ON an evening visit once toMalate, in downtown Manila, I saw a man slumped against the wall of a bank. Under the unforgivinglybright neon strip-light of the ATM sign, I saw that his face, neck, the palms of his hands, even the soles of his bare feet,though blackened with grime and dirt, were covered in ghastly sores and angry red rashes. Around the corners of his mouth were warty pustules. It was a terrible sight. As someone who has read more than enough lavishly illustrated nineteenth century medical texts on infectious diseases,Ihad a horrible suspicion what the man’s illness might be. My immediate thoughtwas syphilis. If my hunch was right, the man was in the secondary stage of the disease. The characteristic features were clearly visible and he was highly contagious.
Syphilis is caused by the bacteriumTreponemapallidum and is transmitted through sexual intercourse and skin-to-skin contact. When contact is made with an infected person’s sore, the bacterium enters the body and stays there forever. Without treatment, the disease devastates the central nervous system and blood vessels, destroys bones and joints, and the functioning of the heart, liver and eyes. If a pregnant woman contracts the disease, her baby will be born with a number of defects, including deafness, nose and tooth deformities. The cure, which was not developed prior to the 1940s, is a single injection of penicillin given in the early phase of the disease. The historian Ken de Bevoise, writing in Agents of Apocalypse(1995),his carefully researched book on epidemic diseases in the Philippines during the late Spanish to the early American periods, has estimated that before the advent of penicillin, between 5 to 10 percent of all Filipinos who caught syphilis died.
Gonorrhea, another sexually transmitted disease, or STD, is thought to be humanity’s most common bacterial disease. It affects the penis, the vagina, the cervix, the urethra, and throat. An infected man will experience pus-like discharges from the penis and a burning sensation while urinating. In women, symptoms include a swollen vulva, yellow-greenish vaginal discharge, painful urination, fever and abdominal pain. The infection will cause both men and women to have an itchy anus, a sore throat that makes it difficult to swallow and, if left untreated, it will lead to infertility, skin sores and arthritis. It is cured easily with a simple course of antibiotics. However, the disease spreads with astonishing speed and carries no immunity from re-infection.
History tells us that mobility, poverty, and prostitution promote the prevalence of venereal diseases such as syphilis and gonorrhea. In the late 19th century, the lethal combination of “rural want and metropolitan money” in the Philippines, as De Bevoise writes, meant that as more poor and powerless rural women migrated to cities in search of work, the more widespread STDs became.These women, usually adolescents, were from the most impoverished families. They workedas domestic servants, cigar rollers, cooks, lavanderas, while some, to make ends meet, also became prostitutes.We have experienced STD epidemics before. Get it?
Since the early 1980s and its first appearance in the United States, HIV, the virus that causes AIDS, has been reported almost everywhere on the planet. One and a half million people die from AIDS each year. John Malcolm Dowling, an American behavioral economist, estimates that of the 34 million people who live with HIV today, a high proportion are in developing countries-–23,500,000 are in sub-Saharan Africa and 4 million in South and South East Asia. With the number of cases rising fast every year, the Philippines, the UN predicts, is on the brink of a “full-blown AIDS epidemic.”In the Philippines, the victims are getting younger: many now fall in the range of 15 to 24 years old.
HIV is predominantly transmitted through sexual intercourse. In general, unprotected anal intercourse is much more likely to spread HIV than penile to vaginal intercourse. HIV compromises the body’s immune system, opens the door to a host of opportunistic infections, and has the ability to mutate, becoming, in time, drug resistant. The body is horribly assaulted by cancer, kidney, liver, respiratory and cardiovascular diseases. Advances in antiretroviral therapy (ART) limit and significantly slow down the progression of the disease to AIDS. But public health systems in developing countries cannot cope with the increasing number of cases.
Condoms are almost 100 percent effective in preventing STDs transmitted by genital fluids. Latex condoms form a barrier against the tiniest STD pathogens. How they work is not rocket science: Open the pack carefully with your fingers and not with your teeth or scissors. Unroll the condom fully from the tip to the base of the penis. Always use a water-based lubricant, never an oil-based one (such as Vaseline). Always use one for every vaginal, penile and oral sex act, and keep it on from start to finish of the sex act. That’s it. Not scary, boring, or tricky at all.
The promotion of condoms through sex education, their proper use and distribution, is extraordinarily effective in reducing the frequency of STDs, including and especially HIV, gonorrhea and syphilis (in the latter, the infected area must be covered). Thailand has experienced considerable success in cutting down HIV/AIDS transmission rates and deaths by aggressively pushing condom use among sex workers and patrons of massage parlors. This can happen in the Philippines.
The Department of Health recently announced that it would ramp up sex education in schools and collaborate more closely with the Department of Education and the National Youth Commission. “We’ll go down to the community, to the households involving the parents, the education sector, the teachers, the whole community,” said Health Secretary PaulynUbial. Next year, condoms will be distributed in schools. If you need to hear good news, this is it.
Condoms arrest the spread of STDs. Condoms stop our people from suffering and dying from STDs. We need condoms because we are human and take pleasure in sex. Condoms make sex safe. Using them will save your life.