Monday, August 04, 2008

Sex, drugs and HIV

This is my column today.

In moments when we want to empathize with whatever dreadful experience others are going through, we try to put ourselves in their situation. We make the effort to imagine what it feels like to live under their skin; we try to sense the pain and anguish that they are living through in the hope that by doing so we are able to relate with them better, perhaps even lighten their pain in the process. But we know that we can only try; we can only imagine what it is like. We can’t really be in the same wretched place.

I’ve been involved in HIV/AIDS prevention work for almost two decades now. All throughout these many years, I have met, counseled, fought and cared for numerous people living with HIV/AIDS. Each one of them had their own sad story to tell, some more tragic than the others, but all of them stories of courage, and in the end, of hope and redemption.

Living with HIV is one of the most paradoxical situations in this world. It makes people living with the virus to come to terms with their own mortality but at the same time appreciative of their own humanity. It exposes people living with the virus to all the possible permutations of the hatred that resides inside other people who aren’t able to deal with their own intolerance and bigotry but at the same time ennobles them to find within themselves the courage to understand and forgive.

I’ve also learned to hone my own coping mechanisms particularly in managing emotions when caring for people living with HIV/AIDS. I used to wallow in the pits of depression every time I’d come across someone with a really tragic story about how he or she got infected with HIV. I would mourn for days when someone I knew and gotten attached to passed away. Eventually, I learned to toughen myself and learned to practice the counseling mantra of being like the proverbial mirror that reflects rather than as the sponge that absorbs. I thought I had it all down pat. Until E and his story came along, that is.

What makes E’s story moving is aside from the fact that he discovered he was HIV positive just when he decided to cut clean from a destructive lifestyle that included trading sexual favors for unlimited access to drugs, he also typifies the really tragic thing about the HIV pandemic: It affects people who are at the most promising and productive years of their lives.

Bear with me and try to imagine you are 25 years old—the age when the pressure to make something of yourself is at its most intense. Having lived a relatively bohemian lifestyle that involved partaking of all the pleasures offered to someone with the physical attributes and the overwhelming craving to experience the best of what life had to offer, you wake up one day to finally realize you are not getting any younger and that it is time to turn a new leaf.

You wean yourself from a destructive drug habit that for many years has enslaved and reduced you to a veritable plaything of people with no compunction whatsoever of using their money and influence to exploit others. You write finis to a life spent trading your body for drugs. You decide to come home and become the good son and brother once again. You make peace with everyone you have hurt in the past. You go back to school and begin weaving new dreams. And then, to really enable you to begin on a new slate, you decide to get yourself tested for HIV. You look forward to the opportunity to really start all over again and be a better, renewed, revitalized person. And then life deals you a major whammy. You discover you have HIV.

This is the story of E. Many bloggers have probably come across the Web log which he put up as some kind of a therapy and tool for catharsis. I won’t mention his blog here because I think that the last thing he needs is unbridled media attention. As much as he wants to do his share in helping take away the static that accompanies discussion about HIV, AIDS, sex and drugs in this country, he needs to guard his privacy very fiercely. As it is, a number of bigoted and intolerant people have already started to gang up on him trumping up the usual messages of hate that emanate from fear and ignorance. E is not a victim, but neither should he be the new whipping boy of the moralists and bigots in this country.

HIV/AIDS still has no cure today, but someone living with HIV can live a productive and healthy lifestyle—thanks to medical breakthroughs. But the stigma has remained. Living with HIV is still looked upon as a curse that befalls “bad” people. E may have lived a carefree existence for a number of years, but deep down he is really just the typical cute boy who could pass off as the little brother you wanted to cuddle and protect from the world.

What makes E’s case particularly worrisome is that he represents the new phenomenon in HIV infections in our country. Of course no one deserves to have HIV and I certainly don’t want everyone else living with HIV to think that their situation is any less significant. But recent incidences of HIV infection seemed to be concentrated on college-age students and young urban professionals; the proverbial hope of the fatherland. E is in college and used to work in a call center. And yes, at the risk of raising alarm and unwanted scrutiny on this particular industry and segment of society, we’re seeing a rise in HIV infection in the call center industry and among college students.

E is not the only college-age person that has tested positive for HIV recently. A number of people he knows (and who move around in his particular social circle) have also tested positive. This is not empirically based, but based on my discussions with a number of young people who have recently tested positive for HIV, the emerging vector seems to be drug use. We are seeing the rise of injecting drug use in other parts of the country although in Metro Manila, recreational drugs are still more popular such as ecstasy, ketamine, crystal (most popularly known as shabu), and yes, cocaine. While recreational drugs per se don’t pose a direct cause of HIV infection the way injecting drug use does, vulnerability to HIV infection increases as inhibitions plummet and risk-taking increases with the use of these drugs.

And as confirmed by E, drugs represent the most potent currency out there today among the young. The really sad thing is that there are predators out there that won’t take money but instead use drugs as bait to lure people into sex in exchange for a line of cocaine or a few grams of crystal. I can already see the knee-jerk reaction of some quarters: Advocating a crackdown on certain bars and establishments and requiring call centers to impose mandatory HIV testing. These courses of action are foolhardy as these will only create an underground culture that’s difficult to track for HIV programs. The most viable way to address the problem is still prevention and education. And harm reduction.

I’ve spent a number of sleepless nights worrying about E and young people like him whose lives have now taken a drastic turn courtesy of a pandemic that we should have been able to manage better. It’s really sad that after more than two decades since HIV/AIDS was first detected in this country, we’re still barely scraping the surface in terms of prevention and control.

If it’s any consolation, E has become hopeful and pragmatic. He has decided to move on with his life and make the most out of the cards life has dealt him today. But not everyone has E’s maturity or pragmatism. He plans to use his HIV status as a wake up call; others are still in denial. We can’t take back the hands of time and change things for people like E, but we can still do a lot for others. And yes, we certainly can still make things better for E with a little more understanding and care.

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