Filipino women and AIDS. (Cover Story: Reproductive Health).

She did not particularly stand out in the crowd of women gathered to discuss women's issues. If anything, she tried as much as she could to blend in, to be inconspicuous. She was about my age. She was petite, pretty, wise beyond her years. She had the same preoccupations as most people my age had. Work. Money. Social acceptance. The future. Relationships Politics. But, I felt then, as I still do now, that there, was something different about her...

Then, she spoke in front. When she did, I was not quite prepared. Without much ado she announced that she was HIV positive. We tried to take her announcement in stride--probably because we were all development workers or health professionals or both. For me though, it was that and more. It gave a human face to the dreaded disease that I, like most of my generation, have been introduced to and been given a barrage of information on. All these took on new meaning for me.

I listened as she told her story--of the men who took advantage of her and abused her, of the man she trusted and who eventually gave her the virus and the subsequent devastation and anger and pain, she went through when she found out she was HIV positive, the social ostracism, how she coped with it, how she accepted and found the peace and redemption within herself and with God.

I listened to her empowering story and admired her courage for fighting to live even as the virus and her body slowly betrayed her. I wondered about all the women out there who are vulnerable to the disease, whose experience is not unlike what this young woman went through, who are Vulnerable, not just because of a complex array of sex, power, gender and class issues, but also, ultimately, because they are women.

This woman liying with AIDS is only one out of about 1, 676 HIV (Human lmmune-Deficiency Virus) cases in, the Philippines. Most of the cases are in the 20-39 age groups. And, as in her case, most of the HIV cases were transmitted through sexual intercourse.

Last year, the Philippine Daily Inquirer (PDI) reported that of these registered HIV carriers, 60% were males and the remaining 40% were females. In the Cordilleras, Dr. Elvira Belingon, the Department of Health- Center for Health Development-CAR AIDS coordinator, reports that there are, already nine cases here--all of which were not locally acquired.

On a larger scale, this young woman is only one of the millions of young women from developing countries who live with AIDS.

As is obvious from the story above, what seems to be the most pressing concern during these times is the issue of how vulnerable the Filipina is to AIDS infection and her complex relationship with sex and AIDS.

Women are more vulnerable to AIDS

Her vulnerability stems from the fact that her biological make-up (e.g. genitalia that is, too exposed and thus much more, likely to be susceptible to lacerations during sex), allows the virus various entry points. The risk becomes greater when it is girls who begin to have sexual relations.

Experts note that the Filipino woman's vulnerability to HIV-AIDS infection also stems from a patriarchal, male-dominated society that prescribes conflicting, sometimes risky behaviors for men and women.

"Being passive, submissive and naive in sex matters, as well as too unquestioning of a partner's peccadilloes. have made women more vulnerable to HIV," Pennie Azarcon Dela Cruz of Philippine Daily Inquirer reported.

There is also that cultural notion that "good" Filipino women should not know about or discuss or decide about sex--which are further reinforced by education, which continues to be conservative about sex and AIDS education.

Dr. Belingon, in fact expressed apprehensions over the current state of the education curriculum vis-a-vis AIDS education.

"Naka-integrate lang (ang AIDS education,) sa Health/Science (subjects) (AIDS education is only integrated in health/science subjects)," Dr. Belingon said. "Which we think is very kulang (or limited)."

Teachers and education officials interviewed admit that AIDS education is not as comprehensive as it should be.

The fact that most Filipino women are economically dependent on their spouses makes them unable to negotiate safe sex because of the fear that their spouses may beat them up, will mistrust them, abandon or withdraw financial support for them. In a country where poverty and unemployment are prevalent, these women would rather choose to be passive and non-assertive in sexual relations than risk being thrown out in the street.

It is this same economic dependence that also forces women to endure forced sex, early marriage and sexual abuse. The double-standard of morality, which encourages men to be promiscuous even after marriage and discourages the same in women, also makes women more vulnerable to HIV infections. If the men have casual affairs, wives accept the casual affairs "as part of a man's nature and thus unavoidable" (Kalayaan-Caram Research, PDI, 2000).

Dr. Belingon notes that in the Cordilleras, studies show that men have a lot more sexual partners than women.

As PDI reports, most HIV cases are rooted in heterosexual contact involving monogamous women and their philandering husbands (dispelling the myths that HIV-AIDS is a purely homosexually-acquired disease).

Other gender factors also come into play when it comes to women and HIV-AIDS. For one, very few men use condoms.

Dr. Belingon says that this maybe due to the perception that condoms are contraceptives, not protection. Another is the belief that condom use reduces sexual satisfaction--especially for the males--a belief that is rooted in the notion that females exist solely to give pleasure to the man, at all costs.

These are not isolated cases. A study conducted by the University of the Philippines Population Institute reports that nearly two million young Filipinos are having unprotected sex, increasing their risks of contracting the disease at an earlier age.

There is also the perception that sex and AIDS are not social issues, separate from the study and formulation of policies and programs for AIDS prevention.

The Filipina Overseas Worker

There are other risk factors Filipino women are exposed to.

For example, the over six million Filipino overseas workers, a majority of whom are women, are at a higher risk of being infected with HIV-AIDS than the less mobile populations. In the Cordilleras, 73% of the 264 people deployed last year, for example, were women.

What kind of risks do these Filipina migrant workers face? A lot. These women, a majority of which are below 30 and are sexually active or sexually curious, are also mostly single, alone, homesick and thus seek comfort in possibly dangerous intimate relationships or casual/paid sex, increasing their risks of being infected.

Others may be sexually abused by abusive male employers, forced into prostitution or sex trafficking.

Due to many Filipinos' (especially women) hesitation to seek medical help, they may not know that they are terminally ill or that they have infected other people, until it's too late.

Actions

RA 8504, or the Philippine AIDS Prevention and Control Act ensures that all Filipinos should be informed and educated about HIV-AIDS in schools, in the workplace, in communities, health service stations, before they leave for abroad and after they arrive from abroad. It also ensures that persons with HIV-AIDS are not only discriminated against but also guaranteed health and support services.

However, the question of whether the law and institutional efforts are effective, or even enough, begs to be answered. It is about time institutions also consider the devastating effects of gender and class issues in the formulation of HIV-AIDS policies and programs.

At the International AIDS Conference in Durban, South Africa, two years ago, representatives convened and put forth suggestions that the government should consider if they want the HIV-AIDS risks Filipino men and women face, reduced:

1. Improving girls' access to education and information to give them more economic options and prevent them from going into the sex trade;

2. Developing female-controlled prevention methods, like female condoms and microbicides (substances that act as barriers to prevent the AIDS virus from getting into the body through the vagina);

3. Reinforcing women's economic independence by multiplying and strengthening existing training opportunities, credit programs, saving schemes and women's cooperatives and linking them to AIDS prevention activities;

4. Integrating STD treatment service with family planning services so women can access them without fear of social censure;

5. Building safer social norms by supporting women's groups and community organizations that question dangerous behavior like child abuse, rape, sexual coercion, etc.

These suggestions are not the cure-all for the interlocking problems and issues that beset the HIV-AIDS prevention programs of the country. However, looking at the HIV-AIDS issue from a different perspective, integrating and including women in prevention programs, changing overall attitudes and behavior by fostering an environment where people can talk about sexual issues, will go a long way in ensuring that all Filipinos--whether male or female--will truly have a right to life, free from HIV-AIDS infection and other diseases.

Or, as Dr. Gro Harlem Brundtland, Director General of the World Health Organization (WHO), put it succinctly, "We will not achieve progress against HIV until women gain control of their sexuality."

References: National HIV Sentinel Surveillance System, Population Reference Bureau, Department of Health, Philippine Daily Inquirer.