Stepping Outside Comfort Zones

Carolina Austria

Advocates in the Philippines have begun to change their approach to HIV/AIDS by talking about it alongside issues of gender, rights and sexual health.

Simon asked for crushed ice and pineapple juice in separate drinking cups before eating lunch. He explained to us that in the acute stages of AIDS, the simple act of swallowing solid food was very painful for him. Doctors earlier advised him to take his food in liquid form, but he missed eating.

Beaming, Simon told us that through his own experimentation, he discovered that chewing crushed ice and swallowing it with pineapple juice before eating, somehow made swallowing food more bearable, surmising it could be the numbing effect of ice on the esophagus. Why pineapple juice, we asked Simon. He just smiled at the unexplained mystery. Out of all the juice he tried, pineapple worked best with his method and he didn’t exactly know why.

I met Simon last year when both of us were invited as resource persons to speak at a youth conference about a host of topics on sexuality, health, gender and the rights of youth. Simon, an advocate living with full blown AIDS, is one of many persons living with AIDS who have committed themselves to educating people about HIV/AIDS in the Philippines.

The forum where I met Simon was, in most respects, not a usual one in urban Metro Manila, Philippines, where for the most part, local governments have a variety of positions on matters regarding reproductive health. The capital, Manila, is even known for its “ban” on all matters relating to contraception. Marikina City’s local government is an exception. The youth conference was the effort of Foundation for Adolescent Development (FAD), an NGO and the local government’s Health Office.

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Apart from the unlikely support of government however, what is also relatively new is the way advocates have begun to change their approach to HIV/AIDS by talking about it alongside issues of gender, rights and sexual health.

Raquel Ignacio, a trainer and grassroots organizer for Action for Health Initiatives, Inc. (ACHIEVE), points out that “It has been interesting to note that over 92% of those who tested HIV positive in the country in fact cite heterosexual sex as the primary mode of transmission and yet programs and approaches have hardly considered how sexual power relations figure in all these things.”

Time and again, condoms have been the focus of local debates, usually with Catholic Bishops decrying condom use and equating it with promiscuity. Raquel opines that instead of challenging “male privilege,” and male defined concepts of sexual pleasure, many advocates just did exactly what the Bishops expected of them, targeting sex outside of marriage, failing to point out that monogamous women within marriage were also at risk.

“While there is nothing wrong with a non-judgmental attitude when talking about multiple partners or non-marital sex per se in the context of consent and responsibility, the problem is that we haven’t really hit upon the problem of why Filipino men aren’t using condoms in the first place and why women (even sex workers) are in no position to even negotiate condom-use!”

Low condom use among Filipino men has been noted in previous, as well as current, research. Recently of course, new infections have been most noted among returning overseas workers since testing is mandatory and imposed by host countries. Likewise Filipino women, specifically those whose partners are seafarers, account for many of the new cases.

Johor, a state in nearby Malaysia, decreed in 2001 that couples be tested in state hospitals. If medically fit, the couple would be issued a certificate by the religious authorities and allowed to marry. But if either one tested positive, the couple would be counseled on the risks and consequences of HIV/AIDS and then the final decision whether to marry would be theirs. The policy, which to date is still being opposed by NGOs and health advocates for violating individuals’ rights, was criticized by WAO as a short- sighted “protectionist strategy which doesn’t account for the unequal power relations of women and men, especially within marriage.”

Malaysia, a close Philippine neighbor in the Southeast Asian region seemingly faces a more serious HIV/AIDS threat than the Philippines. There are 64, 439 reported cases of HIV/AIDS in Malaysia as of 2004, compared with 2,233 in the Philippines as of 2005.

On the other hand, Malaysia is also well known for its state provided primary health care. In 2004, the Malaysian Health Minister announced that all those infected with HIV will be given free life- prolonging drugs by 2005, as soon as the drugs can be locally produced. Malaysia is among the few countries in the world able to provide the drugs, used in the Highly Active Antiretroviral Therapy (HAART), for free.

In stark contrast, the only available confirmatory testing facility in the Philippines is in a DOH funded hospital in the capital Manila; even the “low levels” of prevalence as reflected by “reported cases,” which used to be characterized as “low and slow,” is now more aptly termed by pundits as, “hidden and growing.” Likewise a limited number of NGOs are able to provide subsidized access to ARVs, much less answer a variety of health care needs for people with HIV.

Human Rights Watch in 2004 noted the link between conservative attitudes on sexuality and the growing gap in access to contraceptives, specifically the condom, to the hidden threat of HIV/AIDS.

Despite the a 1998 law, which prohibits “mandatory testing,” there was already a pending bill in the last Philippine Congress, which echoes the self-same Johor policy of mandatory testing for couples prior to marriage.

At the forum where we met, Simon told young people about his condition and how everyday was a struggle. Despite having moved the crowd to tears, he even humbly admitted having learned a lot from the other speakers who talked about sexuality, gender relations and rights. “I’m happy to learn something new everyday,” he noted. Of course, hearing him speak, he sparked in us new things to hope for.

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