Don’t spread the infection, spread the word! Venereologists are here.
Got any questions about Sexually Transmitted Infections? Fear you might have caught one from your recent contact? Well, don’t consult the internet and diagnose yourself, consult a Venereologist!
The term “Venereologist” may not sound too familiar to you but they are doctors who specialize in the diagnosis and treatment of venereal diseases, another term for Sexually Transmitted Infections (STIs). With so many questions regarding the status of the Philippines on sexual and reproductive health care, our team sought answers from a real venereologist and dermatologist: Dr. Emerson Gale Vista, who is a consultant and faculty member of the Department of Dermatology in the Research Institute for Tropical Medicine (RITM).
About the Doctor
Dermatologists are the front runners for treating patients with STIs because majority of these patients present first with skin problems.
When asked about his profession, Dr. Vista started with the common notion that when people think about dermatology, they think about skin problems, and aesthetic, but aside from that, dermatologists are also the front runners for treating patients with STIs because the majority of these patients present first with skin problems. That’s when he saw the need for him to specialize in venereology. Now, as the head of the STI department in RITM, he not only sees patients with STIs, but also works with his colleagues from the Philippine Dermatological Society (PDS), and Philippine Venereologist Society, Inc. (PSVI) in spearheading trials that will help the government’s program for these diseases.
We wanted to get more insight into the factors that were affecting the development of solutions against STIs. So when asked what difficulties they’ve been encountering when dealing with patients, Dr. Vista highlighted two things: lack of data, and the stigma.
We need more Data
“At the moment, the country does not have National Data regarding these cases. We don’t know the exact number of cases for Syphilis, Warts, Herpes and more. We need to establish a national census which is very important for providing a budget and properly addressing these situations. We’re doing a great job for HIV (Human Immunodeficiency Virus), the government is currently focused on that.” We even have a law for HIV, but we don’t have that for the other STIs yet. Dr. Vista believes that being able to collect data completely will be the key to fully developing solutions for STIs in the country.
Republic Act 8504 is the law that established a comprehensive HIV/AIDS monitoring system that provides a periodic census for the cases in the country.
Even the Doctors have the stigma
When asked about the stigma against STIs, Dr. Vista started off with the doctors. Dr. Vista’s current research interests are about the knowledge, attitudes, and practices of doctors in treating STI patients. He says that some doctors don’t like them — they are not comfortable dealing with them. The majority of them say that they lack the knowledge for these cases and that taking on the cases is complicated because it requires a lot of patience and a more intimate approach. When you ask them about their sexual behaviors, it’s not all the time that the patient will tell the doctor right away. So some doctors just refer their patients to him.
Dr. Vista highlighted the importance of STI counseling in primary health care as it aims to attain four crucial goals: encouraging patients to have a preventive and healthy sexual lifestyle, undergo STI testing, adhere to treatment, and inform their partners.
STI counseling is very crucial. You have to know what to say, and follow through with the patient. You have to convince them to under go the test, and at the same time follow the treatment. If you counsel them properly and give them the correct medications, we can stop the STI.
He said that successful STI counseling can be achieved by building an atmosphere of trust between the doctor and the patient. And he does this with a few simple steps. The physical atmosphere should establish a patient-doctor relationship — it should only be the two of you in the room. They should maintain proper decorum, and practice confidentiality. When talking to the patients, the doctors should use open-ended questions, and not interrupt right away to give the patient time to express themselves. Dr. Vista also emphasized on being open-minded; doctors should maintain a non-judgemental attitude when dealing with patients. He said that some doctors show facial expressions when their patients talk about their sexual behaviors or even scold their patients for their sex life. How the doctor responds is very important, and the patient is affected by this. If the counseling is not successful, we won’t be able to attain the four goals.
We’re limited in terms of real doctors treating STI
Dr. Vista said that the society of venereologists is still growing. Their current goal is to be known and identified that they are the doctors who can treat any kind of STIs. Right now they’re still working together with dermatologists and other specialties. Many patients don’t know who to go to, and even some doctors don’t know who to refer them to. That is why they conduct training for people to be members of the PSVI. These will be the people who are really open-minded and knowledgeable to treat these cases.
“We have to empower the venereologists in our country to cooperate with the Department of Health. Raise more awareness of the specialty of venereology and raise more people who are handling these cases. We are so few that we’re not enough for the amount of cases we have today.”
We’re open about sex but not Sexually Transmitted Infections
After talking about how the stigma is affecting doctors, Dr. Vista then moved on to the problem on the part of the patients. He says that the lifestyle of the patients is evolving. Our country is now being more open to talking about sex, and that there’s a revolution that is straying from the conservative type. It’s not only for a certain age anymore, now, but many younger people are also getting sexually involved with their partners. And some parents are already open about their children being sexually active.
Many are even proud that they are sexually active, but the problem is, once they get the disease, or they get infected, that’s when they stop listening. The patients start to fear the disease and they don’t associate with it anymore. They don’t go right away to the doctors, they just try to check online for treatments, or even worse, they don’t do anything because they’re not aware of the consequences of acquiring their infections. The average rate now is almost 2 newly diagnosed cases per hour. However, not all who are diagnosed are getting treatment. 40% of these people who are infected with HIV are nowhere to be found. They got diagnosed but they never followed-up on the treatment.
If we can be open about sex, we should also be open now about testing for STIs.
Dr. Vista said that improvements are happening, but not in a large scale. There are some people before getting married or getting into a relationship who get checked for STIs so that they are sure that they are safe to have sex or have a baby. Sometimes even the family members of their patients come to him for consultation. He encourages the family of their patients to consult with him too to learn more about their conditions and to clarify misconceptions.
For people who don’t know where do go for HIV testing and treatment, Dr. Vista promoted the HIV treatment hubs that the government has put up. As of today, there are fourteen treatment hubs set up across the country, from Ilocos to Manila, and down to Zamboanga. RITM is one of these treatment hubs that people living with HIV and/or AIDS (PLWHAs) can go to for close monitoring and proper medical attention.
“There is always hope”
This is what Dr. Vista answered when asked if there is hope for patients of STIs to continue living a normal life: “There is always hope.” Many of the infections are curable and controllable. He says that HIV is one of the main concerns by the DOH and that they are already subsidizing the treatments, which is why there shouldn’t be any excuse for patients to not get treated once they’re diagnosed.
Dr. Vista explained more about the two incurable diseases: Human Immunodeficiency Virus (HIV) and Human Papilloma Virus (HPV)
When you have HIV, you have an infection. What we don’t want is for it to develop into aids because that’s when it gets life threatening. But once you start treatment, and you maintain it then you can still live a normal life. The goal of the medication is to increase your CD4 levels, the antibody that fights against the virus until the viral load becomes undetectable. Once you achieve these two conditions, you can already have a normal life, you can have sex with very low chances of transmission to other people. You just have maintenance medications that you will take forever.
Dr. Vista then talked about Magic Johnson, a former professional basketball player of the Los Angeles Lakers, who is still alive today and living normally after being diagnosed with HIV 30 years ago. And that in Germany, many people have HIV, but very few have aids. These stories are all possible because the medication is here, and it’s here to control it and give people the normal life that they should have.
HIV is not the worst disease, there are a lot of worse diseases.
He commented that some patients actually prefer to have HIV than to have caught cancer because with HIV they just have to maintain medications for life, unlike for the case of cancer for which you have to go through chemotherapy and surgery. His patients have this analogy that HIV is not the worst disease, and that there are a lot of worse diseases than it. It’s just the stigma that’s causing it to be frowned upon by people.
As for HPV, even though it’s also incurable. It’s just a matter of your immune system controlling the infections so that symptoms won’t arise. HPV does not destroy your immune system. You can still live normally as long as you don’t have any active lesions like warts. But if you do, they just have to be removed through surgery.
Where are we now?
According to Dr. Vista, our medical institutions are developing, expanding, and evolving in research, especially in controlling these diseases. Their goal is to be at par with other developed countries in terms of detection and long term management of the cases. It’s not impossible that we will have access to affordable treatments for all STIs in the future, however, we still have a long way to go.
As of now, some of the testing and treatment for many of the STIs affecting the country are still relatively more expensive compared to that of developed countries like the USA. Which is why we should aim to prevent ourselves from acquiring these infections, and infecting others as well.
The Media needs to do a better job
Dr. Vista said that we need better promotions in the media. We’re making good progress with making people aware of HIV, and how we have the highest incidences of it in the world. A lot more people are being conscious of having sex. They are raising awareness of how grave the situation is in our country, but they are not raising awareness about the misconceptions of getting infected, that these diseases are treatable, and shouldn’t be something to fear. They’re not addressing proper perceptions, attitudes, and knowledge about STIs — They are just scaring people.
They need cooperation from us!
Dr. Vista and his fellow doctors are continuing to help the government by collecting more data, creating more service, and raising awareness in schools and communities. However, he said that with the population that we have, the level of understanding of the Filipinos, and their close connection to their culture, there are so many obstacles.
We have to be open minded not only with being aware of these diseases, but also with accepting that we need to do more in preventing these diseases from spreading. Let’s encourage the people near us to get checked, treated, and if necessary, abstain from sex. We want to make people more aware as casual as possible that these can be tested, treated, and shouldn’t be something to fear.
He added, that we can’t depend on the culture of conservatism to protect people from being infected anymore, because culture is evolving already. We have to make people understand that these diseases shouldn’t be a basis of discrimination.
For people who want to start having a healthy sexual lifestyle, Dr. Vista advises to know your partner well, stay monogamous, use protection consistently, and spread the knowledge regarding these cases. He also discourages relying on the internet for consultation. The doctors are here, and they are ready to provide the health care that you need.
Eradicate the Stigma, Eradicate the Diseases
These STI cases are greatly affecting our country today, and we have to do something about it. This eye opening interview I had with Dr. Vista shed light on the stigma that is not only affecting the psychological health of the patients, but also the progress of our doctors in developing solutions. We learn that everyone of us has a role in their endeavour. So let us all continue promoting education on healthy sexual and reproductive practices, and Sexually Transmitted Infections. And indeed, let us all talk about it “as casual as possible” in our conversations with friends, families, and co-workers.
Let us eliminate the fear and discrimination we are causing with our stigma. Yes, it is OUR STIGMA. It is everyone’s problem that we have to start being accountable for. It is not just the sexually active people of today who are at risk, that’s a misconception. As long as this stigma continues to hinder medical progress in society, everyone is at risk — our children in the future are at risk. But with everyone’s continuous cooperation, I believe that we can eradicate this stigma, and eventually eradicate these diseases .
Dr. Emmerson Gale Silverio Vista is a consultant and faculty member at the Research Institute for Tropical Medicine (RITM), Department of Dermatology. He is also a consultant at St. Luke’s Medical Center in Bonifacio Global City and a visiting consultant at Cavite Medical Center. He finished his dermatology residency training at RITM and participated in the dermatology fellowship observership program at the National Skin Centre in Singapore and dermatology mentorship training on STD-HIV at the Ludwig Maximilian University of Munich, Department of Dermatology and Allergy in Germany. His current research interests include knowledge, attitudes, and practices of dermatology patients or health care workers regarding HIV/AIDS and other STIs.
