Proxy consent enables minors in the Philippines to get tested for HIV

Early detection means early treatment

Marge Francia
A girl stands outside a health clinic holding an umbrella, with her face and identity hidden by the umbrella's shadow.
UNICEF Philippines/2018/Marge Francia

01 December 2018

Nothing gets in the way of Maria’s dreams, not even HIV. Maria, 18, is a transgender from Iloilo City who wants to be a beauty queen, a teacher and a jetsetter traveling to beautiful places like Hong Kong, Tokyo and Paris.

“God has better plans for me. I still want to study. There are still so many places I want to visit,” she said. Maria’s expressive eyes shine as she mentions countries she only sees on television and the Internet.

Two years ago, she was not this optimistic. She became bedridden, weak with high fever and constant bleeding. A friend encouraged her to get an HIV test.

In the Philippines, a minor getting an HIV test requires parental consent. Maria was afraid of being disowned by her family.

Through an activity organized by local NGO Family Planning Organization of the Philippines (FPOP) she was given proxy consent through a nurse and a social worker. The result revealed she was HIV-positive.

A health worker counsels a young person, her face hidden, about HIV inside a clinic.
UNICEF Philippines/2018/Marge Francia
Maria updates Family Planning Organization of the Philippines (FPOP) Iloilo Nurse and Case Manager Kriss Vladimir Homena on her condition. NGO workers like Kriss are at the forefront of HIV prevention efforts among adolescents.

A fast-growing epidemic

“The Philippines has one of the fastest-growing HIV epidemics in the world. Newly diagnosed HIV infections is on a steady increase, from one case per day in 2008 to 26 cases per day in 2016, and 62 per cent of new HIV infections come from the 15–24 age group. This means young people who may have HIV wait until they turn 18 years old to get tested. By then, it might be too late,” Mx Balibago, UNICEF Philippines HIV Specialist, says.

To work around Philippine laws, UNICEF together with partners championed the proxy consent protocol for HIV testing in 2016. Through advocacy, consultation with adolescents and youth, and pilot testing in cities including Maria’s, over 5,000 young people have been tested through proxy consent.

Eventually, the protocol was endorsed by key national government agencies including the Department of Health, Department of Social Welfare and Development, National Youth Commission, Department of Justice, and the Council for the Welfare of Children.

In Iloilo City, for example, out of 135 minors tested from 2016–2018, four including Maria tested positive.“I didn’t cry when I found out I was positive. It was my family who cried. I knew that life must go on for me,” Maria said. 

A holistic approach

With Maria’s early detection, the response for adolescents living with HIV now starts. As Maria receives antiretroviral medicines, all government and civil society actors in Iloilo City, through the leadership of Mayor Espinosa and the city councils, work hand-in-hand to deliver an integrated approach.

Peer education services from local NGOs, health services from the City Health Office and treatment hub, psychosocial services from the City Social Welfare Office, legal and protection services from the Local Council on the Protection of Children, and financial support services from PhilHealth work together to ensure that young people like Maria are supported throughout her journey.

Today, through the efforts of UNICEF and partners, young people can avail of proxy consent in the cities of Cebu, Davao Iloilo, Pasay, and Zamboanga.