When Rey* first got an HIV test, his mother went with him. He was 17 and her consent was required by law.
“My mum and I are pretty close. She has no issues about me being gay and is really supportive. But I know a lot of my friends wouldn’t dare bring their mums with them to get an HIV test,” says Rey, from Palawan.
His test came back positive and although it frightened him, Rey couldn’t say he was surprised.
Sexual initiation came early but condom use did not. He was 14 when he had his first sexual encounter; 16 when he tried to buy condoms at the local pharmacy. Condoms were placed behind the counter. Rey had to endure the awkwardness of telling the cashier he wanted to buy condoms and the knowing looks he got.
“It was bad enough that people in line heard me and knew what I wanted to buy. But the cashier kept looking at me and I could feel her sizing me up. It made me feel so small,” he says. Rey did not try buying condoms again.
“When I started having sex, I didn’t know anything about condoms. When I tried to buy them, I couldn’t. It was just too embarrassing. In a way, getting HIV was inevitable,” he says.
The Philippines, an archipelago of more than 100 million people in southeast Asia, is experiencing a surge in infections. Of the more than 40,000 people living with HIV, the majority were diagnosed in the past five years and many are young men (pdf).
Activists blame the increase on outdated laws and the grip of the Catholic church, which has sought to restrict safe sex programs, sex education and efforts to distribute condoms to at-risk groups.
Homosexuality is legal, but the law prohibits people under 18 from getting an HIV test or taking free condoms from public health clinics without parental consent.
Attempts by politicians to lower the age of testing without consent to 15 failed to gain sufficient support, leaving many young people without the means to protect themselves.
“Comprehensive sex education was never really taught in school. There is a gap in the knowledge of communicating HIV and STI [sexually transmitted infections] prevention on the side of teachers and even healthcare providers,” says Mario Balibago, HIV program officer for the UN children’s agency, UNICEF.
Lack of awareness has resulted in risky sexual behavior among teenagers.
A study by the Department of Health on sexual behavior among young gay men said adolescents were using social networking accounts and cruising sites to meet partners. From 2011 to 2015, newly diagnosed HIV cases among the most affected populations—predominantly young men and transgender people who have sex with men—increased by 230% (pdf).
Cris Pablo, executive creative director of the LoveLife Project, an organization that raises awareness about HIV, says young people have had sex in exchange for playing online games.
“Playing is an all-night activity, there is betting involved and, inevitably, they run out of money. Selling quick sex is an easy solution. The exchange is done in a dark corner outside the internet shops, behind parked vans or secret places identified by the boys as their ‘hang out’ place,” says Pablo.
The health ministry estimates (pdf) that nearly 10,000 adolescents have HIV, but only 10% have been diagnosed. Fewer than 400 are enrolled on anti-retroviral (ARV) therapy.
“We cannot treat them if we cannot diagnose them,” says Dr Genesis Samonte, head of the health ministry’s HIV and AIDS unit. “If we don’t identify them and get them on ARV now, these adolescents are going to die within the next 10 years.”
Authorizing doctors to give proxy consent for minors who want to get tested is reportedly being discussed.
Quezon City, the largest city in metropolitan Manila, has one of the fastest growing HIV infection rates in the country. In response, the local health department launched a free testing campaign at cruising sites and set up clinics open until 11pm to offer people privacy and the convenience of getting tested after office hours.
At a recreational center where students hang out after class, counsellors hold sessions on HIV and hand out condoms and lubricants. “The law says we cannot give out contraceptives to minors. But we are giving out condoms as a prevention tool, not as a family planning tool,” says Dr Rolly Cruz, epidemiologist at the city’s health department.
The government is also trying to reach teens at school. A sexuality education module for grade eight (students aged 13 to 14) is being tested on 3,000 students in Quezon City. The module will be revised based on the test run and is set for full implementation next school year.
“There has been no opposition from the school district. We see from what is happening around us that there is a need for HIV prevention education. We hope that there will be no opposition from the church,” says Cruz.