May 5, 2004

I. SUMMARY

The Philippines faces a possible explosion of human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS), yet its government actively impedes measures that would prevent this incurable and deadly disease.It does so chiefly by impeding access to condoms-the single most effective technology against sexual transmission of HIV, and the cornerstone of HIV prevention efforts since the beginning of the AIDS epidemic.Latex condoms provide an essentially impermeable barrier to HIV pathogens.When used correctly and consistently, they reduce HIV risk to almost zero and have the potential to slow the epidemic spread of AIDS.Programs that include condoms as part of a comprehensive HIV/AIDS response, as opposed to those that promote only sexual abstinence or fidelity, have proven most successful at reducing sexual transmission of HIV and other viruses.In violation of the internationally recognized human right to health, however, the Philippines both interferes with the delivery of effective HIV prevention programs and invests in public health strategies that discourage condom use.

The Philippines shares many of the same HIV/AIDS risk factors of its Asian neighbors, such as high rates of sexually transmitted diseases (STDs), widespread high-risk behaviors, and low knowledge of HIV/AIDS and condom use.What is distinct about the Philippines is that up to 85 percent of the population subscribes to Roman Catholicism, a religion whose leadership objects to the use of condoms for any purpose.In the past, the Philippine government has boldly confronted these objections and pursued an exemplary strategy of condom promotion.But the current administration, led by President Gloria Macapagal-Arroyo, has stood in the way of aggressive HIV prevention strategies by, among other things, failing to support comprehensive reproductive health legislation that would expand access to condoms.In late 2003, President Arroyo was praised by religious conservatives for taking Pesos (P)50 million (U.S.$888,000) from a fund allocated to contraceptive programs under former President Joseph Estrada and awarding the sum to a nongovernmental organization (NGO), Couples for Christ, to teach natural family planning methods.

Condoms are readily available in the Philippines through the commercial sector and through campaigns that provide them at discounted prices.But for poor and marginalized populations, who are arguably at highest risk of HIV, the government restricts programs that would guarantee access to condoms and complete HIV/AIDS information.Government officials have refused to purchase condom supplies with national funds; awarded public contracts to organizations that make misleading statements about condom effectiveness; failed to release local funds earmarked for condom promotion, leading HIV prevention programs to cut services and lay off staff; and even enacted local ordinances prohibiting condoms from public health facilities.The immediate effect of these policies has been to deprive the poorest, most vulnerable members of society of a lifesaving HIV-prevention technology, while leaving relatively unaffected those who can afford private health care.Women and girls, who have been shown to be biologically more vulnerable to heterosexually transmitted HIV than men, have been hit hardest.

The impact of these anti-condom policies on the work of HIV/AIDS service providers in the Philippines is crippling.In interviews with Human Rights Watch, providers said they experienced condom shortages due to the refusal of the Department of Health (DOH) to compensate for a lack of free or subsidized condoms from donor countries.In ManilaCity, where government health clinics are prohibited from distributing or promoting condoms for any purpose, health outreach workers felt compelled to conceal their condom promotion efforts for fear of retribution from city authorities."If the mayor found out, he'd probably have me called into his office and ask me to explain why I do this," one said.Attempts by AIDS educators to teach comprehensive HIV prevention in schools were met with stiff resistance from teachers and principals opposed to birth control.

The Philippine government also fails to counter false scientific claims about condoms, particularly those made by religious authorities.Powerful bishops in the Philippines have always opposed condoms for moral reasons, but more recently some have begun to buttress their moral arguments with false claims about the ineffectiveness of condoms.These include the claim that condoms contain microscopic pores that are permeable by HIV pathogens, a view that is shared by such influential bishops as former archbishop of Manila, Jaime Cardinal Sin, and the head of the Vatican's Pontifical Council for the Family, Alfonso Lopez Trujillo.Although claims of condom porosity have been deemed "totally wrong" by the World Health Organization (WHO)-and, in any case, lack credibility coming from those who oppose condoms for moral reasons-the Philippine government has squandered opportunities to clarify the facts.

To its credit, the government of the Philippines has taken many positive steps to prevent HIV transmission, chiefly through the passage of a 1998 law on the prevention and control of AIDS, and the establishment of HIV surveillance and education activities in several localities.Implementation of the 1998 AIDS law, however, is marred by a flawed legal framework, poor oversight, and a bias against condoms from the highest levels of government.Human Rights Watch interviews with vulnerable persons revealed low levels of knowledge of HIV, inconsistent to no condom use, and poor treatment in public health facilities."I don't use condoms-I never have. . . . I think condoms are not very effective," said one male sex worker in AngelesCity, representing a commonly held view.Institutions mandated by law to provide complete HIV/AIDS information-from public schools to health clinics for sex workers to pre-departure orientation seminars for migrant workers-proved sadly lacking.

Besides repressing condoms and HIV/AIDS information, the Philippines also acts in ways that radically increase the likelihood of a rapid outbreak and spread of HIV/AIDS among populations at high risk, particularly sex workers.Sex workers interviewed by Human Rights Watch said they had been given HIV tests in government clinics without their informed consent-a practice that has been shown to drive people from health and prevention services and increase their risk of infection.Sex workers also said that police routinely used possession of condoms as evidence to arrest and prosecute prostitution."I like to have plenty of condoms in my bag," said one nineteen-year-old street-based sex worker in PasayCity."But if I see the police, I throw my bag away."

The United States, traditionally the largest supporter of HIV/AIDS programs in the Philippines, has proved an unreliable supporter of comprehensive HIV prevention programs.While the U.S. Agency for International Development (USAID) deserves credit for having promoted condoms in the Philippines for many years, in 2002 the agency announced that it would no longer be donating any condoms or other contraceptive supplies to the country.This announcement coincided with a radical policy shift within USAID away from condom promotion and toward programs that gave primary emphasis to abstinence and marital fidelity.While the relationship between these two developments was not evident, it was clear that by early 2004, the Philippines was facing a potentially catastrophic shortage in condom supplies.Non-U.S. donors, such as the United Nations Populations Fund (UNFPA) and the Commission of the European Union, had not implemented a strategyfor addressing this shortage, despite their historic commitment to addressing global condom shortages.

International law guarantees access to condoms and related HIV prevention services as part of the human right to the highest attainable standard of health.The International Covenant on Economic, Social and Cultural Rights (ICESCR), ratified by the Philippines, obliges states parties to take steps "necessary for . . . the prevention, treatment and control of epidemic . . . diseases," including HIV/AIDS.United Nations bodies responsible for monitoring implementation of the ICESCR have interpreted this provision to include access to condoms and complete HIV/AIDS information.[1]The right to information, including information about preventing epidemic diseases, is further recognized by the International Covenant on Civil and Political Rights (ICCPR), also ratified by the Philippines.All major human rights conventions recognize the right to life, which is implicated by policies that interfere with access to life-saving technologies such as latex condoms and the failure to provide life-saving information on HIV transmission and effective HIV prevention measures.

In September 2003, Philippine Health Secretary Manuel Dayrit warned that a combination of high risk behavior and rates of STDs could result in a massive HIV/AIDS epidemic unless swift prevention measures were taken.When asked by Human Rights Watch about his country's approach to condom promotion, however, Dayrit defended his department's decision to fund faith-based family planning programs that shunned condom use.Dayrit said that condoms in the Philippines were provided by many local jurisdictions, and that he could "only persuade" jurisdictions that banned condom use-such as ManilaCity-to change their policies.When pressed, however, Dayrit acknowledged the effectiveness of condoms against HIV, albeit as a last resort after sexual abstinence."The best way to avoid HIV is to abstain from risky behavior," he told Human Rights Watch."[A]nd if you can't help yourself, you have to consider using a condom."

It is a measure of the hypocrisy of Philippine AIDS policy that the Department of Health admits the effectiveness of condoms against HIV/AIDS and yet refuses to promote them aggressively, apparently for fear of offending conservative Catholics.In its 2002 technical report on HIV/AIDS, the Department of Health recommends that local governments "have ample supply of condoms" to prevent further HIV infection.Yet the national government allocates precious resources to anti-condom service providers, takes no discernible steps to counter widespread misinformation about condoms, and permits local authorities to intimidate AIDS service providers who promote condom use.In this environment, it should come as no surprise that many Filipinos avoid or are unaware of condoms as an HIV prevention strategy, risking premature and preventable death.

[1] Committee on Economic, Social and Cultural Rights (CESCR), The right to the highest attainable standard of health: CESCR General comment 14 (22nd Sess., 2000), paras. 16, 34-35.