HIV goes viral

By now, the data are irrefutable: The Philippines has one of the fastest growing rates of HIV/AIDS infection in the world. While globally new HIV cases have declined by 35 percent since 2000, we in the Philippines are seeing a rise: From one new case in 2008, there are now 21 new cases of HIV every day. In certain populations, the epidemic is much more pronounced: An astounding 53 percent of injecting drug users in Cebu are HIV-positive.

Although these figures are alarming enough, they may very likely be understated because they only account for people who have actually been tested for HIV/AIDS. Given the barriers to testing—from stigma to lack of facilities—a vast majority of Filipinos do not know their HIV status, and the 24,936 recorded cases in the Philippine HIV and AIDS Registry as of April 2015 are likely just the tip of the “epidemiological iceberg.”

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How did we reach this point? To answer this question, we must look at the modes of HIV transmission, recent social and demographic trends, and our country’s response to the epidemic since the first case in January 1984.

Because the main mode of HIV transmission is sexual contact, it is impossible to talk about HIV without talking about sex, thus creating barriers to even discussing it—both in familial and institutional settings. As a result, misconceptions remain: For instance, there is a lingering fear among some women that a condom can get lost in the vagina during the sex act. In the 2013 Young Adult Fertility and Sexuality (YAFS) Survey, only 17 percent demonstrated correct knowledge about HIV/AIDS.

Moreover, proper knowledge has not always translated to practice. In the same YAFS study, researchers found that over 70 percent of young people’s sexual encounters are unprotected—even if a similar percentage knew that using condoms can prevent HIV. The reasons are manifold: For many, condoms are seen as a tacit admission to having sex or having an affair, while some feel that these diminish sexual pleasure and intimacy.

Meanwhile, social and technological changes have also engendered risky behaviors. The 24/7 economy and the relative anonymity of urban areas, as well as dating apps like Tinder and Grindr, have made casual sex easier than ever before, increasing risk exposure—a global concern shared by neighboring countries such as Indonesia and Thailand.

Another mode of HIV transmission is injecting drugs, particularly when needles are shared or reused—a particular concern among people who inject drugs (PWIDs) in Cebu. The HIV rates in this population had been kept in check by a needle-exchange program that provided drug users with fresh needles, but it was discontinued in response to provisions in the Dangerous Drugs Act that criminalize possession and distribution of syringes. Advocates implicate this discontinuance in the staggering rise of HIV rates among the PWIDs from less than 1 percent in 2009 to 53 percent in 2010.

That example is illustrative of how misguided policies can engender the rise of an epidemic. But lack of policies can be just as damaging: Until the long-delayed enactment of the Reproductive Health Law in 2012, there was no clear mandate to educate the youth about reproductive health—hence the persistent misconceptions. Even today, there are clear policy gaps, including the provision in Republic Act No. 8504 prohibiting HIV testing of minors without the parents’ consent, an obvious setback to getting many sexually-active youths tested. The RH Law itself remains, as a recent Inquirer editorial put it, “in stasis,” holding back our badly-needed response.

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We can no longer be in denial about the gravity of the problem. Although the absolute number of HIV cases remains low, the rate of increase (>25 percent) means that we are headed toward a full-blown epidemic, the economic and social costs of which would be catastrophic. The Department of Health estimates that just paying for treatments alone will cost the government P4 billion by 2022.

The good news is that science and technology are already there: HIV/AIDS is one of the most studied diseases in history (and, I must add, highly treatable of late—a fact that if widely disseminated should help reduce stigma). We already know, from the voluminous experience of many countries, that proper condom use, harm reduction efforts (i.e., needle and syringe distribution), aggressive information campaigns, accessible testing facilities, and free medicines are effective in combating HIV. Religious groups and politicians like Sen. Tito Sotto must ask themselves about the morality of obstructing proven efforts to stop an illness that is killing people and endangering many others.

We can draw inspiration from the fact that there are tireless campaigners, including people who have come forward as HIV/AIDS-positive and are helping educate their peers and reduce stigma by the very act of coming out. (Hopefully, Miss Universe Pia Wurtzbach will fulfill her pledge to help raise HIV awareness, and that other public figures will follow.) The DOH, for its part, has regularly generated media interest by reporting monthly figures from the HIV registry. But as the recent P1 billion cut in the budget of its contraceptives program shows, even the DOH is subject to political winds.

Ultimately, therefore, a commensurate response boils down to political will, which has hitherto been sorely lacking. For all their claims of leadership, who among the presidential candidates—Binay, Duterte, Poe, Roxas, Santiago—will be strong enough to decisively tackle the rising HIV epidemic?

Gideon Lasco is a physician and medical anthropologist. Visit his website on health, culture and society at www.gideonlasco.com.