Human Rights Watch found that the ability to deliver or advocate for comprehensive HIV prevention services in the Philippines was crippled by official resistance to condom promotion. This resistance took many forms, including ordinances prohibiting condoms from public health clinics, police interference with condom promotion, weak and unimplemented policies regarding the availability of condoms in sex establishments, and the governments refusal to supply condoms to the public sector with national funds. A failure to integrate reproductive health services into HIV prevention, particularly through the enactment of a national reproductive health policy, further frustrated access to condoms and HIV/AIDS information.
Human Rights Watch also found that anti-condom advocates continued to peddle misinformation about condoms and HIV prevention, though perhaps less publicly than in the early 1990s. The guarantee of comprehensive AIDS information in the Philippine AIDS Act proved no match for this misinformation. Interviews with populations at high risk of HIVincluding sex workers, men who have sex with men, adolescents, and migrant workers and their spousesrevealed low levels of HIV/AIDS awareness, inconsistent to no condom use, and inadequate treatment and information in government health clinics.
In some cities in the Philippines, local authorities have gone as far as to prohibit the distribution of condoms in public health facilities, at times attempting to take disciplinary action against organizations that promote condoms with private funds. The example most frequently cited by service providers is Manila City, where Mayor Jose Lito Atienza has issued an executive order banning all artificial birth control, including condoms, from the citys health clinics. While Human Rights Watch did not find direct evidence of disciplinary action against service providers, many said that the ordinance was used as a basis to discipline nongovernmental organizations that promoted condoms as part of a larger family planning service. According to Dr. Jose Narciso Melchor C. Sescon, a gynecologist and director of the Remedios AIDS Foundation, Inc.:
Sescon told Human Rights Watch that in order to provide integrated HIV/AIDS and family planning services, Remedios would have to go underground. If a client living with HIV/AIDS needed family planning servicesfor example, a married woman who wanted to avoid getting pregnant or infecting her husbandshe would have to be referred elsewhere. If you deliver, if you even speak about family planning services, theyll have a red light on your agency, he said.
The Womens Health Care Foundation (WHCF) is a Quezon City-based NGO that provides a range of reproductive health services and HIV prevention through a network of clinics in Metro Manila. Their clinic in Manila City reaches poor women living in squatter communities, some of whom survive by exchanging sex for money with boat workers in Manila Bay. Gladys Malayang, executive director of WHCF, told Human Rights Watch that WHCF volunteers who distributed condoms and pills in squatter communities feared that they would lose their land if they were caught by city authorities.
Malayang added that government health workers, who are mandated to provide only natural family planning services, sometimes referred women seeking condoms to WHCF, because they feared losing their jobs otherwise. Women squatters would then arrive at WHCF with a cough or cold and secretly ask for condoms or birth control pills.
Human Rights Watch interviewed two volunteer community outreach workers, themselves squatters, who had been trained by WHCF to distribute condoms to women in a squatter community near Manila Bay with an estimated population of 80,000. Lilibeth Buenconsejo, thirty-six, said that she distributed condoms and information to women who climb onto the boats to sell sex. But she kept a low profile because she knew the mayor disapproved of contraception.
Marisa Dela Pena, thirty-two, told Human Rights Watch that she began volunteering as a community health worker six years ago so I could educate my neighbors, especially those who know nothing about family planning. 95 She also distributed condoms to women who survived by selling sex, some of them as young as fifteen. Like Buenconsejo, Dela Pena had developed strategies for avoiding disciplinary action.
In August 2002, Dela Pena was one of several volunteers reported to the mayor for attending a training session on family planning.
The day after this incident, Dela Pena said, she was approached by the government nurse and urged to leave WHCF and work for the city health clinic. She said she refused, because the city clinic taught only natural family planning methods and demonized condoms. At the government clinic, they dont learn anything about condoms, she said. They just say again and again that condoms break easily and they arent safe. To encourage her to leave WHCF, the city offered Dela Pena a substantial salary and a larger spending allowance than WHCF. She did not budge.
Gladys Malayang told Human Rights Watch that in late 2002, she was called into city hall and asked to cease distributing condoms and other forms of artificial birth control. In her defense, she questioned how the city could justify allowing drug stores to sell condoms to those who could afford them, while prohibiting clinics like WHCF from distributing condoms for free. I asked them, why are you discriminating against your poor women?, Malayang said.96
Manila City was not the only jurisdiction in the Philippines that had prohibited condoms from public institutions. A similar policy existed for a time in Puerto Princesa on the island of Palawan. In Laguna, an anti-condom ordinance led to higher rates of unwanted pregnancy, unmet family planning needs, illegal abortions, and increased STI and HIV risk, according to research conducted by the School of Environmental Studies and Management in Manila.97 Davao City did not have an explicit anti-condom ordinance, but efforts to require condom availability in sex establishments failed there because of religious opposition.98
Sex workers and their clients face a particularly high risk of HIV infection in the Philippines, not least because the illegality of prostitution drives them and their clients underground and away from health services. Sex workers in the Philippines are generally divided into those that are registered to work in licensed entertainment establishments, and those that work freelance in either illegal brothels or the street. While all sex work is illegal, registered sex workers are required by occupational health and safety laws to undergo testing in government-run social hygiene clinics for STDs other than HIV.99 The Philippine government also recommends that an ample supply of condoms be made available in sex establishments throughout the country.
Outreach workers interviewed by Human Rights Watch said that sex workers often refused their offers of free condoms, because they feared police would use them as evidence and arrest them. It always happens, said Noel Mandanas, a project coordinator for the NGO Kabalikat ng Pamilyang Pilipino (Kabalikat) who distributes condoms and provides HIV/AIDS and STD counseling in Pasay City. The last time it happened, we asked one of the freelance sex workers why she was refusing condoms. She said the police might use condoms as evidence against her.100 Mandanas added that fear of arrest was one of four main reasons Kabalikat did not meet its condom distribution targets in 2003the others being male customers dislike of condoms, having to charge for condoms because of supply shortages, and clients obtaining condoms from other sources.
Freelance, street-based sex workers interviewed by Human Rights Watch said that police impeded their access to HIV prevention services by confiscating their condoms, using possession of condoms as evidence of prostitution, or arresting them for vagrancy without any evidence of prostitution.101 Maria S., twenty-two, a street-based sex worker in Pasay City, said that police arrest her if they catch her carrying condoms.
Maria S. said that the last time police caught her with condoms, in 2003, they arrested her for vagrancy and put her in jail for a week.
Human Rights Watch heard accounts like this from numerous sex workers in Pasay City. Juliet C., twenty-three, said that police arrested her for vagrancy in January 2003 and used condoms as evidence that she had been engaging in prostitution. She spent six hours in jail before being released.
Using condom possession as evidence of prostitution is an unjust and unreliable method of distinguishing sex workers from people who are not breaking the law. It is also a surefire way to deter those who do work in prostitution from carrying condoms in public and protecting themselves, their families and their communities from HIV. I like to have plenty of condoms in my bag, explained Jessica R., nineteen, a sex worker in Pasay City. But if I see the police, I throw my bag away.104
Human Rights Watch documented a number of restrictions on condom promotion in the Philippines that stemmed not from government ordinances or police conduct, but from arbitrary actions by elected officials, government agencies and church leaders. One agency cited by service providers was the television advertising board (Adboard), which reportedly used obscenity laws to impose restrictions on television public service announcements (TVPSAs) promoting condoms. Dr. Carmina Aquino, director of the USAID-funded AIDS Surveillance and Education Project (ASEP), noted that the Adboard operated under the assumption that condoms promoted promiscuity.
Terry L. Scott, Philippines country director of DKT International, a social marketing organization, told Human Rights Watch that the mere fact that we can run condom ads in the Philippines is a huge, huge plus.106 He described the challenge DKT faces as giving a message that is edgy enough without stepping over the boundary of what is acceptable. As an example, Scott contrasted a proposed advertisement for a brand of condoms known as Frenzy with the version ultimately approved by the Adboard.
Scott emphasized that while the approved version was very different from what we intended it to be, it still met DKTs main objective of targeting youth and promoting the brand.
At another point, Scott said that sometimes, the external difficulties can drive you insane. Scott recalled a 2002 incident in which the board of directors of a chain of 7-11 convenience stories, reportedly chaired by a conservative Catholic, pulled all condom stocks off its shelves after a students parents accused the store of distributing condoms to a minor. Also in 2002, DKTs director of marketing, Benny Llapitan, reported that some supermarket owners had been keeping condoms inside glass shelves for fear of complaints from priests, and that some stores had already been chastised for selling condoms. Llapitan blamed the government in part for not addressing these restrictions. We live in a country with cultural hang-ups and religious restrictions, he said at a 2001 forum on condoms in the Philippines. We work with a government that lacks political will. Meanwhile, the virus continues to spread.107
Anna Leah Sarabia, whose organization Womens Media Circle produced television shows on womens health, said that obscenity laws prevented her from talking frankly about HIV prevention on television. Weve had to master how to say things without saying things, she told Human Rights Watch. You can talk about HIV and say how bad it is. They love it when we say you can get HIV from sex, because what they want us to say is, Dont have sex. Its all about abstinence.108 Sarabia described the conduct of the board of censors, the agency responsible for regulating television content, as arbitrary. The board levied substantial fees to review programs, she said, only to make decisions based on the political whims of the boards director. Like most people, we are forced to self-censor, she said. It costs a lot of money. It really is a form of harassment. Thats the way they control information on sex and sexuality.
Dr. Junice Melgar, executive director of the NGO Linangan ng Kababalhan, Inc. (Likhaan), told Human Rights Watch her organization had been reprimanded by a senator for participating in the 2002 Condoms For Life campaign organized by the Washington-based NGO Catholics for a Free Choice (CFFC). The campaign consisted of a series of billboards and advertisements in six cities, including Manila, depicting a group of robed Catholic bishops alongside the headline, Banning Condoms Kills. On May 17, 2002, the chair of Likhaans board received a letter from Senator Vicente Sotto III, chairman of the Senate Committee on Public Information and Mass Media, stating:
Senator Sottos letter encouraged the advertising industry to engage in self-censorship, stating that whenever the sentiments and good sense of a specific portion of the community is offended, the creative departments of the industry should take the cue and review its content and delivery of the message. Manila Archbishop Jaime Cardinal Sin responded to the CFFC campaign by reiterating his opposition to condoms, telling reporters, I maintain the Churchs stand against condoms and artificial contraception. We must always stand up for what is right even if we are pressured by groups like the CFFC.110
Some experts told Human Rights Watch that the pervasive threat of church opposition had placed a chilling effect on efforts to promote condoms in public places. Dr. Michael Tan, a leading AIDS expert and professor of anthropology at the University of the Philippines, said that university administrators had refused to install condom vending machines in campus bathrooms because theres this fear the Catholic church will come breathing down their necks.111 According to Tan, the university health service provided no condoms for HIV prevention, no sex education, and nothing that could be construed as a family planning service.
Part of what allows local officials, police and government agencies to restrict condoms in the Philippines is the absence of a clear national policy on condom promotion. Thailands 100 percent Condom Campaign, whereby entertainment establishments were required to make condoms available to sex workers and their clients, is often cited as an example of a policy that can enhance local HIV prevention efforts, particularly where the policy is supported by national leadership and a commitment to gender sensitivity.112 Advocacy by USAID and other donors in the 1990s led several local government units (LGUs) in the Philippines to enact 100 percent accessibility of condoms ordinances. However, service providers from many of these LGUs told Human Rights Watch that these ordinances were difficult to enforce without a national policy on condom promotion, and that many were unfunded from the moment they passed.
Wilfred Bidad, director of the Social Health Environment Development Foundation in General Santos City, told Human Rights Watch that [t]he ordinance says that 5 percent of the health budget goes to HIV prevention, but this money is seldom accessed by service providers.113 Bidad and other service providers stressed that the problem was not a lack of funds, but poor accounting procedures and a refusal on the part of local governments to release the money. We were about to submit a proposal, but the government doesnt consider it a priority, said Femia T. Baldeo of the Pearl S. Buck Foundation in Quezon City.114 She added:
Not surprisingly, service providers said their programs had suffered considerably since USAID funds dried up and many local governments refused to fill the void. Before, we employed nine staff and forty-six peer educators, said Maria Lourdes Lim of Human Development and Empowerment Services, a former USAID sub-grantee in Zamboanga City. Thats all gone now.115 Noel Mandanas of Kabalikat added that his program began having to charge sex workers for condoms once the USAID program ended.
Service providers noted that the absence of a national policy on condom promotion made it difficult to implement 100 percent condom policies locally. Without a national training program for police, for example, training was needed every time an officer transferred jobs. Changes in local government structure, especially among police, create a need for new gender-sensitive training every time theres a turnover, said Wilfred Bidad.116 An additional problem was that local governments felt unmoved to pass 100 percent condom ordinances in the absence of a national example. Gladys Malayang, director of the Womens Health Care Foundation and a member of the Philippines National AIDS Council (PNAC), put it this way:
Malayang noted other effects of a lack of national condom policy, such as the refusal of the Department of Health in 2003 to issue a statement about condom use on World AIDS Day. Because World AIDS Day events were to be held in Manila City, Malayang explained, the Secretary of Health agreed not to mention condoms for fear of offending Manilas pro-life mayor, Jose Lito Atienza.118 AIDS service providers reportedly discussed boycotting the event, eventually holding a separate World AIDS Day event in nearby Quezon City.
As of this writing, the Philippines faces what could be an unprecedented crisis in condom supplies. In 2002, the United States government announced that it would no longer be supplying the Philippines with condoms or other contraceptive commodities, choosing instead to encourage condom purchases by the Philippines Department of Health.119 USAID had previously donated up to 80 percent of the condoms supplied by the Philippines government. According to experts interviewed by Human Rights Watch, the subsequent refusal on the part of the Department of Health to compensate for the USAID pull-out was putting a critical strain on condom supplies in many parts of the country. Senator Rodolfo Biazon, an advocate for reproductive health rights in the Philippines, told Human Rights Watch:
A representative of the United Nations Population Fund, which provides technical assistance to the Philippines government on condom procurement and distribution, told Human Rights Watch in late January 2004 that public health clinics in the Philippines had a three-month supply of condoms left. A decision has to be made immediately, he said. In three months, its supposed to be zero. There are areas now that dont have any suppliesmany municipalities.121
Experts stressed that this projected shortage was not simply a result of fiscal constraints, but of the Arroyo administrations investment in programs that discouraged condom use. In October 2003, the Philippine Star reported that Arroyo had taken P70 million [U.S.$1.24 million] from a fund allocated to contraceptive programs under former President Joseph Estrada and awarded the sum to the NGO Couples for Christ (CFC) to provide natural family planning (NFP) programs.122 CFC is an organization that makes misleading statements about contraceptives in its official literature and promotes NFP through an explicitly religious message.123 A 2003 edition of CFCs newsletter, Ugnayan, states that we cannot accept unnatural means, such as contraceptives. This is against not just morals but also against nature.124 The newsletter further criticizes family planning programs for engaging in nefarious activities and promoting the gay lifestyle, including gay marriages. As of March 2004, CFCs Statement of Philosophy stated, We believe in marriage as an indissoluble institution as taught be [sic] our Lord Jesus Christ (Mt 19:6); and that God created marriage primarily for love between man and woman, and for the procreation and proper rearing of children.125
Population expert Dr. Corazon Raymundo said of the governments investment in NFP, As a citizen of this country, I find it embarrassing.126 With typical use, natural methods result in unwanted pregnancy within one year in an estimated 25 percent of cases.127 Raymundo told Human Rights Watch that NFP programs had gained only minimal acceptance among Filipinos, and that they could have an adverse impact on HIV prevention by discouraging people from using condoms. While awareness of HIV/AIDS had persuaded Filipino men to use condoms instead of natural methods, she said, the governments financing of natural methods threatened to undo this progress.
By January 2004, HIV/AIDS advocates in the Philippines were beginning to feel the effects of the pending condom supply crisis. Noel Mandanas, who supervises sex worker outreach programs for the NGO Kabalikat, told Human Rights Watch that his organization had stopped receiving free condoms in early 2003.128 Since then, their only option was to purchase condoms from the social marketing organization DKT International, which sold them at a subsidized price of P2.5 P10 [U.S.$0.04 - $0.17]. Mandanas said that Kabalikat only distributed 13,000 of their projected 20,000 condoms in 2003, in part because they could not afford adequate supplies. While condoms could be provided cheaply by donors, they were beyond the means of small NGOs and even more unaffordable to their clients.
Jomar Fleras, president and CEO of the NGO Reachout Foundation International, said that condom shortages were a problem in Angeles City, home to a large sex industry dating back to the former U.S. military presence in the Philippines. There are no condoms in the system, so everyone has to buy them, Fleras said. Some are not using them. A lot of freelance sex workers may use a condom for the first couple of customers and then stop.129 The country coordinator for UNAIDS in the Philippines, Maria Elena Borromeo, observed that it was the street-based sex workers, not the establishment-based ones, who could not afford to buy condoms. The only source of condoms right now is DKT, she said. And freelance sex workers cant afford condoms, even if theyre cheap.130
Dr. Jose Sescon, executive director of the Manila-based Remedios AIDS Foundation, Inc., noted that condom shortages had never been a problem under President Fidel Ramos, whose health secretary, now Senator Juan Flavier, championed the use of condoms against AIDS. When Senator Flavier was secretary, the department of health supplied us with big boxes of condoms, volumes and volumes of them. Now they just supply us with those small boxes.131
Human Rights Watch asked a representative of USAID, Dr. Corazon Manaloto, whether USAID was concerned that its decision to stop supplying condoms to the Philippines might adversely affect HIV prevention efforts. Manoloto responded that USAIDs strategy was to promote acceptance for socially marketed condoms sold at subsidized rates in the commercial sector, and to encourage local government units (LGUs) to purchase condoms with local funds. The Philippines should become self-reliant rather than depending on donors forever, she reasoned.132 At present, only a small fraction of LGUs in the Philippines purchase condoms, and many populations at risk of HIV infection cannot afford even subsidized condoms.
A project officer for the European Union Commission, Ma. Rita R. Bustamante, told Human Rights Watch that the Commission had not [been] aggressive enough in confronting the Arroyo administration on condoms. Taking a more aggressive posture would be a big disaster, she added, saying:
Bustamante added that in this environment, the EU could accomplish more by advocating for condom promotion at the local level, and in that respect had made some progress by supporting the HIV-prevention activities of some local NGOs.
Other donors, such as UNFPA, had not implemented a strategy for addressing the Philippines encroaching condom shortage. A UNFPA programme officer, Dr. Moises Serdoncillo, told Human Rights Watch the agency had been providing technical assistance to the Philippines Department of Health on condom procurement; however, he added that the Department of Health had not shown any willingness to procure condoms, and that the national government is not even promoting their use.134 Some LGUs were purchasing condoms with local funds, he said, but he did not know how many. Nor was the UNFPA official able to provide an estimate of the number of condoms needed for HIV prevention in the Philippines, or how that demand was going to be addressed in the short term. Asked what would happen in three months time, he said, I dont know. The stock will be gone.
The development of a national reproductive health policy in the Philippines would have gone a long way towards facilitating access to condoms and HIV/AIDS information at the local level, according to experts. But efforts in 2003 to enact a comprehensive reproductive health bill, which would have included provisions on HIV/AIDS and a budgetary allocation for condom supplies, were successfully blocked by the Catholic church. In May 2003, the Catholic Bishops Conference of the Philippines (CBCP) issued a pastoral letter opposing the enactment of reproductive health legislation, to be read at every Sunday mass in the country.135 Although survey data suggest that most Filipino Catholics support candidates who promote family planning, the letter was intended to create the impression of popular support against reproductive health.136
The issuance of a pastoral letter formed part of the churchs larger strategy of using its institutional influence to block reproductive health legislation. In August 2002, CBCP president Archbishop Orlando Quevedo warned politicians over church radio that we will remember you in the next elections if they supported the bill.137 Representative Neric Acosta, one of the co-authors of the reproductive health bill, told Human Rights Watch that in 2003, the bishop of his district organized two demonstrations against him for supporting the legislation, putting his name and face on billboards and branding me as the devil incarnate.
Acosta said that the first demonstration, in April 2003, was advertised as peace rally against the U.S.-led invasion of Iraq, an issue on which he saw eye to eye with the church. And then the peace rally became a family rally and a pro-life rally, he said, and then before you knew it, I was the subject of their wrath and indignation.
Acosta also learned that students of Catholic schools had been required by their teachers to attend the rallies, and that some had signed the petitions under pressure. I talked to a number of high school students who went to these rallies, he said. I talked to some of their parents, and I said, Did they know why they were there, did they know why they were asked to go there? They said, No, we were on a field trip of sorts, we were required, we were going to get extra credit for religion class or something.
Condom opponents in the Philippines have a long history of making false scientific claims about condoms in order to buttress their moral arguments. On August 14, 1994, Jaime Cardinal Sin reportedly told an estimated crowd of 1 million Filipinos that the tiny AIDS virus . . . can pass right through the pores of the condom.139 A similar claim appeared in a pamphlet published by the NGO Pro-life Philippines, which reproduced a diagram of various sperm sizes prepared by researchers at Johns Hopkins University and concluded that [t]hese manage to escape through flaws or minute fissures with sufficient regularity to cause pregnancy and render the condom quite an ineffective method of preventing pregnancy.140 As of this writing, the website of Pro-life Philippines states, under the heading What is AIDS:
In 2002, when the NGO Catholics for a Free Choice posted a billboard in Manila opposing the Vaticans stand on condoms, some conservative Catholics responded by citing evidence of condom ineffectiveness.142
Volunteers for the Womens Health Care Foundation in Manila City told Human Rights Watch they had witnessed family planning seminars in government health clinics in which nurses taught that condoms contained holes.143 This testimony was corroborated by WHCF director, Gladys Malayang.
Some members of influential Catholic organizations in the Philippines expressed more moderate views on condom effectiveness. The director of HIV prevention programs at Catholic Relief Services described the approach of her organization as follows:
Sr. Oneng Mendoza, a representative of Caritas Manila, told the 2001 media forum sponsored by the AIDS Society of the Philippines that I am not condemning the condom but I think it is a good springboard to talk about sex and sexuality . . . [I]f only we could depart from talking about the condom and its supposed lack of efficiency or its connection with promiscuity.146 The director of a network of homes and drop-in centers for women and children affected by HIV/AIDS, Sister Mary Soledad (Sol) Perpinan, told Human Rights Watch, The church may take a stand against condoms as contraception, but when used to prevent a deadly illness, the right to life is higher.147
The impact of disparaging condoms on actual HIV risk behavior is debatable, according to a 2003 report of the Health Action Information Network (HAIN).148 In 2001, anthropologist Michael Tan argued that a significant number of Filipinos shunned the use of condoms and that their reported reasons for doing so closely reflected church orthodoxy. The second leading negative attitude toward condoms consisted of feelings of embarrassment at having to buy a condom at a store, Tan wrote, referring to a survey of young adults. Certainly, those feelings come from the way religious conservatives have depicted condoms, associating them with illicit sex and claiming that condom distribution promotes promiscuity.149
Human Rights Watch asked the Philippines Secretary of Health, Dr. Manuel Dayrit, how his department responded to false scientific claims about condoms, particularly claims of condom porosity. We take that as part of the pot of information that goes around, he said. So in that instance we would get a second opinion and find out from the manufacturer or whoever if that is an accurate statement. . . . We wouldnt just accept it at face value unless the evidence was shown.150As of this writing, the website of the Philippines Department of Health states that safe sex is not strongly recommended as an HIV prevention strategy, but mentions correct and consistent use of condoms as an option for people who cannot abstain from sexual contact or who cannot maintain a mutually faithful relationship.151
Some experts felt that the admonition to be faithful to ones partner exposed people to HIV risk just as lying about condoms did, especially people who could not guarantee their spouses fidelity. Women will say, but God will protect me, my husband would never do that, said AIDS educator Anna Leah Sarabia. The realization that their husband is not faithful is more shocking to them than testing positive for HIV.152
Human Rights Watch interviewed numerous individuals at high risk of HIV/AIDS in the Philippines, including male and female sex workers, men who have sex with men, young adults, and migrant workers and their spouses, about their knowledge of HIV/AIDS and how to prevent infection. Given the countrys restricted HIV/AIDS policy environment, it came as no surprise to find that these populations subscribed to dangerous myths about the disease. These myths prevailed despite the fact that domestic law in the Philippines guarantees access to complete HIV/AIDS information in the countrys schools, health facilities, work places, pre-departure seminars for overseas workers, tourist destinations, and local communities.153 Especially troubling was the fact popular opinion sometimes reflectedand exacerbatednegative stereotypes about people living with AIDS.
Human Rights Watch interviewed both registered and unregistered sex workers in the Philippines, the former referring to men and women who work in regulated entertainment establishments, and the latter to those who work in illegal brothels or the street. Numerous sex workers said they did not know anything about HIV/AIDS or how to prevent it. Clara S., nineteen, a registered sex worker in Angeles City, told Human Rights Watch.
Non-registered sex workers, who worked in illegal brothels or in the street, had similar stories to tell. Leah P., twenty-nine, said she worked illegally in a brothel but attended a government-run social hygiene clinic in Angeles City for routine health care. She said she had learned nothing about HIV/AIDS from the clinic:
Leah P. said that she sometimes used condoms, but that the most effective way for her to prevent HIV was to wash with water after sex.
Government surveys of condom use among sex workers in the Philippines show low levels of consistent condom use, as well as decreases in consistency of condom use over time in numerous cities. Only 30 percent of registered female and freelance sex workers reported consistent condom use in 2002.156 In one city, consistent condom use among registered sex workers decreased from 68 percent in 1997 to 11 percent in 2002, even though the government had established HIV prevention programs and sentinel surveillance in this period.157 In another, consistent condom use among freelance sex workers decreased from 58 percent in 1997 to 18 percent in 2002.158
Condom use and HIV/AIDS knowledge was equally low among male sex workers, according to interviews conducted by Human Rights Watch. Joel R., twenty-two, a registered sex worker in Angeles City, said that he had sex with male and female customers at least three times a week, sometimes more, but did not know how to protect himself from HIV.
Asked what he knew about condoms, Joel R. said:
Many sex workers interviewed by Human Rights Watch subscribed to dangerous myths about condoms, including that they were not necessary with a usual sex partner.161 Jane Perez, program coordinator for the Angeles City AIDS Council, observed that in her city, the sex workers only use condoms for their one-time partners, but not for their regular partners.162The belief that condom use is unnecessary in long-term or single-partner relationships is especially dangerous for people whose regular partners engage in extramarital sex without consistently protecting themselves. Richard P., thirty-two, a sex worker in Quezon City who also has a girlfriend, told Human Rights Watch that he did not use condoms with all of his customers, because sometimes . . . I know the customer, and that he cant have multiple partners besides me. I know because he tells me. But Richard P. did not use condoms with his girlfriend because, as he put it:
Richard P. added that his girlfriend did not know he worked in the sex industry, because she would not accept it.
Other sex workers interviewed by Human Rights Watch harbored unfortunate prejudices about HIV/AIDS, including that people with AIDS or STDs were recognizable by their symptoms. I dont use condomsI never have, said Jericho M., twenty-four, a registered sex worker. The customers dont look like they have any sicknesses. Asked what a sick person looked like, Jericho M. shrugged and said, I dont know. They looked healthy. They didnt look like they were sick.164
Filipino men who have sex with other men, some of whom assume feminine traits and identify as bakla or queer men,165 face a disproportionate vulnerability to HIV/AIDS. Deep stigma, often manifested by outright violence and discrimination, can drive men who have sex with men away from mainstream health services and toward anonymous, casual, and unsafe sexual encounters. As of 2002, 83 percent of reported AIDS cases in the Philippines were attributed to sexual transmission, of which 21 percent involved male-to-male sex.166
Men who have sex with men interviewed by Human Rights Watch subscribed to a number of dangerous myths about condoms and AIDS. I dont ask men to use condoms, because I know them, said Syper T., eighteen, who sometimes accepted money from men to have sex.167 Syper T. said he also had sex with girls, but men often approached him to buy sex in a pool hall in Pasay City. When I have sex with girls, theyre not sick, he said, asked whether he used condoms. Theyre not like women who sell themselves.
Men who have sex with men also said that condoms reduced sexual pleasure. Theres no thrill if you use it, said Syper T. Aramina F., twenty-one, who said he exchanged sex for money with taxi drivers in Pasay City, said, I hardly ever use them [condoms]. The customers usually dont want condoms. They say its a bother, that it disturbs them.168
Unpublished research provided to Human Rights Watch by the NGO Progay Philippines focused on a number of health issues, including access to condoms, faced by eighty Filipino bakla in Manila and Baguio City. The research concluded that [d]espite many attempts to share information for safer sex in gay communities, the bakla in many poorer communities do not seem to have heard that condoms are also for gay sex.169 This may have been because, as one bakla pointed out, condoms were perceived solely as a method of contraception. Of eighty bakla interviewed, only one reported consistent condom use for anal sex.
Even for men who had sex with men and used condoms consistently, Human Rights Watch found that harassment by police could increase HIV risk. Trina F., twenty-one, told Human Rights Watch he had learned from an NGO that condoms could prevent HIV and other STDs, but some police just take the condoms.170 On one occasion in November 2003, Trina F. was apprehended by police after a friend of his offered sex to an undercover officer. They found a condom on one of my friends because it was hanging out of his pocket, he said. It seemed like they got harsher with him because they had evidence.
For the approximately 16.5 million Filipinos aged fifteen to twenty four, lack of complete information about HIV prevention, including information about condoms, can be a death sentence. The 2002 Young Adult Fertility Survey (YAFS), a survey of almost 20,000 Filipino adolescents from sixteen regions, found that 23.5 percent of respondents had engaged in pre-marital sex, the majority of which was unprotected.171 Only 27.5 percent of sexually active males and 14.9 percent of sexually active females reported using contraceptives of any kind for their first sexual experience. For their most recent sexual experience, 26.6 percent of males and 21.8 percent of females reported using contraceptives. Adolescents said they had sex to express love (40 percent), release an urge (14 percent), and satisfy curiosity (20 percent). Of those who had engaged in pre-marital sex, 35 percent said they had more than one partner, and 11 percent said they had sex with a same-sex partner.
In 2002, the United Nations reported that most of the worlds young people have no idea how HIV/AIDS is transmitted or how to protect themselves from the disease.172 This observation is borne out starkly in the Philippines, where 73.4 percent of a sample of youth aged 15-24 said in 2002 they thought they had no chance of getting AIDS.173 This figure is even higher than it was in 1994, when it stood at 72.8 percent. While 95.1 percent of YAFS respondents said in 2002 they had heard of AIDS, 27.8 said they thought AIDS was curable, compared to 12.5 percent in 1994. This suggests that knowledge of HIV/AIDS among Filipino youth is decreasing over time.
In Manila City, where the mayor had banned condoms from public health clinics, NGOs that specialized in school-based sex education found it difficult to deliver their services. Dr. Marilyn A. Pajel-Calilung, executive director of the NGO Kabalikat, said that sex education there is limited to basic human anatomy, without any discussion of sexual health.
Corazon Raymundo, the principal author of YAFS, concurred. Technical information is not what young people need, she said. Youth need people to talk to when they feel something they cant explain. These are things you cant learn from sex education as it is here in the Philippines.175
The very provision of the Philippines AIDS law requiring HIV/AIDS education in schools contains a confusing clause mandating that such education not be used as an excuse to propagate birth control or the sale or distribution of birth control devices. This clause was inserted to placate religious leaders, who worried that HIV/AIDS education would eventually lead to artificial contraception and abortion. HIV/AIDS educators interviewed by Human Rights Watch found this provision impossible to comply with. According to Marilyn Calilung of the NGO Kabalikat, which provides school-based HIV/AIDS education in Metro Manila:
Calilung added that principals or guidance counselors sometimes vetted their teaching modules in advance to ensure they did not contain information about artificial birth control such as condoms. In one school, she said, we have difficulties because our contact person, who is a guidance counselor, does not believe in our project and has misconceptions about reproductive health. She added:
The testimony of Prue S., sixteen, illustrates the detrimental impact of family planning lessons that discuss only natural methods on HIV prevention. A high school student in Baguio City, Prue S. told Human Rights Watch that he thought that the calendar method a term commonly used in natural family planning materials to refer to the timing of sexual intercourse according to the fertile phases of a womans menstrual cyclewas an effective method of HIV prevention. He described the application of the calendar method to HIV prevention as follows:
While Prue S. could not identify where he saw the pamphlet containing this information, his testimony illustrates the dangers of not providing complete information about both behavior change and condom use.
In educating students about HIV/AIDS, schools in the Philippines have to compete with anti-condom messages delivered in some churches. According to YAFS, 18 percent of Filipino youth think that their religion is against family planning. Nelly P., fifteen, told Human Rights Watch that she had learned in church that condoms were only a method of family planning, and an unadvisable one at that.
Nenet L. Ortega, who does school-based HIV/AIDS education in Manila for the Remedios AIDS Foundation, Inc., added that private Catholic schools were particularly resistant to condom education. One school said to us, No, you cant say anything about condoms, Ortega said. We said, OK, if that is your wish, we wont discuss anything about condomsjust abstinence and monogamy.179
The government of the Philippines actively promotes overseas employment, yet its laws and policies do not adequately inform migrant workers of their high vulnerability to HIV/AIDS.180 This vulnerability stems from a myriad of factors, including homesickness and the desire for sexual contact, unwanted sex (including sexual violence) in the workplace, economic pressure to engage in paid sex to augment income, and vulnerability to sex trafficking.181 The Philippines AIDS Act requires migrant workers to attend a pre-departure orientation seminar (PDOS), which includes a module on HIV/AIDS prepared by the Philippine National AIDS Council.182 Experts have observed, however, that the HIV/AIDS component of PDOS is truncated, not integrated into the overall discussion of migration realities, and, like the PDOS itself, conducted immediately before departure when the worker is preoccupied with other business.183
Malou Marin, executive director of a nongovernmental organization specializing in migration and HIV/AIDS, told Human Rights Watch that she did not offer her organizations services to PDOS, because she felt the process was flawed and that her time would be better spent educating departing migrants and their families at the community level. HIV/AIDS is often neglected, Marin said of PDOS. They just do the basic stuff, which isnt relevant to most overseas workers. Its AIDS 101 without any links to migration.184
Human Rights Watch met Noel P., forty-five, at a home for people living with HIV/AIDS in Manila. Noel P. said he had become infected with HIV in 1999 as an overseas worker in Riyadh, Saudi Arabia. At the time, he said, I didnt know the mode of HIV transmission. I only knew AIDS was a scary disease. His attitude toward condom use had been shaped in part by what he learned in church.
Noel P. added that he did not receive adequate post-test counseling when he tested positive for HIV, only prejudice from a health care worker. I remember that the doctor wanted me to sign for the test results, but she didnt want me to use her pen, he said. I thought, Oh God, this is the one preaching to me about how to avoid HIV transmission?
The spouses of migrant workers, no less than migrants themselves, also face a high vulnerability to HIV/AIDS when they are not provided with adequate information. Despite this, the only HIV/AIDS programs for spouses of migrants in the Philippines are carried out by NGOs.186 Immediate deportation of migrant workers who test positive for HIV, which is a policy in many countries where Filipinos work abroad, further marginalizes workers and their spouses from support services and counseling after the migrants return home. Without proper counseling, many spouses of migrants cling to the myth that fidelity in marriage will protect them from AIDS. It is a religious belief here that if someone is my partner, I will protect him, and he will protect me, said Michael Tan. This is only reinforced by the message that condoms dont work.187
Aimee V., forty-one, told Human Rights Watch her husband infected her with HIV after he returned from a one-year overseas contract in South Africa.
Aimee V. said she did not find out her husband was HIV-positive until three days before he died, in 1997. By that time, she had been having unprotected sex with him for four years. She also realized that she had breastfed her youngest child until 1994, one year after her probable infection with HIV. She tested positive herself in 1999 but did not have the courage to have him tested. I cant handle it, she said. I have no money for treatment.
The illegal status of all sex workers in the Philippines predisposes them to HIV infection by impeding their access to information and prevention services. As of December 2002, nearly one-fifth of reported AIDS cases in the Philippines had occurred among men and women working in entertainment establishments, where sex is frequently exchanged for money.189 Human Rights Watch documented numerous violations of the rights of sex workers, ranging from forced HIV testing to denial of complete HIV/AIDS information, that elevated their risk of HIV infection.
As noted above, Philippine law requires sex workers who are employees of licensed entertainment establishmentssometimes known as registered sex workersto receive regular screening for STDs other than HIV in government health facilities known as social hygiene clinics. These clinics date back to the U.S. military presence in the Philippines, when American soldiers fueled a high demand for sexually available Filipina women and the U.S. military sought to protect their troops from STDs.190 The clinics are currently mandated to provide voluntary HIV tests, pre- and post-HIV test counseling and regular HIV prevention seminars, in addition to testing for other STDs. Testimony gathered by Human Rights Watch, however, suggests that some sex workers were not giving their informed consent for HIV testing, making the tests de facto mandatory in violation of Philippine law.
Clara S., nineteen, told Human Rights Watch she had been a dancer at an entertainment establishment in Angeles City for four months. She described the treatment she received at the social hygiene clinic as follows.
Twenty-seven-year-old Rosie P., a sex worker in Angeles City, said that she opted for regular HIV testing in addition to required STD tests because she wanted to know if she was HIV-positive. Still, she could not answer basic questions about HIV transmission.
Jericho M., twenty-four, a registered sex worker in Angeles City, gave a similar account.
Testimony from Diane R., nineteen, suggested that some sex workers may not have been giving their informed consent to HIV tests administered in social hygiene clinics. A registered sex worker for eleven months, Diane R. was under the impression her HIV tests were required.
In Quezon City, the manager of a gay bar told Human Rights Watch that the Quezon City health department conducted annual mandatory HIV tests of all of the sex workers in the bar.
The manager added that the sex workers never received the results of their HIV tests. The health office came back after one month, he said, but by the time they came back, the claim stubs for the results were almost all lost, so no one claimed their result.
Human Rights Watch asked Dr. Celia Flor Brillantes, chief of the social hygiene clinic in Baguio City, how her clinic ensured that sex workers gave full and informed consent to HIV testing. Brillantes said that because of the success of their information and education campaigns, 100 percent of the clinics patients wanted HIV tests. We try as much as much as possible to have them understand they need to be tested, she said. Her response also suggested, however, that informed consent was not something the clinic took seriously.
HIV testing without informed consent is a violation of Philippine law as well as international public health and human rights standards.197 Just as important, testing without informed consent may deter people who do not want HIV tests from seeking routine health care. Sex workers who think that attending to a health clinic will result in an involuntary HIV test may sooner not attend a clinic at allthus being deprived of vital HIV prevention services and even primary medical care. Social hygiene clinics in the Philippines should review their policies in HIV testing to ensure that patients are fully apprised of their option to refuse HIV tests, in accordance with national and international law.
Health experts interviewed by Human Rights Watch identified a number of problems with using a system of social hygiene clinics to prevent HIV/AIDS and other STDs among sex workers. Chief among them was that the clinics functioned more as an employment screening process than as a genuine health service. The clinics should provide a more honest to goodness testing and treatment for STDs, rather than just a clearance to work in sex establishments, said Dr. Corazon Manoloto, a public health adviser for USAID.198 Other experts said that police sometimes used the mandatory testing system as a pretext for harassing sex workers whose tests were not up to date.199 As a substitute, experts suggested that the government provide confidential STD testing and information through a network of mobile clinics and NGO outreach workers.
Social hygiene clinics also fueled the stereotype that sex workers were an unsanitary population that needed to be kept clean for their customers, experts said. Even the term social hygiene clinic itself is so repulsive, said Dr. Michael Tan. Its all about keeping the sex workers clean for the men.200 This approach also created a false sense of security among clients. Because the pink card is stamped, clients think, Im OK, said Carmina Aquino, director of the USAID-funded ASEP program. It makes women responsible for protecting their customers, when its not their responsibility.201 To remedy this problem, one social hygiene clinic in Angeles City had renamed itself the reproductive health and wellness center and begun to target populations other than sex workers.
Finally, by targeting establishment-based sex workers for mandatory STD testing, social hygiene clinics inadvertently discouraged others in the communityincluding freelance sex workersfrom seeking health services. Social hygiene clinics are overwhelmingly frequented by sex workers and are typically located in the heart of red-light districts. The clinics reinforce the idea that the only population that needs HIV testing is registered sex workers, said Tan. Manoloto noted that freelance sex workers, while allowed in the clinics, might stay away for fear of arrest, inferior treatment, or simply because the clinic has been branded as being for registered sex workers.
91 Human Rights Watch interview with Dr. Jose Narciso Melchor C. Sescon, executive director, Remedios AIDS Foundation, Inc., January 20, 2004. Sescon did not specify when this inspection took place.
92 Human Rights Watch interview with Gladys Malayang, executive director, Womens Health Care Foundation, Quezon City, January 28, 2004.
93 The barangay is the lowest level of government in the Philippines. As of December 31, 2000, there were an estimated 41,943 barangays in the country.
94 Human Rights Watch interview with Lilibeth Buenconsejo, community health outreach worker, Womens Health Care Foundation, Quezon City, January 28, 2004.
95 Human Rights Watch interview with Marisa Dela Pena, community health outreach worker, Womens Health Care Foundation, Quezon City, January 28, 2004.
96 Human Rights Watch interview with Gladys Malayang, Quezon City, January 28, 2004.
97 Human Rights Watch interview with Oslek Espaldon, Womens Health Care Foundation, Quezon City, January 28, 2004; Email communication from Dr. Maria Victoria Espaldon to Human Rights Watch, March 31, 2004.
98 Human Rights Watch interview with Dr. Roberto V. Alcantara, Davao City Health Office, Quezon City, January 21, 2004.
99 The Code on Sanitation of the Philippines, Presidential Decree No. 856 (1976), ss. 57, 62. As a pre-condition to employment in entertainment establishments or massage parlors, sex workers are issued a health certificate, sometimes known as a pink card, noting the results of regular STD tests. Compulsory HIV testing as a precondition to employment is illegal in the Philippines pursuant to s. 16 of the Philippine AIDS Prevention and Control Act.
100 Human Rights Watch interview with Noel Mandanas, project coordinator, Kabalikat ng Pamilyang Pilipino, Manila, January 16, 2004.
 Vagrancy laws have been declared a violation of human rights in some countries because of their excessive vagueness, but they remain on the books in the Philippines.
102 Human Rights Watch interview with Maria S., Pasay City, January 30, 2004.
103 Human Rights Watch interview with Juliet C., Pasay City, January 30, 2004.
104 Human Rights Watch interview with Jessica R., Pasay City, January 30, 2004.
105 Human Rights Watch interview with Dr. Carmina Aquino, Manila, January 19, 2004.
106 Human Rights Watch interview with Terry L. Scott, country director, DKT Philippines, Inc., Manila, January 19, 2004.
107 AIDS Society of the Philippines, Condoms: Issues and Controversies, proceedings of a Special Media Forum of the AIDS Society of the Philippines (2001), p. 20.
108 Human Rights Watch interview with Anna Leah Sarabia, executive director, Womens Media Circle, Quezon City, January 21, 2004.
109 Letter from Senator Vicente C. Sotto III to Dr. Sylvia Estrada-Claudio, chairman of the board, Likhaan, May 17, 2002.
110 A. Nocum, Sin firm vs condoms, Philippine Daily Inquirer, February 23, 2002.
111 Human Rights Watch interview with Dr. Michael L. Tan, professor, University of the Philippines and senior program advisor, Public Health Institute, Quezon City, January 21, 2004.
112 See, e.g., UNAIDS, Report on the global HIV/AIDS epidemic: 2002, pp. 88-89.
113 Human Rights Watch interview with Wilfred Bidad, Social Health Environment Development (SHED) Foundation, Manila, January 15, 2004.
114 Human Rights Watch interview with Femia T. Baldeo, program development officer, Pearl S. Buck Foundation-Philippines, Inc., Manila, January 15, 2004.
115 Human Rights Watch interview with Maria Lourdes Lim, Human Development and Empowerment Services, Manila, January 15, 2004.
116 Human Rights Watch interview with Wilfred Bidad, January 15, 2004.
117 Human Rights Watch interview with Gladys R. Malayang, Quezon City, January 28, 2004.
118 Ibid.; Human Rights Watch telephone interview with Dr. Manuel Dayrit, secretary, Philippines Department of Health, New York, February 9, 2004. Mayor Atienzas pro-life policies are discussed above, Anti-condom ordinances.
119 Y. Fuertes, Last USAID shipment of condoms in November; Human Rights Watch interview with Dr. Corazon R. Manaloto, public health advisor, USAID Office of Population, Health and Nutrition, Manila, January 26, 2004.
120 Human Rights Watch telephone interview with Sen. Rodolfo Biazon, New York, February 5, 2004.
121 Human Rights Watch interview with Dr. Moises Serdoncillo, programme officer, United Nations Population Fund, Manila, January 30, 2004.
122 Arroyo diverted funds for contraceptives UN, Philippine Star, October 24, 2003. The press later reported that the amount was P50 million [U.S.$888,000]. Natural family planning (NFP) programs are those that aim to control the spacing of children through methods that do not include artificial contraception. They include the rhythm or calendar method, whereby couples voluntarily avoid sex during the fertile phase of the womans menstrual cycle, and withdrawal or coitus interruptus, whereby the man completely removes his penis from the womans vagina before he ejaculates. Other natural methods include the cervical mucous method, whereby the woman attempts to recognize the fertile phases of her menstrual cycle by the presence of cervical mucus in the days leading up to ovulation; the basal body temperature method, whereby the woman charts changes in her body temperature against her menstrual cycle; the sympto-thermal method, a combination of monitoring cervical mucous and body temperature; and the lactational amenorrhea method, whereby the woman attempts to use breastfeeding as a method of suppressing ovulation. These methods, in addition to various barrier methods such as condoms, diaphragms and spermicides, are described at http://reproline.jhu.edu/english/1fp/1methods/1methods.htm.
123 A number of family planning advocates, including former Secretary of Health Dr. A.G. Romualdez, Jr., objected to the decision to fund CFC as a potentially unconstitutional violation of the separation of church and state. See, e.g., An Expression of Protest Against Secretary Dayrits Diversion of DOH Funds Allocated for Family Planning Contraceptives, http://www.plcpdfound.org/News/press percent20stmts/jan_mar04/protestStmt.htm (retrieved March 13, 2004); R. Jimenez-David, Brazen and Wrong, Philippine Daily Inquirer, December 6, 2003; A.G. Romualdez, Jr., Couples for Christ and the DOH, Malaya, December 18, 2003.
124 F. Padilla, Population Control and CFC, Ugnayan, vol. XIV, no. 5 (Sept-Oct. 2003), p. 19.
125 Couples for Christ, Statement of Philosophy, http://www.cfcglobal.org.ph/aboutus/statement_of_philosophy.htm (retrieved March 13, 2004).
126 Human Rights Watch interview with Dr. Corazon M. Raymundo, professor, University of the Philippines and project director, Young Adult Fertility and Sexuality Study (YAFS), Manila, January 21, 2004.
127 J. Trussell and D. Kowal, The Essentials of Contraception: Efficacy, Safety, and Personal Considerations, in R.A. Hatcher et al., eds., Contraceptive Technology: Seventeenth Revised Edition (New York: Ardent Media, Inc., 1998), p. 216, Table 9-2. Typical use of male condoms results in unwanted pregnancy within one year in an estimated 14 percent of cases. With perfect use, natural methods fail in anywhere from 1 percent to 9 percent of cases, depending on the method used. This compares to a 3 percent failure rate for perfect use of male condoms, a 0.1-0.5 percent failure rate for perfect use of pills, and a 0.1-1.5 percent failure rate for perfect use of intrauterine devices (IUDs). The newsletter of Couples for Christ claims, misleadingly, that NFP, properly lived out, is proven to be 99% effective, more effective than condoms, pills or IUDs. F. Padilla, Population Control and CFC, p. 20.
128 Human Rights Watch interview with Noel Mandanas, Manila, January 16, 2004.
129 Human Rights Watch interview with with Jomar B. Fleras, president and CEO, Reachout Foundation International, Manila, January 15, 2004.
130 Human Rights Watch interview with Dr. Ma. Elena F. Borromeo, Manila, January 15, 2004.
131 Human Rights Watch interview with Dr. Jose Narciso Melchor C. Sescon, Manila, January 20, 2004.
132 Human Rights Watch interview with Dr. Corazon R. Manoloto, January 26, 2004.
133 Human Rights Watch interview with Ma. Rita R. Bustamante, project officer, Delegation of the European Commission to the Republic of the Philippines, Manila, January 29, 2004.
134 Human Rights Watch interview with Dr. Moises Serdoncillo, Manila, January 30, 2004.
135 Catholic Bishops Conference of the Philippines, Magdanay Kamo Sako Asin Magdadanay Ako Saindo (Juan 15:4), May 19, 2003.
136 A December 2000 survey of Filipino adults conducted by Pulse Asia, for example, revealed that 69 percent of 1200 respondents said they would support a candidate who favored a couples free choice of contraceptive methods. Institute for Social Studies and Action, ReproWatch, vol. 32, no. 4 (August 16-30, 2002), p. 2.
137 Ibid., p. 1.
138 Human Rights Watch telephone interview with Congressman Neric Acosta, New York, February 11, 2004.
139 E.K. Wilkinson, AIDS Failure Philippines, p. 98. Wilkinson claims to have attended this rally and heard the claim himself. He also excerpts a transcript of a February 21, 1993 episode of the television show Mel and Jay, in which Bishop Teodoro Bacani reportedly said: And the hole of the smallest condom, according to what was taught us is 0.5 microns. And do you know that the sperm is 0.03 microns? 0.01 microns can easily penetrate the hole that condoms have.
140 Ibid., pp. 99-102.
141 See http://www.prolife.org.ph/article/articleprint/81/-1/34/ (retrieved March 4, 2004) (emphasis in original).
142 P. Goodenough, Philippine Pro-Lifers Take On Free Choice Catholics, Cybercast News Service, April 19, 2002.
143 See testimony in Local anti-condom ordinances, above.
144 Human Rights Watch interview with Gladys Malayang, Quezon City, January 28, 2004.
145 Human Rights Watch telephone interview with Mila Lasquety, Catholic Relief Services, Manila, January 30, 2004.
146 AIDS Society of the Philippines, Condoms: Issues and Controversies, p. 34.
147 Human Rights Watch interview with Sr. Mary Soledad Perpinan, president and CEO, Third World Movement Against the Exploitation of Women, Quezon City, January 27, 2004.
148 Health Action Information Network (HAIN), HIV/AIDS Country Profile Philippines (2002), p. 4.
149 M.L. Tan, Condoms, chastity and justice, Philippine Daily Inquirer, August 14, 2001.
150 Human Rights Watch telephone interview with Manuel Dayrit, New York, February 9, 2004.
151 Philippines Department of Health, AIDS Primer, http://www.doh.gov.ph/chd-cv percent20homepage/primer/AIDSPrimer.htm (retrieved March 2, 2004).
152 Human Rights Watch interview with Anna Leah Sarabia, Quezon City, January 21, 2004.
153 Philippine AIDS Prevention and Control Act, art. 1, implemented by rule 2.
154 Human Rights Watch interview with Clara S., Angeles City, January 23, 2004.
155 Human Rights Watch interview with Leah P., Angeles City, January 23, 2004.
156 Status and Trends of HIV/AIDS in the Philippines, p. 18, Figure 7.
157 Ibid., p. 19, Table 9.
159 Tulo, the Tagalog word for drip, is slang for so-called discharge STDs such as chlamydia and gonorrhea.
160 Human Rights Watch interview with Joel R., Angeles City, January 23, 2004.
 Experts attribute inconsistent condom use among sex workers in the Philippines largely to the belief that one cannot get HIV from an intimate sex partner. See, e.g., Status and Trends of HIV/AIDS in the Philippines, p. 19.
162 Human Rights Watch interview with Jane Perez, coordinator, Angeles City AIDS Council, Angeles City, January 23, 2004.
163 Human Rights Watch interview with Richard P., Quezon City, January 19, 2004.
164 Human Rights Watch interview with Jericho M., Angeles City, January 23, 2004.
165 The translation of bakla into queer men is from E.D. Atadero, Needs assessment on health information sharing dynamics of bakla communities, unpublished report prepared for DKT Philippines, 2003.
166 Status and Trends of HIV/AIDS in the Philippines, p. 14.
167 Human Rights Watch interview with Syper T., Pasay City, January 28, 2004.
168 Human Rights Watch interview with Aramina F., Pasay City, January 28, 2004.
169 E.D. Atadero, Health information sharing dynamics of bakla communities.
170 Human Rights Watch interview with Trina F., Pasay City, January 28, 2004.
171 C.M. Raymundo, Sex Practices and Reproductive Health of Filipino Youth, presentation at the First Philippines National Conference on Sexual and Reproductive Health, Manila, January 16, 2004.
172 UNICEF, UNAIDS and WHO, Young People and HIV/AIDS, p. 13.
173 C.M. Raymundo, Sex Practices and Reproductive Health of Filipino Youth.
174 Human Rights Watch interview with Dr. Marilyn A. Pajel-Calilung, executive director, Kabalikat ng Pamilyang Pilipino, Manila, January 16, 2004.
175 Human Rights Watch interview with Dr. Corazon Raymundo, Manila, January 21, 2004.
176 Human Rights Watch interview with Dr. Marilyn Calilung, Manila, January 16, 2004.
177 Human Rights Watch interview with Prue S. Baguio City, January 22, 2004.
178 Human Rights Watch interview with Nelly P., Baguio City, January 22, 2004.
179 Human Rights Watch interview with Nenet L. Ortega, program manager, Remedios AIDS Foundation, Inc., Manila, January 20, 2004.
180 Overseas Filipino workers (OFWs) accounted for 32 percent of reported AIDS cases in the Philippines as of December 2003. However, because OFWs are subject to mandatory HIV testing unlike other populations, they are likely to be overrepresented in official HIV/AIDS estimates. HIV/AIDS Registry, Monthly Update: December 2003.
181 For a recent discussion of these vulnerabilities in the context of the Philippines, see Action for Health Initiatives (ACHIEVE), Inc., Labor Migration and HIV/AIDS: Understanding the Intersections (2002).
182 See Philippine AIDS Prevention and Control Act, sec. 7 (The State shall ensure that all overseas Filipino workers . . . shall undergo or attend a seminar on the cause, prevention and consequences of HIV/AIDS before certification for overseas assignment).
183 ACHIEVE, Inc., Labor Migration and HIV/AIDS, pp. 13-14. In some cases, applicants have reportedly been given certificates of completion without having attended the PDOS at all. Undocumented migrant workers circumvent PDOS altogether and therefore receive virtually no HIV/AIDS information.
184 Human Rights Watch interview with Malou Marin, executive director, Action for Health Initiatives (ACHIEVE), Inc., Quezon City, January 28, 2004.
185 Human Rights Watch interview with Noel P., Manila, January 29, 2004.
186 In addition, mandatory testing and deportation laws often make it impossible for NGOs to reach HIV-positive migrants and their spouses on their return, because they are often summarily deported without being given any referrals or information about HIV prevention.
187 Human Rights Watch interview with Dr. Michael L. Tan, Quezon City, January 21, 2004.
188 Human Rights Watch interview with Aimee V., Manila, January 29, 2004.
189 Status and Trends of HIV/AIDS in the Philippines, p. 13.
190 Thanh-Dam Truong, Sex, Money and Morality: Prostitution and Tourism in Southeast Asia (1990), p. 329, cited in A. Jordan, Commercial Sex Workers in Asia: A Blind Spot in Human Rights Law, in Askin and Koenig, eds., Women and International Human Rights Law, vol. 2 (Ardsley, NY: Transnational, 2000), pp. 525-585.
191 Human Rights Watch interview with Clara S., Angeles City, January 23, 2004.
192 Human Rights Watch interview with Rosie P., Angeles City, January 23, 2004.
193 Human Rights Watch interview with Jericho M., Angeles City, January 23, 2004.
194 Human Rights Watch interview with Diane R., Baguio City, January 22, 2004.
195 Human Rights Watch interview with Luis Gabrenbina, Quezon City, January 19, 2004.
196 Human Rights Watch interview with Dr. Celia Flor Brillantes, medical officer and chief of social hygiene clinic, Baguio City, January 22, 2004.
197 Philippine AIDS Prevention and Control Act, sec. 16; OHCHR and UNAIDS, HIV/AIDS and Human Rights: International Guidelines, guideline 3, para. 28(b) (Apart from surveillance testing and other unlinked testing done for epidemiological purposes, public health legislation should ensure that HIV testing of individuals should only be performed with the specific informed consent of that individual).
198 Human Rights Watch interview with Dr. Corazon Manoloto, Manila, January 26, 2004.
199 Human Rights Watch interview with Wilfred Bidad, Manila, January 15, 2004; Human Rights Watch interview with Dr. Aurora E. Perez, country director, and Enrico Caja, The Futures Group International/Policy Project, Manila, January 20, 2004.
200 Human Rights Watch interview with Dr. Michael L. Tan, Quezon City, January 21, 2004.
201 Human Rights Watch interview with Dr. Carmina Aquino, Manila, January 19, 2004.