ON any given Thursday, which is outpatient day at the H4 Pavilion of the San Lazaro Hospital in Sta. Cruz, Manila, dozens of HIV-positive patients queue up for their regular check-up.

Roughly nine of 10 patients are male. In mid-April this year, the medical staff was seeing 600 outpatients; 17 were confined in the 12-bed capacity ward. There were also 17 children in the HIV pediatric ward.

?H4? is the altered term for HIV, attached to the word ?pavilion? to somehow obscure it from public attention as the ward is for hospitalized HIV-infected patients. It opened in 1984 when the country?s medical profession was in fear of the first Filipino diagnosed with AIDS, who was shuttled in and out of hospitals because of the terror triggered by the new infection. Twenty-six years later, the H4 Pavilion, now undergoing renovation to accommodate the rapidly increasing number of patients, still stands inconspicuously within the hospital compound. With beds at least three meters apart, the renovation also hopes to control infection.

The government-run hospital for infectious diseases is one of the country?s three largest hospitals that have specially-trained health workers in an HIV/AIDS Core Team (HACT). The other two institutions are also pioneers in HIV treatment and care ? the Philippine General Hospital on Taft Ave., Manila, and the Research Institute for Tropical Medicine (RITM) in Alabang, Muntinlupa City.

Dr. Rosario Jessica Tactacan-Abrenica, HACT team leader and pavilion head, said HIV infection in the Philippines has taken on a different face. Called the ?pre-departure? ward during the 1980s and 1990s because confined patients then ? most of whom were sex workers ? were already in the terminal stage of AIDS complications, the pavilion now hosts a different generation of patients.

?Our patients are mostly students and young professionals in their twenties and thirties. We also have doctors, lawyers and managers,? the doctor said.

Abrenica heads a lean workforce of about four physicians (only two on non-Thursdays), two nurses and an equal number of nursing aides, who attend to an average of at least 10 patients a day, apart from those confined, and the 60 to 70 who come on outpatient Thursdays. The task can be daunting: from explaining the basics on HIV to new patients, to monitoring their viral load (amount of HIV in the blood) and CD4 count (amount of disease-fighting cells in the body). It also entails work-ups to prepare patients for a life ahead that involves adherence to a drug regimen that may have long-term toxicities, besides the psychosocial disturbances of being HIV-infected.

Listening to a patient?s concerns is usually the most challenging. ?We take time to let them cry,? said Abrenica. ?The work is often toxic but we are grounded by the rule that there is a human being behind every patient code.?

Dealing with HIV and AIDS has largely improved over the years, along with the swell of patients. Services such as confidential counseling and support for infected persons and their families and friends are being put in place to achieve the ideal holistic care. Medicines called antiretroviral drugs that interfere with the replication of the AIDS virus and prolong life are now accessible and available.

At the RITM, Dr. Rossana Ditangco, head of the hospital?s AIDS Research Group, said the facility tends to 500 outpatients and receives around 100 to 160 new patients every year. More than 90 percent of the patients are male; ?females are only sporadic? in the roster. The RITM no longer confines HIV-infected patients to a single ward; they are distributed in other rooms, except for those who already have severe infections. There is also a lounge for outpatients who want to linger and socialize with other patients while awaiting their turn with physicians.

?They can now party,? said Ditangco, recalling that one patient just recently celebrated the fifth anniversary of his being a person living with HIV (PLHIV) by hosting a gathering at the lounge. Now that PLHIVs live longer lives, Ditangco said there are initiatives to let them forget about death and instead celebrate life, such as self-empowerment workshops that help them ?plan and prepare to live longer lives? and make them potential HIV prevention advocates.

San Lazaro?s Abrenica said the rising epidemic has to be complemented with scaled-up health and psychosocial services. The hospital is also renovating Bahay Lingap, the two-story halfway home for HIV-infected persons who live far from Manila but need to be monitored regularly. The HIV-infected children will also occupy a ward in this building.

Because the work can drain medical personnel, Abrenica said debriefing processes are also now in place, often in workshops called ?care for the carers? conducted as often as needed. With the increasing number of patients and the demand for better medical services, she said it is just appropriate to take care of oneself as well. Diana G. Mendoza