and AIDS: The Global Inter-Connection
Deocampo and Jomar Fleras
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
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.
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
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.
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.
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.
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
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.
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
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.
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.
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
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
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
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.