HIV/AIDS: Stemming the rising tide

An activist lights a group of candles during World AIDS Day in Manila. Ted Aljibe/AFP/Getty Images

Though you wouldn’t know it from the media, the Philippines is in the midst of an alarming public health crisis. It is at a critical juncture with its growing numbers of HIV/AIDS cases. World Health Organization studies indicate that, once prevalence rates exceed 5%, the spread of the infection becomes practically unstoppable. Currently, Cebu (7.7%), Manila (6.7%), Quezon City (6.6%)and Caloocan (5.3%) are over the line, while Davao (5.0%) and Cagayan de Oro (4.7%) are next on the list.

Why this rise in HIV/AIDS cases, and why the deafening silence around it? Perhaps, one reason has been the fact that it is a disease that has so far impacted primarily Men having Sex with Men (MSM) and sex workers of various sexual orientations. At the same time, it is important to realize that, like all sexually transmitted diseases, HIV/AIDS can readily infect all other members of society, creating a pandemic that we ignore at our peril. Indeed, Dr. Jose Gerard Belimac of the Department of Health (DOH)’s National HIV/STI Prevention Program warns of a “concentrated HIV epidemic” in our cities. In particular, he considers Caloocan to be the most problematic city because of its high concentration of male sex workers, as opposed to infections elsewhere, which tend to involve mainly casual MSM contact.

He urges “active public cooperation” to avert this dangerous health outcome. But there’s the rub: the public. Most Filipinos—much of the media included—have cultivated a willful ignorance about the workings of the disease. Many still regard it as a problem restricted only to the LGBT communities and sex workers whose lives don’t intersect with theirs. The putative tolerance of homosexuality among Filipinos has always been accompanied by wide-spread homophobia by way of casual but no less vicious attacks or benign neglect against LGBT people. Sex workers are seen as victims as much as they are pariahs, relegated to the lowest rung of society. These attitudes can only have disastrous results on public health. By impugning the dignity of an entire population, they make it possible to violate their rights. Hence, there is the tragically mistaken tendency to regard their problems as separate from the rest of the country as a whole.

Just as the poor find their voices excluded from policy-making, so it is with the populations most at-risk for HIV/AIDS. The poor, to be sure, are woefully in the dark about how HIV infection spreads, just as they are less well-informed about procuring available PhilHealth coverage and less likely to seek medical care or testing (HIV/AIDS Testing Centers in the Philippines). Looking at the data on working-class youth, we can see gaps in information, health options and especially policy influence. As a result, those infected with HIV/AIDS come to be stigmatized rather than cared for. Moral condemnation, however, has never been known to cure a disease, much less contain a pandemic.

The Millennium Development Goals mandated by the United Nations (which end this year)had set goals for arresting and then reducing the spread of HIV/AIDS infection world-wide. The Philippine record in this regard has regrettably remained dismal. In 1990, there were only 66 cases reported. But, as of 2014, that number had ballooned to 5,460 active cases. Unlike our relative success in containing malaria and tuberculosis, our response to the spread of HIV/AIDS has been a resounding failure.

So what has been government’s response to the crisis? The DOH’s National HIV/STI Prevention Program has a budget of about P500 million for 2015. Of that, 60% is committed to treatment. The remaining amount—about P200 million—goes into a number of supporting strategies: establishing community-based HIV testing facilities and satellite treatment hubs;working to establish 100% condom-use in entertainment establishments; holding community-based seminars to increase knowledge and awareness of HIV; developing MSM-friendly health facilities and other activities to reach MSMs.

The DOH also supplies officially approved educational materials for legally mandated sex education, including HIV/AIDS and STD prevention. This mandate extends to public and private schools at intermediate grades, secondary and tertiary levels, including non-formal and indigenous learning systems.

However laudable, these policies don’t always reach the most at-risk populations. Many in these groups see “officials” as the enemy, harassing and persecuting them. This perception of officials is understandable, but needs to be changed. For one thing, the DOH’s outreach programs and messaging style could be somewhat improved. For example, it could make greater use of social media, advertising in numerous LGBT and cisgendered dating and hook-up sites. It could also seek out the help and advice of LGBT and sex workers themselves, empowering them to generate tactics for disseminating safe sex practices.

Fortunately, some of the slack has been taken up by NGOs. Organizations like Love Yourself, Inc. and Network to Stop Aids Philippines(NSAP) not only take important roles in community building, they also take an active social media role in encouraging HIV/STD testing within the LGBT-MSM community. Love Yourself, Inc.—a primarily young, mostly MSM group—is an excellent example of community building among at-risk groups that places an emphasis on prevention. NSAP, on the other hand, is a coordinating organization with links to many different communities, platforms and organizations dealing with HIV/AIDS—including people living with HIV support groups.

Though both groups partner with DOH and disseminate their educational material, they are very much independent advocates. Both, for instance, oppose the call of DOH and others for mandatory HIV testing, even though only 0.73% of the men and women in the 15-49 year-old age group have ever actually been tested.

Among the objections to mandatory testing include fears of discrimination (which, though forbidden by law, is still quite common), concerns about privacy and the steep cost of testing in the Philippines, putting it out of the reach of the poor. Mandatory testing as a pre-requisite for university admission or job hiring as proposed by the DOH can thus be seen as discriminatory, and it is understandable that some NGOs would oppose such moves. We might do well, instead, to look to other countries that have done a better job of slowing the spread of HIV/AIDS by providing free and anonymous testing by way of government, universities, private companies and community clinics.

Where sex workers are concerned, there are additional challenges to controlling the spread of the disease. Sex workers are not only socially stigmatized. They are also criminalized not only for what they do but also for who they are. Despite recent legislative attempts that criminalize the buyer of sexual services, anti-vagrancy laws are still enforced that allow the police to arrest women on the mere suspicion that they might be prostitutes.

The United Nations, for its part, has issued a report recommending the legalization of prostitution. Decriminalization,according to the UN,would curb the spread of sexually transmitted diseases. It would also mitigate the exploitation of sex workers, protecting their rights by setting workplace standards.Most significantly, decriminalization would stem the spread of HIV/AIDS by countering the social stigma that limits access to sexual health services, and allow sex workers “to make informed choices about their health.”

However, other advocates for women who are concerned with the spread of HIV/AIDS strenuously oppose legalization. What is missing from this argument, they claim, is the plain fact that all prostitution entails exploitation. Legalization would merely regularize exploitive practices without addressing the socio-economic problems of unequal development under patriarchy from which prostitution emerges. Amore neo-liberal–and perhaps more jaundiced—view contends that legalization is a good thing and would allow women and other sex workers the freedom to make livelihood choices. Still other voices contend that legalizing prostitution could spur trafficking, making it easier to capture and sell women and other persons into the conditions that make up modern day slavery.

These debates are healthy and should be encouraged. As with all public health crises, addressing the threat of HIV/AIDS requires a multi-faceted approach. It calls for the active participation not only of those most at-risk, but of the entire population in conversation with the government, NGOs and an array of international agencies. Rather than scapegoating and shaming, education and empathy must accompany intervention and treatment.

These approaches, however, cannot thrive in an environment that considers only heterosexuality to be normal. We must find ways not only to confront the spread of a disease that–it bears emphasizing–affects everyone. We must also seek to discard the deadly attitudes of homophobia and sexism that fall disproportionately, as will all modes of discrimination, on the poor. Then and only then can we properly address and stem the rising tide of HIV/AIDS. –Lila Ramos Shahani (philstar.com)