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Philippines: Policy Failures Fuel HIV Epidemic

Duterte Should Improve Condom Access for Men Who Have Sex With Men

(Manila) – The Philippine government is fueling a rising human immunodeficiency virus (HIV) epidemic among men who have sex with men through policies that restrict interventions proven to prevent transmission of the virus, Human Rights Watch said in a report released today.

The 46-page report, “Fueling the Philippines’ HIV Epidemic: Government Barriers to Condom Use by Men Who Have Sex With Men,” documents the failure of national and local governments in the Philippines to address the growing HIV prevalence among men who have sex with men.

The Philippines is facing one of the fastest-growing epidemics of HIV in the Asia-Pacific region. According to official statistics, HIV prevalence among men who have sex with men has increased tenfold in the last five years. National education on effective HIV prevention methods is nonexistent, and laws prohibit condom access and HIV testing to people under 18 without parental consent. These factors are contributing to the worsening epidemic among adolescent males who engage in same-sex practices.

“President Rodrigo Duterte has inherited a legacy of failed or counterproductive policies of previous administrations that are contributing to the alarming increase in HIV infections among men who have sex with men,” said Carlos H. Conde, Philippines researcher. “Reducing HIV transmission isn’t rocket science. But it does require the Duterte government to implement an HIV prevention program and remove obstacles to condom and HIV testing access so that young Filipinos – particularly men who have sex with men – can protect themselves from an otherwise preventable illness.”

While the Philippine government instituted effective policies in the 1990s targeting the HIV outbreak among commercial sex workers, it has failed to adapt its prevention strategies in line with the epidemic’s shifting epicenter. Although Department of Health reports indicate that 81 percent of recorded HIV cases since 1984 have been among men who have sex with men, the government has failed to target HIV-prevention measures at this group.

Instead, government policies have created obstacles to condom access and HIV testing. In January 2015, the Senate cut 1 billion pesos (about US$21 million) from the Department of Health’s budget for family planning commodities. Doctors have warned that without the Senate reinstating the needed funding, government clinics are likely to exhaust their condom supplies in early 2017. Local city governments in Balanga City and Sorsogon City have issued directives forbidding government clinics from procuring and distributing contraceptive products, including condoms.

These restrictions reflect the influence of conservative forces in government at both national and local levels, driven by the underlying authority of the Catholic Church. An estimated 80 percent of Filipinos are Roman Catholics, and the Catholic Bishops Conference of the Philippines, which stated in 2015 that Filipinos who contract HIV are products of “broken, dysfunctional families,” has had a longstanding obstructive influence on government health and education policies.

Despite national laws mandating compulsory sexuality education, the Philippine government has failed to provide adequate education programs on safe-sex practices. The majority of public and private schools provide no sex education classes or instruction on methods of prevention of sexually transmitted infections through safe-sex condom use. Promotion and commercial marketing of condoms ignores the population of men who have sex with men by focusing on heterosexual couples rather than lesbian, gay, bisexual, or transgender (LGBT) people.

Policies restricting access to condoms are a threat to public health. International law obligates states to ensure 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, ratified by the Philippines in 1974, directs governments to take steps necessary for the “prevention, treatment and control of epidemic … diseases,” including HIV/AIDS.

During the presidential election campaign, then-candidate Duterte spoke in favor of improving the rights of LGBT people, which LGBT rights activists hope will extend to needed policies for addressing the HIV epidemic among men who have sex with men. Duterte has also committed to improving the “professional competence and operational capabilities” of public health care.

Philippine Health Secretary Paulyn Ubial announced on December 2 that the Department of Health will begin distributing condoms in Philippine schools in 2017 to address the rise in HIV infections among Philippine youth, and is considering the distribution of HIV self-testing kits. Those are positive initiatives if the government can ensure that children can access condoms and HIV self-testing kits through mechanisms that are non-stigmatizing and encourage, rather than discourage, that access. The Department of Health has also announced an initiative to encourage parents to teach safer sexuality education at home, but did not provide details on the need for comprehensive safer sexuality education in Philippine schools.

“The Duterte government has a golden opportunity to remedy the legal and policy errors of previous administrations by implementing proven low-tech and low-cost interventions that can help stop in its tracks the country’s HIV epidemic among men who have sex with men,” Conde said. “Failure to do so will only ensure that the already alarming number of new HIV infections among men who have sex with men will continue to rise.”

Filipinos light candles, which are shaped into an AIDS symbol, to mark World AIDS Day on December 1, 2012, in Manila, Philippines. © 2012 AP Photo/Bullit Marquez

Selected Accounts
“I suppose if the epidemic exploded among, say, mothers and children, we would have a different response by the government. The fact that the epidemic is concentrated on [men who have sex with men], however, makes [the government] ignore it. That happens all the time with government: ‘If it’s gay people who are affected, let’s just look for them, have them tested, list those who are positive, and then we can monitor their movements and behaviors.’ The biggest challenge is stigma.”
–Jonas Bagas, LGBT and HIV/AIDS activist, April 2016

“I never used condoms because I didn’t know [about] condoms. I didn’t know what safe sex was.”
–Nathan, 24, an HIV-positive gay man, San Mateo, May 2016

“These men who have sex with men are happy that there are NGOs that distribute condoms for free, because we’ve found out that they are embarrassed to buy condoms from stores even if these condoms are literally within reach. It’s because when they buy at the pharmacy, the clerks and cashiers couldn’t help looking at them as if they’ve done something wrong. They felt like they were being judged each time they do this in a drugstore.”
–Chard, peer educator, CebuPlus, Cebu City, May 2016

“The messaging about condoms has not changed. The public is always told: ‘Abstain! Be faithful!’ That doesn’t work.”
–Mara Quesada, executive director, Achieve, Quezon City, May 2016

“Condoms are a sensitive product so you have to [market them] in a different way. Not just about the product, but empathy for people and the problem. If there is only one man [in an ad], it’s okay. If there are two men, that’s problematic if the situation is in a bedroom, or if they are ‘lovey-dovey.’”
–Digna D. Santos, executive director, Ad Standards Council, Makati City, April 2016

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