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