The Quiet Grief of an HIV Nurse in the Philippines

In the quiet aftermath of a patient’s passing, I often find myself grieving alone, in a space that cannot publicly acknowledge the depth of our connection.

As an HIV nurse in the Philippines, most of my work begins at the doorsteps of patients’ homes, long before we meet again in the clinic. We exchange not just vital signs and medication reviews but glances heavy with trust and stories too sacred for outsiders to know. When a patient dies—often in silence and sometimes in isolation—there is no lamay (wake), no public ritual, no eulogy. The mourning is quiet and carried internally. It is a grief rendered invisible, not because their life lacked meaning, but because so few were ever allowed to know the truth. Only I, the patient, and perhaps a few family members often understand what they were fighting against. Our bond, formed in pakikipagkapwa (empathy and recognition of a shared identity) and sealed by shared courage, is unlike any other. When death comes, it does not sever that connection—it deepens the silence.

The hidden intimacies of HIV nursing

HIV nursing in the Philippines is a quiet vocation. In every home visit, I carry not just a stethoscope or antiretroviral refill but the awareness that I enter spaces where hiya—that deeply ingrained sense of shame and modesty—can shape how patients live and how they choose to be seen. In these intimate settings, trust is everything. Patients may confide in me before they tell their kin. I have sat on plastic stools beside beds, hearing confessions wrapped in grief and resilience. I have brought coffee to afternoon visits where the silence between words held more than symptoms could describe.

To provide culturally safe care means respecting patients’ decisions to remain unseen, even when I wish the world could witness their strength.

My role is not just clinical. I become the keeper of secrets, the listener of life stories that are too painful, too complex, or too dangerous to be shared beyond our four walls.

This intimacy is a privilege but also a heavy responsibility. The nurse-patient relationship in HIV care is not a transactional exchange; it is an act of malasakit (compassion). I am allowed into my patients’ inner worlds, but I am also asked to carry their pain discreetly. Professional spaces rarely account for this emotional labor. When a patient dies, especially one whose HIV status was never known even to their family, I mourn with no one to turn to. There is no place to say, “I cared for him,” or “They wer more than their diagnosis.” Grieving becomes a private discipline, one that lives between clinic hours and home visits, between kumustahan (check-in) texts and death certificates that never list HIV.

Stigma, silence, and the cost of cultural invisibility

Stigma is a shadow that follows every step of HIV care in the Philippines. In a society shaped by deep religiosity and pakikisama (cultural value that prioritizes social harmony that involves compromise), the mere mention of HIV can disrupt entire family systems or neighborhood dynamics. I have made home visits coded as routine blood pressure monitoring, just to avoid suspicion from kapitbahay (neighbors). Some patients request to be seen early in the morning or late at night, when the tsismosa (gossip) next door is least likely to notice. Others ask me to enter through the back gate. I understand. Disclosure here is not just personal—it can be dangerous. A diagnosis can cost someone their job, their place in church, or their child’s admission to school.

As a nurse, I am constantly navigating these layers of secrecy. I adjust language, shift body language, and tread carefully. To provide culturally safe care means respecting patients’ decisions to remain unseen, even when I wish the world could witness their strength. This invisibility, however, comes at a cost. It means their deaths are rarely acknowledged, their struggles seldom named. I have watched families reframe deaths as pulmonya (pneumonia) or cancer, even as they clasp the hand of someone who fought quietly against AIDS-related complications. These silences, born of survival, are deeply painful. For the patient, for the family, and for the nurse who knows the fuller story but cannot speak it

Grieving in the shadows: the emotional labor of HIV nurses

There is no babang-luksa (end of mourning/first anniversary of death) for nurses. Our grief does not follow a ritual or rhythm. It simply accumulates, one case at a time. The emotional labor of HIV care is relentless and invisible. I have wept in tricycles on the way back from home visits. I have lingered in health centers longer than I needed to just to collect myself before the next patient. The grief is not always loud. It is a tightening in the chest, a heaviness in the hands, a quiet ache when you pass by a home you used to visit weekly but no longer do.

Many patients I care for have no one else. Some have been abandoned by their parents or left out of family reunions for reasons no one dares speak of. In those cases, I become not just their nurse but their only witness. When they die, the grief is complex—part sorrow, part guilt, part rage at a world that failed them. There are no institutional debriefings, no scheduled memorials. So I create my rituals. I light candles at home. I keep their initials in my notes. Sometimes I whisper, "Patawad, kaibigan. Hindi kita malilimutan" ("I am sorry, my friend. I will not forget you."), before moving on to the next task. These quiet acts are my way of saying: You mattered to me.

Bearing witness and honoring the lives of the lost

To bear witness is an act of pagkilala (recognition)—of naming someone’s life as worthy of memory, even if others choose not to see it. In my practice, I have cared for professionals, call center agents, overseas workers, and queer teenagers estranged from their families. Each one lived with a complexity that does not fit neatly into charts or records. When they die, it often falls on me to remember. I recall the way they always offered me merienda (a snack) after a visit or how they’d joke about side effects even when their body was failing. These memories are not just personal; they are counter-narratives to the shame that often surrounds HIV death in our country.

Honoring them means refusing to reduce their lives to clinical outcomes. It means telling their stories, even in anonymized form, so others may understand what courage looks like. Some nurses plant trees. Others write. I remember through presence—through continuing to care with the same compassion they once received. In a system that too often renders lives of those living with HIV disposable, to remember is a form of resistance. It insists that no one dies nameless.

A call for compassionate visibility

If there is one thing I hope for, it is this: that we build a healthcare culture where HIV care and the grief it carries are no longer relegated to the shadows. We need compassionate visibility—not the kind that sensationalizes, but the kind that honors. We need policies that support frontline HIV providers with counseling, debriefing, and peer connection. We need academic spaces to recognize the emotional labor of HIV nurses and to teach it not as a burden but as integral to care. We need public narratives that stop asking, “Bakit siya nagkaroon ?” (“Why did he get [AIDS]”) and start asking, “How can we care better?”

But more than anything, we need pakikiramay (sympathy)—not just at the time of death but throughout the long journey of life with HIV. We need a bayanihan (communal support or unity; a Filipina collectivist cultural value) spirit that extends not only to patients but also to those of us who care for them, who carry their stories, and who grieve when no one else knows we do.

Ultimately, we do not need to shout our grief to the world. But we deserve to have it heard. To honor the lives of our patients, to honor the quiet sacrifices of HIV nurses, and to build a future where no one has to die unseen, unloved, or alone.

Noriel Calaguas, PhD, MSHSA, RN, ACRN, is an associate professor and former chairperson at the Holy Angel University School of Nursing and Allied Medical Sciences. He currently serves as the Co-Chair of the Association of Nurses in AIDS Care Global Committee and is a Trustee of the Philippine Society of Sexual and Reproductive Health Nurses. He is a member of Sigma’s Lambda Delta Chapter.