Quezon City shows one city can transform the AIDS epidemic

Quezon City prides itself on innovation and being on the cutting edge of social change. This dynamic drive has led the city to be an engine of transformation for many issues including the country’s burgeoning AIDS epidemic.

This week, we are both in New York City attending an event showcasing the insights and experiences of smart cities in moving the world towards ending the AIDS epidemic as a public health threat by 2030. While this goal is ambitious it is achievable if city governments take the lead. Large urban areas lie at the heart of the epidemic. Around 150 cities account for almost 90% of new HIV infections around the world.

Quezon City is showing how one city can change the course of the AIDS epidemic in the Philippines. It has prioritized the response to HIV at the very highest levels of government, working closely with UNAIDS in an unrelenting effort to pursue and sustain its programme of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

Together, we have walked the talk: not only have we advocated for everyone to get tested, but we have had HIV tests ourselves.

The city has left ideology behind and instead shown what is possible when science meets political engagement. Its HIV programme is shaped by the latest epidemiological mapping, which pinpoints the communities most affected by the epidemic.

As in many other cities, the majority of new infections are among key populations, such as men who have sex with men (MSM), transgender women, people who inject drugs and sex workers. In the past five years, HIV has swept through the city’s gay community, claiming many lives. HIV prevalence among men who have sex with men increased from under one percent in 2007 annually to nearly seven percent in 2013. 

The first step to stopping HIV in its tracks is making sure people know their status. However, many gay men fear the consequences of a positive test result. In an environment where there is high stigma and discrimination relating to HIV and to same-sex practices, the people who are most at risk are less likely to access services that could save their lives. For example, studies show that two-thirds of MSM in Quezon City have never had an HIV test.

This should not be happening today. Everyone has an equal right to health.

In response, Quezon City opened the ground-breaking Klinika Bernardo - popularly known as the Sundown Clinic - in October 2012.

This community-friendly facility became the first local government clinic in the country to cater specifically to the sexual health needs of MSM and transgender people.

The Sundown Clinic has pioneered a stigma-free, non-discriminatory and safe environment. From its convenient after-hours schedule, cheerful decor to its friendly staff the clinic is successfully reaching out to MSM and providing HIV testing, counseling and treatment services for free to more than 4000 clients.

Friendly staff have won the trust of their clients, but even more importantly city officials designed the programme in partnership with community organizations. Peer educators promote the facility’s services and educate the gay and transgender community about HIV prevention.

Quezon City has also taken steps in recent years to address broader social barriers to effective HIV responses, including through passing local laws which protect against discrimination on the grounds of HIV status, sexual orientation and gender identity.

The city’s innovative approach is having results. The first Sundown clinic has been so successful the Health Department opened two more facilities based on this same model. The number of gay men and MSM being tested in the city has increased about five times from 2011 (the year before Klinika Bernardo opened) and 2015. An Executive Order earlier this year has institutionalized peer education as a strategy for strengthening HIV prevention among key populations.

The high-level event we are attending is convened by the mayors of New York City and Paris and includes participation from around 30 city leaders from around the globe. It is part of a global movement to Fast-Track the response to HIV by front-loading investments over the next five years to reach critical prevention and treatment targets. Quezon City has increased local investments in HIV programmes from less than P5 million annually prior to 2012 to P24 million in 2015.

Quezon City is a model for the ASEAN’s Getting to Zero cities initiative. In December 2015, it initiated the Metro Manila Mayors Compact, encouraging other city leaders to adopt a Fast-Track approach. By February 2016, the League of Cities of Philippines which is chaired by Quezon City adopted a resolution supporting the strategies that will end the AIDS epidemic by 2030 in all its member cities.

The epidemic is expanding rapidly in the Philippines. Some have even compared the situation to New York City in the eighties, where the gay community lost many lives to HIV. However, unlike back then, we now know what it takes to end AIDS.

We know political engagement, science, community involvement and wise investments can change the course of the disease. We ask other city leaders to seize the small window of opportunity and implement programmes which will end the AIDS epidemic. By investing wisely now, we will save lives and create healthier cities. We cannot wait and let the epidemic spiral out of control. We have a moral obligation to stop history from repeating itself.  By HERBERT BAUTISTA, Mayor, Quezon City