Tackling stigma and discrimination in the Philippines By Chris Munoz, Adviser of the Yellow Warriors Society Philippines

Chris Munoz, Adviser of the Yellow Warriors Society Philippines (YWSP), carries out a variety of work to overcome the stigma and discrimination that people living with viral hepatitis in the Philippines face. By working directly with people with the disease, collaborating with policy makers and educating the general public, he and his members hope to increase diagnosis rates and provide better health outcomes for people diagnosed with hepatitis.

The issue

Stigma is a powerful social process of devaluing people. The discrimination that follows stigma is the unfair and unjust treatment of an individual based on this stigma.  All too often, people living with viral hepatitis in the Philippines face this stigma and discrimination. This might be in their work, for example being denied employment or being asked to leave a job because of their hepatitis status, it could be among family and friends who may change how they treat their loved one, or at school, such as when testing positive for hepatitis precludes participation in certain courses.

 

The first step in overcoming stigma and diagnosis is to understand it, including its prevalence. A 24 hour Facebook poll of YWSP supporters found the following devastating statistics:

  • 81% of followers felt discriminated against at the point of diagnosis
  • 46% of followers reported experiencing discrimination from a healthcare worker
  • 62% of followers with hepatitis had not disclosed their status with their friends. 18% hadn’t told their family.

From our work we understand that sadly, stigma and discrimination has both a psychological and physical impact on people living with hepatitis. Stigma related stressors can mean people are afraid to live their normal lives, socialise with friends and even become reluctant to seek medical care, which can have a further adverse effect on their health. Frustratingly, this attitude of stigma and discrimination stems from misconceptions and a lack of awareness. As a result, this is where YWSP focuses its work.

The approach

  1. We provide psychosocial support to people who have faced stigma and discrimination. We encourage them to move forward by enabling them to accept their health status, in the hope that this will break the vicious cycle of depression and disappointment. Furthermore, by helping them to engage in the health care system, we hope that they can be empowered and confident once again.
  2. We recognise that stigma and discrimination around viral hepatitis stem from a lack of understanding and misconceptions. We therefore work hard to educate the general public on what hepatitis is and how it is transmitted. We create an open dialogue about the disease where people are able to ask questions to ensure that they are fully informed.

As part of these workshops, we concentrate on geographically remote areas and in lower income communities. For example, we recently held an educational workshop in one such village in Nanan Payao Zamboanga Sibugay. Our chapter leader Mr. Mark Takios collaborated with the principal of the school who was very accommodating and allowed him to deliver a two hour talk to 150 students.  We were pleased to get feedback from both the principal, who noted that there was a worrying lack of awareness of the disease in the area before the workshop, and from the students, who said that knowledge of the disease was essential to overcome discrimination.

We have plans to expand the education programme. We hope to secure further funding so that we can travel into more hard to reach areas and lower income communities and have the opportunity to educate more people. With funding we would also hope to incorporate screening as part of the workshops so that we are not just educating people on stigma and discrimination, but also contributing to ‘Finding the Missing Millions’.  

  1. Finally, we work with local governments to address inequalities and inequities in health. This work takes a variety of forms but the focus of it is to identify policy makers in the local and national government to reduce the burden of discrimination on health and wellbeing.

Local government collaboration in Antipolo City

An example of this work is when we collaborated with the local government as part of an awareness raising and screening programme in Antipolo City. We were pleased to have an engaged Mr. Shiloh Pajac, Chapter Leader of YWSP Rizal Chapter, who could lead his members with the support of members in other chapters, to implement the programme. After securing sponsorship for screening kits from a pharmaceutical company, we turned our attention to developing strong relationships with the local government, the Office of the City Health Services in Antipolo and the Philippine Health Insurance Corporation, as we knew that their support was crucial to the programme. Our local chapter leader, a constituent in the area, was able to connect with his local government and the Office of the City Health Services.  As Vice-President of the Philippine Alliance of Patient Organizations, another area of advocacy, I already had working relationships with the Philippine Health Insurance Corporation . For example, we help them increase their membership by promoting them through YWSP’s activities and I was able to further build on this relationship.  Our efforts paid off, and the City Health Officer, Dr. Conception, became engaged with the programme. She was kind enough to provide the venue for the event and was one of the speakers on the day.

The event was a great success, with approximately 200 people screened for hepatitis B. Both the chapter leader and the YWSP members were pleased with the outcome of the event. There were lots of discussions about how empowering the event was and what a great sense of achievement everyone involved felt. In fact, the members have plans for us to replicate this work! Most importantly, we have forged strong relationships between the YWSP, the Rizal Chapter who are now one of the organisation’s most active chapters, the Office of the City Health Services in Antipolo and the Philippine Health Insurance Corporation. These relationships will be invaluable for when we carry out similar work in the future.

We have since managed to replicate this programme in other areas. 10% of those screened in subsequent programmes have tested positive for hepatitis B.

Educating and testing health care professionals in Lipa City

We recognise that if we are to raise awareness about viral hepatitis in an effort to overcome stigma and discrimination, we must also work with health care professionals.  We recently worked with the local government in Lipa City to do just that. Given that healthcare professionals are the gatekeepers to the general public, we liaised with the local government to organise an event to raise awareness among health care professionals and to encourage them to get tested themselves.

To approach this task, the local YWSP Batangas chapter leader, Mr. Krisno Ilagan, worked closely with our members in Manila. As with all work with local governments, the first step was to build strong relationships with the relevant stakeholders. He therefore contacted the Mayor of the area and the chief of the local health centre. Being a local constituent and also a health worker, it took six weeks of correspondence, reaching out to contacts at various levels within the health administration and building relationships to eventually carry out the project. It took time because there were some activities in the pipeline in the Office of the City Health, but with perseverance our chapter leader was able to pull it off and we were pleased with the outcome. In one short lecture, were able to educate health care professionals and test 78 people. Two of these tested positive and will undergo counselling as a result. All of the health care professionals that attended are now upskilled in diagnosis and diagnostics of viral hepatitis.

Developing and maintaining these strong relationships with local government and policy makers means that we are able to educate as many people as possible about viral hepatitis and how it is transmitted. Another positive outcome is because of the activity we were able to get hepatitis into discussion with the health executives. I believe hepatitis has to compete with other popular diseases like TB, malaria and other communicable and non-communicable disease.  For us, education is key to overcome the misconceptions associated with the disease and tackle the issue of stigma and discrimination.

 

Challenges

  • Stigma and discrimination is a huge issue to overcome, but we are working on it. Our approach in delivering the educational workshops is to not spend much time focusing on this as an issue itself. Instead, we spend our time educating people on what viral hepatitis is and how we can overcome it. Stigma and discrimination develops from ignorance and so through giving people the facts we find that they can disregard their misconceptions.
  • A lack of funding is always going to be an issue. For our awareness and educational programmes, we require tests and venue costs to be covered. We seek sponsorship for such costs, for example through pharmaceuticals. Securing these sponsorships often takes time, but it is worth it. Hopefully our advocacy can be appealing to both corporate companies and public.

Collaborating with a diverse range of stakeholders in governmental organisations can present its own challenges. People have their own priorities, level of commitment and resources. We approach this by taking time to establish long term relationships; we listen to colleagues and their suggestions, ensure their buy-in and develop our work around their needs. Our role is to ensure the smooth delivery of the programme and to make sure that we have developed a strong relationship with the stakeholders who we know we can rely on for future work.

Top tips for success

  1. In all of our work, collaboration is essential. From working with the principal of the local school, to developing strong relationships with the local government, to engaging our own chapters, we would not be able to reach the amount of people that we do without the help of others. Take time to invest in these relationships to ensure others’ commitment.
  2. Develop leaders and inspire others. The YWSP is able to carry out the work that it does because we have engaged leaders and members.
  3. Don’t let financial constraints affect your advocacy. The YWSP doesn’t receive any funding, but we don’t let that stop us in our work. We adapt projects accordingly, such as by running smaller pilot schemes to demonstrate their impact before scaling these up. Believe in what you do and the rest will follow.

 

Find out more

If you’re interested in finding out more about how you can work directly with people living with hepatitis, educate the public on the disease or collaborate with local government, then contact Chris Munoz, Adviser of the Yellow Warriors Society Philippines on ywsp.president@gmail.com.