'Sakit ng lalake'
'Sakit ng lalake'
Updated 01:28am (Mla time) Dec 01, 2004
By Michael Tan
Inquirer News Service
Editor's Note: Published on page A15 of the December 1, 2004 issue of the Philippine Daily Inquirer
I COULD have kicked myself. I was taking my lunch after delivering a plenary lecture at the Philippine Society for Microbiology and Infectious Diseases (PSMID) when I realized I had forgotten to mention something very important: "sakit ng lalake" (men's diseases).
PSMID, which is composed of health professionals working in the area of communicable diseases, had invited me to speak about HIV/AIDS and STIs, with special focus on whether Filipinos had outgrown the stigma around these illnesses.
My answer to the question about stigma was an unequivocal no, pointing out that this stigma was in fact contributing to the spread of these STIs. I thought of sharing some of the points I made during my lecture to explain how this happens and will eventually get back to this point about sakit ng lalake.
Not in my home, please
I started out the lecture by presenting some figures from the 2003 National Demographic and Health Survey (NDHS). I know this is the third column in which I'm mentioning that survey but that nationwide study conducted by the National Statistics Office (NSO), covering 13,000 women and 5,000 men, is a rich mine of information on many health issues.
The NDHS included several questions to measure people's knowledge about and attitudes toward HIV/AIDS and STIs. One of the questions was this: "If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret?" Surprisingly, 76 percent of women and 79 percent of men replied, "No."
I was elated when I first saw that figure, thinking it meant Filipinos were now more ready to accept someone with HIV/AIDS. But my optimism faded quickly when I saw other responses in the survey. Asked if they would care, in their own household, for a relative with AIDS, only 34 percent of women and 29 percent of men answered, "Yes." And when asked if a female teacher with the AIDS virus should be allowed to continue teaching, only 14 percent of women and 11 percent of men said yes.
How do we explain these statistics? It seems that people feel that a diagnosis of HIV/AIDS shouldn't be kept a secret precisely because they fear the disease so much. The responses to the questions about caring for a relative or having an HIV-positive teacher suggest that people want to know who has HIV so they can keep away. The NDHS results show clearly that HIV/AIDS remains heavily stigmatized, to the extent that we would turn our backs on relatives with the disease.
Antibiotics and brake fluid
Although saddened, I was not surprised by the NDHS statistics. Our attitudes toward HIV/AIDS are a carry-over from the way we look at STIs in general. Even the older terms for these diseases-"venereal disease (VD)" and "sexually transmitted diseases (STDs)"--still elicit feelings of dread.
Among these STIs, HIV/AIDS is the most feared because it is seen as deadly and because of widespread misconceptions that it spreads easily. The NDHS in fact found that most of those surveyed still believe HIV/AIDS can be spread by mosquitoes, or by food shared with someone who is infected. (To set the record straight, HIV/AIDS is not spread through those routes. If it were, we'd have an even more deadly epidemic right now.)
But there's more to the fear of HIV/AIDS and STIs than misconceptions. The stigma around these diseases relate to the moralism that has emerged around these diseases. Too quickly, we presume that someone with STI is promiscuous, a term which Margy Holmes defines as anyone who has more sex partners than ourselves.
In the Philippines, the fear of STIs is a fear of women's sexuality, reflected in the widespread use of the term "sakit ng babae" (women's diseases) to refer to STIs. It isn't just any woman that's feared; specifically, it's "liberated" women, "liberated" here taken in its Filipino-English meaning to refer to someone who is "easy" with sex.
STIs are used to reinforce moralistic ideas that sex should be used only for reproduction and that outside of this purpose, it is dirty and dangerous. Discussions about STIs, like those about sex in general, are therefore driven underground. This only adds to the stigma so that when someone is infected, he will not go to a physician and resort to self-treatment with information gathered from the grapevine. The stuff used both for preventing and treatment of STIs is amazing, ranging from the newest antibiotics to brake fluid (yes, I got this from an interview with a taxi driver who argued that if it was powerful enough to stop a car, it should stop STIs as well).
So who's spreading STIs?
Filipino men are actually ambivalent about STIs. There's fear but there's also fatalism, even some attraction to the risks. When an infection does occur--as long as it is not HIV/AIDS--it may even be considered a badge of honor, something to boast about to the barkada (peer group).
The networks for treating STIs are more accessible to men because discussions about sex and STIs are less stigmatized (and because there is, to some extent, pride in being infected). Women, on the other hand, are unable to get the information they need because it's just not acceptable to talk about STIs with other women friends.
Women, in fact, may be aware that they are vulnerable because of a philandering husband, and yet would not dare to even suggest to their husbands that they use a condom for protection. The power relations are too skewed, which is why the theme around this year's World AIDS Day is "Women, Girls and HIV/AIDS," warning that the AIDS epidemic has now taken an alarming trend, where many women are being infected by their own husbands.
"It takes two to be monogamous" is a message I've kept repeating in my lectures. You might be faithful, but if your partner isn't, you're also at risk for STIs. And the risks are greater for women because, contrary to popular misconceptions, it is easier for men to infect women rather than the other way around. The reason is simple: women are the ones on the receiving end, so if her male partner has an STI, he literally deposits the infectious germs in her, and these stay on for several hours. The risks for women are further increased because the vagina is more prone to tearing and injuries during intercourse than the penis.
We can all contribute to removing the stigma around STIs through a more frank discussion of sex and sexuality, including the unequal relationships between men and women that fuel the spread of these diseases, including HIV/AIDS.
At the PSMID convention I asked for greater caution in our choice of words. I've always reacted strongly against the term "core transmitters," often used by AIDS organizations to refer to women sex workers. I did forget to appeal to the PSMID members to also stop using the term "sakit ng babae," which tends to blame women for these diseases.
Should we now call these diseases "sakit ng lalake"? It's your call.
Updated 01:28am (Mla time) Dec 01, 2004
By Michael Tan
Inquirer News Service
Editor's Note: Published on page A15 of the December 1, 2004 issue of the Philippine Daily Inquirer
I COULD have kicked myself. I was taking my lunch after delivering a plenary lecture at the Philippine Society for Microbiology and Infectious Diseases (PSMID) when I realized I had forgotten to mention something very important: "sakit ng lalake" (men's diseases).
PSMID, which is composed of health professionals working in the area of communicable diseases, had invited me to speak about HIV/AIDS and STIs, with special focus on whether Filipinos had outgrown the stigma around these illnesses.
My answer to the question about stigma was an unequivocal no, pointing out that this stigma was in fact contributing to the spread of these STIs. I thought of sharing some of the points I made during my lecture to explain how this happens and will eventually get back to this point about sakit ng lalake.
Not in my home, please
I started out the lecture by presenting some figures from the 2003 National Demographic and Health Survey (NDHS). I know this is the third column in which I'm mentioning that survey but that nationwide study conducted by the National Statistics Office (NSO), covering 13,000 women and 5,000 men, is a rich mine of information on many health issues.
The NDHS included several questions to measure people's knowledge about and attitudes toward HIV/AIDS and STIs. One of the questions was this: "If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret?" Surprisingly, 76 percent of women and 79 percent of men replied, "No."
I was elated when I first saw that figure, thinking it meant Filipinos were now more ready to accept someone with HIV/AIDS. But my optimism faded quickly when I saw other responses in the survey. Asked if they would care, in their own household, for a relative with AIDS, only 34 percent of women and 29 percent of men answered, "Yes." And when asked if a female teacher with the AIDS virus should be allowed to continue teaching, only 14 percent of women and 11 percent of men said yes.
How do we explain these statistics? It seems that people feel that a diagnosis of HIV/AIDS shouldn't be kept a secret precisely because they fear the disease so much. The responses to the questions about caring for a relative or having an HIV-positive teacher suggest that people want to know who has HIV so they can keep away. The NDHS results show clearly that HIV/AIDS remains heavily stigmatized, to the extent that we would turn our backs on relatives with the disease.
Antibiotics and brake fluid
Although saddened, I was not surprised by the NDHS statistics. Our attitudes toward HIV/AIDS are a carry-over from the way we look at STIs in general. Even the older terms for these diseases-"venereal disease (VD)" and "sexually transmitted diseases (STDs)"--still elicit feelings of dread.
Among these STIs, HIV/AIDS is the most feared because it is seen as deadly and because of widespread misconceptions that it spreads easily. The NDHS in fact found that most of those surveyed still believe HIV/AIDS can be spread by mosquitoes, or by food shared with someone who is infected. (To set the record straight, HIV/AIDS is not spread through those routes. If it were, we'd have an even more deadly epidemic right now.)
But there's more to the fear of HIV/AIDS and STIs than misconceptions. The stigma around these diseases relate to the moralism that has emerged around these diseases. Too quickly, we presume that someone with STI is promiscuous, a term which Margy Holmes defines as anyone who has more sex partners than ourselves.
In the Philippines, the fear of STIs is a fear of women's sexuality, reflected in the widespread use of the term "sakit ng babae" (women's diseases) to refer to STIs. It isn't just any woman that's feared; specifically, it's "liberated" women, "liberated" here taken in its Filipino-English meaning to refer to someone who is "easy" with sex.
STIs are used to reinforce moralistic ideas that sex should be used only for reproduction and that outside of this purpose, it is dirty and dangerous. Discussions about STIs, like those about sex in general, are therefore driven underground. This only adds to the stigma so that when someone is infected, he will not go to a physician and resort to self-treatment with information gathered from the grapevine. The stuff used both for preventing and treatment of STIs is amazing, ranging from the newest antibiotics to brake fluid (yes, I got this from an interview with a taxi driver who argued that if it was powerful enough to stop a car, it should stop STIs as well).
So who's spreading STIs?
Filipino men are actually ambivalent about STIs. There's fear but there's also fatalism, even some attraction to the risks. When an infection does occur--as long as it is not HIV/AIDS--it may even be considered a badge of honor, something to boast about to the barkada (peer group).
The networks for treating STIs are more accessible to men because discussions about sex and STIs are less stigmatized (and because there is, to some extent, pride in being infected). Women, on the other hand, are unable to get the information they need because it's just not acceptable to talk about STIs with other women friends.
Women, in fact, may be aware that they are vulnerable because of a philandering husband, and yet would not dare to even suggest to their husbands that they use a condom for protection. The power relations are too skewed, which is why the theme around this year's World AIDS Day is "Women, Girls and HIV/AIDS," warning that the AIDS epidemic has now taken an alarming trend, where many women are being infected by their own husbands.
"It takes two to be monogamous" is a message I've kept repeating in my lectures. You might be faithful, but if your partner isn't, you're also at risk for STIs. And the risks are greater for women because, contrary to popular misconceptions, it is easier for men to infect women rather than the other way around. The reason is simple: women are the ones on the receiving end, so if her male partner has an STI, he literally deposits the infectious germs in her, and these stay on for several hours. The risks for women are further increased because the vagina is more prone to tearing and injuries during intercourse than the penis.
We can all contribute to removing the stigma around STIs through a more frank discussion of sex and sexuality, including the unequal relationships between men and women that fuel the spread of these diseases, including HIV/AIDS.
At the PSMID convention I asked for greater caution in our choice of words. I've always reacted strongly against the term "core transmitters," often used by AIDS organizations to refer to women sex workers. I did forget to appeal to the PSMID members to also stop using the term "sakit ng babae," which tends to blame women for these diseases.
Should we now call these diseases "sakit ng lalake"? It's your call.
posted by Dante at 4:32 PM
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