The Predictable Failure of HIV/AIDS Education and Prevention in the Philippines

By Godofredo U. Stuart, MD

In the late 80s, I became immersed in the HIV epidemic in the U.S. So little was known then, a time of ignorance and fear—when doctors were afraid to take on HIV patients, even afraid to breathe the same air, fearful of blood splashes and needle sticks. In this milieu of fear and ignorance, I joined a clinic in Baltimore, one dedicated to providing HIV/AIDS treatment to a patient population of mostly gay men and IV drug users, staffed by nurses and mostly gay and lesbian volunteers who provided unbelievably compassionate care.

It took a while to get over my fears—at first refusing to share in pastries and cakes brought in by patients, needlessly double-gloving on simple examinations, and suffering sleepless nights when a patient’s nail caused a superficial skin injury.

It was a time when science offered nothing but hope—a few years before the first antiretroviral (AZT) became available. Likewise, the clinic offered nothing but hope and the promises of research and development. What was dispensed in abundance was education—anal sex, rectal tears, oral sex, needle sharing, safe sex practices, condom use, vaginal gels and condoms, sexually transmitted diseases, hepatitis and tuberculosis, and an attempt at a comprehensible 101 on CD4 counts and how it relates to prognosis. Instead of candy, there were jars and bowls of condoms strategically placed in the clinic, refilled often enough to know that patients were pocketing handfuls for future use.

All the while, the Catholic Church ranted and rage, charged homosexuality with the spreading of AIDS, banned safe sex education and condom use.

As the epidemic continued to unfold, I was reassured by the minuscule numbers of the HIV infected in the Philippines.

Two decades later, the Philippine numbers are reported to be rising at “fast and furious” rate, a more than 500% increase from 2008 to 2012, and a 79% increase in new reported cases from 2012. The UNICEF reports the Philippines to be one of only two countries in Asia, and one of seven globally, where new HIV cases have increased by over 25% from 2001 to 2009. An Inquirer headline blazons ONE FILIPINO GETS HIV VIRUS EVERY 1.5 HOURS. In January 2013, DOH reports a total of 358 new cases in January 2013. Of the 358 new cases, 318 were through sexual contact, 148 of which were homosexual contact, and 40 were through sharing contaminated needles. Since the DOH registry opened in 1984, it has reported 16,516 cases, 1507 of which have developed AIDS, with 887 deaths.

For a population of more than 90 million, the numbers are still low. However, without an effective program of education and prevention, the potential looms for an epidemic, especially among the key populations with specific risk behaviors: unprotected male-to-male sex, commercial sex and IV drug use. Although the continuing rise in numbers of HIV infection reflects on the failures of education and prevention campaign, it is education that will continue to be key.

Constrained by language, sex education is a frustating task. In the HIV and AIDS, the constraints and limitations are doubly daunting. How do you explain to those less proficient in English that “anal sex can cause rectal tears that could facilitate the entry of HIV virus from the semen into the bloodstream”? In the vernacular, it’s a caution that can be easily translated and communicated.

Some may find the the vernacular too “bastos” for HIV/AIDS education. But for many in the affected patient population, English as default language will be ineffective. Education should be in a language comprehensible to most Filipinos, unabashed and uncensored, that will effectively and efficiently disseminate the necessary information on prevention. A vernacular or Taglish option should be made available for information dissemination to provide the necessary understanding of the disease—how the virus affects the immune system, cells counts and its prognostic implications, risk behaviors, safe sex practices, HIV in pregnancy, and the preventive use of condoms.

In 2010, Pope Benedict issued a statement that ended the Catholic Church’s absolute ban on condom use—that using condoms to prevent HIV can be “a first step in a movement toward a different, a more humane sexuality.” Still, the Philippine Catholic Church continues to wage a crusade against condom use.

Science has stripped HIV/AIDS of myths and misinformation. There are more than 15,000 diagnosed and living with the virus. An estimate suggests only 20% of the risk populations have been tested. There are many more infected, untested and unaware, who will continue to infect others. Most will eventually get sick—or, although asymptomatic, their cells counts and immune system will continue to decline—and require treatment. Although treatment is available to prolong survival or turn its incurable and fatal nature into a seemingly chronic disease state, many will not be able to afford therapy and basic health care services. Many will be consigned to suffer in secrecy and isolation, and their deaths veiled with some other diagnosis.

The key is prevention and education. Alas, in this country that is 85% Catholic, the church stands as the formidable barrier to HIV/AIDS prevention and education. Separation of church and state is myth. It holds sway over policies, politics, and politicians. It stands immutable in its stance against sex education and condom use.

Therein lies the predictable failure of HIV/AIDS prevention in this country.

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The context of condom use among young adults in the Philippines: Implications for HIV prevention
Sex Education: Comic Failure of Language

HIV alert… the vernacular of sex

448 fresh HIV cases reported for the first month of the year … 118 of the new HIV patients belong to the 15 to 24 age bracket. … 50% or 224 patients are from Metro Manila, 16% from the Calabarzon, 7% from Davao region, 4% from Western Visayas … epic failure of sex education, such as it is.

SEX EDUCATION: Comic Failure of Language
By Godofredo U. Stuart, MD

As language, Filipino is very expressive and illustrative. I often marvel at its descriptive powers, a single word that will need half a dozen or more English words to describe: umaampiyas. Or words that wax poetic: takip-silim, agaw dilim, bukang liwayway. It’s a language that lends to the Pinoys’ penchant and delight for word play, never at a loss in coining words that become mainstream: trapos, epal, promdi. Its vowel-rich words lend to the staccato and cadence of Rap music. But when it comes to the language of sex, the vernacular fails—dreadfully—and looks to English for rescue.

The failure is widespread—in schools, in media, and homes. A failure that is both comic and stupid.  Read on…

our china relations, our u.s. alliance

there’s the china that’s playing the cat to our mouse (the goliath to our david?) in the west philippine sea, aggressively claiming and taking control of territory that is ours by no stretch of the imagination, and, naturally, it’s nakakagalit that we’re obviously in no shape to push back.

and then there’s the china that’s our 3rd biggest trading partner (next to the u.s. and japan), and whose investments we continue to welcome and woo, and whose State Grid Industry Development Ltd. has a 40 % stake in our National Grid Corporation (4 china bigwigs on the board of directors, 7 of 10 with chinese names: read rafael alunan iii’s brief history and who’s who of PNC).  yes, think exports, jobs, electricity supply, sabay fret over national security.

and then there’s the china that’s homeland and/or once-homeland to millions of chinoys, some of them now among the wealthiest filipinos, and whose silence could mean anything: abstain, or no comment, so as not to offend either china or the philippines?  or kampi naman sa pinas pero loathe to speak against china at this point, hindi pa naman kailangan, di pa hinihingi ng panahon, malay natin, biglang tantanan na tayo ng tsina ngayong napipinto ang pagbabalik ng u.s. bases, version 2014, puwede na rin?

whatever, i agree with jose ma. montelibano who urges that government mount a serious info campaign on our problems with china.

It is not unusual for war to begin with a single shot. The American Civil War started with a single shot from a mortar. History also says that a Serbian assassin shot an Austrian Archduke Ferdinand and triggered World War I. It is not so much that shots were fired, but that they were fired when there was already tension between countries.

And there is tension now. I cannot speak of what is happening inside China but I can definitely speak about our own country. If the tension is not yet palpable, it is only because the Philippine government has deliberately held back from rousing public anger. The news of China’s bullying has been in the news but government has not pounced on the aggression of China to whip up an emotional storm among Filipinos. I can understand why our government chooses moderation, but the game is not up only to us and belongs more to the aggressor.

I do not want to be an alarmist, but I am alarmed. The state of unpreparedness, or naiveté, of the Filipino people will send them to absolute shock if a shot is fired, either by Filipino or Chinese soldiers. Panic is not the best stage from where we can mount our defense. Patriotism is better, and anger instead of fear.

It might be advisable if government begins to roll out an information campaign via tri-media. Social media has been ahead of the game, so far, and will naturally pick up what government will publicly share. The tone of social media will be much more belligerent than the sobriety that government will expectedly display, but that is par for the course. Without some amount of heat, it will be hard to get through both ignorance and apathy

…This early, too, it may be time to send a quiet message to Chinoys. … They control the wealth of the Philippines as gleaned from the latest list of the richest persons in the Philippines. As such, public attention and expectation will be focused on them and their actuation as conflict deepens due to China’s bullying. Loyalty is serious business, and becomes deadly so in times of war.

i get it that the prez’s strategy — invoking the rule of law and taking the dispute to the UN for arbitration, meanwhile refusing to be provoked into any action other than diplomatic — meets with general approval.  so, too, the enhanced presence of u.s. troops, in the hope that it would deter further chinese aggression around here, which the leftists, among others, dispute, of course, on grounds that enhanced u.s. military presence would more likely enhance us as target for enemy attack.

but i’m more concerned about this interval between now and that day when the ITLOS rules in our favor (being optimistic).  kailan pa yon.  meanwhile china seems bent on pushing ahead, testing our limits — jan 27 water-cannoning our fishermen away from scarborough, mar 9 blocking our vessels that were carrying supplies to our sierra madre outpost in ayungin — and all we do is protest vociferously sabay step back, step aside, give way.  kaya ba nating i-sustain ang ganyang strategy until ITLOS rules (whenever) without losing more than we seem to have lost already?

and now this via rodel rodis: What did Erap and GMA promise China?

…on March 17, China’s Foreign Ministry spokesman Hong Lei revealed in a press conference in Beijing that two previous Philippine presidents had made an “unequivocal commitment to China ”that the Philippines would tow away the Sierra Madre from the Ayungin Shoal. China demanded that Pres. Aquino “heed the promises” made by his predecessors otherwise, Hong Lei warned, the Philippines risks losing its “credibility”.

According to Hong Lei, the promises were made in 1999 by Pres. Joseph “Erap” Estrada and reiterated in 2003 by Pres. Gloria Macapagal-Arroyo (GMA). Estrada and Arroyo have yet to respond to this new Chinese allegation. Did they make such commitments to China? If so,why and what did they get in return?

Many observers doubt this new Chinese claim because the Ayungin Shoal did not attain any strategic value to China until after GMA entered into a Joint Marine Seismic Undertaking (JMSU) with China in 2005-2008 allowing China the authority to explore the waters within the 200 mile Exclusive Economic Zone boundaries of the Philippines around Palawan.

China’s exploration led to its discovery of the presence of large deposits of oil and natural gas in the area around the Recto Bank which is just 85 nautical miles from Palawan. The Ayungin Shoal is considered the “gateway” tothe Recto Bank and China did not express any interest in occupying it until after the JMSU was entered into.

According to a Newsbreak report in2008 (“Arroyo Gov’t Pleasing China sinceDay 1”), GMA “clinched the most number of bilateral agreements with China in the two countries’ 30-year relationship.” GMA signed 65 bilateral agreements with China, far surpassing the 8 agreements signed by former President Ferdinand Marcos.

Could one of these agreements have included a promise to tow away the SierraMadre off Ayungin Shoal and turn over all the Spratly Islands to China?

In a special “Correspondents” documentary which was shown more than six years ago, Ricky Carangdang claimed that GMA sold the Spratlys to China.

so, has anyone asked erap and gma yet what’s true and what’s false?  never mind.  like rodis says, we can’t be held to these alleged secret promises, secret deals, in much the same way that china refused to be held to its june 2012 commitment to leave scarborough shoal.

China is not the party to talk about sticking to commitments and losing credibility for failure to do so. China should recall that in June of 2012, it made a commitment to withdraw its ships from the Scarborough Shoal if the Philippine Navy withdraws its ships as well, in a deal brokered by the US. When the Philippine ships left, China’s ships remained as China said it had never agreed in writing to leave.

rodis also takes on, calls out, rigoberto tiglao, once press secretary and spokesman of gma, whose more ‘nuanced’ approach to the china dispute now makes me wonder if he’s speaking pa rin for gma, or if he has just found his way back to the left via cenpeg.  full circle?

and now here’s a romualdez, philstar columnist babes, urging “pragmatism,” i.e., maintain cordial relations with china just like the u.s. is doing; as in, barak’s michelle is in beijing for a week of “educational and cultural exchanges.” o, ha.

pareho lang naman sila, these superpowertrippers.  gugulangan tayo at gugulangan, pagsasamantalahan at pagsasamantalahan, hangga’t nakakalusot.  magkaiba lang sila kung dumiskarte sa atin, pero di nagkakaiba ang pagtingin sa pilipinas: a weak state, but comely, and strategically located (america’s “gateway to china” since “benevolent assimilation” times), and incredibly rich in untapped gas, oil, and metal deposits, and therefore eminently desirable as ally, i mean, as pawn, i mean, as possession, and worth fighting over, if not divvying up.

paranoid ba.  maybe.  but we could seriously use a united front at this point in time.  the dispute is between the philippines and china, sampid lang ang amerika.  playing the china card, as the leftists and the tiglaos and the romualdezes and other anti-aquino camps are doing, is like forgiving china for that atrocious 9-dash line and all the troubles it has brought to our people out in the west philippine sea.  as if we needed the extra aggravation.  as if we didn’t have enough threats to sovereignty to deal with.

again, we could use a united front at this point in time.   we need to get on the same page against china’s belligerence in the west philippine sea.  okay lang to pray, hope, for the best, but we also need to  prepare nation for the worst.  just in case.

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National security is the real issue by Elfren Cruz
Pragmatism: Key to our foreign relations by Babes Romualdez
https://stuartsantiago.com/special-relations/
Listen to Kung Fu Panda by Teddy Locsin Jr.

9-dash

By Alex Magno

… When the UN Security Council considered the resolution denouncing Russian actions in Crimea, the veto from Moscow was expected. The only suspense involved China’s vote on the matter.

Both Russia and China are permanent members of the Security Council and enjoy vote powers. China almost consistently voted with Russia on key issues in international politics, including the massive repression in Syria.

This time, however, China chose to distance itself from Russia without aligning itself with the western position on Crimea. Beijing did not need to deliver a veto. The Russian veto suffices to kill the resolution.

Nevertheless, the bold moves taken by Putin, the apparent helplessness of the western powers in the face of such audacity and the domestic popularity Putin reaps must be instructive for the Chinese leaders. Much as Beijing maintains its usual inscrutable posture on a matter not directly concerning China’s interests, its abstention raises concern.

To put it bluntly, what Russia did in Crimea with astounding swiftness, China could do in the South China Sea where barren shoals are hotly contested. It is a much easier maneuver for China to implant its forces in the contested (and unpopulated) shoals and reefs in the sea Beijing wants securely in its fold.

We can only wait and see the extent Putin has inspired his Chinese counterparts.