AIDS creeps up on unsuspecting Philippines

Reuters NewMedia - September 12, 2005
Ambika Bhushan

http://www.aegis.org/news/re/2005/RE050917.html

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MANILA (Reuters) - For Carlos, working in a Saudi Arabian hypermarket
was his chance to escape a life of poverty in the Philippines.

But while working there, one simple act ruined his life.

Several years after having unprotected sex with a female co-worker,
Carlos began to suffer chronic fever and a cough.

He waited a year before seeking a medical examination. The results
confirmed his worst fears -- he was HIV positive.

Carlos is one of about 3,000 Filipinos who have contracted HIV/AIDS
working abroad, and health workers say ignorance about disease and
poor public education are largely to blame.

"There were so many temptations abroad. But I never thought that
they'd put me at risk," Carlos said.

The more than eight million Filipinos working abroad are just one
ingredient in a cocktail of risk factors, raising worries about a
creeping AIDS problem in the Philippines, a mostly Roman Catholic
country.

Low official rates of HIV infection are belying the extent of the
problem and breeding complacency, health officials say.

"All the ingredients of an explosion are there," said Dr. Roderick
Poblete of the Philippine National AIDS Council.

"What we're experiencing is the ebb tide before the tsunami ... but
it's only a matter of time before we feel the tsunami's impact. It
will hit the country very, very hard."

CULTURE OF SILENCE
Among the red flags signaling AIDS risks are a thriving commercial sex
industry, low condom use, a growing community of injecting drug users,
rising rates of sexually transmitted infections and increasing
promiscuity.

The Philippines has 2,200 officially reported HIV cases and 676 AIDS
cases, but the Department of Health and the World Health Organization
estimate that 10,000 Filipinos were HIV positive by 2003, which
translates into more than 7,000 unreported cases.

"We're definitely not getting the right figures. Our surveillance
system needs to be perfected," said Dr. Dominic Garcia of the AIDS
Society of the Philippines.

"There are a lot of Filipinos who are HIV positive but don't know it.
Some haven't even heard of the disease."

A conservative culture that is still strongly influenced by the
Catholic Church is thought to deter thousands of sufferers from
undergoing testing and reporting themselves HIV positive.

Having quit his job and returned to Manila to seek care, Carlos, 49,
now conceals his illness from his family in the countryside for fear
of discrimination.

"I was scared my neighbors might rally against me and throw me out,"
he said.

CHANGING ATTITUDES
Perhaps the biggest risk factor is the low rate of condom use, which
stands at just 30 percent among men aged 14-45, according to UNAIDS,
the UN agency focused on combating AIDS.

Condoms have long been a flashpoint for controversy in the
Philippines, where the Church remains vehemently opposed to their use
and only condones natural family planning methods.

The government remains faithful to the Vatican's AIDS policy,
restricting free condom distribution. Critics say that policy is
effectively courting an AIDS epidemic.

Condoms cost nearly 20 pesos each at local drugstores, a considerable
deterrent for the poor.

In a news conference in February, UNAIDS' executive director Peter
Piot criticised the Church's stance in strong terms.

"Church leaders should not make statements that will kill people,"
Piot said.

Filipino macho culture may also have a role in low condom usage,
experts say. Cultural inequity leaves women with weak bargaining power
when negotiating the conditions of sex.

"A condom is an exclusively man-controlled item, and unless the woman
persuades the man to use it, he doesn't," said the AIDS Society's
Garcia.

The future of AIDS is also linked closely to the changing attitudes
and behavior of Filipino youth, officials say.

A culture of monogamy might have been one factor behind the relatively
low infection rate in the past, but there are signs that is changing.

A survey conducted by the University of the Philippines in 2002 showed
38 percent of young men and 22 percent of young women condone
pre-marital sex, up sharply from 14 and 9 percent respectively in a
similar survey in 1994.

Filipino youth have an attitude of invulnerability toward the disease,
said Garcia.

The survey starkly confirms this observation -- nearly 75 percent of
youth thought they had no chance of getting AIDS.

"Right now, it's really a challenge for those working with HIV/AIDS to
sell the abstract," said Poblete.

"If we don't shape up by 2010, the epidemic may turn the tide on us."

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