As H.I.V. Soars in Philippines, Conservatives Kill School Condom Plan

Jhay-ar Tumala remembers sitting in a pew in Manila’s Quiapo Church, holding a sealed envelope with his H.I.V. test results, and praying. He was 19 and had been having sex since he was 15.

“I didn’t know anything about H.I.V. or AIDS,” Mr. Tumala, 23, said last week. He does not remember reading about it in the papers 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 H.I.V. 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 H.I.V. infection rate in Asia, along with Afghanistan,” said Steven Kraus, director of Unaids, the United Nations H.I.V./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 have led to a global decline in H.I.V. infection rates. In Asia, rates have decreased 5 percent. Unaids estimates significant decreases of more than 30 percent in neighboring Southeast Asian countries like Thailand, Cambodia and Malaysia.

While the total number of Filipinos living with H.I.V. 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 percent between 2010 and 2015.

The infection rate has been particularly explosive among gay men under 25 years, like Mr. Tumala. Among young people most at risk for H.I.V. — gay men, injecting drug users, transgender women and female prostitutes — the rate of new infections has increased 230 percent 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 percent of Filipinos between the ages of 15 to 24 understand what H.I.V. 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 H.I.V. 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.

“The Department of Health and the Department of Education should concentrate on uplifting the values of the Filipino youth,” Senator Vicente Sotto III said in an interview last month. He argued that distributing condoms in schools amounted to encouraging promiscuity, and pointed out that condoms were already available free at public health centers and for sale in convenience stores.

The Rev. Jerome Secillano, an officer of the Catholic Bishops’ Conference of the Philippines, praised the decision to back away from the plan as “a wise move.” About 80 percent of Filipinos are members of the Catholic Church, which advocates abstinence as the way to reduce H.I.V. infections.

Dr. Jose Gerard Belimac, H.I.V. 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 percent of young gay men at risk for infection are currently high school or college students, and 67 percent of people currently living with H.I.V. are between the ages of 15 and 24.

While the department runs several anti-H.I.V. programs, 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 centers or to get tested for H.I.V.

Laws limiting government distribution of contraceptives have played a large part in preventing extensive condom distribution drives, a proved method of prevention. People who want condoms can get them from the health centers, but the centers do not do outreach to the people mostly likely to be exposed to H.I.V., 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 H.I.V. 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 H.I.V. know they have it and get treatment, in the Philippines both testing and awareness are low, and experts say that effective H.I.V. 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 emphasizes safe-sex practices and education.

“All good and successful national AIDS programs use condoms,” Mr. Kraus said. Of the countries that have posted 30 to 35 percent reductions in new H.I.V. 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 last two decades to less than $100 per person per year, condoms can be produced for less than a penny each.

Chris Lagman, director of learning and development at Love Yourself, a nongovernment H.I.V. testing center he helped open in 2011, said the barrier to a more robust program 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 S.T.I.s,” sexually transmitted infections, “including H.I.V.,” he said. “The youth explore, but do it without the proper education.”

While there is a certain level of acceptance of homosexuality in the Philippines, sex is seldom discussed openly. Buying a condom can be a shameful experience; younger people fear the humiliation of being carded, and others fear the judgment of getting caught preparing for sex.

Getting tested for H.I.V. provokes a similar response. Michael Jamias, a 30-year-old volunteer at Love Yourself, said he had to to brace himself at public health clinics to be chastised by nurses for being malandi, the Filipino term for flirty, with the implication of promiscuity.

“You feel like you’re being shamed for having sex,” he said, and shame remains a powerful deterrent to access.

The long stretch of relatively low numbers of H.I.V. infections in the Philippines bred carelessness toward condom use that continues in the current epidemic.

While H.I.V. is currently concentrated among youth and gay men, the Philippines is in danger of losing an opportunity to address infections within those groups, experts say.

Both Dr. Belimac and Mr. Lagman have observed that H.I.V. infections have begun to spread more to the general population.

For the first four years at Love Yourself, Mr. Lagman says all cases that turned up positive were among young gay men. Starting last year, however, the testing center has observed a shift. The center is now seeing some women, as well as children as young as 2 and 3 years old, who have tested positive for H.I.V., suggesting the infections are moving into the general population, which will make prevention an even more complex challenge.