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MANILA — Mr Jhay-ar Tumala remembers sitting in a pew in Manila’s Quiapo Church, holding a sealed envelope with his HIV test results, and praying. He was 19 years of old and had been having sex since he was 15.
“I didn’t know anything about HIV or Aids,” said Mr Tumala, 23, last week.
He does not remember reading about it in the newspapers or learning about it in school. And he had used condoms only intermittently.
The envelope contained bad news.
His story is not unusual, and that may also mean bad news for the Philippines.
While the rate of new HIV infections has been falling across the Asia-Pacific region in recent years, in the Philippines it is soaring. The biggest increase is among gay or bisexual men under 25.
“The Philippines has the fastest-growing HIV infection rate in Asia, along with Afghanistan,” said Mr Steven Kraus, director of UNAids, the United Nations HIV/Aids agency, for Asia and the Pacific. “Right now, the Philippines runs the risk of letting the infection get out of control.”
Between 2010 and 2015, aggressive awareness and prevention campaigns led to a global decline in HIV infection rates. In Asia, rates have decreased 5 per cent. UNAids estimates significant decreases of more than 30 per cent in neighbouring South-east Asian countries such as Thailand, Cambodia and Malaysia.
While the total number of Filipinos living with HIV is low — about 39,600 in a country of more than 100 million — new infections are skyrocketing. UNAids estimated the rate of new infections has increased by more than 50 per cent between 2010 and 2015.
The infection rate has been particularly explosive among gay men under the age of 25, such as Mr Tumala. Among young people most at risk for HIV — gay men, injecting drug users, transgender women and female prostitutes — the rate of new infections has increased 230 per cent between 2011 and 2015.
But the Philippines has been stymied in its efforts to raise awareness about the disease and to arrive at an effective strategy for preventing it among young people.
According to the Health Department, only 17 per cent of Filipinos between the ages of 15 and 24 understand what HIV is and how it spreads.
Last month, the Philippine Department of Education announced that it would scrap a plan developed by the Health Department to distribute condoms to juniors and seniors in public high schools. The plan would have trained teachers to counsel students on how to prevent pregnancies and sexually transmitted infections, and to offer voluntary HIV testing. It would have also provided training to help parents talk to their children about sex.
The plan was opposed by a coalition of parents, the Roman Catholic Church and conservative politicians.
Dr Jose Gerard Belimac, HIV and Aids coordinator for the Department of Health, called the reversal “a lost opportunity”.
A 2015 survey by the Health Department that found that 57 per cent of young gay men at risk for infection are currently high school or college students; and 67 per cent of people currently living with HIV are between the ages of 15 and 24.
While the department runs several anti-HIV programmes, it faces a huge gap in reaching young people. Filipinos under 18 are required by law to have parental consent to buy condoms, to get them from health centres, or to get tested for HIV.
Laws limiting government distribution of contraceptives have played a large part in preventing extensive condom distribution drives, a proven method of prevention. People who want condoms can get them from the health centres, but the centres do not do outreach to the people mostly likely to be exposed to HIV, and there are few public health services specifically aimed at those vulnerable groups.
These barriers leave authorities relying more heavily on a strategy known as “treatment as prevention” — using antiretroviral therapy to decrease the chances of passing HIV to others, coupled with testing drives, as a way to stop the spread of the virus.
While such an approach can be helpful if a large number of people who have HIV know they have it and get treatment, in the Philippines both testing and awareness are low, and experts say that effective HIV prevention requires a response that combines all proved methods. Focusing on treatment as prevention, they say, is more expensive and less effective than an approach that emphasises safe-sex practices and education.
“All good and successful national Aids programmes use condoms,” said Mr Kraus. Of the countries that have posted 30 to 35 per cent reductions in new HIV infections, “a lot of those reductions have been the result of comprehensive condom programming”.
And while the cost of antiretroviral treatments have plummeted in the past two decades to less than US$100 (S$140) per person per year, condoms can be produced for less than a penny each.
Mr Chris Lagman, director of learning and development at Love Yourself, a non-government HIV testing centre he helped open in 2011, said the barrier to a more robust programme came not just from church teachings but from a clash of generational values between younger Filipinos, who are growing up in a more permissive culture and experimenting with sex earlier, and their parents who, like the generations before them, are disinclined and ill-equipped to discuss sexual health.
“That’s the perfect formula for STIs (sexually transmitted infections), including HIV,” he said. “The youth explore, but do it without the proper education.” THE NEW YORK TIMES