A Klinika Bernardo nurse waiting for patients at the Philippines’ first Sundown Clinic (Raymund Villanueva/Kodao)

This article by Raymund B. Villanueva was originally published on Kodao, an independent news site in the Philippines. An edited version is republished on Global Voices as part of a content-sharing agreement. This story was made possible through a grant by the Philippine Press Institute under the auspices of the Hanns Seidel Foundation.

“MM” [name changed for anonymity purposes] became a commercial sex worker soon after he became sexually active. He had earned a college degree and was already working as a sale consultant when he learned he was HIV (human immunodeficiency virus) positive. Then active in LGBTQ+ circles, he met an incognito Quezon City government (part of Metro Manila) health worker who convinced him to test for HIV. As he recalls:

I had myself tested in July 2011. I received the result on September 26 at exactly ten o’clock in the morning,” he recalled. “Iyon nga, positive.” (That was it, I was HIV positive from thereon.)

MM asked his new friend for a meeting to ask her advice on what to do. It was then that Adelle Aldaz revealed to him she was a health worker of the Quezon City government. Aldaz told him that Quezon City’s “mega-clinics” have special services for those who find themselves in such a situation.

Undercover health workers

“Mama Adelle,” as MM eventually started calling her, was then a counselor for HIV patients at one of Quezon City’s mega-clinics, the Klinika Batasan. The counselors are not licensed health professionals but have undergone intensive trainings in dealing with commercial sex workers and the LGBTQ+ community, especially MSM (men having sex with men), and in convincing and educating them on safe sex and HIV. As Aldaz explains:

We went to bars at night where our clients usually were and that was where I met MM. We do not identify ourselves as health personnel of the LGU [Local Government Unit] until we have earned their trust. It is easier to talk to gay men; the commercial sex workers in Cubao are more difficult to befriend. We have to convince them at first that we are not the police out to arrest them or convince them to stop doing what they are doing.

A Quezon City social hygiene clinic counselor with an HIV patient at Klinika Bernardo. (Raymund Villanueva/Kodao)

A first in the Philippines: A social hygiene clinic for HIV patients 

Klinika Bernardo physician Leonel John Ruiz said there were only two places people could go to have themselves tested and treated for HIV a decade ago: the RITM (Research Institute for Tropical Medicine) in Muntinlupa (south of the capital Manila) and San Lazaro Hospital in Manila. Both were too far away for Quezon City (north of Manila) residents, the lines were always too long, and the test results usually arrived weeks after. “We thought of putting one up in Quezon City for the MSM and commercial sex workers our counselors were able to convince,” Dr. Ruiz said.

Then Vice Mayor Joy Belmonte of Quezon City inaugurated Klinika Bernardo when it opened as a social hygiene and HIV treatment clinic in October 2012.

It later won the Galing Pook Award of the Department of Interior and Local Government-Local Government Academy, which recognizes innovative practices by local government units.

“Because of such support, we now conduct in-house laboratory procedures that drastically cut the waiting time for test results if they were taken at either RITM or San Lazaro hospital from weeks to just two or three days,” Dr. Ruiz said.

He added that they received great assistance from several donors that helped Quezon City design Klinika Bernardo’s service delivery procedures, including training its personnel on motivational counseling. The product is a safe space for HIV patients and commercial sex workers.

We are open at three o’clock in the afternoon until 11 at night because of the nature of work and lifestyle of our clients, who go out mostly at night. Here, they do not have to be with many other patients of other illnesses who [used to] look down on them.

Klinika Bernardo has two sections on its two floors. The first floor is the social hygiene clinic that caters to commercial sex workers mostly for their sexually-transmitted infection screenings and check-ups. The upper floor hosts the HIV testing and treatment area. But the lively chatter and banter of the counselors, personnel and the clients is what defines it more as safe space. “Klinika Bernardo is not only discreet, it is very welcoming to all. Even our security guards are LGBTQ+ community members,” Dr. Ruiz said.

Not just a clinic

Klinika Bernardo’s successes provided lessons that encouraged Quezon City’s other social hygiene clinics to become HIV-treatment centers as well.

The clinic played a leading role in the creation and operation of the HIV inter-referral system and service delivery network with not just health institutions but with persons with disability (PWD) groups, the Department of Social Welfare and Development (DSWD) and churches. Klinika Bernardo’s experiences also helped in the creation of policies supporting HIV patients, such as financial assistance packages from the DSWD and the granting of PWD identification cards to persons with HIV and AIDS.

The latest innovation is the use of the motorcycle delivery services to send medicines to clients who could not take public transport due to their co-existing health conditions or simply do not have fare money.

A Klinika Bernardo medical technologist operating a testing machine. (R. Villanueva/Kodao)

Despite the special support it receives from the local government, Klinika Bernardo faces specific problems: it has its share of shortages of anti-retro viral drugs that only the Department of Health (DOH) can buy from abroad. The clinic also experiences low supply of testing kits for viral loads of HIV/ AIDS patients as well as pre-exposure prophylaxis tablets for their sexual partners.

Klinika Bernardo health workers said it has yet to experience running out of medicines and kits despite conducting 30 to 40 tests every day, but is always concerned when supplies are getting low.

“It could not come sooner as HIV cases have gone back up to pre-pandemic levels. There were not many walk-ins and there were less visits by our clients during the lockdowns, but we are now back to 1,000 cases under our care,” Dr. Ruiz said.

Klinika Bernardo counselor “Jaja” has a radical dream: Clinics for transgenders like them.

HIV information for MSM is already getting adequate. But HIV cases among transgenders are also rising. We need dedicated clinics for us because we need to study if treatment for HIV or any other illness is safe to administer if a transgender patient is undergoing hormonal therapy.

Life–saving

MM said Klinika Bernardo saved his life, the reason why he left his sales consultancy job and applied to become a full-time health counselor. He is now both a Klinika Bernardo worker as well as client. With Aldaz’ guidance and support, he follows all health protocols and regularly takes his medicines. “It’s been 10 years and I have never suffered an opportunistic infection,” he said.

He said his being a Klinika Bernardo counselor now gives meaning to his life.

Akala ko wala nang silbi ang Buhay ko. Pero narito ako ngayon, tumutulong sa iba para madugtungan ang Buhay.

I thought my life had become meaningless. But here I am, helping others live on.

He said he is always grateful to and constantly inspired by her “Mama Adelle.” MM said he still periodically sends her text messages: “I owe you my life.”

Asked what messages he receives from his own clients and fellow patients, MM said: “Pareho din lagi. Utang nila ang Buhay nila sa akin.” (The same, always: They owe their lives to me.)