Low and slow too is the institution of comprehensive HIV/AIDS-related programs to keep an epidemic from happening. With the withdrawal of contraceptive donations from the United States Agency for International Development (USAID), the Philippines is facing a "potentially catastrophic shortage in condom supplies," says the HRW report. The USAID, a long-time provider of modern contraceptive devices to the Philippines, has shifted its policy "away from condom promotion and toward programs that [give] primary emphasis to abstinence and marital fidelity." This, the report points out, has become a part of US foreign AIDS policy since George W. Bush assumed the presidency. References to condoms and their effectiveness have been altered, if not taken out, in government web sites; a number of overtly "pro-abstinence-only" officials are now occupying high-level positions as HIV/AIDS advisers; international reproductive health agreements have been opposed every time modern contraceptive methods and abortion are brought up (see for instance the report on the 2002 Asian and Pacific Population Conference plan of action, "Semantic Conflict," in the February 2003 issue of MEDICAL OBSERVER).

CONDOMS CONDEMNED

    Sectarian politics remains a massive stumbling block in coming up with realistic HIV/AIDS intervention programs. During the term of Dr. Juan Flavier as secretary of health, he came under the attack of religious conservatives for his public declarations on the effectiveness of condoms in preventing HIV/AIDS and other sexually transmitted infections. They claimed that condoms fray the moral fiber, diminish the value of sex and "reduce it into a plaything," and destroy the sanctity of the family.

    Aside from taking the moral higher ground, these critics also attempted to "scientifically" disprove the effectiveness of condoms. They claimed that the condom is not as effective as its supporters say-in fact, the anticondom activists explained, the latex of condoms are riddled with "pores" large enough for sperm, more so HIV, to pass through.

    It turns out that this "scientific" observation is prevalent in other parts of the world as well. In October last year, the British Broadcasting Corporation program Panorama showed a documentary called "Sex and the Holy City," where high-ranking officials of the Catholic Church, including Cardinal Alfonso Lopez Trujillo of the Pontifical Council for the Family, pointed out the "pore" problem. Some even went as far as claiming that condoms spread the virus. Of course this was sharply criticized by the World Health Organization, who called the declarations "scientifically wrong" and "quite dangerous."

    Added Cohen: "The argument that condoms have holes in them is itself full of holes."

PUSSY-WHIPPED?

    The population program under current Health secretary Manuel Dayrit has been repeatedly criticized for seemingly subjecting itself under the power of the Catholic Church. For instance, the government's promotion of "natural" family-planning methods has been attacked as a move to avoid a frontal clash with religious conservatives, which the DOH denied, saying that the promotion of natural family planning was a move to inform the public about other available choices. But just late last year, the government was attacked by population advocates-and praised by religious conservatives-for awarding a PhP50-million (others sources peg it at PhP70 million, while Dayrit says it's in "the neighborhood of PhP100 million") contract to Couples for Christ, a conservative lay Catholic organization, to teach natural family-planning methods. It goes without saying that "natural" does not involve the promotion of condoms.

    Dayrit does recognize the effectiveness of condoms in protecting people from HIV/AIDS infection. In fact, he instructed local health facilities to keep "ample supply of condoms." However, these condoms are the ones that used to come from the USAID. At present, no other agencies provide free condoms to health centers-in fact, people from some centers use their personal money to have a regular condom supply.

    Says the report: "It is a dangerous irony that the same health minister who warns of a possible HIV/AIDS outbreak in the Philippines refuses to support the public sector purchase of condoms for HIV prevention, even in the face of an unprecedented condom supply crisis." Cohen also hit a statement Dayrit had made-abstinence is primary prevention, but use condoms if you can't help yourself-as "stigmatizing" people who use condoms to protect themselves from HIV/AIDS as "people who cannot help themselves."

DANGER ALL AROUND

    The threat of an HIV/AIDS explosion doesn't only arise from decisions made on global and national levels. In fact, matters decided on in local and personal levels make a strong dent in the worsening of the problem.

    A number of local government units have instituted certain "anticondom ordinances," over which the DOH says they have no power. For example, Manila mayor Lito Atienza issued an executive order prohibiting city health centers from having artificial birth-control devices. Although there have also been claims of disciplinary action being taken against nongovernment organizations that promote condom use, the HRW did not find "direct evidence" of disciplinary action. However, there have been reports of pressure being exerted on advocates of artificial birth control methods. The report quotes Dr. Jose Narciso Melchor Sescon of the Remedios AIDS Foundation: "If at any point you advocate for family planning in Manila, the next day you will have your services shut down and padlocked. I know of two NGOs who have been shut down. In one case, the wife of the mayor performed an inspection and found contraceptive commodities on the premises. The next day, their door was padlocked."

    Another NGO reports that there are squatter communities who fear being caught carrying pills or condoms. Gladys Malayang of the Women's Health Care Foundation is quoted as saying: "They actually feel they are being subversives because they are carrying condoms…It's like they're dealing drugs or doing something illegal. They think the city will take their land if they find out."

    Sex workers, meanwhile, reportedly refuse offers of free condoms from NGOs. The report quotes Noel Mandanas of the Pasay City-based NGO Kabalikat ng Pamilyang Pilipino: "We asked one of the freelance sex workers why she was refusing condoms. She said the police might use condoms as evidence against her." A woman charged with vagrancy by Pasay City police confirmed this: "The police came up to me and said, 'It's already late,' and they arrested me. I felt degraded. They called me names. They said, 'You may be beautiful, but I don't like your vagina, because it stinks.' I spent six hours in jail. I had 10 condoms with me. They used it as evidence. They said, 'This is the evidence you are a prostitute.' I told them, 'Just because I have condoms, that doesn't mean I am a prostitute.' The police don't believe that."

    The report continues: "Using condom possession as evidence of prostitution is an unjust and unreliable method of distinguishing sex workers from people who are not breaking the law. It is also a surefire way to deter those who do work in prostitution from carrying condoms in public and protecting themselves, their families, and their communities from HIV."

    The advertising of condoms is also "arbitrarily" restricted, with the television advertising board (Adboard) citing obscenity laws to impose restrictions. The report quotes Dr. Carmina Aquino of the AIDS Surveillance and Education Project (ASEP): "We wanted to air a [television public service announcement] where a real condom comes up on the TV. It was very difficult to have this approved by the Adboard-the image of a condom on TV…They didn't want a real condom. It promoted promiscuity."

    The Philippine AIDS Prevention and Control Act of 1998, the report says, "marked a watershed in the country's fight against HIV/AIDS." However, the implementation of the law has languished: reasons cited include the lack of political will, the religious sector opposition to condom, and certain policies that interfere with the dissemination of correct HIV/AIDS information. "However comprehensive the AIDS law on paper," the report states, "it has proved a weak match for government-promoted anticondom policies and misinformation about HIV/AIDS."

NO CLUE

    And given the absence of any comprehensive HIV/AIDS information programs, the lack of any venue where the problem may be discussed without resorting to sectarian sloganeering, the gap in the provision of adequate resources for contraceptive services (whether for family planning or the prevention of sexually transmitted infections), the number of people at risk of the disease continues to grow.

    Misconceptions that have long been proved incorrect still persist, especially among high-risk people themselves. There continue to exist sex workers who believe it's "very effective to use water to wash" or that AIDS can also be contracted via kissing; MSMs who "do not seem to have heard that condoms are also for gay sex"; adolescents who are taught at school about the evils of premarital sex but engage in it anyway; and OFWs who do have a module on HIV/AIDS in their predeparture orientation that is deemed "[not] relevant to most overseas workers" and called "AIDS 101 without any links to migration."

    There have also been reports of HIV testing among sex workers who have not given an informed consent, "making the tests de facto mandatory in violation of Philippine law."

    Cohen warned: "Silence and lies could undermine HIV prevention for all Filipinos, and condom shortages condemn the poorest to facing the highest risk."

    The study concludes: "The Philippines has all the ingredients of an explosive AIDS epidemic: widespread high-risk behaviors, low AIDS awareness, sporadic condom use-and a government that panders to anticondom Catholic bishops…Promoting condoms as part of a comprehensive HIV prevention strategy would not just be sound health policy. It would be a test of the government's commitment to confronting the stigma of HIV/AIDS and respecting the dignity and human rights of those living with and affected by the disease."

    On May 11, however, UNAIDS executive director Peter Piot said the Church did not oppose condoms, saying the issue is still the subject of hot debate in the Vatican.

    Piot told told Agence France-Presse that Vatican officials had assured him in January that there was an "inconclusive" internal discussion on AIDS and "how to handle particularly that piece of latex."

    "What I was told repeatedly is that the church has no competence on the quality of materials including the quality of latex," Piot added.

    Piot said there were clergy in the field who were "very engaged, even distributing condoms," while others were preaching against them and "saying unscientific things that are actually putting people's lives in danger." "Our approach is one of dialogue because the church and its associated institutions has an extremely important role to play for example in care, treatment and prevention of mother to child transmission-there are many examples."

 

 

 

 

Hearing Health Encouraged

    One of the greatest gifts we have in life is our hearing. Yet, many times, we take this gift for granted, never realizing how easily it can be lost."

    This was the consensus from hearing specialists all over the world, conveyed to the public during the celebration of the ninth international noise awareness day April 28.

    "Who says loud is cool?" They ask, and most people will reply, "It is, isn't it?"

    Thus the noisy fun in concerts, video arcades, dance clubs, restaurant, movie theaters, some sporting events, and home entertainment-which often exceeds the safe level of 85 decibels (dBA).

    "Playing it Loud isn't Playing it Safe," however. Prolonged or repeated exposure to noise above 85 decibels destroys hearing receptors, the hair cells lining the inner ear.

    And once they are destroyed, they are gone forever.

    Past the age of 20, their gradual destruction is inevitable, actually, which is why some degree of hearing loss is to be expected at age 60. However, studies are showing that the noisy lifestyle of many young people hastens this biological attrition.

    Confirms Better Hearing Philippines, Inc. (BPHI) and the University of Santo Tomas (UST) Center for Audiological Sciences: "Recent health statistics suggest that the incidence of noise-induced hearing loss is occurring at younger and younger ages."

    In the United States, noise is one of the leading causes of hearing loss in the 28 million people with impaired hearing.

    When the League of the Hard of Hearing, a worldwide leader in the campaign for noisy awareness, conducted a study in 1998 among third-graders to see if they had hearing problems, it found that 46 percent did.

    These children reported an occasional ringing in their ears-a warning sign of hearing loss caused by noise.

    Adds hearing experts: "Hearing loss from noise is painless, progressive, permanent, and preventable."

    This statement explains the prevalence of the condition. Because it is painless and cumulative, we think nothing of constant exposure to noise in our leisure time-until it is too late. Noise-induced hearing loss is irreversible, but it can be prevented-by being aware.

    BHPI cites some important facts:

    The longer you are exposed to a damaging level, the greater will be the eventual hearing loss.

    Noise levels at video arcades can be as high as 110 dBA.

    Sound levels at live music conserts can be measured at 120 dBA and above.

    The noise level of gunshots can be measured at 150 dBA. Hearing loss can result from just a few shots of a high-powered gun.

    Sports such as speedboating (85 to 115 dBA) and auto racing (140 dBA) produce dangerously loud noises.

    Exposure to noisy restaurants can damage hearing when exposed up to eight hours a day. Studies have shown that personal stereo systems with headphones have maximum output levels that put hearing at risk, at 105 to 120 dBA. Some children's toys, like squeak toys and toy guns, emit explosive or popping noises.

    Physiological changes such as indigestion, high blood pressure, and stress-related disorders are also consequences of continuous exposure to noise.

    Knowing that the same dangers to hearing exist locally, the UST Center for Audiological Sciences, UST Hearing and Dizziness Center, BHPI, and Christoffel Blinden Mission International offered a month-long free hearing evaluation to the public, which started April 28. This is the sixth time the Philippines has joined the international noise awareness day.

    These institutions advise everyone to limit exposure to noisy activities and wear adequate hearing protection.

    When does sound become noise? This is the rule of thumb: "If you have to shout in order to be heard three feet away, then the noise is probably too loud and could be damaging already to your hearing." M. Ciriacruz