HIV and AIDS: The Global Inter-Connection STRUGGLING WITH CONTRADICTIONS

As the Philippine night descends, much of the facade that masks this predominantly Catholic society is stripped away to reveal Manila's stark realities. The glow of the capital city's neon-lit streets reveals a netherworld where the commercial sex industry thrives.

Elmer is but one among many who make their living there. His regular source of income comes from stagings of toro, the local lingo for anal or vaginal sexual intercourse performed in public. First popularized in underground heterosexual bars during the sixties, toro has found its way to those gay bars known for producing masturbation contests and sex orgies. Elmer, who takes the receptor role, is one of the district's best-known performers.

Lured into the sex trade at an early age, he has performed this act nightly before a jeering crowd for the last ten years. It is an ugly, dehumanizing way of making a living but with the money Elmer, who lives in the slum colony of Tondo, supports a son, an ailing grandmother, a number of brothers and several other relatives.

He has heard of HIV and knows that it kills. He is concerned because it threatens not only his life but the lives of those who depend on him for support. Yet Elmer has only a vague idea of how HIV is transmitted and how infection can be prevented. This degree of ignorance about the disease remains alarmingly high throughout the country. The distortion and confusion that surround the subject have created a climate where people affected by and at risk of contracting the disease demonstrate complex and conflicting responses: anxiety, fear, guilt, apathy, denial, anger, and fatalism.

Perhaps to deflect the fear, perhaps in denial, Elmer has adopted a to-hell-with-it attitude that borders on hysteria. He violently objects to having an HIV blood test and does not use or request the use of condoms during his shows. When asked what he would do if he became HIV-positive, Elmer candidly replied, "I will get a can of gasoline and set myself on fire," noting that it would be front page news. Elmer's reaction, though histrionic, is not an isolated phenomenon. Twenty-eight per cent of male sexual workers in a recent survey said they would commit suicide if they became infected with HIV.

Here in the Philippines, to understand reality one must struggle with contradictions. Our colonial history can best be described as 300 years of convent life under Roman Catholic Spain and forty years of Hollywood under America. We have undergone a barrage of indoctrinations from two extreme ideologies, the medieval spirituality of the Catholic Church, and the modernity and commercialism of American pop culture. America's teaching of sexual freedom has helped foster behaviours that are enabling the spread of HIV in the Philippines. The Catholic faith, as bequeathed by Spanish friars, has instilled reactionary religious beliefs that are also helping the disease's spread.

This social history has resulted in a double standard and is responsible for many of the contradictions that pervade Filipino life. These contradictions manifest and represent a distinct aspect of the national personality. Youngsters are torn between the family's strict moral codes and peer group pressure to break sexual taboos. As a rite of passage, groups of friends commonly arrange for boys to lose their virginity in brothels. Marriage is extolled as the social ideal, yet married men regularly seek extra-marital sex. Sex work is regularly denounced and blamed on the American military and other foreigners. Yet, in one study, female sex workers said that 75 per cent of their clients were local married men. On paydays, it is common to see Filipino men trooping to massage parlours which are fronts for the commercial sex industry.

These contradictions are also illustrated in the ways some people seek to reconcile their sense of powerlessness with the divine. At the very heart of Ermita, Manila's red-light district, is a church where sex workers pray the novena before plying their trade. Images and icons of saints meant to inspire luck can also be found in brothels. Many commercial sex workers wear religious scapulars, crosses or amulets as protection against sexually transmitted infections. It is not unusual to find Filipinos employing a combination of folk Catholicism, mysticism, and superstition in dealing with HIV. Adhering to the belief that everything is the work of Divine Providence, that all is a matter of fate, creates a sense of helplessness and insecurity in many Filipinos.

One shudders to think how easily HIV can become a crisis in Manila. The city has more than 1,000 bars, massage parlors, and discos catering to sex-seeking tourists. During Ferdinand Marcos' regime, sex tours were in high demand and commercial sex work claimed not only females and males, but children as well. The permissive sexual climate during that twenty-year period was merely symptomatic of the decay in the country's economic, political, and moral structure; a decay epitomized by political repression and the conspicuous consumption of our conjugal dictators Ferdinand and Imelda Marcos.

Today the economy of the Philippines is devastated. Seventy per cent of the population lives in poverty. While our literacy level is one of the highest in Asia, the quality of education leaves much to be desired. People are ignorant about basic health issues and the commercial sex industry runs at full tilt.

We are tired of fighting powerful tyrants and colonial masters; tired of typhoons, earthquakes, floods, and other natural calamities; tired of the poverty, corruption and political instability that has gripped our nation for generations. To many Filipinos, the threat of HIV, with its insidious power to spread undetected, is another fearsome and fatiguing burden.

The advent of HIV was met with the customary denial and suppression of information. America, and those politicians with close ties to her, were blamed for the virus' incursions. Opposition leaders used the issue to criticize the government for advocating sex tourism and the media sensationalized the disease by focusing on its incurable nature.

To counter the fear, jokes about HIV and AIDS abounded. The government's report of 218 cases of HIV infection at the end of 1990 led many Filipino's to believe that the situation was not serious. The public does not realize that if we do not intervene now, we will have a serious problem in our near future.

The last decade has witnessed a substantial rise in migration. More than 1 million Filipinos have left home seeking temporary work abroad. There is little doubt that some returning workers are infected with the virus.

The presence of American GIs in our country has always been associated with commercial sex work and consequently with sexually transmitted infections. Although the U.S. military bases are now closed, they will have left this legacy behind. In Olongapo and Angeles where the U.S. military bases were located, approximately 25,000 licensed hospitality women and thousands of other free-lance workers served the rest-and-recreation needs of U.S. military personnel.

Female commercial sex workers, estimated to number between 200,000 and 500,000, are stigmatized by their work, class origins, rural backgrounds and, lately, by HIV. They have often been the objects of collective denial by government and the public. Although the majority of sex workers are female, clandestine male brothels are found in all major urban centers. Many male sex workers also work out of gay bars and massage parlors offering "special services." An undetermined number of male sex workers solicit customers near commercial centers, cinemas, parks, and public toilets. In addition to other men, a significant percentage of their clients are women.

Numbed by alcohol or drugs or lured by the money, many commercial sex workers easily succumb to unsafe sexual behaviour. Anything goes if the price is right, including sex without condoms. For many, the risk of infection is far less frightening than the immediate threat of hunger, because becoming bedridden may take five to eight years but their hungry stomachs must be filled today. The response of one female commercial sex worker is sadly typical of this pervasive fatalism: "I've been selling my body for five years. If HIV has been going around here, I'm sure I would have caught it. But I don't care."

Gays in the Philippines have also been stigmatized by being classified negatively since the arrival of HIV. There is a large gay population in the Philippines and, despite the Church's official stance, homosexuality is not illegal. Activism has been slow to build because the gay community is disorganized and divided by the same class divisions, discrimination, and racism found in the heterosexual community.

The gay community's reaction to the crisis has ranged from disavowing any responsibility to accusing others. Some feel that sex workers and foreigners are to blame for the virus' spread.

One prominent homosexual man has even suggested that "low-class gays should be rounded up for testing since they're the only ones who sleep with foreigners." The owner of a male brothel accepts only long-term expatriates as clients on the assumption that they are "clean." Even many call boys have begun to shun foreigners who used to be their favoured clients.

All this is evidence of the social havoc rendered by the disease among those labeled as high-risk in the Philippines. This categorization has resulted in further stigmatization of people already burdened by the moral prejudices of society. Yet little has been done to promote general awareness and change sexual behaviour.

The growing scarcity of decent-paying jobs and the ever-growing labour force make it tempting for young men and women to capitalize on their bodies. A shadow population of hundreds, perhaps thousands, of children and adolescents who occasionally engage in the sex trade already exists. There are children who exchange sex for trips abroad or household appliances, as well as those who sell themselves for a meal or a pair of shoes. Many young people, especially boys from middle-class families, resort to occasional sex work when pressured by their peers to prove, ironically enough, their manhood, or to provide money for the group.

The burgeoning group of sexually active children, adolescents and young adults, many of whom have little knowledge about safe sex, make the Philippines a nation ripe for catastrophe. Many will become exposed to HIV infection while fulfilling their sexual urges or struggling to survive. They are an elusive group that is not easily counted or identified, not easily contacted by educational campaigns. It will be even more difficult to effectively reach young males who chauvinistically reject condoms. Few will consent to testing and fewer still will acknowledge they were infected for fear of being ostracized by their peers.

Although commercial sex work is illegal, the government has devised intervention efforts targeted towards commercial sex workers as part of its national HIV/AIDS programme. While the government is accelerating its drive to identify those affected by the disease, it has yet to implement a viable plan to care for the sick and the dying. In the interim, many who are already infected may be driven underground, becoming even harder to reach. Already there is resistance to testing among sex workers.

The Department of Health has created programmes to inform the public about the nature and transmission of HIV. Print and broadcast educational programmes have begun to confront some myths surrounding the disease. Telephone hot lines and television phone-in programmes have been helpful in answering questions.

The Catholic Church has planned its own intervention efforts and it has mapped out an educational programme for schools and the population as a whole. Counselling, care, and creating alternative income generation for infected people are part of its provisions.

Non-governmental organizations and other groups have sprouted up almost overnight to address the need for more immediate HIV and AIDS care. Artists have formed an organization called Reachout using theater, literature, and other art forms to inform the public about the issues. A number of private organizations are implementing intervention work among commercial sex workers. And gay men are finally banding together to form HIV support and informational groups, among them, the Library Foundation and the Gay Response to AIDS Prevention and Education (GRAPE).

The use of condoms must be an integral part of any HIV prevention programme. Yet here in the Philippines, resistance is high. Sometimes commercial sex workers, fearful that their clients will consider them diseased or dirty, shy away from using condoms. Filipino men are equally if not more resistant to their use for similar reasons and because they believe condoms diminish pleasure.

Many Filipinos continue to regard condoms merely as contraceptives and not as barriers to sexually transmitted infections and HIV. The belief that ordinary hygienic measures such as washing the genitals before and after sex can prevent gonorrhea, syphilis, and HIV infection is still strong. Most people also assume that taking vitamins, having regular check-ups, exercising, maintaining proper diet and, of course, praying are all effective HIV prevention methods.

Much of the resistance to condoms stems from their use as contraceptives and is centered in the Church. In a Catholic country struggling to deal with the problem of HIV, no issue is more controversial. The Catholic church forbids artificial birth control methods of birth control, despite galloping population statistics. The Vatican has condemned the use of condoms even for disease prevention. Consequently, the government faced with the all-powerful Archbishop of Manila, Jaime Cardinal Sin, has found it difficult to launch a full-scale safer sex programme.

The Pontiff maintains that HIV can be defeated only by a resurgence of moral values. But how can we stop commercial sex work? Unless we eliminate poverty, the basic reason commercial sex workers exist, we will never have this "moral regeneration". Calling for a moral renewal, instead of advocating practical means of combating the spread of HIV, ignores the social, economic, and medical realities and the urgency of the crisis.

This is no time for ideological bickering. What the Filipino people need is a decisive and concerted effort to face the problem in all its varied ramifications. We do not need the veil of ideological vagaries and abstract mysticism. We must not wait until the epidemic begins to take a heavy toll on both our population and our economy.

Young, sexually active Filipinos are at risk. They are the country's labour force. We are also dependent on remittances of foreign investments and tourism, all of which would undoubtedly fall off if there were a large-scale epidemic. It is ironic that tourism is partially to blame for the problem but remains one of the country's major means of survival. Lastly, what are the ramifications for a government that is already cash-strapped? How will we be able to cope with the economic demands posed by a large-scale epidemic?

Now that the U.S. military bases have been dismantled, thousands of commercial sex workers, some of whom are already HIV-positive, are leaving Olongapo and Angeles to seek work in other urban and rural areas. It is becoming even more difficult to gain access to and empower them. The possibility of containing HIV infection within those areas will be lost. Inevitably the disease will spread, cutting across gender and class lines, and geographic regions.

For intervention programmes to be successful, information and education are not enough. We must empower people to believe that they shape their own destinies, that what they do makes a difference, that HIV is not God-given. We found this approach effective in battling the political dictatorship. We can rekindle this spirit in our efforts to stop HIV.

We must tap into existing cultural values like the spirit of tulungan, which fosters concern and participation in any community undertaking. Filipinos are, deep at heart, communal as a people. They will lend a hand to someone in distress.

When and if the situation worsens, there is the spirit of damayan, oneness in the community. One demonstrates damayan by aiding the bereaved and aggrieved, by carrying the burden of one's fallen neighbor. The media has called on these traits many times in soliciting support for victims of natural calamities. We must draw on these values again in our fight against HIV.

Several miles outside of Manila a volcano, dormant for more than six hundred years, erupted in 1991 claiming hundreds of lives, forcing thousands upon thousands to flee. HIV, like Mount Pinatubo, will lie dormant, without signs or symptoms for years. In those years of silence, the virus builds up its strength. One day it will erupt, not as spectacularly as Pinatubo, but far more fatally.

How much time is left before it will be too late to stop the disease from erupting? What will happen to people like Elmer and their families? What will happen to Filipino society? What measures are in place to forestall this major catastrophe? How prepared are the people? The alarm bell is ringing.

Although we have painted a grim scenario here, we still believe that all is not lost. We are not a hopeless lot. We are a nation of survivors who are resilient in the face of disaster. We can be shaken out of our apathy, as dramatized by the 1986 People's Power Revolution that toppled the Marcos regime. Ours was a revolution that served as a model for Eastern Europe's struggle for democracy. HIV demands that we organize a new revolution if we are to effectively control and prevent the spread of this disease. The future is in our hands.