Volunteer medical technologists speak to students about a free HIV testing program, at the State University in Manila, Philippines on Sept. 13, 2019.MARIA TAN/Getty Images
Darwin Tenoria, an HIV program officer with a charity in the Philippines, was preparing to speak to a group of high school students when a teacher came to him with a request.
After a decades-long global effort, HIV rates are on the decline in all but a handful of countries, one of which is the Philippines. With attitudes toward sex liberalizing in this still deeply Catholic country and teenagers having sex increasingly earlier, there is a recognized need for better education about the risks of sexually transmitted infections (STIs). The school was on board with Mr. Tenoria broaching the subject with its students, but the teacher asked if he could do so without mentioning condoms.
“It’s frustrating,” Mr. Tenoria told The Globe and Mail at a social hygiene clinic in Quezon City, an IT and entertainment hub of three million people neighbouring the capital, Manila. “Religion is acting like a barrier. Young people are more open, they’re having sex, but they don’t know how to protect themselves. We’ll be No. 1 around the world for HIV if we continue business as usual.”
The Philippines already has the fastest-growing HIV epidemic in Asia-Pacific, with a 418-per-cent increase in new HIV infections and a 538-per-cent increase in AIDS-related deaths between 2010 and 2022, according to the Pilipinas Shell Foundation (PSF), which funds anti-HIV programs nationwide. The number of newly diagnosed HIV cases increased from six per day in 2011 to 48 last year.
“We used to call this a hidden and growing problem, now it’s fast and furious,” said Dr. Loyd Brendan Norella, HIV program manager at PSF.
Manila has taken steps to address this growing health crisis: Both antiretrovirals (ARVs), which prevent HIV from developing into AIDS and have made the infection no longer a death sentence for most early diagnoses, and pre-exposure prophylaxis (PREP), which can prevent infection in the first place, are free from the national health care system.
In some areas, Manila can already claim success: Sex workers used to be a major vector for HIV and other STIs, but by requiring testing for people who work in businesses adjacent to the – still illegal – sex industry, such as massage parlours and karaoke bars, rates have come down significantly.
In interviews, multiple HIV workers and activists all described a system that, on paper, should be the envy of many countries but is being hamstrung by conservative attitudes and particularly the influence of the Catholic Church, with its strict edicts against artificial contraception. Comprehensive sex education is rare in schools while providing condoms to those under 18 is illegal without parental permission.
“There’s a feeling that giving out condoms might encourage sexual promiscuity,” said Dr. Norella. “This results in a gap where young people are sexually active but not using protection.”
The Catholic Bishops’ Conference of the Philippines did not respond to a request for comment. In the past, the body has put out statements warning against condom use and claimed – falsely – that “given its high failure rate, the condom cannot really put a stop to AIDS.” (The country has the third largest population of Catholics in the world at 85 million.)
The government is showing greater flexibility. While the law against providing contraception to under-18s stands, legislation around HIV treatment does not reference condoms, which some health workers regard as a loophole allowing them to hand them out on the basis of protecting against STIs. They also acknowledged they’re not likely to ID anyone who comes in to take the free condoms and lube on offer at government-run clinics.
But doing so requires someone to appreciate they need to use condoms in the first place and be willing to overcome any perceived stigma they feel about entering a social hygiene clinic (which, despite the name, mostly treats STIs). This may be doubly daunting for members of the LGBTQ community, even as attitudes toward sexual minorities have liberalized in recent years, particularly in big cities.
Around half of new HIV infections in the Philippines in 2024 were among people aged 15 to 24, with the largest cohort being men who have sex with men. Closeted or bisexual men can transmit HIV to women, who may then unknowingly pass it to their children, resulting in what health workers regard as the Philippines’ most egregious statistic: a growing number of mother-to-baby HIV infections.
That’s how the dozen or so children gathered on a recent Thursday at My Hub Cares, a private sexual health clinic in Pasig, a city in Metro Manila, came to be infected.
Co-founder Ico Johnson, a prominent LGBTQ activist who was himself diagnosed with HIV in 2011, said that as well as helping the children in its care, the clinic can act as an important bridge to donors and politicians who may think – as many in the West did during the ‘80s and ‘90s – that HIV is only a risk to marginalized communities.
“It changes the perspective,” he said. “We can say look, mothers can be affected, you can be affected if you’re not careful, your kid can be affected.”
As the children age into adolescence, programs have shifted from mostly medical to also social, educating older attendees on how to disclose their status to potential sexual partners and their right not to do so in other instances. Even Mr. Johnson’s wards are not immune to conservative attitudes coming from the pulpit, however: One teenage My Hub Cares patient – whom The Globe is not identifying to protect their privacy – cited their priest as someone they learn about sex from and talked of people needing to control their urges and suffer the consequences of not doing so.
Mr. Johnson shakes his head at this response, acknowledging the uphill battle those preaching safe sex sometimes have to fight against the actual preachers. Gregarious and energized, he was clearly comfortable in fundraising mode, rattling off success stories and the potential for expanding My Hub Cares, but even he admitted the frustration at not being able to solve an issue that has been addressed elsewhere for years now.
“It’s 2024,” Mr. Johnson said. “I am embarrassed for the Philippines. We have free HIV testing, we have free condoms and lubricants, we have free PREP and free antiretroviral medicines, and of course, we have all the experience globally, and yet the cases are still going up.”
Sighing, he added, “We have everything here, in the Philippines, all we have to do is educate.”
James Griffiths travelled to the Philippines as a guest of The Global Fund to Fight AIDS, Tuberculosis and Malaria. Global Fund did not review this article.