PHILIPPINES: Fear and Whispers Swirl amid HIV Epidemic
What you need to know
Public health agencies and the Catholic Church are caught in a moral battle as HIV infection rates continue to rise. Family members of the deceased, who frequently fail to get tested, are left only with questions.
In August 2017, the Philippines Department of Health (DOH) announced that the country has the fastest growing rate of HIV (human immunodeficiency virus) infections in the Asia-Pacific region. According to the latest HIV/AIDS and ART (antiretroviral therapy) Registry of the Philippines (HARP) data, reviewed by The News Lens, there were 56,275 reported cases as of June 2018 – a drastic leap from only 117 cases in 2008.
Not all HIV cases are recorded. The World Health Organization (WHO) estimates that only 70 percent of people living with HIV worldwide know their status, and in the Philippines, many HIV positive people have never been tested. Many people do not know that the DOH provides HIV treatment in the Philippines at no cost. This is just one of many reasons why people fail to get tested or seek treatment.
In the Philippines, HIV is usually driven by sexual contact, and most of those infected are gay or bisexual men. Dr. Genesis Samonte, chief of the DOH’s Public Health Surveillance, stated that based on their data, men who have sexual intercourse with men (referred to as MSM by the DOH) are more susceptible to HIV.
“We're not talking about those that are openly gay... What we're saying is any male who has sex with another male for whatever reason, is at risk for getting HIV based on our data,” Samonte said.
The DOH originally planned to distribute condoms in schools for students ages 15 to 24, but the proposal was rejected by the Department of Education, which claimed it would only lead to increased sexual promiscuity among teens. Instead, they vowed to fortify the sex education being taught in schools.
However, despite continued governmental efforts, the Catholic Church of the Philippines has strongly resisted sex education not geared towards teaching abstinence. As a result, many Filipinos are unaware of the HIV threat. MSMs are commonly convinced that they will not get infected with HIV, thinking that infections only happen overseas.
Javi, a call center employee, died of acute viral encephalitis in August 2016 after spending several months in and out of the hospital. He was admitted to a hospital in Mindanao, the southernmost island of the Philippines, a month before his death. At the time, he had begun rapidly losing weight. According to his mother, his fever never stopped, and he could no longer recognize people around him.
His cousin, Michelle, said that she already suspected Javi to have contracted HIV when she learned that he had encephalitis and memory loss, which are HIV-related conditions. She knew he was sexually active, and his friends constantly reminded him to practice safe sex.
Michelle said she believed Javi had most likely reached stage 3 of HIV, better known as AIDS (Acquired Immunodeficiency Syndrome), because of how quickly his immune system deteriorated. She believes that he was terrified to reveal his status, or even to seek treatment, because of public humiliation and embarrassment.
Unfortunately, the social stigma of being HIV positive remains a big impediment for those who need testing or treatment. Many flatly refuse to get tested out of fear and denial. But the DOH aims to trim down, if not eradicate, the increasing HIV prevalence in the Philippines, urging all sexually active MSMs, as well as women, to use condoms at all times.
Failures to mandate reproductive health
However, government policies and laws come with restrictions. In the Philippines, these include the Responsible Parenthood and Reproductive Health Act of 2012 (Republic Act No. 10354), better known as the RH Law, which was passed in 2012 but saw key provisions axed by the Supreme Court after the country’s Catholic Church aggressively challenged its constitutionality
The revised law requires parental consent for teenagers below the age of 18 who wish to purchase condoms, removing a provision allowing minors to independently obtain contraceptives.
According to Dr. Samonte, MSMs usually become sexually active around the age of 16. They can get embarrassed when store employees ask for identification to validate their age – and they certainly do not ask their parents for permission. As a result, young people resort to unsafe sex.
Human Rights Watch Philippines researcher Carlos Conde told The News Lens that young Filipinos are very private about sexual matters, often consulting their peers instead of discussing it with their parents. Thus, a parental consent to purchase condoms at retail stores is off-putting for the wilful juveniles. “Condoms have become underground or clandestine,” he added, making people think that “safe sex, reproductive health, or sex in general, are not something that Filipinos should be open about.”
This restriction, said Conde, violates human rights as it robs the young Filipinos an arsenal to keep the HIV infection at bay. While HIV is a manageable condition, it takes lives when left untreated.
Albert Billones, 35, a Filipino educator in Malaysia, echoed Conde’s evaluation. One of the major factors of the rapid increase of HIV rate in the Philippines, he said, is the diffidence of young people in talking about sex with their parents or other family members. “I noticed that the young ones are usually uncomfortable to talk about it with their mom or dad, and would rather turn to their colleagues,” he said.
Philippine law is also influenced by the Roman Catholic Church, which has perennially opposed sex education and the use of condoms. The Catholic Bishops Conference of the Philippines (CBCP) has long pushed against easy access to condoms and other modern contraceptives. They believe these are no better than abortifacients – drugs or substances used to induce abortions, which remain banned under the Revised Penal Code.
Restrictions against condom access, along with the Catholic Church’s resistance to the RH Law, have fueled the increasing prevalence of HIV in the country. Conservative legislators such as Senators Manny Pacquiao, a devoted born-again Christian, and the pro-life Vicente Sotto III are opposed to the RH Law.
Social stigma and fear keep HIV positive Filipinos in the shadows
But the virulent opposition of religious and political leaders against reproductive health provisions are not the only major factors behind skyrocketing HIV rates in the Philippines. The brisk increase in numbers is also caused by the fears of the HIV patients themselves. Sadly, 50 percent of those who got tested never returned for the result, which means that the virus continues to spread and puts lives in jeopardy.
Daniel, a young educator, died in May 2018 in his mother’s arms after a battle with tuberculosis, rashes, and a severe fever and flu. His fellow teachers and his family are still searching for answers to why he died.
His confidant, Ed, believes Daniel contracted HIV. “He was sexually active,” said Ed. “He even explored outside the city, but I understand he was young and untamed. I just wished we learned it at the earliest time possible to avoid the virus from developing into AIDS.”
Daniel’s fate, like Javi’s, will never be known – a consequence of the fear among Filipinos of getting tested.
One member of the LGBTQ community said that easy access to condoms may not be the answer to preventing HIV in the Philippines. Christian, 31, a hospitality director, suggested that the government should provide access to Pre-exposure prophylaxis (PrEP) to sexually active people – even those who are not HIV positive – to reduce their chances of getting infected with the virus.
He also believes that sex education in high school and college must be improved, as this is the time when youngsters begin to explore their sexuality. “Things like social media, mobile apps, and technology induce it,” said Christian.
Progress made in public health initiatives
The fight for access to contraceptives in the Philippines has never received full-throated executive support. Former Presidents Gloria Macapagal-Arroryo and Benigno Aquino III, wary of offending the powerful Catholic Church, declined to push the matter. And while President Rodrigo Duterte has vowed to prioritize reproductive health, he has also made public statements urging Filipinos not to use condoms as they “aren’t pleasurable.”
The World Health Organization (WHO) has taken on a valuable support role in the Philippines, providing technical assistance for HIV patients and promoting policies to encourage HIV self-testing and PrEP access.
HIV self-testing guidelines were first published by the WHO in 2016, and the process expands access to those who would rather take the test in complete privacy.
The WHO has pushed access to PrEP in the Philippines by recommending and assisting Project PrEPPY (PrEP Pilipinas), which evaluates community-based, peer-driven delivery of PrEP services for MSM and transgender people in Metro Manila. It is also working closely with local governments and frontline health facilities to deal with bottlenecks in providing PrEP services. WHO also supports the DOH in evaluating data to determine the scale of services.
World Health Organization (WHO) Communications Officer Faizza Tanggol told The News Lens that the best way to prevent the spread of HIV is to combine existing effective prevention methods.
“The choice for a prevention method differs from one individual to another depending on her/his own characteristics, risk exposure, and the contexts where she/he evolves,” she said. “The most appropriate options for an individual will also vary throughout life cycle.”
Nowadays, HIV is not a death sentence and has become manageable. But many people living with HIV in the Philippines are not actively seeking treatment – or, in many cases, are not aware that they have it. HIV positive Filipinos can live long lives by being proactive and taking advantage of available treatment options. Rising HIV rates in the Philippines, however, suggest that prevention efforts in the country continue to fall short.
To protect the identities of their families, the names of Javi, Michelle, Daniel, Ed, and Christian have been changed for this story.
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Editor: Nick Aspinwall (@Nick1Aspinwall)
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