A success story?

Here's an enigma: why, in a part of the world where there's a lot of HIV/Aids, would you have a country reporting very low rates of HIV and a tiny number of people with Aids?

"It's perplexing," says Terry Scott, country director for the Philippines of DKT Marketing, a non-governmental organisation that sells and promotes condoms. "There's lots of risky behaviour. There 's a window of opportunity that has remained open for a long time, but on the bad side there's complacency."

The official figures for people who have ever tested HIV positive stands (as of June 2003) at a cumulative total of 1,892. With a population of around 79.2m, that's a prevalence rate of under 0.1%. Its neighbour Thailand, by contrast, has a rate of 1.8%.

So is the Philippines really a success story? Perhaps less than it might appear at first sight. "I hate the phrase 'low and slow '," says Dr Jojo Sescon, executive director of the Remedios Aids Foundation, referring to the way in which the Philippines is seen as having a low level of HIV infection and a slow rate of growth. Remedios Aids Foundation offers health information and services to people affected by HIV/Aids. "Cases are rising, we are seeing a new sector of society being plagued and support is starting to scale down. It is disheartening."

Nobody working in the field argues that the actual rates of HIV infection really are as low as the reported figures would indicate, the only difference appears to be the extent to which they are wrong.

Dr Roderick Poblete is director of the Philippines National Aids Council, the advisory, planning and policy-making body which oversees the government's response to HIV/Aids. He says that in the early 1990s,the estimated projection of HIV rates was comparable to those in other south-east Asian countries. From 1993, the department of health conducted HIV surveillance of female sex workers, MSMs (men who have sex with men) and injecting drug users. "When we tested risk groups, we had to start downsizing the estimates. With the general public, we downsized them further."

So why does he think there might be so few cases of HIV?" The Philippines is culturally conservative; Filipinos, even sex workers, have fewer sex partners. MSMs have three sex partners a month. Also the Philippines is an island country - there are no borders. Possibly there is a genetic factor, some natural resistance. Also men are circumsized, which may be a protective factor." Nevertheless, he remains baffled: "We have the ingredients for an explosion of HIV - but no HIV."

When it first became apparent that the pandemic was going to have an impact on the Philippines, the government, headed by President Ramos (a Protestant) acted decisively. Senator Flavier, secretary of health in the mid 1990s,was a strong advocate for condoms and was instrumental in getting funding for groups such as Remedios Aids Foundation. The National Aids Law, based on the universal declaration of human rights, was passed in 1998. From confidentiality, to protection from mandatory HIV testing, the law spelt out precisely how the rights of people living with HIV/Aids (PLWHA) should be respected.

But however laudable it seems to be in theory, in practice, nobody knows the extent to which it works. The anti-discrimination legislation has never been tested: anyone bringing a case against, say, an employer would be outing themselves and their HIV status, and in a country where almost nobody is completely open about their positive status, the price of doing this has obviously proved to be too high.

The Philippines is a Catholic country - one where religious influences have an impact in all sorts of ways. Starting at the top, this summer President Gloria Arroyo refused to back the Reproductive Health Care Act. As long as I am president, I will veto abortion, she said. But the bill does not legalise abortion, merely addresses post-abortion complications, in a measure designed to give reproductive health care to all. A devout Catholic, she also diverted $1.5m that, under the previous administration had been allocated to modern contraceptives, to "natural " family planning. This of course has an impact on the availability of condoms for family planning and HIV prevention.

Read the second part of this article .