Category: HIV-AIDS

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.

Read on…

duterte, pemberton, HIV-AIDS

it was the first time i’d ever heard digong duterte speaking lengthily on anything, so i was totally unprepared for all of it.  yes, the puntanginas and other cuatro letras and the libog and bathroom and bayag talk  shocked me at first, pero sabay halakhak everytime.  i think i forgave him very quickly for the ‘tanginas because, well, he was cursing mostly at stuff i have myself cursed at in private (except for the pope), and it was somewhat cathartic, haha.

but beyond the oral ejaculations he was talking a lot of sense, he knows, he has lived, mindanao history, and is rightfully pissed off at imperial manila and whoever made a fish out of moro hero lapulapu LOL.  however, the sex talk and the going-to-confession and related stories were not as easy to forgive, napaka-for-adults-only, what if the kids are listening?  my nanay was very old school.

the very next day, as i was listening to the olongapo judge’s ruling on the killing of sex worker jennifer laude by US marine scott pemberton  — JUNK EDCA! — and hearing more sex talk, if on a different plane and in a different language from duterte’s — fuck, oral sex, blow, penis, vagina — the synchronocity struck me, and the thought occurred that this could be a good thing.  the start of a process of desensitization to sex talk, because we NEED to talk about sex.  real sex education, in the vernacular, is the only way we can stop HIV-AIDS from spreading and becoming full-blown.

PHILIPPINE HIV EPIDEMIC UPDATE (2015)
UN AIDS

The rapid rise in HIV infections nationwide, with some 21 new cases reported every day per DOH records4, has made the Philippines one of only a handful of countries at risk of a full-blown AIDS epidemic if it is unable to address the problem on time. The 646 new cases reported last February is the highest number since the Philippines’ first case in 1984, according to the DOH. The numbers in six cities — Quezon City, Manila, Caloocan, Cebu, Davao and Cagayan de Oro—already exceed the national prevalence rate of 3.5 percent4. While HIV is spread primarily through unsafe sexual contact, it can also be contracted through the sharing of dirty needles during drug use.

Increasing prevalence in key populations. National HIV prevalence remains under 0.1%, but rapidly expanding among key affected populations (KAP)2. By 2013, HIV prevalence reached 5% to 8% among males who have sex with males (MSM) in the cities of Cebu, Quezon and Manila; 53% among people who inject drugs (PWID) and 5% among female sex workers (FSW) in Cebu City1.

More are infected. The number of cases reported has shown a steep increase in the recent years – from less than 1 case a day in 2006 to 21 cases a day by March 20151. The actual cases are estimated to be at least double of those reported. The Philippine National AIDS Council (PNAC) has projected that the total number of HIV cases in the Philippines could reach 37,000 [as high as 54,000] by 20152. 12,000 of those will be needing treatment2 which could cost the Philippine Health Insurance around P360 million ($8.4 million).

Those infected are young with a median age of 27. HIV infection among 15-24 years old increased more-than ten-fold, from 44 in 2006 to 995 in 20151. The period of initiation to sex and drug use among key affected populations is as early as from 14 years old2.

Male to male transmission had significantly increased. Sex is still the main mode of transmission with, 85% of new cases were reportedly through male-to-male sex in 20151.

More local transmission. HIV cases among Overseas Filipino Workers (OFW) continue to increase (395 cases in 2013 – highest ever) despite the decrease in proportion of OFW to the total cases from 42% in 2006 to 11% in 2013 indicating that local transmission has outpaced infections reportedly contracted overseas.1

Very Low Prevention Coverage mostly below national targets of 80% since 2005; specifically 63% for establishment-based Female Sex Workers, 38% for freelance FSW, 23% for Males Who Have Sex wth Males (MSM) and 11% among people who inject drugs (PWID). Low number of Key Affected Persons (KAP) are tested for HIV (merely 14%) and zero for key affected populations under the age of 18.

High-risk practices among KAP continues. Knowledge levels (index of basic HIV knowledge including misconceptions) among Key Affected Persons was only 32%, with those aged 15 to 17 years, even lower.

basic HIV knowledge, including misconceptions, of gay and bisexuals, female sex workers, needle-using druggies, is only 32%, and even lower than that for teen-agers.  sa madaling salita, kulang na kulang ang sex education.  the departments of education and of health will, of course, claim that all students get sex education, but the question is, what kind?

In a recent media forum, people living with HIV (PLHIV) advocate Wanggo Gallaga said there is an immediate need for schools to include sex education modules in order to encourage those with risky sexual behaviors to practice safe sex.

“What we have to do is to educate people properly. It has to start earlier. When it comes to health, education is very shallow. Biology lang ang tinuturo sa schools e. We don’t talk about consequences of sex,” said Gallaga. 

yes.  it’s not enough to teach about reproductive body parts and how babies are made.  kailangan din ituro ang tungkol sa libog and hormones, vaginal and anal sex, and the consequences of unprotected sex, besides unwanted pregnancies, as in sexually transmitted diseases, the worst of which is human immunodeficiency virus (HIV) infection that untreated leads to the painfully deadly Acquired Immunodeficiency Syndrome (AIDS).

most important, these teaching modules should be not only in english but also in tagalog and taglish, and gayspeak na rin, as well as in the dialects of target audiences, which should include young and old, male and female, gay and bisexual, specially the sexually active who engage in casual sex / exchange bodily fluids with different partners.

read godofredo u. stuart’s Sex Education: The Comic Failure of Language and marlon james sales’ Sex and the Missionary Position: The Grammar of Philippine Colonial Sexualities as a Locus of Translation.

sex education is key to preventing an HIV-AIDS epidemic.  government agencies (DEPED and DOH) simply have to get on the job, the sooner the better.  for certain the bishops will raise a howl.  let them.  it might even be a good sign that all they’re apoplectic about right now is the cursing at the pope, the adultery committed with two wives and two girlfriends, and the allegation of sexual abuse by jesuits.  i haven’t heard anyone decrying the bayag and libog talk.  maybe they can’t find the words.  while we have all the words we need.

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772 cases of HIV/AIDS recorded in June, the highest ever in one month – DOH
Living with HIV in the Philippines
The Predictable Failure of HIV/AIDS Education in the Philippines

national security concerns

while i try to come to terms with rigoberto tiglao’s story that the prez rushed the crafting (behind closed doors) and signing of the enhanced defense ek-ek just so obama would drop by while he was in the neighborhood and not snub the philippines again as he did when he visited indonesia not once but twice… yeah yeah because if he had snubbed us yet again, china would have been delirious with joy…

and while i try to understand where the prez is coming from, giving american troops access to practically any place they might desire to occupy/locate themselves, almost any place — i assume the palace is off limits? — in the archipelago, rural and urban, civilian and military,  with the americans retaining jurisdiction, criminal and whatever, over everyone and everything they bring in and do wherever… i don’t get it, why do the americans want, need, to be all over the place?  what’s the real agenda?  why all the secrecy?

and while i wonder if government knows something we citizens don’t know regarding our status as sovereign nation, as in, we’re not pala, sovereign, akala lang natin, and we citizens are the last to know?  could this be america’s and the aquino admin’s way of telling us without saying it in so many words?

and while i wonder if senator miriam’s promised senate probe would could make any difference, and if taking the question of constitutionality to the supreme court would only bring on another double negative, as in, not unconstitutional, lol, and whether american soldiers are regularly tested for HIV-AIDS and have unlimited supply of top-of-the-line leak-proof condoms to keep our women and children safe from sexually transmitted diseases…

and finally there’s napoles and the pdaf scam, and talk that enrile, estrada, and revilla will be arrested soon.  talaga?  meanwhile i’m intrigued by this mother’s day tweet by malou tiquia :

@maltiq One flew over d cuckoo’s nest n landed on a sanitized list 2 b revealed next week. JN n Cam lost their aces! Circus coming! #pdafblues 

is d cuckoo who i think it is?  but isn’t that what sandra cam was warning about, a sanitized list that would not tally with napoles’s?

and what about ping lacson claiming in a radio interview that the napoles list is explosive, it could bring the senate down, and that’s a national security concern, therefore it can only be revealed to the senators themselves in a secret session.  big mistake.  keeping that list secret from the public would create more of a national security concern.  for sure it would infuriate and galvanize million-people-march-ers to storm the streets in protest, demanding that the list be made public, stop coddling the accused, or else!

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What should the Senate do?  http://opinion.inquirer.net/74438/what-should-the-senate-do 
The normalization of corruption http://opinion.inquirer.net/74408/the-normalization-of-corruption 

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