HIV:

A hot random sex date is set with a click of the mouse. Casual sex with an acquaintance, or a total stranger is arranged with an exchange of mobile text messages. Sometimes, knowing looks are enough to access sex in a dark alley. This is sex in the Philippines today: secret, but available; hidden but accessible; rampant and potentially dangerous.


She walked in the coffee shop in denim shorts, a towering mirage in her long bare legs laced up in stilettos.  A white blouse, seductively baring one shoulder, suggested an ample bosom.

The salesperson behind the counter asked, "May I have your narne, sir?"

"Ma'am  naman",  she pouted. "Victoria," she answered, with a dramatic flip of her long black hair, her dangling earrings jiggling with the movement.
Victoria Rivera, 24 is a transgender. Biologically born a male, she has always concidered herself a woman.
Her world is just one of the emerging sub-cultures of clandestine sex, fostered by changing lifestyle, technology and kinship in attitude.

Alive and thriving, experts say these sub-cultures provide a potential breeding playground for sexually transmitted infections and HIV.

Even more worrisome, health experts are havlng dlfficulty in reaching out to these high risk groups, further faciliating the spread of HIV and other sex-related infections to the general population.
This piece provides a peek into that world, invisible to some, but a reality for others.

Rivera is the internal affairs officer of the Society of Transexual Women of the Philippines (STRAP), the first and only support group of transgender women in the Philippines.

STRAP has about 49 active members. "But those are just members of STRAP, you just need lo look around you tu see that there are hundreds of transwomcn everywhere", said Rivera.

Calling themselves "transpinays", STRAP memhers are a diverse mix. Some are professionals in corporations; others work in the creative industry and some like Rivera, are engaged in sex work.

Rivera joined the flesh trade in the streets of Hong Kong in 2006, playing cat and mouse with police authorities there.
That is, until she found that she could just as easily sell her services online in the Philippines through the Internet.

"I set up my own site." she says. "Google 'transsexual' or 'transgender sex' and my site will appear." Her contact numbers and restrictions are listed on Ihe site. A call confirrns a "booking," she explained referring to a sex date.
Rivera charges her clients who are either straight or bi-sexual asmuch as USD200 an hour. She used lo cater mainly to foreign clients. But Manila is also increasingly becoming a source of lucrative business.

"I think the line l hear the most often from Pinoy men is, kung naging babae ka lang, but l am a woman!" Victoria Rivera, transexual Pinay

Experts believe that the easy and quick access through the Internet to commercial transgendcr escorts like Rivera could be one of the factors that contributed to the rising number of men who have tried anal sex with a (biological) man.

In the process, because of the higher risk associated with unprotected anal sex, these men expose themselves to HIV infection.
In 2007, the DOH estimated that there were 223,042 to 669,125 men who were at risk for HIV infection because of having sex with other men. In that same year, it was noted that most of the new HIV infectlons were coming from this segment of the population who are also often referred to as MSMs (men having sex with men).

"There were no clients before in the Philippines. But now, there is a growing number and they're getting younger and younger," related Rivera.

In the last two years, she estimates she has had at least 20 Filipino clients, 10 of whom she considers "regulars".
And there are countless others, who are curious and interested but "can't afford the price", Rivera said.

She has come a long way.

Rivera recalls her younger years when she was the paying, receptive partner.
"Now, I have Pinoy clients who are married, have kids and want to try transsexual sex and even want to be the receptive [anal] partner." The clients are usually in their mid-20s to mid-40s; most have girlfriends and some are married with children.

Rivera is an exeption in this potentially risky group. She strictly implements a "no glove, no love" policy among her customers. "I know the kind of business l'm in. I always use condoms."
A 2007 review entitled, "Size Estimates of Populations at Risk for HIV" conducted by the Department of Health National Epidemiology Center (DOH NEC) indicated that about 1% up to 3% of adult males aged l 5-49 have had anal sex with another man in the past year.
But experts say that this data may be flawed because some classifications like "MSM" or "men vvho have sex with men" exclude other high risk groups.

For instance, there are heterosexual men who have sex vvith other men but refuse to identify themselves as gay, Philip Castro, program manager at the United Nations Development Programme (UNDP) explained.

Contrary to general belief, according to Castro, the MSM segment has many variations. "There are different sub-populations of MSM," he said.

There are the discreet ones, who are either married or have girlfriends. "They are difficult to track as most find their Partners online," Castro said.

Transgenders like Rivera are different from MSM because they think of themselves as women, and are thus easy to identify.

Certain terms are used to informally segment MSM. There's "bakla" or the outvvardly gay segment; "ladyboy", "effem" (for effemlnate), "pa-girl", "parlorista".
And there are those who are known as "shifters" or whose sexual preference bends. In gay lingo, this group are also referred to as "Transformers", "Robocops", "Darwins' or "bisexuals", and "trippers."

This cluster includes the likes of Shinobi.

In a coffee shop inside a crowded mall, Shinobi holds an "eyeball" session with other members of the social networking site, Fetlife. He is with a Fetlife member, an engineer, and they are poring over sketches and measurements for paddles, whips and contraptions. These are going to be used to suspend a bound and gagged human body.

Fetlife is a network of "fetishists" or those who live the BDSM (bondage, domlnation, sadism and masochism) lifestyle.
Thc membcrs, who hide themselves using the codenames on their Fetlife profile, think of bondage as an art form, as practiced in the Japanese art of shibari. Shinobi claims that he is the only openly practicing male bondage artist in the Philippines.

"The circle of fetishists in the Philippines Is still a small one, but growing," Shinobi admitted. "It's hard to tell how many exactly because many don't want to come out. Others are just beginning to try it."

Shinobi has 6 different female partners he dominates called "submissives". He also has one exclusive partner.
The youngest of his partners is 22 years old and the oldest is in her late 30s. Shinobi met all of them online. "Years ago, it was through chatrooms, then there were sites like Manilatonite. Now, there are sites like Fetlife for groups who have similar interests."
Shinobi gets requests from both men and women who want to experience the art of bondage.
While it doesn't always involve sex, occasionally, men ask him to perform oral sex on them. "I'm hetero-flexible", he said, "I don't have a problem performing oral sex or giving anal sex to another man."

The 2003 Behavioral Scientists Surveillance report conducted by the DOH revealed that MSMs reported an average of two Partners per month. Some reported as many as 55 sex Partners per month. The median age of the
respondents was 15 years old.

The number of sex partners of those that fall in the higher end of the spectrum attests to the fact that sexual partners are easy to come by. Some are strangers they meet online or casual acquaintances at work or church. Others are referred by other friends. Some become friends after an initial sexual encounter.

With sexual Partners being easy pickings and condom use being dismally low at 2.8%, according to the National Health and Demographic Survey (NDHS) of 2008, the sexual behavlor of MSMs indicates that they could be prime candidates for STI and HIV.
Shinobi always uses condoms as a general rule. But he admitted to sometimes forgetting especially with a submissive who has become a regular.
In the last four years, he estimates that he had been with at least 20 different women, and a handful of men.
He also had one STI scare. One of bis female submlssives had gotten a bad case of herpes and accused him of being the source. "l got tested and had my other girls testet. We were all clcar. It was her latest partner who got her infectcd," Shinobi disclosed.

Rivera and Shinobi's vvorld may cater to the older group but there is no doubt that it is the bigger segment of the population-the youth- that are especially vulnerable to accessible sex via online means.
University of the Philippines Psychology Department Professor Chei Billedo, one of the few experts who specializes in the new field of cyber psychology or the persona that one assumes on-line, described the youth as, " ...a generation born into technology."
She explained, "They don't know of a world without the internet and the difference between offline and online experiences blurs."
Explaining how people interact and form relationships in cyber space, Billedo said: "Online, [because you don't see each other), you make an identity for yourself-one that may be totally different from what you are really like."

In the safety of anonymity, "It becomes easy to start an exchange of sexual innuendos; foreplay begins even whlle on-llne. So when you meet, it is a consummation of the initial cyber foreplay."
From the interviews she has conducted among; young; people for various research papers, Billedo had this to say: "It's so easy. Thc results are very quick and they like it that way. You don't have to go out for dinner, or make ligaw pa."
"It's like the way we are used to consuming media now-on demand. We exptect sex to be on demand as well," Billedo concluded.

Social media is largely the culprit for this phenomenon.
Gatner, Inc. a US-based IT research Company, recently released a study that identified the Philippines as a country of the "most avid social networkers." The Philippines has the 6th highest penetration of Twitter worldwide. Locally, Facebook is the most visited Internet site.
The 2009 Nielsen Media Index of Internet behavior revealed that the people in one's cyber social circle differ by age group.
For the 15 to 19 age group, the highest number of people within their cyber social circle are those they knew only in the virtual world, people they met once or twice in person and referrals by friends.
Comparatively, people in the contacts list of those in the 20 to 29 age bracket are mostly friends that they've lost contact with.
While there is no study that directly relates the impact of online engagement to being sexually active, there are accounts like that of GJayo, 23, a trainer at a call center in Quezon City.
Gjayo* lost bis vlrginity to a girl he met online when he was 17. The girl was 16 years old. "We connectcd in a chatroom, met up in person and went to a cheap motel.", he said simply.
Casual sex led to pregnancy. They decided to terminate the pregnancy and the casual relationship.
Shortly after, he met another girl online and again got her pregnant. Abortion was again resorted to.
More than the pregnancy, GJayo got concerned about rashes that have appeared on his upper thighs. He was afraid that he had gotten a STI.
He was vague and dismissive when asked about this. "I went to a derma, had it checked and just took antibiotics for it", he said and dismissed the question.

The number of HIV / AIDS cases in the Philippines has been growing double time.        
As of 2009, there are two new cases dlagnosed every day.              

Men make up most ot the HIV cases, with bulk being between the ages ot 20-29.


Source: "This is it.'": A presentation made by the National Epidemiology Cent
(NEC) in December 2009.

While technology opened thePandora's box to easy sex, it failed, however, to overcome the shame that often comes as a consequence of risky sex. It also failed educate the public on its dangers.
Shame, shrouded in denial and coated with ignorance, hindcrs people from seeking rnedical treatment for STIs says Dr. Marcellano Cruz, a board member of the Philippine Society of Venereologists, Inc. (PSVI), a group of 3,000 physicians across various medical disciplines like dermatology, infectious disease, and family medicine.
"They are afraid of thc stigma so they just self-medicate," Cruz said.

It is a dangerous attitude.

In September, PSVI hosted a Conference warning about the dangers of STIs that go unreported and undiagnosed. STIs, if untreatcd may Iead to infertility, mental disorientation and sometimes death.
    It is also makes one more vulnerable to being infected by HIV.

According to the 2003 National Demogniphic Health Survey, only 7.6% of men aged 15-19 and less than 2.2% of those aged 20-49 reported an STI or STI symptoms.

    In the 2004 DOH data, there were 221 cases of gonorrhea and 64 cases of Chlamydia reported. But Cruz warned that this number is underreported and does not paint an accurate picture for a number of reasons.

    For one, private clinics and hospitals are not required to be report STI incidence among patients. There is no regulation on the tracking of STIs and after the 2004 data, no recent studies were done on STIs, Cruz said.
    Cruz, a dermatologist, said some of his patients come in for a consultation without being avvare that he has STI or is showing symptoms for one. As STIs usually manifest on the skin, dermatologists are often the first to be consulted.
    "Sexual history is needed to make a diagnosis. That's when I find out that they have had unprotected sex with various multiple sex partners," he said.
    Social media is not only the culprit. STDs and HIV have found its niche in workplaces, experts say, courtesy of young professionals working in call centers.
    Packed with young, mobile and moneyed young people, the call center industry has been labeled a natural magnet for STIs and HIV. Estimates shovv that about 80% of all contact center employees are in their eatly to mid-twenties, each earning around Php 16,000 a rnonth.

To Identify themselves as dancers and Guest Relations Officers (GROs), their IDs have a pink stripe that runs arross the bottom.

In a study made by the Philippine General Hospital (PGH) during the
period November 2009 to January 2010 involving 406 male respondents, over half of those who were tested positive for HIV were call center agents.
The PGH study was bolstered by a March 2010 study by the University of the Philippinos Population Institute (UPPI) that revealed that call center employees are more likely to engage in rlsky sexual behavior compared to those who do not work in call centers.
The UPPI study was conducted in Metro Manila and Metro Cebu, covercd 16 call centers and 675 respondents, all below the ageof 35.
For comparative purposes, some 254 employees from different industries wcre also interviewed.

The study revealed that:

• The prevalence of risky sexual activity is higher among call center respondents for casual sex, non-romantic regular sex ("friends vvith benefits" or "fuck buddies"), unprotected sex vvith multiple sex partners, sex with same gender and commercial sex."

• Significantly     more     call     center respondents had casual sex as compared to non-call center employees. (40% vs 27%)

• Male call renter respondents reported a higher average number of Partners than non-call center employees, at 3.2 vs 2.2

• More than 40% of the respondents reported that their last sexual encounter was unprotected.

    Grace Cruz, UPPI director, however, has a caveat. "The report did not examine timing, so these behaviors may have been initiated long before the respondents started working in a call center." The impact of social media and the Internet on how people engage in relationships was also not studied.

Registered Sex Workers must get a weekly smear to her for common STIs. The results of these smear tests are logged in her Health Card.


Eric Manalastas of the UP Psychology Department describes call centers as "strong situations" "where one refashions bis identity, one's sense of right or wrong."
    The erratic working hours isolate call center employees from others who have regular day jobs. This displacement makes the call center not just a workplace, but one's reality.
Manalastas cited examples like jails, OFW populations, and same sex schools "where they create their own subculture because they are somewhat disconnected from reality".
The Contact Center Association of the Philippines (CCAP) denies that call centers have become a hotbed of STIs and HIV.
"I will not say that [casual sex] it is not happening in call centers, but l don't undcrstand why we are the only industry being highlighted." Jojo Uligan, CCAP director, said.
    Uligan says there are "solid health and wellness programs" which cover STI prevention in all call centers. But he admitted that condoms are not distributed in the work place so as not to be perceived as promoting casual sex.

As easy access to risky sex has gone unchecked, health authorities worry that HIV could just make a grand entrance.
    The Philippines has been classified as "low and slow" in HIV infection, but such description may not be accurate anymore.
    While more people are engaging in unprotected sex with multiple partners, condom use remains dismally low.

A Reuters report identified the Philippines as having the lowest condom use in Asia.

Experts say that elements indicative of a rising epidemic are here: low condom use, multiple and concurrent Partners, high mobility (in relation to OFWs), and incrcasing practice of anal sex among MSM.
    There are signs pointing towards this possibilily.

In 2009, there were two new HIV cases reported everyday. The latest numbers in 2010 show that there are now five new HIV cases reported everyday.
Health experts are now struggling to keep within the goal of less than 1% prevalence among the most at-risk groups.
They are, only now, starting to uncover where the epidemic is hiding and to acknowledge why it is growing.

Five days a week, rain or shine, bar girls can be seen lining up in the Angeles City's reproductive health and wellness center for their weekly STI test.
Angeles City - It is a scene that has become a part of life in this "entertainment capital of the Pliilippines".
The Reproductive Health and Wellness Center (RHWC) issues health cards to the bar girls, which allows them to work in a licensed establishment like a bar, massage parlor or a karaoke bar as a regular or contractual employee.
The IDs are colur-coded according to one's work description.
The RHWC program is part of the 100% Condom Use Programme (CUP) that the Department ol Health (DOH) launched in 2003, targeting the cities of Urdaneta, Dagupan, Laoag San Fernando, La Union and Angeles.
The CUP was patterned after a similar initiative in Thailand which saw a drastic drop in HIV  infection among commercial sex workers and their clients, and to the general population, after the program's implernentation.
In Angeles City, In line wlth the policy and a local city ordinance on HIV and AIDS prevention, bars were mandated to distribute condoms for free and to display HIV awareness messages.

It's busy every day at the Angeles City Reproductive Health and Wellness Center. Working on a rotating schedule, bars are designated one day per week for their RSWs to come in for their srnear test.



The League of Angeles City Entertainers and Managers (LACEM), a group of more than 102 bar owners and managers, together with tlie RHWC, combine efforts to implement this policy.
In order to work, girls are registered wlth the RHWC and are given an ID. Guest Relations Officers (GROs) and dancers sport IDs with a pink stripe; while IDs for
cashiers and other personnel have a green stripe on it.
The dancers and the GROs have to prominently display their IDs while they are on duty LACEM estimated that there are around 7,000 registered sex workers in their records.
The results of the smear tests are recorded by LACEM in a monthly smear report which also contains 1 x 1 pictures of the girls. Thc RHWC also keeps track of the results in a booklet callcd a health card. The health card looks like a library card stamped with test dates of her weekly smears.
If infectcd, they are given antibiotics for treatment. Their health cards are kept by the RHWC staff to monitor their condition.
While undergoing  treatment, a registered sex worker will still be allowed to work at the bar, but will not be allowed to take home clients. The floor manager of the bar, who is notified of her condition, will not accept the client's payment ol a bar fine to take a sex worker out.
Lyn Velasco, chief nurse at RHWC, says LACEM has been vigilant in "keeping track of their girls".

According to Velasco, apart from the weekly smears, condom distribution and avvareness programs, mass HIV counseling and testing are conducted twice a year.
Trixie, 20 a GRO at La Bamba Bar said she welcomes the idea of condom use. In a clipped English accent, she said, "I'm not tryin' to be cute with you or nothing, but I can make as much as P 80,000 here."
According to the External Assessrnent Report done in 2007 to evaluate the 100% CUP program, "there is no information on condom use rate in four of the five cities visited, except for Angeles which reported 67%."
The report went on to say that, despite efforts from the DOH and other stakeholders, "no concrete results were documented" and that "with-no- assessment results and evidence of success if there were, il was extremely difficult to move it [ 100 % CUP] forward."
There was little evidence to support if program implementation was succecssful or not.
Angeles City was the only one to report 67% condom use, but this was still below thc goal of 90%.
But it has paid off. From being identified in the 2003 IHBSS as the number one site for HIV infection, Angeles City is no longer in the top three.
According to the IHBSS of 2009, Angeles City has Iess than 1% HIV or Syphilis prevalence. The top three cities with more than 1 % HIV prevalence were identified as Metro Cebu, Metro Davao and Metro Manila.
Apparently, it pays to use condoms even in the Company of angels.


The article was produced under the Maggie de Pano Fund
for Investigative Reporting on Health. The Fund, which is
managed by Newsbreak, is funded through a grant from
Macare Medicals, Inc.
The author is a freelance journalist whose area of
interest is sexual health rights. She also advocates safer
sex practices and HIV-AIDS awareness  through  her
personal website, SexAndSensibilities.com
Name of the respondent has been changed upon their
request.