RP’s small number of AIDS cases may hide bigger problem

The Philippines is rife with the ingredients for an AIDS disaster: an active sex industry that draws foreign tourists, with the dominant Roman Catholic Church’s stance against contraceptives contributing to relatively low condom use.

But it hasn’t happened — at least not yet. No one is calling it a success story, however. Some officials worry that the sprawling archipelago may just have been just lucky so far with a number of factors contributing to keeping down the number of HIV/AIDS cases, while others fear that actual cases are greater than surveys and estimates indicate.

The national AIDS registry listed 2,499 confirmed HIV infections and AIDS cases in January 1984-April 2006. The Department of Health estimated the actual number of people with HIV/AIDS at 11,168 this year — a tiny number for a country with a population of 85 million.

A joint study by the World Health Organization and the Department of Health in 2000 said the low prevalence of HIV/AIDS could possibly be attributed to many sex workers having only a few regular partners and that the majority of the male population have only one sex partner.

It said also only a few males engaged in anal sex and the number of injecting drug users is small. In addition, almost all Filipino males are circumcised — which some researchers believe cut down on transmission of HIV — and the country is an archipelago of more than 7,000 islands, hampering transmission of any pandemic.

The health department’s latest estimate may still be a "conservative figure," according to Dr. James Piad, a medical specialist with the Philippine National AIDS Council, which plots counter-AIDS strategies for the country and has warned of a "hidden and growing" threat.

"Right now, what we see is that it is increasing among the high-risk groups in the Philippines — commercial sex workers, their clients, injecting drug users and men who have sex with men," he said, noting that sexual intercourse accounted for 86 percent of all infections.

A UNAIDS report released recently said the "very limited epidemic" in the Philippines could turn bad as a result of low condom use, high levels of sexually transmitted infections and rising numbers injecting drug users who share needles.

"If it (the number of cases) is really low, well and good, but it is scary to think that that is only what we see though we have all the conditions that could actually trigger an epidemic," said Mara Quesada, program officer for the non-government organization Action for Health Initiatives. "We only want that we don’t treat the numbers as a license to be lax."

A survey last year showed an average of only 57 percent of female sex workers in 10 key Philippine cities used condoms consistently.

About 12 percent of sexually active men ages 15-24 used condoms the first time they had sex, it said.

There is also widespread lack of knowledge about HIV/AIDS, with 60 percent of young people surveyed in 2002 saying they were invulnerable to the disease.

Dr. Eric Tayag, director of the National Epidemiology Center, said he was aware that agencies and AIDS prevention groups may be watching out for the "tipping point" that will drive an epidemic.

"But instead of looking for the tipping point, everything that may give rise to this tipping point, we are addressing," he said.

Tayag said the government plans to establish counseling centers and laboratories where people who suspect they have HIV will be encouraged to undergo rapid testing and receive immediate counseling if found positive. The government also is stocking up on anti-retroviral drugs, he said.

Health workers and AIDS activists agree that one major obstacle to getting a clearer picture of the actual situation in the country, and thus prevent the further spread of the disease, is the stigma attached to HIV/AIDS.

Piad of the National AIDS Council said the stigma can turn violent, citing a case where villagers tried to burn down the house of a couple who died of AIDS with their three young children inside in Pampanga. In another, a man barely escaped a lynch mob that drove him out of his home in Manila after the local community leader learned he had HIV.

The strong influence of the Roman Catholic Church also prevents more people from using condoms because it has equated it with contraception and promoting sex, Piad said. — AP