Klinika Bernardo, A Male Sundown Clinic
Worldwide, unprotected sex between men and women is the main route of Sexually Transmitted Infections (STI), such as the Human Immunodeficiency Virus (HIV). In Australia, HIV has mainly been transmitted through unprotected sex between men. In Quezon City, the LGU also monitored a sudden rise in STI/HIV infections, especially among Men Having Sex with Other Men (MSM).
While Social Hygiene Clinics (SHCs) are mandated by National Laws, and in some LGUs by local ordinances, to be at the forefront of STI/HIV prevention and control, there were none, prior to 2012, that catered mainly to the needs of MSM clients.
Before 2012, the Quezon City government had three SHCs which served as the main facilities for the diagnosis and treatment of STIs. The clients were mostly those working in entertainment establishments who flock to the clinic for the weekly gram stain. Like most clinics, its regular office hours were conducted from 8:00 AM to 5:00 PM. This meant that the MSM clients, who were young male students and professionals, could not readily avail of the services of the SHCs as they were attending class or working at the offices during these hours. Moreover, the regular SHCs are operated by an almost all-female staff, as these catered mostly to females who work in the entertainment establishments. Surveys showed that the MSM clients were reluctant to go to these clinics as they did not want to be associated with these female clients.
HIV cases among MSM clients in Quezon City increased from 1.4% in 2009 to 6.6% in 2013, which meant a new set of clients with specific needs. In response, the Quezon City Health Department (QCHD) began to put in place MSM-specific interventions such as the hiring of 20 Peer Educators that were assigned to increase referrals for MSM services in these SHCs. But, the inflow of MSM clients in the SHCs remained low. Surveys revealed that a more MSM-friendly clinic has to be put-up to entice them to avail of HIV Voluntary Counseling and Testing (VCT).
In October 2012, QCHD established Klinika Bernardo as a stigma- free and non-discriminatory environment for MSM clients. It is housed in the same facility as the Bernardo SHC, but operates from 3:00 PM to 11:00 PM. Its personnel are composed mainly of males who were chosen from the roster of QCHD personnel and trained on STI/HIV interventions. Initial resources for the operations were allocated from the regular budget of the department. Peer educators provide VCT for HIV. STI diagnosis and treatment as well as distribution of condoms and lubricants are also done in the facility. Klinika Bernardo became the first sundown clinic operated solely by an LGU. This clinic was conceptualized and operational before national guidelines on MSM-Transgender (TG) interventions or programs were formulated. In 2013, the QCHD registered a 133% increase of VCT among male clients.
Regular consultations with Community Based Ogranizations (CBO) are undertaken by Klinika Bernardo to gather relevant information and recommendations. These are conducted during the regular meeting of the Quezon City STI/AIDS Council (QCSAC), a multi-sectoral body that provides directions to the HIV response of the city. Klinika Bernardo also partners with private organizations such as the Association of Spa, Massage parlor, Clubs, and KTV bars Operators (SAMACKA), Take the Test, Inc. (TTT)—an MSM organization—and AIDS Society of the Philippines (ASP) to promote HIV prevention. By monitoring social networking sites, Klinika Bernardo identified and engaged 25 MSM clans in Quezon City. These clans hold events or face to face gatherings (called eyeballs) every weekend; Klinika Bernardo provides voluntary counseling and testing during these clan events. Taking its cue from a USAID project, Klinika Bernardo also made use of mobile technology as a channel to provide MSMs with information on HIV/ AIDS including available testing and treatment services. The Quezon City government institutionalized SMS4MSM by providing funds to enrol 25 MSM clans.
In collaboration with the Reaching Out to Most at Risk Population (ROMP) project, a Case Management Approach Team was started in Klinika Bernardo to increase client initiation, retention and adherence to treatment as well as provide early access to and maintenance of comprehensive package of health and social services, and improve the quality of life of people living with HIV (PLHIV). In addition, Klinika Bernardo—which is limited to providing only primary health care for PLHIV—helped establish a functional Service Delivery Network (SDN) of providers to link together health and non-health services for the care of PLHIV and their families. The network aims to strengthen the referral process and coordination mechanism, to ensure continuous provision of needed services and monitor outcomes of individual referrals.
Klinika Bernardo shows the importance of addressing access issues not only in terms of distance and cost but also in the light of conflicts in time and confidence and trust in personnel. It also demonstrated that minor innovations can result in major gains, particularly community participation and involvement and the value of peers. These are simple strategies that can be replicated by other LGUs.