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In the midst of an HIV epidemic, the Philippine government must break with the official Church stance and encourage the use of barrier contraceptives.

Uncomfortable laughter reverberated around the room as President Duterte of the Philippines popped a candy into his mouth, comparing using a condom during sex to leaving the wrapper on a sweet. His comment, given before a migrant women’s health assembly, exemplifies the government and public’s attitudes towards contraceptive use. 

The Philippines is experiencing one of the worst HIV/AIDS epidemics in the Asia-Pacific region, with 120,000 people currently living with HIV. In the span of a decade, this number has increased by nearly 80 percent—a growth rate more than double that of Vietnam, which has experienced the second steepest rise in cases in the region. In the developing world, less than a quarter of new infections are due to intravenous drug use, and causes other than sex without barrier contraception account for very few of the remaining cases. It follows that, in the Philippines, transmission of the disease is most likely overwhelmingly due to unprotected sex. What makes the issue in the Philippines particularly baffling is that its citizens have sufficient access to sanitation, treatment, and contraceptives— the lack of which typically drives HIV epidemics. 

As the United States learned in the 80s and 90s, the most successful strategy to combat AIDS is to prevent HIV infections in the first place. Sexually transmitted HIV can be easily prevented with low-cost contraceptive barriers like condoms, which are readily accessible to Filipino citizens. However, access and usage rates are not correlated. Condom usage in the Philippines is shockingly low: According to a 2019 PhilCare study, only 30 percent of people in the country use condoms. This is due to a conflict of messaging between the two most powerful political voices in the country—the government and the Catholic Church. 

The high level of religiosity in the Philippines may be the key to understanding resistance to condom use. In 1989, during the height of the American HIV epidemic, Pope John Paul II called the usage of condoms a path to “moral degradation.” Since then, the Catholic Church has never officially changed its position on barrier contraceptives. In a country where nearly 90 percent of the population is Catholic, the Pope’s edicts are highly influential. In fact, the Vatican holds far greater sway in the Philippines than it does in nearly any other Catholic country. According to Pew Research Center, 91 percent of young adults in the Philippines describe religion as being “very important.” For context, in Mexico—another predominantly Catholic country—this number measured only 45 percent. 

But a high level of religiosity does not mean hope is lost. In Brazil, another very religious Catholic country, over two-thirds of Brazilian women use contraception regularly. This is largely due to spirited government efforts to change popular attitudes during the height of their own HIV epidemic. To achieve similar success in reducing cases of HIV/AIDS in the Philippines, the Philippine government must take similar action. 

Despite the Philippines’s socialized healthcare system with a reasonable standard of care, cultural impediments are such that Filipinos only occasionally seek out doctors. The centralized nature of the system also means that without regular interaction with a general practitioner, medical issues are generally treated as they come up. As a result, the average citizen hears only two major voices when it comes to health-related ethical issues: the state and the Church. 

The Vatican’s stance on the issue of contraceptives is clear and unlikely to change. The Philippine government, while nominally supportive of condom use, has only weakly stated its position on the issue. Most programs seeking to change people’s opinions on barrier contraceptives are carried out by foreign NGOs with minimal cooperation from the central government. If Duterte’s comment to the women’s health group is any indication, encouraging the prevention of HIV/AIDS through contraceptive use doesn’t seem to be high on the government’s agenda. 

While the government and the clergy occasionally disagree, as evidenced by a few members of the local clergy’s spirited opposition to Duterte’s drug war, the government has never come into direct conflict with official Church doctrine. Knowing the outsized impact that the Vatican has on public opinion, the government has always been wary of the positions of the Holy See. A famous example of the government’s capitulation to the Church is President Duterte’s public apology for calling Pope Francis “a son of a whore.” This kowtow was no crisis of conscience: The public outcry in the Philippines was so great that it threatened the president’s re-election. 

Despite the political danger of confronting the Church, the government must strongly recommend barrier contraceptives as the best strategy to combat the HIV epidemic. For the first time in the nation’s history, the government must emphatically and publicly come into conflict with an official Church stance—any other choice will result in thousands of needless deaths.