Jose Roel II Javarez was 22 when he was rushed to hospital on the brink of death — but he doesn't know when he contracted the virus that drove him there.
Mr Javarez, who grew up in a village in the Philippines' westernmost province of Palawan, started engaging in casual sex about the age of 13, a decade before he was eventually diagnosed with the human immunodeficiency virus (HIV).
He estimates that he had about 30 sexual partners during that time.
"During my village days I was a bit curious: exploring everything, trying everything," he told the ABC.
"I still don't know how I got it."
HIV testing is low in the Philippines, with stigma and fear fuelling hesitancy in the conservative Catholic nation.
Meanwhile, the country is in the grip of one of the world's fastest-growing HIV epidemics.
While in 2012 there were only about nine new HIV cases recorded daily in the Philippines, that number rose to 46 in 2023 — a 411 per cent increase in a little over a decade, according to a Department of Health report.
Young people are driving the surge, with people under 35 accounting for more than 75 per cent of reported cases.
Forty-seven per cent of new infections in 2023 were estimated to be among those aged 15 to 24.
While the vast majority of cases are from unprotected sex, research indicates that a lack of testing and late presentation is further fuelling infections.
A paper published in the Tropical Medicine and Infectious Disease medical journal found that in January 2023 almost a third of new confirmed HIV cases in the Philippines had clinical manifestations of advanced HIV at the time of diagnosis.
Earlier research published in 2022 observed that while about 70 per cent of HIV cases in the Philippines were among men who had sex with men, over three-quarters of that same demographic had never obtained an HIV test.
Mr Javarez, for one, knows about 50 people who have the virus, as well as a handful who are still afraid of getting tested for fear of being shamed, stigmatised or discriminated against.
It's a feeling he can relate to.
"I was afraid of being screened," he said.
"We have community-based HIV screeners here in Palawan, but I was one of those who was hesitant and afraid of getting tested, because if I ever tested positive during the testing, [I would have to face] the judgement of the community."
Only after his near-death experience, when he was taken to hospital with pneumonia, a urinary tract infection and "many complications," did he finally get tested for HIV at the insistence of his doctor.
On May 19, 2022, he was diagnosed with the virus.
"At first it didn't sink in," Mr Javarez recalled.
"Then when I got home things started to. I [thought], 'Oh my god, I'm gonna die.'"
Now, two years later, the 24-year-old has a wife and two children, and has become an advocate for his friends to get tested every month.
Mr Javarez still hasn't disclosed his status to anyone outside close friends and family.
"People will reject me if they know my status," he said.
"One connotation is: 'He has a disease that can spread throughout us, so stay away from him,'" he explained.
"I am afraid for my family being judged because of my situation."
A dangerous stigma
Stigma towards people living with HIV (PLHIV) is widespread in the Philippines, Mr Javarez explained — especially among those who are poorly educated or who live in rural areas.
"Our community considers being PLHIV as a weakness," he said.
"So that's why they are targeting that weakness."
Such stigma is a major factor fuelling the rise in cases, according to Ronivin Pagtakhan, founder of Manila-based HIV advocacy group LoveYourself.
Meanwhile, he and other experts warn that the average age of reported cases is trending downwards.
"I think one of the main reasons why it's rampant in the Philippines right now is because sex is still taboo to many families," Dr Pagtakhan told the ABC.
"The Philippines is highly Catholic … It's sometimes too conservative, to a fault, that people and some families do not want to talk about sex when sex is happening."
Rowalt Alibudbud, a lecturer in sociology and behavioural sciences at Manila's De La Salle University, similarly cited stigma and a lack of education as barriers to addressing the Philippines' worsening HIV crisis.
In a 2021 research paper published by the Royal Society for Public Health, Mr Alibudbud noted that HIV infection in the Philippines "is often equated to sin and immorality".
"Strong roots in Catholicism coupled with poor HIV education are some of the main drivers of both HIV and sexual orientation-related stigma," he wrote.
LoveYourself is fighting to erode these barriers.
Founded in 2011 as a community-based organisation, the NGO now has 22 community centres and clinics offering free sexual health, trans health and mental health services, and tests about 250,000 people every year.
It currently has 14,000 PLHIV in its treatment program.
It's part of a broader public health movement, spearheaded by advocates, activists and NGOs, that is trying to turn the tide of the Philippines' HIV epidemic.
In that light, Dr Pagtakhan described the rising case numbers as a "double-edged sword".
"There is an epidemic, it's ramped up, it's happening — and we're just seeing the tip of the iceberg," he said.
"[But] I think the rise in cases is also due to more people getting themselves tested."
Lack of protection
Another barrier that has long been flagged by experts and health advocates is low condom use in the Philippines, which "has been identified as the primary reason for the dramatic increase in HIV infections," according to an article published by The Lancet HIV.
It said although condoms were widely available in the Philippines, stigma and discrimination, as well as laws that prohibit healthcare workers from providing those younger than 18 with protection, were hindering uptake.
Dr Pagtakhan and his advocacy organisation LoveYourself has responded to this need.
In 2018, it launched a smartphone app that directs users to locations with condom dispensers.
"It's a Google Maps for condoms inspired by Pokémon Go," Dr Pagtakhan told The Lancet HIV at the time.
"When a person is nearby, they just need to access the app and it will show where the nearest condom station is where people can access condoms for free."
Dr Pagtakhan also noted, however, that more work needs to be done, on a much greater scale, to meaningfully respond to the spiralling crisis.
One big part of that is for the Philippines government to lead the charge on advancing the country's sex education programme, he said, and actively try to dissolve the stigma around sex and sexually transmitted infections.
"I hope the Philippines and the Department of Education and the Department of Higher Education will create programs so that they will have a comprehensive sexual, social and mental health program for students at a young age," he said.
"And it should be designed in such a way that it's sex positive."
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2024-07-06 19:18:29Z
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