Exploring the realities of HIV/AIDS-related
discrimination in Manila, Philippines
N. L. ORTEGA1, B. F. BICALDO1, C. SOBRITCHEA2, & M. L. TAN2
Remedios AIDS Foundation, and 2University of the Philippines, Philippines
Operating according to UNAIDS’ ‘Protocol for the Identification of Discrimination against People Living with HIV’, this study analysed health infrastructure in Manila, Philippines and determined that despite the existence of anti-discriminatory legislation, discrimination still occurred in practice. This was attributed to an absence of written regulations and inadequate training among health staff. Discrimination associated with HIV/AIDS has been found to be a hindrance to the development of successful preventive strategies, as it discourages people living with HIV/AIDS (PLWHA) and other people from contacting health and social services. This paper argues that if the Philippines is to maintain its low prevalence rate of HIV (and even reduce it), the discrimination that PLWHA incur must be addressed taking account of their human rights.
The first case of AIDS in the Philippines was reported in 1984; by 1987 the prevalence among female sex workers was estimated to be 1 in 1,000 (Dayrit et al., 1987; Hayes et al., 1990). Data from behavioural surveillance in 1997/98 indicated high rates of unprotected sex among men who have sex with men (75%) and among female sex workers (34%) (Gacad et al., 1998). The level of high-risk exposure and the observation that nearly all (90%) HIV cases occurred through sexual transmission (UNAIDS, 2002), suggest that the Philippines should have a high prevalence of HIV. Anomalously, it has a relatively low prevalence compared to its similarly exposed regional neighbours. In June 2003, nationally reported cases totalled 1,892. Although the World Health Organization and UNAIDS estimated cases around three times and 4.5 times greater, respectively (UNAIDS, 2002; WHO, 2003), the discrepant estimates would nonetheless indicate a prevalence of less than 0.1% among people aged 15 to 49 (UNAIDS, 2002).
A number of explanations have been proposed for the slow progression of HIV in the Philippines and these have generally related to differences in sexual practice (Philippines Department of Health, 2002). However, given the high rates of other high risk behaviours, like needle sharing among injecting drug users, this does not seem to be a complete explanation for the difference in the trajectory of the epidemic (Amadora-Nolasco et al., 2002).
Globally, HIV-related discrimination has been identified as a significant determinant of the spread of HIV (Aggleton, 2002; Parker & Aggleton, 2003). Discrimination increases the
Correspondence: Ms Nenita L. Ortega, 1066 Remedios Corner, Singalong, Malate, Manila, Philippines, 1004. ISSN 0954-0121 print/ISSN 1360-0451 online # 2005 Taylor & Francis Group Ltd DOI: 10.1080/09540120500119833
N. L. Ortega et al.
suffering and the burden of the disease of PLWHA as it violates their most basic rights including access to treatment, the right to employment, housing, and education. This, in turn, is likely to increase the vulnerability of others to infection, as stigma and discrimination discourage both PLWHA and others from contacting health and social services to seek prevention information, get tested and engage in other prevention strategies. A failure to monitor and control HIV discrimination in the Philippines, coupled with the presence of high levels of behavioural risk, may therefore provide an ideal environment for future increases in the rate of infection. If the Philippines is to maintain its low prevalence of HIV (or even reduce it), human rights violations against PLWHA must be addressed; ensuring, among other things, fair and equitable access to care and support. Despite the significant role of discrimination, few studies have examined...