Mong Palatino

* Speech during the Parliamentary Side Event on the Integration of Sexual Reproductive Health and Rights and HIV/AIDS at the eve of XVIII World AIDS Conference 2010 in Vienna, Austria

Access to Sexuality and Reproductive Health Rights (SRHR) services: Are youth programs meeting the needs of young people? Let me immediately answer the question with respect to the Philippine situation: There is little or no SRHR services for young people in the Philippines. Programs are not sufficiently meeting the needs of young Filipinos.

What is the relevance of the Philippine situation in relation to the global campaign to fight HIV-AIDS? Let me enumerate some issues which might be applicable also in your countries.

First, enacting a law to combat the problem of HIV-AIDS, sadly, at least in the Philippine case, is no guarantee that HIV-AIDS cases will also go down or that SRHR services will be delivered to the people. The Philippines was the first country in the region to pass a law that laid a legal framework on how to protect people living with HIV-AIDS. This was in 1998. A master plan was drafted to tackle the issue. An AIDS council was instituted. The government also implemented surveillance and education programs in various provinces.

But despite these efforts, which by the way are only good on paper, HIV-AIDS cases have risen in the Philippines. They have risen at an alarming number, in epidemic proportions. Let us look at some of the numbers.

The Department of Health reported that in the year 2009, a total of 709 cases were recorded as compared to only 508 in 2008. The agency also said that two HIV/AIDS cases were recorded daily. There are 4,218 people living with HIV in the Philippines. Male HIV patients outnumber the female. The victims are getting younger.

So here is the paradox: the Philippines may be one of the first countries to recognize the seriousness of the problem despite registering only few cases in the 1980s up to the early 1990s but today it is facing an explosion of HIV-AIDS.

It is right to claim that it has already accomplished MDG6 but civil society and health practitioners are not rejoicing because of the rising number of HIV-AIDS cases. Globally, the trend is going down and the number of young people affected with the disease is also decreasing. The reverse is happening in the Philippines.

Next lesson: The Philippine case highlights the need for proper information and accurate reporting. Then and now, HIV-AIDS cases are underreported. The problem is worse than we think. Health authorities believe that HIV cases are 5x worse than what is actually reported. It is not good that HIV-AIDS cases are rising; but somehow it is already forcing our leaders and our people to admit reality – that HIV-AIDS situation in the country is getting worse and a more effective intervention is needed to prevent the disease from spreading.

To obtain a clearer picture of the situation, programs must also encourage the patients to seek government help. Testing (voluntary) must be done to give immediate help to those infected with the disease. How do we encourage HIV infected persons to seek medical assistance? Patients are willing to come out if adequate services are offered, and more importantly, if social stigma is removed. This is a sad reality. Instead of providing moral assistance, friends and relatives are sometimes abandoning HIV patients. Even health workers must be taught not to discriminate against people infected with HIV. In short, government must fight misinformation, disinformation.

Third lesson: Intervention should target specific groups. In the case of the Philippines, the main carriers of HIV, for the longest time, are migrant Filipinos. There are more than 8 million Filipinos working and living outside the Philippines. As a preventive measure, the government has mandated the holding of health seminars for Filipinos who are planning to leave the country. But is this enough?

Recent government statistics reveal that aside from migrant Filipinos, another major grouping of HIV-AIDS patients come from workers in the Business Process Outsourcing sector. Most of the workers in this industry are young, fresh college graduates.

It is ironic that the exodus of professionals to other countries, and the BPO sector which was hailed by the government as the country’s sunshine industry, these dollar-earning economic activities of the Philippines, are also among the top producers of HIV-AIDS patients. Hope turns to nightmare for some Filipinos working in these sectors. Is this the price of progress? Since the government is not expected to abandon its labor export policy, and since it continues to encourage more BPO investments, programs must be developed to prevent the spread of HIV in these industries.

Fourth lesson: impact of devolution of health services. Devolution was meant to empower local governments and to deliver better health services. The aim was to remove the negative impact of a centralized health system. But our experience shows that devolution could also lead to the abandonment of the government role to provide health services. Local governments, which are now in charge of government hospitals at the local level, are complaining of insufficient funds to maintain hospitals, health centers, and other services. For small provinces, this means the people are unable to access vital health programs, including reproductive health programs.

Fifth lesson, and most controversial issue in the Philippines in relation to reproductive health. The government is held hostage by the Catholic Church. The Philippines is one of the two countries in Asia with a Catholic-majority population. Catholic bishops wield enormous influence in Philippine society. Politicians are afraid to antagonize the bishops who can use their clout to undermine the local and national leadership. Result: the government is only promoting natural family planning. Abstinence. Many local governments are not providing reproductive health services. Condom use is not promoted since the church views it as a promotion of promiscuity. Reproductive health is equated with abortion. Pills, IUD, and other artificial contraceptives are described by the church as poisonous health products.

Young people, especially the poor, cannot easily access reproductive health services in health centers. Because there are no teen health centers, young people are forced to self-medicate. Unmarried teenagers cannot comfortably consult health workers on reproductive health issues for fear of being stigmatized and reprimanded by the elders.

The church is also opposing the introduction of sex education in schools. We renamed it into reproductive health education but the church says it is still sex. We renamed it again as Teen Wellness Program but the church is stubborn in its opposition. They see sex everywhere. By the way, the new education minister is a prominent Catholic educator.

If young people are deprived of their right to be informed about reproductive health in schools, where will they learn these things? Parents are responsible for this type of education but we know that parents are often uncomfortable discussing this sensitive topic in front of their children. The school setting is the most appropriate venue to teach comprehensive sexuality health. Or if we want to follow the Church, the other alternative is to allow the students to continue believing in the unscientific and sometimes dangerous views of their peers about sex and reproductive health.

Education is the key to protect the young against HIV-AIDS. It discourages the young not to engage in risky behavior. It gives them accurate knowledge and awareness about their bodies and the risks involved in having unprotected sex. Filipino politicians who subscribe to the doctrines of the Catholic Church do not realize the role of education in empowering the sexually-active young since they view public discussion of sex as taboo and they are in a state of denial with regards to the sexual activities of the young.

Parents must be involved in the sexuality education program, especially since the Church regards them as the only acceptable teachers on sexuality. Community education is also essential to make them aware about the risks of unprotected sex and the need to respect the sexuality rights of young people. Adults need to be reoriented about the components of reproductive health. This is needed to counter the lie peddled by the Church that reproductive health deals only with contraceptives. They presented the issue as a battle between pro-life and pro-choice advocates. This is unfortunate since reproductive health is all about the protection of life – of protecting pregnant mothers, infants, teenagers, and the general well-being of the people.

Another proposed mode of education is to tap the potential of the internet. Popularize reproductive health concepts and services by maximizing the social networks. Young people, at least for the urban residents, are accessing the web everyday. They can be reached through popular networks like friendster, facebook, and twitter. We should use the internet as an alternative platform to remind the young about their reproductive health rights.

The national government must not reject or surrender its role in leading the fight against HIV-AIDS. It must exert political will by refusing to be bullied by the Catholic Church. There must be a multisectoral coalition to address this major social and health problem, which is now an epidemic level. The grassroots, including civil society, should be active participants in the campaign. But the government should not use the involvement of the grassroots as an excuse to reduce its role in the battle against HIV-AIDS. The people must assert greater government participation, not less, if we want to seriously address the problem.

The state must be reminded that RH rights are human rights. And denial of reproductive health services constitutes a violation of the basic rights of the people.

Note: I delivered a shorter version of this paper because of time limitations. Thanks to Mon and Ann of PLCPD for the materials on the current HIV-AIDS situation. The speeches of Rep. Garin (here and here) are also recommended readings. Thanks Emee of UNFPA for the ideas on youth reproductive health.

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