When I graduated from high school in Baguio City, I never imagined that the next time I would be there I would be conducting research on HIV/AIDS for Human Rights Watch in the Philippines. Baguio is a lush oasis away from Manila. It used to be the ideal R&R camp for American soldiers stationed at the nearby Clark Air Base. Little did I realize that Baguio was then, and is now, also home to a thriving sex industry. It was the second stop on our HIV/AIDS investigation.
As I listened to sex workers tell their stories, I began to fear an HIV/AIDS explosion in the Philippines. The government boasts that the spread of HIV/AIDS in the country is "low and slow"—only 10,000 cases in a country of 84 million. But an alarming number of people, from teenagers in Catholic schools to monogamous housewives to sex workers, are today rejecting condoms and engaging in unprotected sex. Government surveys show that only 30 percent of female sex workers use condoms consistently, and that the percentage may be falling due to the cost of condoms.
Indeed, HIV is spreading throughout the Philippines. Unfortunately, the country's two most powerful institutions—the government and the Catholic Church—have done little to head off this potential disaster.
While in the Philippines, a researcher and I traveled to four cities and interviewed dozens of sex workers, men who have sex with men, students, and others at high risk of HIV. A male sex worker, Troy, told us that he didn't know anything about HIV except that it was "a contagious disease." We asked him how one could contract it, but he did not know. We asked him if he used condoms with his customers, and he replied "no." He claimed he kept himself safe by choosing only customers who looked healthy. When asked what someone who has HIV would look like, he said, "You know, not healthy."
This attitude is not surprising. In the predominantly Roman Catholic Philippines, condoms are taboo. When I was in school in Manila in the mid-'80s, "sex education" mentioned nothing about HIV/AIDS or condoms, or how to protect ourselves from the disease in any way. Almost 20 years later, with some 30 million people worldwide dead from AIDS, Filipino schools still include only rudimentary lessons on HIV prevention, and virtually no discussion of condoms.
Most Filipinos are taught to associate condoms with birth control-that is, sin-not HIV prevention and protection. One high school student, Nelly, told us she had learned in church that condoms are only a method of family planning, and an unadvisable one at that. "In church, they say abstinence is the most important thing," she said. "They really stress morality. I think condoms have been mentioned, but more in conjunction with family planning. They'll say, 'Why would you try to prevent God's work?'"
Though the Catholic hierarchy opposes the use of condoms, there are some Catholics who are able to reconcile supporting condom use with their religion.
When I was a child, my mother introduced me to Sr. Mary Sol Perpinan, a Catholic nun who takes care of women and children affected by AIDS in Manila. Meeting her again last January, she told me that she advises all of the sex workers she meets to use condoms with their clients. "The Church may take a stand against condoms as contraception," she said. "But when used to prevent a deadly illness, the right to life is higher."
Unfortunately, some key Filipino policymakers disagree. Some local authorities prohibit the distribution of condoms in public health facilities, at times attempting to take disciplinary action against organizations that promote condoms with private funds. Manila Mayor Jose "Lito" Atienza has even issued an order banning condoms and all other artificial birth control from the city's health clinics. As a result, already vulnerable populations, most of whom are extremely poor, have limited access to free condoms. The government says condoms are widely available for sale, but the reality is that they are too expensive for some impoverished Filipinos.
The Philippines still has a chance to avert a deadly HIV/AIDS epidemic, but the government will have to change its complacent attitude and start prioritizing HIV/AIDS as a health issue.
The Philippines is no stranger to calamity. It might take 20 years-or it might take only five—but eventually HIV/AIDS will hit this poverty—stricken nation hard and leave a trail of death. If HIV becomes an epidemic, the government will have no choice but to make it a priority, but the disease will already be out of control. The government and the Filipino people will then be forced into quelling an epidemic, when they could be preventing one now.
Ami Evangelista works for the Asia Division of Human Rights Watch in New York, USA.
