AIDS and TB

There have been strong reactions from NGOs to a statement by Health Secretary Enrique Ona made last week at a meeting of the Philippine National AIDS Council supposedly calling on parents to have their homosexual children tested for HIV/AIDS.

Ona has since clarified that his comments “were taken out of context” and that he was merely emphasizing the need “to involve the family in combating the spread of HIV.”

The AIDS NGOs’ sensitivity about homophobia (an irrational fear of gay people) and stigmatization are well-founded. All throughout the world, countries are reporting major gains in controlling the HIV epidemic. In the Philippines, after years of boasting of a low infection rate, we are now seeing an increase in the number of people with HIV, and the global experience is that in countries where there is discrimination against gays or other groups, the epidemic spreads even more quickly.

Looking at the HIV/AIDS situation has made me think more about tuberculosis or TB, a problem that has come under control in most countries of the world but which continues to be serious in the Philippines. In 2009, the Department of Health identified almost 60,000 new infections.  These were the fortunate ones, most of whom will get treatment. The latest Philippine Health Statistics from the DOH,  which was for the year 2004, listed TB as the cause of some 25,000 deaths, making it the sixth leading cause of death in the country.

Why is TB still so prevalent? Our notorious habit of spitting anywhere and everywhere has been blamed, but this habit is not unique to the Philippines. Even staid and antiseptic Singapore used to have a problem with duraristas (spit terrorists) but didn’t have TB rates like we do today.

Is it poverty?  That certainly plays a role, too, given the way the disease spreads more rapidly in the crowded living conditions of impoverished communities. The high cost of anti-TB medicines was also undoubtedly one reason patients could not finish their treatment but today, through the support of international agencies, the government is able to provide free medicines in a program called DOTS or Direct Observed Therapy Short-term.

Stigma

What’s not talked about enough is how stigma fuels the spread of TB by reinforcing myths and misconceptions around the disease and preventing people from coming out to get medical help and treatment.

Among adults, TB is still seen as the product of a negligent lifestyle, of people who don’t take care of themselves. There is still a widespread misconception, for example, that a prolonged cough is what leads to TB, when it’s actually the other way around, meaning someone with TB develops coughing that doesn’t get better. TB has also been blamed on overwork, lack of sleep, even drinking too much alcohol.

Because we associate TB with men who neglect their health, we go into denial when someone gets TB and doesn’t fit into the stereotype. The fact is that the person with TB can be someone who looks healthy, even the neighborhood security guard or your domestic helper. Yet we blame the long hacking cough on “asthma” or on the fickle weather, afraid to confront the possibility of TB.

It could be worse. About two years ago, I wrote about how my housekeeper asked me to help a friend from Samar who had brought a teenage daughter to Manila for medical consultation. I referred them to UP’s Philippine General Hospital where they were diagnosed with TB.

It turned out TB was the diagnosis as well in Samar, but the family was incredulous and continued to refuse to accept PGH’s confirmation. How could a young girl get TB, the family asked. They were convinced it wasn’t TB but kulam or sorcery. The family continued to refuse treatment and the girl, already with advanced TB, died a few weeks after being brought to Manila.

Victim blaming

We are seeing similar stigmatization and denial around HIV/AIDS. When the first HIV infections were diagnosed in the United States, it was seen mainly as a gay disease. Gay groups throughout the world knew their communities were truly affected, but mobilized themselves to educate each other and to fight discrimination. Rates dropped dramatically in the gay population in countries where they took the lead in education and information campaigns.

In the Philippines, HIV/AIDS was initially associated with overseas workers, particularly seafarers. Local AIDS groups, working with the DOH, responded by focusing on education, coordinating with agencies working with overseas Filipinos and getting AIDS into the pre-departure orientation seminars conducted by government for Filipinos about to be deployed overseas.

Local infections were also blamed on women sex workers.  Again, the NGOs worked hard to educate sex workers and the establishments where they worked in. I will be bold and say many sex workers are probably better protected than our average Filipino because they have more access to information and education about AIDS. (This is not to say they don’t get infected. They do, often because even if they want to use condoms, they don’t have access to them, or their customers refuse to use the condoms, some even citing the Catholic Church ban on their use as an excuse.)

In the last two years, people began to stigmatize call center workers, the result of mass media’s distorted reports on a study from the UP Population Institute. The study was on night-shift workers in general, with call center workers as a subset. Unprotected sex with multiple partners was indeed reported, but this was found for all types of night-shift workers, and not just call center workers.

About the same time as the call center worker scare, there were DOH warnings about increasing infections among men who had sex with men, which then led to gay men being stigmatized.

All these developments will exacerbate the AIDS problem because you will have people arguing that they don’t belong to any of the so-called “high-risk” groups and therefore do not need to protect themselves from HIV infection.

There are men who have sex with men but will insist they are not effeminate, and therefore not gay and not vulnerable when it comes to HIV.

Sounds convoluted? There are overseas workers who rationalize they are not seafarers, and therefore are “safe.” There are young people who have sex occasionally when they need money (for example, “prostituition” for tuition money), or for gifts rather than money, and therefore do not take precautions because they don’t think of themselves as sex workers.

For decades now we have had proven ways of preventing and treating TB, yet it continues to be a major plague for Filipinos. It will be worse with HIV/AIDS, where we have no effective prevention method except condoms, and where the expensive medicines that are available only slow down the virus’ reproduction in the patient. We are still paying for our stigmatization and denial of TB. With AIDS, the toll in human lives and suffering will be much worse, and protracted. –Michael L. Tan, Philippine Daily Inquirer