MANILA – "The sales lady actually asked for my ID. And she asked me, what am I going to use [the condoms] for, why am I buying a condom."
This, said 24-year-old Bryan, a peer educator from HIV/AIDS support group PinoyPlus, was his experience when he once tried to buy contraceptives from a store in Metro Manila.
This kind of reaction, said international rights group Human Rights Watch (HRW), is the reason why many Filipinos prefer to engage in unprotected sex, instead of preventing conception or sexually transmitted diseases through contraceptives or infection of the human immunodeficiency virus (HIV) through condoms.
Bryan was one of the people interviewed by HRW for its report "Fueling the Philippines' HIV Epidemic: Government Barriers to Condom Use by Men Who Have Sex with Men".
Poor government policies when it comes to condoms also contribute much to the steep rise in the number of HIV infections among Filipinos in recent years, HRW said.
"Ang tugon ng gobyerno ay hindi sapat. Sa HIV kasi, ang isang paraan para hindi ka makakuha ng sakit ay condom. Unrealistic ang abstinence [lang bilang solusyon]," said Carlos Conde, HRW's researcher for the Philippines.
(Government policies on this are not enough. One way to prevent HIV infection is through the use of condoms. Abstinence is an unrealistic solution.)
The "epicenter" of the spread of HIV among Filipinos from female sex workers and overseas workers (OFWs) has also shifted to males having sex with males (MSM), said HRW, which is due to an environment "hostile" to policies and interventions proven to help prevent the illness.
The Philippines was ranked third, after Afghanistan and Pakistan, in a 2016 Joint United Nations Program on HIV and AIDS (UNAIDS) report on prevention gaps, in terms of percentage growth in the new HIV infections in the Asia-Pacific region from 2010 to 2015.
People from young professionals to children as young as 15 are also contracting the illness, particularly due to sexual encounters among males, HRW said.
One of HRW’s interviewees, a 20-year-old from Misamis Oriental, engaged in commercial sex work when he was 17, serving mostly male clients, to pay for his schooling.
"I was doing this work, which paid for my schooling, but I had no idea about condoms and HIV," HRW quoted Jake.
From January 1984 to October 2016, a total of 38,114 new HIV cases were reported to the HIV/AIDS & ART Registry of the Philippines (HARP); 1,912 of these cases resulted in deaths in the same period.
According to the Department of Health (DOH), from July to October 2016, there were 3,112 new individuals who were diagnosed to be infected with HIV. Of this number, 96 percent were male, with most ranging from 25 to 34 years of age. However, 28 percent of the new cases were youth aged 15 to 24.
Most of the reported cases of infection were from highly populated areas such as the National Capital Region (NCR), CALABARZON, Central Visayas, Central Luzon, and the Davao region.
From July to October 2016, NCR reported the most number of cases, followed by Regions 4A, 3, 7, and 11. Most infections in NCR were reported to be from sexual contact (2,997), needle sharing among injecting drug users (104), and mother-to-child transmission (11).
Of those who were infected through sexual contact, 87 percent were among males who have sex with males.
LESS SEX WORKERS INFECTED
Data from the DOH showed a drop in the number of cases of HIV infection among sex workers, who are mostly female. This, Conde said, was due to government's previous measures to address unprotected intercourse between men and women, such as a campaign by the DOH during the 1990s, under then Health Secretary Juan Flavier.
It also helps that entertainers who engage in transactional sex on the side are part of a "captive sector" who got checked.
"Kaya bumaba ang [prevalence ng HIV] sa female sex workers, kasi sila ang captive sector. Sila ang pumupunta sa clinics," said HIV prevention program manager Dr. Jose Gerard Belimac of the DOH in an interview with ABS-CBN News.
(Prevalence of HIV among female sex workers dropped because they are a captive sector. They go to clinics.)
Most entertainers go to the DOH to comply with Presidential Decree No. 856, or the "Code on Sanitation of the Philippines," which requires them to get a health clearance prior to being issued a permit to work. While this was policy, it is now "tradition" to have services intended for entertainers, said Belimac.
However, very few males who engage in transactional sex go through this process, he said, as their services can now be booked through social media.
"Ang isang gap ng program ay ang hindi pumupunta diyan [sa mga bar o club] tulad ng upper segment ng lower class o lower middle class, o above, na may phones that can access apps," said Belimac.
(One of the program's gaps is that it cannot reach those who do not go to bars or clubs such as those from the upper segment of the lower class, or lower middle class, or above, who have phones that can access apps.)
Recently, the DOH said it will push for condom use to prevent the spread of HIV.
DOH Secretary Paulyn Ubial said in a speech in Tacloban City in July, "The strategy that we are going to implement, besides pushing for more safe sex practices, is to implement condom use in the country."
According to the DOH, 3,371 cases of HIV infection reported from December 2012 to October 2016 were from people who engaged in transactional or paid sex. Of these cases, 96 percent were male.
This underscores the need for a more effective campaign for sectors which were not previously targeted by government campaigns, HRW said.
"Naintindihan ng mga tao [noong 1990s] ang value ng condom. Ang problema lang ng mga tao ng panahon na iyon, karamihan ng mga naiinfect at the time, dahil sa commercial sex work. Kaya nag-work ang condom, medyo nakontrol natin ang epidemya at the time," said Conde.
(People understood the value of condoms during the 1990s. The only problem is that, before, many were infected due to commercial sex work. That is why condoms worked to control the epidemic at the time.)
"Ngayon, dahil nga nag-shift na ang epicenter [ng pagkalat ng HIV]…doon na sa MSM, hindi na ganoon ka-aktibo, o kaayos ang tugon ng gobyerno, unlike before."
(Now, because the epicenter of the spread of HIV has shifted to MSMs, the government has not been as active or effective in responding, unlike before.)
In addition to the lack of adequate government policies, the stigma placed on members of the lesbian, gay, bisexual, and transgender (LGBT) community also makes it difficult to curb the spread of HIV.
Anyone purchasing or approaching government health centers to acquire condoms, which are known to help prevent HIV infection, also become the recipients of censure from sellers or health workers, said Conde.
Limitations are also placed on the promotion of condom use, as it can potentially offend standards of certain sectors and institutions.
"Ang pag-promote ng condom, hindi naman ibig sabihin na pag-promote ng imoralidad o pakikipagtalik. Ang pag-promote ng condom ay pagtugon lang sa realidad," Conde said.
(The promotion of condom use does not mean promotion of immorality or indiscriminate sexual practices. It is addressing reality.)
"Aminin man natin on hindi, ang kabataan ngayon...nage-explore ng kanilang sekswalidad, lalo na iyong LGBT community. Sila mismo ay naapektuhan din ng mga ito kasi dini-discriminate din sila."
(Whether we admit it or not, the youth explore their sexuality, especially members of the LGBT community. They are affected because we discriminate against them.)
They are hoping that the current administration's political will and previous expressions of commitment to the Reproductive Health Law will allow helpful measures to be implemented, despite protests from the religious sector and groups who do not believe in the benefits of birth control.
"Although the Philippines' HIV prevalence rate of below 1 percent among the country’s population of 100 million is still low compared to many other countries, it is experiencing a sharp rise in new infections among key affected populations and areas," said the HRW in its report.
Also, Philippine laws prohibit the distribution of condoms to minors under 18. They likewise cannot undergo HIV testing without parental consent, which limits options for people such as minors who are afraid to speak to their elders for fear of harsh consequences.
As of this writing, a temporary restraining order is in place over the Reproductive Health (RH) Law, which mandates sex education, and the distribution of contraceptives such as condoms by government, along with other reproductive health measures. The DOH is petitioning the Supreme Court to lift the hold order.
PREVENTION BETTER THAN CURE
While condoms are widely available in stores and health centers around the country, except for Balanga City in Bataan and Sorsogon City in Bicol, where the distribution of contraceptives are blocked by local officials on the basis of so-called "morality issues," many of those who need them are unable to get them due to cultural stigmas that they encounter during attempts to condoms.
Younger men who have sex with other men, said HRW, also have difficulty acquiring condoms, according to a survey by the Department of Health in 2015.
Among boys and young men aged 15 to 19, 54 percent did not buy or receive free condoms, while only 12 percent bought them.
The RH Law is a "key battleground," HRW said, as it restricts children under the age of 18 from getting access to family planning methods without written consent from their parents or guardians, except when the minor is already a parent or has had a miscarriage.
The same rule applies to those who wish to be tested for HIV.
According to Commissioner Percival Cendana of the National Youth Commission (NYC), they are now working very closely with the health department and the Philippine National AIDS Council (PNAC) to craft an AIDS medium-term plan specially to curb infection among the youth, and allow social workers to stand as guardians so that minors can undergo testing for HIV infection.
"In addressing HIV in the Philippines, kailangan mo talagang i-arrest ang infection sa [youth aged] 15-24. Ito talaga ang nagfu-fuel sa spike sa incidence. There has to be more aggressive, out-of-the-box, and bolder actions when it comes to this, sabi nga ni [Health] Secretary Ubial," Cendana said.