were forcibly asked to move out of their homes. Being uprooted from their current domicile did not only result to anxiety and depression, it also created an atmosphere of hostility in the community.

"I wanted to talk to them. They didn't want to talk to me so I sent them a letter asking them for a meeting because I had a lease contract with them and we had an agreement. They were afraid to face me. Their son, who was a policeman, spoke to my househelp. He shouted at her outside the house and told her, "If you and your employer will not leave, I will shoot and kill all of you. You tell your employer to leave our house." (MA 02)

Discrimination by the community against PLWHAs takes many forms. The case studies have pointed out that even though the person enduring the discrimination may have gotten some support, e.g. from his or her parents or friends, she or he will have to endure the feelings of rejection and isolation alone. This is especially true if the person faces such an ordeal on a day-to-day basis.

Two of the respondents (MA 02 and GG 03) who had children had to rise up and defend the latter when they were being ridiculed and subjected to harsh treatment by their peers at school and at the neighborhood. Both parents realized that the taunts and jeers their children endured were encouraged and in some cases, taught by other parents in their community.

"She's been discriminated twice. She would cry and tell me, "Mama, what is AIDS?" I said, "Why?" "Because the kid told me I have AIDS. I am sick with AIDS," she said. It was painful to hear her story. I said, " My child, don't believe them, you're not sick. Only your papa and I are sick." I then asked the people (in the community) to stop treating my daughter that way because she was not (HIV+)." (GG03)

What the case studies also illustrate is that in some instances where there is no actual or overt discrimination, the respondents would undertake self-imposed isolation (see section on Impact).

2.4.6 Rejection by Family and Blood Relations

One of the most difficult situations that PLWHAs had to deal with involved their own families. While some respondents did get vital support from their families, especially when they were going through harsh treatment from their communities, one respondent experienced otherwise. Her family did not offer any support and in fact drove her away.

"My family drove me out when they found out about my status. I lost shelter. I stayed in different places. Of course, I needed to earn, I had to live… I had to escape from the discrimination I was experiencing with my family. I was forbidden to come and see them." (AR-17)

While this study showed only one such case of discriminatory treatment by the family, other researches and public forums have documented negative experiences of PLWHAs within their own families. Some had experienced being denied as a family member, others were subjected to insults and verbal abuse and others were forced to leave home.

The Philippines is a country that protects and promotes the family as a basic social institution. However, in cases where the family has ceased to be a safe haven and has instead become the seat of turbulence and turmoil arising from a member's HIV+ status, such beliefs and practices need to be reexamined. Only through public recognition and acceptance that even families are not exempt from being unkind and unfair treatment of PLWHAs can actual and workable solutions be thought out.

2.4.7 Economic persecution

HIV/AIDS creates an impact on the economic situation of PLWHAs. For those who are employed, there is the possibility that benefits, which are due them, may not be delivered because they became HIV+. There is no insurance policy that covers HIV/AIDS. This was the case with one respondent (AR-04) whose husband was diagnosed with HIV and eventually died of AIDS-related complications. His company did not give the respondent the full benefits that was due him because they reasoned out that HIV/AIDS is not an compensable ailment. The absence of guidelines that address HIV/AIDS and HIV/AIDS related illnesses has caused problems to previously employed PLWHAs who are unable to avail of benefits that are rightfully theirs. Many of these guidelines are determined by the individual policies of the companies they are employed in, and to date, little has been done to include HIV/AIDS.

2.4.8 Unwarranted media exposure

The role of the media in perpetuating discrimination against PLWHAs was explored in the study. One respondent, NO-06, recounted her unwarranted and careless exposure to the media. While she agreed to be interviewed for an article in a daily broadsheet and had allowed photographs to be taken of her, she had a verbal agreement that only parts of her body, excluding her face, could be shown in print. The published article included a story on her and her face was mistakenly printed in place of another PLWHA. Even though it was not a major broadsheet, her sister's co-teacher from the province saw the article and informed her sister about it. Her sister admonished her from coming out in public without informing them first. NO-06 further shared that she could not go out of their house without fear of being recognized by her neighbors and other community members. She also had to limit her visits to her sister in the province because of the talk that her photo generated. While she attempted to seek redress for the unfortunate exposure, no resolutions had taken place.

The media remains a powerful tool in the advocacy on HIV/AIDS issues. However, it can also be a negative force, especially when it tackles the issue without the proper orientation and information. A lot of the existing mainstream media coverage on the issue needs perspective coming from PLWHAs and the NGO community working on the issue.

2.4.9 Lack of legal support or inaction on specific cases

What appears to be common among the respondents is that there is no proper forum or mechanism for their grievances to be formally aired and resolved. A number have sought the help of NGOs providing legal support but such assistance was not sustained. Others had formally raised the issue to the Philippine National AIDS Council (PNAC) and even to the Department of Justice (DOJ) representative to the PNAC, Undersecretary Ricardo Paras, but such actions were also not sustained.

One of the main problems that have been raised with regards to sustainability of complaints or cases filed is that these would eventually become public knowledge. Again, because of the continuing stigma and discrimination faced by PLWHAs, there is still a resistance in pursuing cases or complaints which could result to them being identified in public documents or records.

Another issue, which has been raised in the study, is the enforceability of RA 8504. While it is easy to invoke or refer to the law in order to raise issues related to discrimination of PLWHAs, there is still a gap in the implementation of the law.

2.4.10 Impact on the person

• Self-pity, self-blame

  Almost all the respondents shared their feelings and thoughts about the impact of their experiences on their personhood. The most notable were their feelings of self-pity and self-blame. Because of the stigma and the negative connotations that mainstream society continues to associate HIV/AIDS with, most of the respondents felt that the world seemed to have closed in on them and they were stuck in the most rotten and terrible situation. One respondent (GE-07) thought that he had been a good person and that he did not deserve to be in that situation. For those who went through many harrowing experiences of discrimination and got little support, such feelings were much more intense.

  "What you feel is a mixture of anger and at the same time, self-pity. You want to pity yourself, why is your reaction like this. Because there is lack of information, because you also don't know anything…" MA-02

• Depression and mental anguish

  Almost all the seven respondents experienced depression in various forms. Many of them attributed this to their own lack of knowledge about HIV/AIDS. They also admonished the absence of correct public information on the issues related to HIV/AIDS, which resulted to their experience of stigma and discrimination. The absence of support systems within their own communities and families made the situation worse.

  "You would hope to die at that moment. You would wish that everything would fall apart. Only a few among your friends are helping you out. Even your housemates would tell you that you have AIDS and would spread the information…" (AR-14)

  The knowledge that HIV/AIDS still has no cure adds to feelings of hopelessness and helplessness. Thus, many do not know that even though one is HIV+, one can remain healthy and productive for a long period of time.

• Fear

  The respondents experienced fear in a number of ways. For those who had kept their status a secret, e.g. from their families or communities, fear of being known to be HIV+ predominates their day-to-day existence.

  "I told my doctor, "Doc, don't tell my father and mother about my illness." I was a bit ashamed that they would know because as far as I knew about myself, I was a good kid. And then, I would get sick with this. So I was a bit afraid of my whole family knowing." (GE-07)

  One respondent whose HIV+ status was inadvertently exposed by the media shared that the fear of people recognizing her was worse than the fear she experienced when she became positive.

  Fear is also caused by the belief that being HIV+ means that one would get sick, deteriorate physically and die. Such fears could have been avoided if proper counseling had taken place before and after the testing was conducted.

  "Before I was tested, I should have known what would happen to my life, that I would be ready. They should have made me (go through) the process. That it does not lead to sudden death. I thought at that time I was going to die. I thought once I was positive, I would have wounds. It was clear to me that maybe after a few months I would die". (AR-14)

• Internalized stigma

  Most of the respondents experienced extreme difficulty in accepting their HIV+ status. Such difficulties were compounded by the fact that they had very little information about the disease before and even immediately after their diagnosis. Thus, their own reactions mirrored the societal stigma placed on HIV/AIDS. Some of them deliberately curtailed their interactions with people. Others imposed limits on where they could go, especially when it came to being in public places.

2.4.11 Women's vulnerability to HIV/AIDS

Two of the women respondents were wives who were infected by their husbands. Because their husbands had gotten sick before dying, they took on the care giving and supporting role, even though they were equally in need of care and support. Both wives had to deal with a double dose of discrimination, against themselves and against their husbands. Because their husbands were too ill to fight back and deal with the problems, they ended up dealing with it and bearing the brunt of everything.

While the research did not ask gender-specific questions, there are a number of gender issues that have surfaced. One has to do with the exercise of reproductive rights within the context of HIV/AIDS. One respondent who got pregnant and chose to continue the pregnancy was questioned for her decision. She was treated as if she acted carelessly in choosing to continue the pregnancy and eventually giving birth. It must be understood that even outside the ambit of HIV/AIDS, reproductive health and rights are issues that have yet to be fully recognized and understood in the Philippines. Thus, within the context of HIV/AIDS, the discussions on gender and sexuality are still confined to looking at the roles of women and how these make them vulnerable. The issue of enabling women living with HIV/AIDS to make autonomous choices and decisions with regards to their health and sexuality has yet to be addressed. Too, the gender specific impact of HIV/AIDS infection have yet to be studied and documented.

V. PROBLEMS ENCOUNTERED

1. Data Analysis

1.1 Quantitative

There were some difficulties encountered during the course of the analysis of the survey results. Most basic is that the survey did not establish a common understanding of the concept of stigma and discrimination among the respondents. This is very important in contextualizing the experiences of the respondents. The survey simply identified different acts that may constitute HIV/AIDS-related discrimination but may also happen in a totally different context. For instance, the delay in the provision of health services that was experienced by 17 respondents may also happen to other people who are non-positive because the hospitals they went to are simply inefficient. Such an act can happen to anybody who is unfortunate enough to go to such a hospital.

Another problem was that there were questions that needed explanations but not all of the interviewers solicited the explanations from the respondents. In the question, "Have you ever been ridiculed, insulted or harassed because of your status?" only 11 of the 20 respondents who experienced this form of discrimination described the incidents they experienced. And there are also other questions that should have asked for explanations. For instance, on the question of losing their job due to HIV, there was no explanation whether those who answered 'yes' to this question were fired from their jobs or were not able to apply for jobs. The latter explanation applies to migrant workers where most of them can no longer apply for overseas work because most host countries require HIV anti-body testing. Though both acts constitute discrimination, the circumstances differ and the legal implications also differ. The person affected can seek legal remedies for having been fired from a job due to HIV but not for being refused by a receiving country as an overseas migrant worker.

In the way the questionnaire was structered, many questions were asked in a way that the respondents could answer or skip questions based on their answer to a preceding question. This created some problems because many of the respondents kept answering the questions they should have skipped. As a result, many answers were considered invalid. In the section of Right to Employment, the first question was completely disregarded because the responses to specific questions that followed would no longer tally. Since these subsequent questions were more specific and more telling of the situation, it was decided among the researchers that they should be retained.

1.2 Qualitative research

The interviews on the qualitative study do not contain a basic profile of the respondents. This is because they were chosen from among the survey participants. Unfortunately, the survey respondents are not identifiable, thus, no correlation can be made between the data that was gathered through the survey and the in-depth interviews. Thus, the analysis of the interviews does not contain a profile or background of the respondents.

The interviews were focused on very specific situations. In some instances where other experiences are mentioned to bolster the previous facts, these were not probed thoroughly. Thus, there are statements that may give valuable information about the subject but because there is neither background nor clear context, these could not be used in the report.

VI. CONCLUSIONS

• To understand the range of discriminatory attitudes and actions.
• To understand the pathways of AIDS-related stigma and discrimination.
• To review and understand the nature of AIDS-related stigma and discrimination in the Philippines.
• To train people living with HIV/AIDS on how to recognize human rights violations and how to document these.
• To document actual violations of human rights faced by Filipinos living with HIV/AIDS.
• To identify the need for full implementation of the R.A. 8504, also known as the "Philippine AIDS Prevention and Control Act of 1998."

Overall, both the survey and the case studies fulfilled the objectives that were set out at the beginning of the research. Both studies gave evidence to the existence of discrimination against PLWHAs in the Philippines. Such discrimination took on various forms and occurred in many settings. The health care system, the workplace, the community, the family, and society at large, were the key players identified that facilitate or perpetuate stigma and discrimination. However, it is ultimately the State, which is accountable for the continued stigma and discrimination that PLWHAs go through. For as long as RA 8504 remains only in paper, for as long as there are no mechanisms that PLWHAs can access in order to seek legal redress for their grievances, and for as long as there are no adequate support systems, there can be no real empowerment and fulfillment of human rights for PLWHAs.

The researches very clearly showed the role of education in combating stigma and discrimination against PLWHAs. Most of the problems that PLWHAs encountered were due mainly to the low level of knowledge of HIV/AIDS of the people they encountered. Family members, neighbors, co-workers, media-people and even medical professionals still subscribed to myths and stereotypes about HIV/AIDS. Alternately, their own lack of knowledge aggravated the impact of the discrimination that they experienced.

Experiencing stigma and discrimination can result to a low sense of self-esteem and self-worth. A low sense of self-esteem and self-worth results to disempowerment. A disempowered self can be equaled to a death-like meaningless existence, a fate that may be worse than dying from a battered and damaged immune system. It is therefore imperative that timely, appropriate and responsive interventions, both at the personal and political arena are undertaken to address HIV/AIDS-related stigma and discrimination.

VII. RECOMMENDATIONS

1. Research Recommendations

1.1 Improvement of Research Design

The questionnaire was first developed in English before being translated into the languages of the participating countries. Upon translation into Tagalog, the questionnaire should have been piloted among a small number of respondents to make sure that the translated version captured the essence of the original questions. Then a back-translation should have been undertaken to get the most accurate translation possible. For instance, in the question on current health condition, the selections for the English version were 'good', 'just okay' and 'unwell'. In the Tagalog version, it was 'mabuti naman, 'ok lang' and 'hindi mabuti', respectively. The problem is that in Tagalog, 'mabuti naman' and 'ok lang' are very often used interchangeably. The nuances between 'mabuti naman' and 'ok lang' are not necessarily captured and thus, the responses to both questions may in the end, mean or refer to the same thing.

The questionnaire also appeared to have an assumption that all the respondents have an understanding of HIV/AIDS related stigma and discrimination. However, it would have also been important for the survey to have included questions designed to establish the actual understanding of the respondents on the concept of HIV/AIDS related stigma and discrimination. As it is, the research objective to gather information on experiences of discrimination among people living with HIV/AIDS may have been achieved but without an established definition of stigma and discrimination in the context of HIV/AIDS coming from the respondents themselves. This can be still be addressed in future discussions by Pinoy Plus with its respondents and with other PLWHAs who may not have been involved in the research.

1.2 Future Research

There are many areas in this study that need further probing and examination. While the survey touched on the issue of clinical trials, it would be useful to make case studies on specific experiences of those who had undergone this process. Discrimination in the economic sphere also needs to have a more in-depth examination. It is important, for example, to make a clear distinction between experiences of those who are locally employed and foreign employed. Since there are other researches that are also being undertaken by other organizations in this field, e.g. with migrant workers, it may be useful to refer to these studies for reference. Another area that is important to know is the usefulness of RA 8504. This law has been invoked so many times by the respondents and it is important to understand the context of its application, vis-à-vis the actual situation and experiences of PLWHAs. Lastly, the issue of gender and sexuality needs to be integrated into the research design. Currently there are no gender or sexuality-specific questions in the survey. They were also not discussed in the case studies.

1.3 Proactive dissemination of research findings

This research has wide-ranging implications, specifically on the sectors that have been identified as those perpetuating discrimination against PLWHAs. Thus, there must be a proactive effort to disseminate the results of the research to these particular sectors. Such process should be accompanied by discussion and dialogue so that issues and concerns arising from the research findings and recommendations are immediately addressed. As this is a pioneering effort in peer documentation among PLWHAs, it is essential that PLWHAs themselves should also be primarily involved in this process.

1.4 Sustaining capacity building of PLWHAs to undertake the research

Some of the gaps in the research were noted as resulting from the lack of rigor in the implementation of the research. The survey showed some lapses and inconsistencies in the recording of responses and this may be due to the lack of attention and vigilance on the part of some researchers. It must be mentioned that this is the first time that most of the PLWHAs were involved in a research project. Such involvement has given them a sense of fulfillment and empowerment and it is only necessary that such engagement in research activities is sustained. Thus, there must be a proactive effort to continuously build their capacity so that they can be more rigorous in their future research involvements.

2. Action Recommendations

2.1 A clearer understanding and framework on the concept of discrimination as it relates to HIV/AIDS status needs to be fully developed with PLWHAs. The research clearly showed that there are many areas where discrimination can happen but it should be clarified that there are specific contexts and situations that apply to one's HIV+ status. This is important given the various intersections of discrimination that may occur because of a person's other status, e.g. class, gender identity, sexual orientation, age, race, ethnicity, etc.,.

2.2 Following the dissemination of the findings, sector-specific action plans need to be formulated. In the health care sector, the call remains for sustained massive information and education on HIV/AIDS issues, especially among private establishments outside Metro Manila. Health care services must be expanded and improved among government hospitals so that more PLHWAs can have access to better health care.

The media is also one arena that needs constant sensitization, owing to the highly mobile nature of its practitioners. PLWHAs who have been undertaking media appearances also need to be given full support and encouragement, as well as constant guidance so that they are able to discern the results of their advocacy work. This is important, given the possibility of burn-out and stress that accompany public disclosure of one's HIV+ status.

Discrimination by the community and family require more than just fleeting public education and information campaigns. As structures that develop and form values and attitudes, communities and families should also be the main target of proactive, sustained and community-based efforts. HIV/AIDS awareness can be integrated in community affairs, e.g. barangay-level discussions, forums and events. Civic organizations that cater to families and communities should also be tapped as these are more structured, organized and financially stable.

The workplace is one area that needs to have more active involvement in HIV/AIDS education. There are good models of HIVA/IDS in the workplace programs that have been initiated by other NGOs and government agencies. These can be replicated in other settings. However, there must also be a recognition that 95% of the Philippine economy is in the informal sector. There is therefore a need to come up with an action plan that takes this reality into consideration.

2.3 Greater involvement of PLWHAs must be realized especially in education and information work on HIV/AIDS. This can be undertaken through continued capacity building and strengthening of PLWHAs, funding support and provision of health care services.

2.4 NGO responses to HIV/AIDS must also be strengthened. It has been noted that the NGO response to HIV/AIDS has been wider in scope and coverage than the work undertaken by the government. However, while NGOs have been able to mobilize more human and material resources, the needs of the community in addressing the issue remain largely unaddressed.