Mac Valledor
I WAS listening to a radio interview the other day when I heard a clinician reply to a listener that pre-ejaculate and genital ulcers contain negligible amounts of HIV (because there is apparently little semen involved) and thus pose only a very small risk for HIV infection—he was wrong. I was horrified at the blatant negligence for the public welfare. This misinformation, however, is not surprising given that about 90% of Filipinos of reproductive age believe that one can get HIV by sharing a spoon over a meal (no pun intended) with a person with HIV. Not only do some of our clinicians misunderstand the nature of HIV epidemiology, but also the Department of Health in its campaign to distribute condoms to minors through DepEd schools nationwide, reportedly costing Filipino taxpayers a hefty 1 billion pesos.
Condoms are ineffective in combating the long-term spread of HIV. I am not anti-condom and I stand for the condom as a symbol of sexual liberation and female emancipation, but a systemic analysis of scientific research suggests it is wrong to say that condoms are the answer to the fight against HIV infection. The long line of research points that promiscuity (concurrently having multiple sexual partners) is the main factor driving HIV emergence. The public health machinery should instead focus largely on behavioral interventions to modify life-threatening behavior patterns and risk compensation, say through HIV education, counselling, and “sexual partner reduction”. While all people should have full access to condoms and condoms should be a substitute strategy for those who will not or cannot stay in mutually faithful and monogamous relationships, the first priority for sexually active adults should be to promote mutual fidelity.
For school-aged minors, teachers should be trained to discuss the benefits of abstinence and the effects of casual sex to ensure that the proposed DOH-sponsored condom distribution program will not become a tool to promote promiscuity.
To understand the nature of the spread of HIV, one has to look at its evolutionary and epidemiological history. Since HIV (a member of the retrovirus family that has been around for half a billion years and of which a significant part of our very own human DNA is made) was first clinically observed in 1981, it has infected an estimated 65 million people and killed 25 million of them. About 33 million people are living with HIV today. The virus evolved over many years in Africa starting from man’s closest relative, the chimpanzee, until it crossed the species barrier, probably through African hunters eating bushmeat (meat from wild animals). Research found that the most recent common ancestor of HIV-1 (HIV-2 is predominant in West Africa and the former Portuguese colonies) dates back from the early 20th century. This coincided with the rapid growth of large colonial African cities and the influx of colonial immigrants, which led to societal and cultural changes, including a higher degree of sexual promiscuity, the spread of prostitution, and the incidental high frequency of genital ulcer diseases (such as syphilis) in emerging colonial cities— providing a very permissive time window for HIV strains to emerge and spread.
The initial spread of HIV in Africa in the previous century also holds true to its contemporary epidemiology, agreeing with our modern ideological commitment to absolute sexual freedom and our capitalistic propensity towards the billion dollar condom industry (our Malaysian neighbor, Karex, is the world’s biggest condom maker). The body of research shows that rates of infection have risen most aggressively in countries, which relied on condom distribution as the primary ublic health intervention for HIV prevention. However, rates have fallen in the few countries that have encouraged monogamy and fidelity among sexual partners.
The overwhelming body of epidemiological evidence also tells us that there is very little to show for all the investments in condom distribution programs, in spite of the assurances that they were the essential solution to HIV prevalence. You would be stunned to learn that condoms have not delivered as promised in the fight against HIV. Perhaps, in a quick note, condom programs worked in countries such as Thailand and Cambodia, where most HIV transmission is through commercial sex and where it’s been possible to impose a 100% condom use policy in brothels. Contrast this against the Philippines where casual sex is the main culprit. In theory, condom distribution programs will practically work everywhere and rationally, some condom use ought to be better than no use at all. However, that’s not what the recent body of research, especially in Africa and several other countries, shows. Certainly, it is time to start providing more evidence-based HIV-Aids prevention programs to get our taxpayer’s money’s worth.
