SHADOWY RISK
A new survey uncovers a lurking threat of HIV/AIDS escalation in the Philippines
By Grace L. Roxas, Contributing writer
Despite no report of new cases of HIV/AIDS, the high rate of sexually transmitted infections (STIs) recently found among a local segment of high-risk individuals is said to show disturbing parallels with the preoutbreak situation of countries now under serious threat from the disease.
"The Philippine situation now … is like [that of] Thailand in the late 70s-high STI but zero HIV/AIDS cases. Then in the 80s, dun biglang sumabog," says Laufred Hernandez, lead researcher for a recent behavioral and serologic survey among Filipino MSM (men having sex with men). The survey was conducted by the University of the Philippines-National Institutes of Health with the help of the United States Agency for International Development.
Hernandez adds that if STI incidence among MSM in the country continues to rise unchecked, the Philippines will soon follow in the footsteps of HIV/AIDS-threatened countries like Indonesia, India, and China. "We have all the ingredients for an HIV explosion [so] we have to be careful."
The survey, a time-location sampling conducted among 522 MSM in Metro Manila and Baguio City, reported at least one form of STI in more than one out of every three MSM. According to Hernandez, the mostly rectal cases of STIs found among the subjects alarmingly echoes a growing global trend of MSM with HIV/AIDS detected in the rectum.
Risky sexual behavior, such as intercourse (anal and vaginal) without using condoms and having multiple sexual partners of both sexes, is also prevalent. In Metro Manila for instance, 99 percent of MSM who do it with paid partners do not use condoms, illustrating a knowledge-to-practice gap in the face of a 65-percent awareness level among Metro Manila MSM that condoms can prevent HIV/AIDS.
Overall, only 36 percent have been exposed to any kind of HIV/AIDS intervention in the country. "There is generally low knowledge still, in terms of HIV prevention and the behavioral change of those exposed to interventions still leaves much to be desired," notes Hernandez.
Other risk factors for infections documented were the use of oil-based lubricants instead of the safer water-based preparations; alcohol intake before, during, and after sex; and use of recreational drugs, especially in Baguio City.
Eight of 10 Metro Manila MSM surveyed also admitted having multiple sex partners in the last 12 months, either commercial or consensual. At least one respondent reported as many as 600 different partners within the past year. These liaisons are consummated not only in the privacy of homes, hotels, or other hospitality establishments but in fairly public settings like third-rung cinemas where MSM orgies are also known to happen.
Complicating matters further is the more encompassing definition of an MSM as understood in the context of HIV/AIDS. Hernandez points out that MSM are not necessarily homosexuals but can include heterosexual men who only want to test the limits of their sexuality.
The survey appears to bear out this definition in the local setting, showing that more than 30 percent of the respondents admitted to having sex with both males and females in the past year.
"Why do we need to be worried about MSM in the Philippines? They are a high-risk segment that can also sleep with a low-risk group, the women. You can just imagine the high rate of STI they can then pass on to women. Kaya kawawa pa rin ang mga kababaihan dito," Hernandez said.
In Baguio City, where consensual sex is more common, even rural inhabitants from the mountains are endangered. "What's so surprising about Baguio is that [there are] tribal folks from Mountain Province who go there for sex so that if they become positive for STI, they bring it back to their girlfriends and wives," Hernandez said.
Furthermore, MSM in the Philippines are a shadow population living in a culture where sexual proclivities, especially unconventional ones, are not really discussed in the open. This could account for only 36 percent of the respondents claiming to access health facilities to seek treatment for STIs, with a bigger percentage resorting to self-medication. Only 14 percent in Baguio had themselves voluntarily tested for HIV/AIDS. Surprisingly, it's even lower in Metro Manila at only eight percent.
Social stigma still strongly inhibits health-seeking behavior, either for treatment or testing. Hernandez notes that male sex workers, for one, would always prefer male doctors, but there's always the chance of encountering moralizing, on the one hand, or discomfiture with their condition from doctors who are "as straight as a rod" so they would rather not go for consultation.
Hernandez said that for MSM, nothing much is being done yet-or effectively anyway-by way of intervention. "We can do better with the help of the Department of Health and nongovernment organizations. We need to frame a policy, a module in behavioral change communication in order to intervene appropriately. For each cluster of population, there should be an intervention program."
A 2005 estimate placed the number of HIV/AIDS positive cases in the country at 11,200, most of which are unreported, in part due to the asymptomatic stage of the disease for many years. "We often get asked why our incidence here remains slow and low despite key ingredients like having a lot of [overseas Filipino workers] and our archipelagic geography. But it may actually be hidden and growing," warned Hernandez. M
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