Philippines: Dictating choices, risking lives

Doe-eyed and frail, with a mellow voice and a cheery smile, nothing about Sara (not her real name) suggested she had been through ordeal after ordeal in her 22 years. Forcibly married at 15 to a much older man, she discovered after the marriage that her husband had HIV, and that he had infected her. When her in-laws found out, they subjected her to a barrage of abuse and accused her of infecting her husband. Before he died, her husband apologized to her: Deported as a migrant worker from Malaysia for testing HIV positive, he knew he was positive before he married her. He told her he had not known much, though, about HIV itself, how it is transmitted, or that condoms could have kept him and her from becoming infected.

If the betrayal was not devastating enough, her husband's death plunged her into poverty and desperation. Pregnant when he passed away, she received no help from her in-laws and was forced to cut back on her anti-retroviral drugs. After her baby was born, they still would not help her and even refused to give her and her child food. Though not HIV positive, her child eventually died of malnutrition and related complications. Today, however, Sara is an HIV/AIDS educator and counselor, and a passionate advocate of condom use.

This is a story of a Bangladeshi woman with extraordinary resilience and courage, but unfortunately experiences like Sara's are not uncommon in the Philippines. What is striking is the number of lives that are adversely affected because of poor information about HIV transmission and prevention.

The 2010 UNAIDS Global Report says that between 6,100 and 13,000 people are living with HIV in the Philippines and that most of them were infected through sexual contact. There is a worrying trend because there has been a spike in HIV cases in the Philippines in the last few years, with a significant increase in the numbers of new cases reported every month.

Condom use is one of the most effective strategies for preventing HIV transmission. Correctly and consistently used, condoms reduce the risk of HIV and other sexually transmitted infections and have the potential to slow the spread of HIV and reduce AIDS-related deaths. The alternative often proposed -abstinence-only programs - has been shown to be largely ineffective, especially in situations in which women are seldom able to negotiate whether or not to have sex.

But condom use in the Philippines is low. Among those who reported having more than one sexual partner in the 12 months before the 2007 National Demographic and Health Survey, condom use was an abysmal 11 percent. About 65 percent of female sex workers and 30 percent of male sex workers reported that their last client used a condom.

Instead of heeding the warning in the 2010 UNAIDS report that "catching up on prevention interventions among MARPs (most-at-risk-populations) is imperative" in arresting the spike in HIV cases, local authorities have once again buckled under pressure from groups that seek to impede access to condoms because they are an artificial method of birth control. The Catholic Church promotes a non-barrier method of birth control that is completely ineffective in reducing the risk of HIV transmission.

Local authorities in several barangay (villages) in the Philippines have proposed or issued ordinances limiting condom use. For instance, in March seven barangays in Bataan province issued ordinances banning condoms and other forms of modern contraceptives without a medical prescription. In January, a similar ordinance was passed in the barangay of Ayala Alabang. The Ayala Alabang council has since reportedly proposed a revised ordinance, prohibiting the sale of condoms and other contraceptives to individuals under age 18. Previously, condoms were available without a prescription.

These measures are baffling, not least because they came soon after the announcement in December 2010 of the Aquino Health Agenda for Achieving Universal Health Care for All Filipinos. One of the "strategic thrusts" of the program is meeting the United Nations Millennium Development Goals, including reducing the spread of HIV.

Requiring a doctor's prescription for condoms will invariably have the opposite effect. It will restrict people's ability to purchase condoms, infringe on their privacy by requiring them to consult a doctor before they can have safer sex, and could even exacerbate discrimination against at-risk populations, especially sex workers and men who have sex with men, driving them to have unsafe sex. Depriving young people of access to condoms, which are critical to HIV prevention - as the Ayala Alabang council would like to do - seriously jeopardizes their health and lives.

Such measures add to the Philippines' dubious track record on condom promotion as part of its HIV-prevention strategy. Human Rights Watch has previously reported how funds allocated to contraceptive programs were actually channeled to nongovernmental organizations that supported abstinence-only approaches.

Instead of dictating choices about condom use and curtailing its access through policies that are rooted in religious beliefs, local authorities should provide scientific and accurate information to all Filipinos, Catholics and non-Catholics, about HIV transmission and prevention. Weighing the costs and benefits of condom use, balancing it with their belief systems, and deciding whether to use it, all this is an individual's prerogative.

The state should not usurp these individual choices that have life-and-death consequences, on the basis of religious beliefs. By curbing people's right to accurate health information and access to scientifically proven HIV prevention techniques, local authorities are condemning people to live with HIV or, worse still, condemning them to death that could have been prevented.