MANILA, Philippines—Amid the celebration of World AIDS Day on Monday, the health department is grappling with the problem of declaring an epidemic of HIV infection among a sector it calls MSM, or men having sex with men.

Increasingly, recent victims are students and young professionals.

The huge problem is that it could not declare this epidemic in the same way it does an outbreak of dengue fever because of the “gay” stigma implicit in it.

Dr. Eric Tayag, head of the health department’s National Epidemiology Center, sounded the alarm in October during the Philippine National AIDS Convention, a biannual event of the NGO AIDS Society of the Philippines.

Citing the health department’s HIV/AIDS Registry, a collection of reports from hospitals, clinics and treatment centers of laboratory-confirmed HIV tests, Tayag noted sudden, steep increases in HIV infection among MSM in the last three years.

The registry recorded 210 new infections among MSM in 2005, 309 in 2006 and 342 in 2007. This year, from January to September alone, there were already 395 cases, up 96 percent since 2005.

Tayag said there was nothing like this in the 21 years since the government kept an official record of HIV infections starting in 1984 when the first AIDS case was reported in the Philippines.

Because the cases were tremendously in excess of what was usually expected, Tayag concluded that there was “an ongoing HIV and AIDS epidemic among the MSM.”

“Several factors may be responsible but we believe MSM has become the new sexual norm (in HIV transmission),” he said. Independent behavioral studies, he said, have shown widespread unsafe sex in this group, such as the nonuse of condoms during anal sex.

“The die is cast,” Tayag said in an interview. The epidemic is likely to escalate and will not be contained in the next five years unless fearless, aggressive interventions are done, he warned.

The health department is attempting to engage in a dialogue with the MSM communities, but Tayag said those involved are either “invisible men” or “closeted” and not open about their sexual activities.

This is one reason why the health department is cautious in declaring the epidemic.

“We cannot predict the level of stigma and discrimination against MSM when we link the new findings to them,” Tayag said. “The last thing the health department wants is to label HIV and AIDS as a gay disease.”

Through the years, males comprised 69 percent of the total infections through heterosexual, homosexual and bisexual contact, with MSM triggering the bulk. MSM is grouped in the homosexual and bisexual modes.

Tayag noted that for the first time in 2007, homosexual and bisexual mode of infection surpassed heterosexual transmission—56 percent as against 43 percent; and from January to September 2008, it rose to 67 percent as against 34 percent.

He said that in the cumulative total of 1,097 infected MSM from 1984 to 2008, 49 percent were reported in the last three years alone; 108 have died when reported, and slightly more MSM were reportedly already with AIDS, the terminal stage of HIV infection.

The most affected age group among males has also moved younger—from 45 to 49 years old to 20 to 29.

Among the newly infected, Tayag said, “we are looking at a special population of 15 to 24 years old and we would like to see how HIV moves in this age group.” He said the 25 to 34 age group was also widely affected.

Yuppies among newly infected

Tayag said the newly infected—90 percent of whom were single—were mostly students and young professionals—a sudden departure from the sectors that health experts called “most-at-risk populations.”

These are freelance sex workers in the streets, those working in nightclubs and girlie bars, male clients of sex workers and drug users. Prostituted males who service other men are also in the newly infected MSM group, and they are also very young.

Because the registry is a passive surveillance system, he said the entire picture of HIV infection is not captured, but nevertheless provides a trend.

If the current rapid increases persist, there will be 10,000 to 12,000 HIV-infected MSM in the next three to five years.

There are now 3,456 cases in the Philippines from 1984 to September 2008. The Joint United Nations Program on HIV and AIDS said the number of cases had been increasing at a “low and slow” pace at less than 1 percent until 2004 when the problem was declared as “hidden and growing.”

For now, Tayag said the predominance of MSM was highest in Metro Manila. Increasing infection rates were also reported in the cities of Angeles, Cebu and Davao.

Dr. Diana Mendoza (not related to this writer) of the Manila social hygiene center said her small staff was trying hard to do confidential counseling, but risky sexual behavior was widespread.

“These are men who know they have risks but they still have sex, if not with one partner that was unprotected, it’s with more than two partners, either male or female, often under the influence of drugs and alcohol,” she said.

For male adolescents and teenagers, the liking for a partner of the same sex, just for kicks, is common, and so are parties and orgies. Smoking, drinking and drugs are fixtures. In some cases, older men initiate the risky practices to the young.

“I often tell my patients, you should be scared, not other people,” Mendoza said.

The clinic staff even handles “double burden” personal problems when it comes to a patient’s disclosure of his medical status to his family of a practice still taboo in the country.

Evolving norm

Tayag said the shift in the mode of transmission was reflective of the evolving sexual norm.

“It is possible that same sex experience is enjoyed as an alternative behavior to opposite sex relationships either influenced by peers or by society’s permissiveness,” he said.

He said more studies were needed to reveal factors that influence this sexual norm. According to one such study in 2004, males are traditionally privileged in Filipino society and they have more sexual choices and freedom than women.

Men can have multiple identities, from highly masculine men whose primary sexual partners are women, through gay and bisexual men, to transgenders.

The study said prevention programs had often been limited by lack of understanding of the behaviors of different MSM subgroups and of the impact of those behaviors on the dynamics of HIV infection.

The settings are reflected in the 2002 Young Adult Fertility and Sexuality Survey of 20,000 15-27 year olds that found out that twice as many males had had premarital sex compared to females (31 percent as against 16 percent).

It also revealed that 15.1 percent of sexually active males have had male partners.

Likewise, a health department and Family Health International study showed that 11 percent of 1,204 men in the general population had multiple sexual partners in the previous six months.

Dr. Ofelia Monzon, who pioneered the first medical studies of HIV and AIDS in the Philippines through the Research Institute for Tropical Medicine, saw this epidemic earlier.

“Some of the men labeled MSM do have sex with females, showing a possible route for spread to others outside the group and so on,” she said.

According to Tayag, risky behavior often outweighs knowledge and awareness, citing results of a UN survey in the Philippines indicating that MSM have basic knowledge of sexually transmitted infections such as HIV.

Only two out of five men used a condom with their most recent sex partner but the use varied with consensual sex and paid sex.

Counseling on Internet

Providing information alone requires complementary efforts in reaching out to target populations such as MSM.

In Davao City, the NGO Wo/Men’s Access to Vital Education and Services (WAVES) is implementing HIV and AIDS counseling through Internet live chat and it is able to touch base with MSM.

John Roxas, executive director, said most of his organization’s MSM chatters were struggling with their emotions and ideas about their sexuality.

For a few who have come to terms with it, they believe they are men who happen to like and prefer to have sex with other men, Roxas said. Some have issues about “letting the girl in them but remain manly looking.”

The Internet is a good instrument to build rapport and a trusting relationship for both the MSM and counselors, Roxas said, encouraging local government units and NGOs to use this.

“The message has always been safer sex—correct and consistent use of condom with all sex partners,” he said.

Monzon lamented the gradual demise of many NGOs involved in prevention over the past years, pointing to constraints in effective public health programs.

“Public health prevention, such as AIDS control, require a strong interest on the part of those involved in public health, the financial support necessary for the institution of measures required, and the ability of health administrators to elicit budgetary support.” she said.

“The continuing emphasis on low and slow infection prevalence has detracted from the important observation that HIV infection is present in the Philippines, has been present for more than 20 years, and that efforts to maintain low numbers require continuing and intensive prevention efforts in order to keep those numbers low.”

He and partner Angelina Jolie have said they would wed when everyone who wants to get married in the United States is able to do so. Same-sex marriages are illegal in most US states.
 

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I noticed that everybody has been asking me if I saw the movie Shelter.  Its a gay theme movie about two surfers.  Nice story and ending.  But my personal favorite would still be The Trip (2002) starring Rosemary Alexander and Alexis Arquette, director by Miles Swain.
 

I watched this movie with my best friend back in 2004 during my vacation in Manila.  As expected, he cried hahaha...

This is not your typical gay movie.  Very well written.   It tells a story about two lovers across two decades.  It shows the progress of gay rights from the 70s to the 80s.  It will make you feel thankful to previous generation of gay activist who fought for the rights that we have right now.  If you are expecting porn, forget it.  Some scenes are cheesy, but it complements well with the story line.

Here's the review from Amazon:

"Miles Swan's romantic comedy The Trip spans 11 years, charting the lives of two men through the Gay Rights movement of the '70s, the conservative backlash of the Reagan-era, and through the AIDS epidemic. Straight, Young Republican author Alan (played by Larry Sullivan) meets Tommy (Steve Braun), a Gay Rights activist, while Alan is completing his anti-gay book. Falling in love with Tommy, Alan tries to avoid publishing "The Straight Truth," but an alleged friend of Alan's underhandedly sabotages him by not only publishing it but also securing for it a place on the bestseller list. As a converted gay man, this enrages Alan and also ruins Tommy's credit as an activist, thereby breaking them up for several years during the '80s. Finally, the two do reunite to pledge their eternal love, though under tragic circumstances. Relevant gay rights news footage, from Stonewall for example, historically sets each segment in the film, making the movie more realistic and educational. Alan and Tommy's plight to fight for the acceptance of homosexuality takes on metaphorical significance, while other characters in the film, like Tommy's best friend, Michael (Alexis Arquette), and Alan's mother (Jill St. John), bring the narrative humor specific to The Trip back into focus. At times, the movie verges on corny, but for the most part avoids cliché. The satisfaction one gets from watching a deep relationship unfold over the years makes this coming-of-age tale a meaningful reminder that there is absolutely no justification for keeping any couples in love apart. --Trinie Dalton "

"Excellent love story that's moving and loads of fun, November 7, 2003
By A Customer
The film, "The Trip", is a wonderfully told love story with a sense of humor, that just about anyone who has ever been in love can relate to. The story itself is fairly basic; the struggle with coming to terms with ones sexuality, first love, and how life can change us. However, it is how the story is presented with a balance of diverse characters, entertaining dialogue and timeless themes of love and emotion that make the film extremely entertaining. The characters are well written for their roles in the story, nicely developed and represented. Gay or straight, just about everyone can relate to this film on one level or another. The witty dialogue keeps the films' pace brisk and fun to follow. But, the gem of this film is its comedic presentation of the period in which the story takes place (70's and 80's). From the clothes to the hairstyles, the film gives us a hilarious reminder of the way we were. Everything about this film is just the way it should be; an intriguing story woven together with outstanding acting and masterful direction. Jill ST. John, who plays "Mary" has never been better. She plays a great character and it's obvious she's having a good time. This film will be a part of my DVD library for years to come and I anxiously await Miles Swain's next film! "

Watch it! :-)

This episode of South Park is so funny.  Tons of characters: Lord of the Rings, Star Wars, Narnia, Thundercats, Friday the 13th, Snow White, Street Fighter, McDonalds, Mel Gibson, Kurt Russell, Michaal Bay, Al Gore, Ninja Turtles, Popeye, Zeus, etc.

LOL!!!!  Super crazy and wicked!  Hahaha... Watch!

Wow!  I'm excited!