AIDS: Low simmer or slow boil?
AIDS: Low simmer or slow boil?
Posted 00:45am (Mla time) Feb 23, 2005
By Michael L. Tan
Inquirer News Service
Editor's Note: Published on page A15 of the February 23, 2005 issue of the Philippine Daily Inquirer
FOR the past few days, groups doing HIV/AIDS work in the Philippines-government, non-government, local and international-have been buzzing with activity, everyone busy preparing for a big AIDS meeting, now going on at the Mandarin Oriental.
No less than Pieter Piot is attending the meeting, he being the head of UNAIDS, an inter-agency body coordinating HIV/AIDS work throughout the world. The summit is co-sponsored by the Swedish Embassy and the Asian Development Bank.
I was asked to present a paper at the meeting but had to decline because of previous engagements. To make up for this, I promised my friends at UNAIDS a column summarizing my concerns around HIV/AIDS in the country.
Let me start by explaining why there's so much international interest in the Philippines. For several years now, AIDS experts have been intrigued by the fact that HIV-now affecting more than 40 million people worldwide-hasn't gone on a rampage in the Philippines. "Low and slow" is the way the epidemic is described in the Philippines. The Department of Health's AIDS Registry reports fewer than 3,000 cases. No doubt, there are many more unreported cases, but even taking under-reporting into account, the estimate is that less than one percent of the adult population is infected. Compare that to a prevalence rate of about 2 percent in Thailand and, in some southern African countries, of up to 33 percent-yes, 1 of every 3 adults.
Ideally then, we need to keep the epidemic at this low and slow level, because if it goes out of control, we know from the experience of other countries that the costs will be disastrous, adding to our already long list of economic and social woes.
Saliva and mosquitoes
It's clear that the epidemic in the Philippines may be low and slow because as early as the 1980s, shortly after HIV/AIDS was recognized as an international problem, our government and NGOs began to act. Some readers will remember intensive HIV/AIDS information campaigns in the past, with a deluge of seminars, workshops and educational materials.
Unfortunately, our efforts have slackened. These days, we rarely hear of HIV/AIDS except for the boring monthly updates reporting new infections, or an occasional sensational report in the paper of some sex worker having tested positive and gone into hiding.
The result? Public awareness levels of HIV seem to be on the downturn. The other week, in a research methods class I teach to seniors at the University of the Philippines, I used HIV/AIDS as an example for possible survey questions. When I asked the students if they thought HIV could be transmitted by mosquitoes, almost half of them actually thought this was possible.
The 2003 National Demographic Health Survey (NDHS), with a sampling of almost 14,000 women and some 5,000 men, gives us very alarming statistics concerning HIV/AIDS awareness. Nationwide, some 95 percent of respondents have heard about AIDS. But this awareness level varies across income groups and regions. For example, in the Autonomous Region in Muslim Mindanao (ARMM), only 75 percent of women and 51 percent of men had heard of HIV/AIDS.
Remember these figures apply only to awareness, meaning "having heard" of HIV/AIDS. When you get to specific knowledge about HIV, we have even more disturbing findings. Some 40 percent of women and 43 percent of men, for example, believe AIDS can be transmitted by mosquito bites. About 20 percent of both men and women believe AIDS can be transmitted by supernatural means.
Dangerous denial
The National Demographic Health Survey (NDHS) didn't ask people if they knew the difference between HIV and AIDS, but I've observed that even among university professors, there's still vagueness about the two terms. I'm not about to take chances, so let me explain the difference here: HIV means Human Immunodeficiency Virus, the microbe that causes HIV disease. Once infected with HIV, a person's immune system comes under attack but it does not necessarily mean he or she has AIDS or Acute Immunodefiency Syndrome. Without access to drugs to fight the virus, a person will, after several years, develop AIDS. But during the years of infection without AIDS-a time without any signs or symptoms-the person can pass the virus on to other people.
I'm mentioning all this because people continue to look for "signs" of HIV infection as if they existed. Sex workers, for example, will insist that they don't need to use condoms since they can tell if their customers are "clean." Conversely, the male clients of these sex workers will insist they don't need to use condoms if they get women from bars and beer houses that don't have foreign customers.
Periodically, we'll hear some radio talk show commentator calling for widespread testing for HIV. Again, this reflects ignorance about HIV/AIDS. The government already requires "entertainment workers" to be tested for HIV and sexually transmitted diseases (STDs), for which they're issued a health certificate. These certificates only lull people into a sense of complacency. The tests for HIV only detect antibodies to the virus produced after an infection occurs. The problem is that there may be a delay of several months before the antibodies are produced. This means a person may have already been infected but still test negative.
Discrimination
Ignorance about HIV/AIDS leads to denial about the risks of HIV/AIDS, and risky behavior. The NDHS figures show that people not only had misconceptions about the way HIV is spread but about prevention methods as well. For example, only 48 percent of women and 62 percent of men knew that condoms could prevent HIV.
Discrimination comes with denial. We dismiss HIV/AIDS as a problem "only" for sex workers and their customers. Or, if we hear about the rising infection rates among overseas Filipino workers, we think mainly of entertainers and seafarers. The reality is that HIV infections among overseas workers have been reported, too, among domestic helpers and nurses, and locally, among housewives, many of whom have been faithful to their husbands and who felt no need to protect themselves even if they suspected their spouses' many infidelities. As the expression goes, it takes two to be monogamous.
Discrimination drives HIV/AIDS underground, something to be discussed in whispers. And if someone does get infected, he or she will choose to be quiet about it, maybe even to remain in denial, because of the stigma around HIV. Our experiences in the Philippines and overseas have shown clearly that in a more accepting environment, care and support for people with HIV make them part of the solution, rather than exacerbating the problem.
Given the way denial and discrimination can fuel the spread of HIV, I wouldn't be surprised if the local epidemic has moved from a low simmer to a slow boil.
Posted 00:45am (Mla time) Feb 23, 2005
By Michael L. Tan
Inquirer News Service
Editor's Note: Published on page A15 of the February 23, 2005 issue of the Philippine Daily Inquirer
FOR the past few days, groups doing HIV/AIDS work in the Philippines-government, non-government, local and international-have been buzzing with activity, everyone busy preparing for a big AIDS meeting, now going on at the Mandarin Oriental.
No less than Pieter Piot is attending the meeting, he being the head of UNAIDS, an inter-agency body coordinating HIV/AIDS work throughout the world. The summit is co-sponsored by the Swedish Embassy and the Asian Development Bank.
I was asked to present a paper at the meeting but had to decline because of previous engagements. To make up for this, I promised my friends at UNAIDS a column summarizing my concerns around HIV/AIDS in the country.
Let me start by explaining why there's so much international interest in the Philippines. For several years now, AIDS experts have been intrigued by the fact that HIV-now affecting more than 40 million people worldwide-hasn't gone on a rampage in the Philippines. "Low and slow" is the way the epidemic is described in the Philippines. The Department of Health's AIDS Registry reports fewer than 3,000 cases. No doubt, there are many more unreported cases, but even taking under-reporting into account, the estimate is that less than one percent of the adult population is infected. Compare that to a prevalence rate of about 2 percent in Thailand and, in some southern African countries, of up to 33 percent-yes, 1 of every 3 adults.
Ideally then, we need to keep the epidemic at this low and slow level, because if it goes out of control, we know from the experience of other countries that the costs will be disastrous, adding to our already long list of economic and social woes.
Saliva and mosquitoes
It's clear that the epidemic in the Philippines may be low and slow because as early as the 1980s, shortly after HIV/AIDS was recognized as an international problem, our government and NGOs began to act. Some readers will remember intensive HIV/AIDS information campaigns in the past, with a deluge of seminars, workshops and educational materials.
Unfortunately, our efforts have slackened. These days, we rarely hear of HIV/AIDS except for the boring monthly updates reporting new infections, or an occasional sensational report in the paper of some sex worker having tested positive and gone into hiding.
The result? Public awareness levels of HIV seem to be on the downturn. The other week, in a research methods class I teach to seniors at the University of the Philippines, I used HIV/AIDS as an example for possible survey questions. When I asked the students if they thought HIV could be transmitted by mosquitoes, almost half of them actually thought this was possible.
The 2003 National Demographic Health Survey (NDHS), with a sampling of almost 14,000 women and some 5,000 men, gives us very alarming statistics concerning HIV/AIDS awareness. Nationwide, some 95 percent of respondents have heard about AIDS. But this awareness level varies across income groups and regions. For example, in the Autonomous Region in Muslim Mindanao (ARMM), only 75 percent of women and 51 percent of men had heard of HIV/AIDS.
Remember these figures apply only to awareness, meaning "having heard" of HIV/AIDS. When you get to specific knowledge about HIV, we have even more disturbing findings. Some 40 percent of women and 43 percent of men, for example, believe AIDS can be transmitted by mosquito bites. About 20 percent of both men and women believe AIDS can be transmitted by supernatural means.
Dangerous denial
The National Demographic Health Survey (NDHS) didn't ask people if they knew the difference between HIV and AIDS, but I've observed that even among university professors, there's still vagueness about the two terms. I'm not about to take chances, so let me explain the difference here: HIV means Human Immunodeficiency Virus, the microbe that causes HIV disease. Once infected with HIV, a person's immune system comes under attack but it does not necessarily mean he or she has AIDS or Acute Immunodefiency Syndrome. Without access to drugs to fight the virus, a person will, after several years, develop AIDS. But during the years of infection without AIDS-a time without any signs or symptoms-the person can pass the virus on to other people.
I'm mentioning all this because people continue to look for "signs" of HIV infection as if they existed. Sex workers, for example, will insist that they don't need to use condoms since they can tell if their customers are "clean." Conversely, the male clients of these sex workers will insist they don't need to use condoms if they get women from bars and beer houses that don't have foreign customers.
Periodically, we'll hear some radio talk show commentator calling for widespread testing for HIV. Again, this reflects ignorance about HIV/AIDS. The government already requires "entertainment workers" to be tested for HIV and sexually transmitted diseases (STDs), for which they're issued a health certificate. These certificates only lull people into a sense of complacency. The tests for HIV only detect antibodies to the virus produced after an infection occurs. The problem is that there may be a delay of several months before the antibodies are produced. This means a person may have already been infected but still test negative.
Discrimination
Ignorance about HIV/AIDS leads to denial about the risks of HIV/AIDS, and risky behavior. The NDHS figures show that people not only had misconceptions about the way HIV is spread but about prevention methods as well. For example, only 48 percent of women and 62 percent of men knew that condoms could prevent HIV.
Discrimination comes with denial. We dismiss HIV/AIDS as a problem "only" for sex workers and their customers. Or, if we hear about the rising infection rates among overseas Filipino workers, we think mainly of entertainers and seafarers. The reality is that HIV infections among overseas workers have been reported, too, among domestic helpers and nurses, and locally, among housewives, many of whom have been faithful to their husbands and who felt no need to protect themselves even if they suspected their spouses' many infidelities. As the expression goes, it takes two to be monogamous.
Discrimination drives HIV/AIDS underground, something to be discussed in whispers. And if someone does get infected, he or she will choose to be quiet about it, maybe even to remain in denial, because of the stigma around HIV. Our experiences in the Philippines and overseas have shown clearly that in a more accepting environment, care and support for people with HIV make them part of the solution, rather than exacerbating the problem.
Given the way denial and discrimination can fuel the spread of HIV, I wouldn't be surprised if the local epidemic has moved from a low simmer to a slow boil.
posted by Dante at 4:48 PM
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