UP A FLIGHT of stairs, in a room with red, yellow, purple, and green walls, the talk is all about sex, all of the time. This is, after all, the hotline center of the Teen Foundation for Adolescent Development (FAD), an organization dedicated to adolescent health. In this room, among a few potted plants, counselors are always ready to answer calls from youths and discuss with them the consequences of premarital or unprotected sex.
In the past, typical hotline questions involved girl-boy relationships and family, school, and peer issues. But in the last year alone, the number of inquiries about sexually transmitted infections (STI) has soared. It now ranks third among the top five most commonly asked issues.
“It’s very alarming,” says Cecilia Villa, president of FAD, which has its offices right smack in the heart of Manila’s university belt. Awareness is higher now, she explains, but very few people realize they can be infected with a disease because of one mistaken assumption or a momentary lapse of judgment. With the invincibility characteristic of the young, they “know about it but don’t think it can happen to them.”
Dr. Rosendo Roque, head of adolescent health of the Philippine Obstetrical and Gynecological Society (POGS), is himself quite worried. There is a lack of statistics and woeful underreporting, but based on feedback from obstetricians and gynecologists across the country and from his private practice, Roque believes STIs among youth is a growing health concern.
STIs are infections of the reproductive system, transmitted through sexual contact generally through warm, moist mucous membranes such as the vagina, anus, urethra, and the mouth. “STI” is used interchangeably with the more common term STD” or sexually transmitted disease. Some organizations, including the Department of Health (DOH) and the World Health Organization, are now using the more politically correct STI. The most common STIs diagnosed are gonorrhea, known in the vernacular as tulo, chlamydia, trichomoniasis, genital herpes, and genital warts.
There are many factors behind the increase of STIs, says Dr. Teresita Brion, an ob-gyn at St. Luke’s Hospital in Quezon City. “There’s the media. There’s the barkada. There’s the breakdown of families. You don’t need hormones surging to want to experiment.”
There is certainly no lack of stimuli either. Today’s youth are exposed to sex and sexuality earlier and in larger doses. There may still be the constant nagging of elders about sex being a sin, but between advertisements using sex to sell products, double entendres on noontime variety shows, and pirated pornographic DVDs sold for less than P80 in Quiapo to gyrating MTV starlets and explicit lyrics of hip-hop songs, young people are constantly bombarded with messages about sex. These contribute to a shift in cultural values that makes casual sex more permissible and traditional preconditions for sex such as marriage or true love increasingly irrelevant.
As a result, Filipino youths are having sex earlier. Last year, Roque’s youngest patient was all of 14. This year he has a 12-year-old. Brion sees patients who are sexually active even before their first menstrual cycle. According to the 2002 Young Adult Fertility and Sexuality (YAFS) survey of the University of the Philippines Population Institute, the average age for the first sexual encounter for both men and women is 18. About 55 percent of these first sexual experiences were not planned or were something the teenagers did not want to happen at that time.
Premarital sex is also becoming more accepted, its prevalence rising from 18 percent in 1994 to 23 percent in 2002. But the sex is often unplanned, sporadic, or a product of either being nadala (carried away) or peer pressure. It often takes place before teens learn about STIs and other health risks. “They still don’t know what is going on in them,” says Roque. “Most of them are getting into it because of peer pressure or experimentation. They are not well-guided.”
He also cites the impact of broken families, absentee parents, and lack of role models created by the mass exodus of Filipinos overseas. Parents abroad shower their children with gifts in order to compensate for their absence, so the children grow up in an nvironment of material excess without proper guidance. In today’s sexually charged landscape, there is a surfeit of teenagers left on their own to figure out their own values.
Dr. Brion suspects that experimentation on bisexuality and homosexuality, as well as one-night stands and having sex “for old times’ sake” or “just because” have become increasingly common. And while the dominant practice is still to have a single partner, there is a trend toward multiple partners, especially among young men. YAFS data show that about 50 percent of men have had multiple sex partners compared to about 11 percent of women.
THE CALLERS of FAD’s phone-a-friend hotline are a good mix of students and young professionals. Most are male. One possible reason is because males are more likely to have multiple partners and are therefore more vulnerable to contracting an STI.
At the same time, some STIs tend to be asymptomatic among women. Only 20 percent of women, for example, exhibit symptoms of gonorrhea; just half show symptoms of trichomoniasis, which is marked by painful, burning urination and a yellowgreen discharge among females.
STIs become a serious public health concern when ignored: in women, gonorrhea can lead to pelvic inflammatory disease, which increases the risk of infertility and ectopic pregnancy. Chlamydia, left untreated, can spread to the upper reproductive tract and in women, infect the uterus, fallopian tubes and ovaries, leading to infertility. Untreated syphilis may lead to nerve damage, mental disorientation, and eventually death. Yet approximately 80 percent of men and women who experience reproductive health complaints such as painful urination, abnormal vaginal/penile discharge, genital warts, or ulcers do not even consult a health professional.
This may be partly why the official number of STI cases in the country seems deceptively low. The 2003 National Demographic and Health Survey, for instance, says only 7.6 percent of men aged 15-19 and less than 2.2 percent of those aged 20-49 reported an STI or STI symptoms. But underreporting may be at work here; while public health centers usually report the STI to the health department for statistical purposes and the necessary contact tracing, private clinics are not obliged to do the same.
Even patients of private clinics rarely openly acknowledge their sexual practices or articulate the suspicion they might have an STI. And the young, for instance, would not tell their parents they think they may an infection because of what this may imply about their sex lives (which their parents often assume they don’t have). But they also might be too embarrassed to tell their barkada so they go on the Internet and self-medicate. The good news is that some STIs like gonorrhea and chlamydia are responsive to antibiotics. The bad news is that with self-medication, these drugs have been abused by over medication, under medication, wrong dosage, or prematurely stopping medication before the required time frame. As a result, doctors say they are beginning to see strains that are resistant to antibiotics.
When Lina (not her real name) experienced a burning, itching sensation while peeing two months ago, the first person she consulted was her yaya. The 18-year-old’s trusted nanny told her to use a feminine hygiene wash and put a hot water bottle on her tummy before sleeping. But the symptoms — which by then included an abnormal yellowish discharge — did not ease; Lina thought it was time to consult a doctor, by herself.
Lina was shocked when the doctor told her she had gonorrhea. She is sexually active, she admits, but has been with only one partner, her high school sweetheart. They have been together for four years. Now she believes he has been unfaithful to her and gave her gonorrhea.
Lina says she had planned to wait until marriage to have sex but college, with its accompanying independence, freedom, and openness of thought, challenged her long-held traditional beliefs. “Suddenly it’s ok to be affectionate with your boyfriend,” she says. “It’s ok to have sex with your boyfriend because everyone is doing it.”
They did not use condoms. “I’m not an idiot,” she says. “I know I can get pregnant but he did not want to use one…” Her voice trails off, and then she says, “Anyway, it doesn’t matter now. Di naman ako nabuntis, ‘di ba (I didn’t get pregnant, did I)?”
FAD’S PHONE-a-friend hotline is one of the few venues that young people can anonymously call and ask about questions about relationships and reproductive health. One hotline counselor there says that young people are likely to have many misconceptions and few facts. For example, she says, they will judge reproductive health on mere appearance. “They think if someone is beautiful or sexy and looks rich and clean, he or she is healthy,” the counselor says. “They say you can get STIs only from nightclub workers.”
Sometimes, she says, callers reason, “Kilala ko naman siya. ‘Di siya gano’n (I know the person. He/She is not like that.).” But it is precisely knowing their partner in the biblical sense, unarmed with the knowledge of the consequences, that gets these teens into trouble in the first place. Some other common misconceptions include drinking Coke to prevent STIs and jumping up and down steps to regulate the menstrual cycle. There are even those who believe one can’t get pregnant from one’s first sexual intercourse or if the woman’s on top.
Two of three respondents in the YAFS study said they know about STIs in general. Awareness of HIV/AIDS is near universal at 95 percent, yet only 27 percent think there is a chance of them getting AIDS. Also, the misconception that AIDS is curable has worsened from 12 percent in 1994 to 28 percent in 2002. Predictably, HIV/AIDS and STI awareness is higher in urban areas, among better-educated classes, and among older youth (20-24) vs. the younger (15-19), and those with more exposure to the media. The hotline counselor says that some teens are unfazed when they test positive for an STI. Adolescent males may even consider STIs to be “warrior marks,” proof of their sexual prowess. The first concern of younger callers — those 16 and below who consult the hotline because they suspect they have been infected — is not their own health but how they could win back their girlfriends or boyfriends. “They don’t see it’s a serious problem,” notes the counselor.
Indeed, they don’t. The YAFS study says only 80 percent of young people used contraception the first time they had sex. Unsurprisingly, 74 percent of all estimated illegitimate births are by 15-24 year olds. There are 400,000 cases of illegal abortions every year, and young women account for nearly four out of 10 cases of abortion complications.
WHO IS supposed to teach young people about sex? Some experts believe schools should. They say many parents lack the knowledge and may even be the ones perpetrating misconceptions. In addition, studies show young people do not talk to their parents about sex. Information from family is often limited to ideal gender roles and lectures about refraining from sexual activity. Most teens get their information from peers, movies, television shows, and books.
While the government has opened its doors to talking about adolescent health, it is unable to do this enough. There are NGOs that try to fill the gap but, as FAD’s Villa says, “we have limited reach.” The government, by comparison, “can be everywhere.”
Unfortunately, the government can also block information. Without a clear national population control program, local health workers are obliged to obey municipal officials who impose personal beliefs on state policy. With Mayor Lito Atienza’s staunch stance against artificial birth control, for example, the city of Manila has become a hostile place for NGOs. Clinics are discouraged from promoting family planning and safe sex and from distributing condoms.
Dr. Carolyn Sobritchea, director of the Center for Women’s Studies at the University of the Philippines, is aghast. “The right to reproductive health is a human right,” she says. “Governments must provide all the information for individuals to make the right decisions for themselves.” She adds, “I don’t look at it from a moral dimension. That’s not my place. As a teacher, I would like to imbue them with the knowledge and skills to protect themselves.”
She calms down the fears of officials who think that more knowledge about sex could lead to promiscuity. “It’s simply not true,” she says. “I can cite the statistics of Japan and other countries where you have condoms and pills in dormitories.”
Most health workers support sex education in schools although they unanimously stress that abstinence remains the best protection. But they reiterate that balanced teaching is key. Although information should never be withheld, it should be balanced with responsibility.
FAD, for one, has produced “STI Confidential,” an educational video with popular young star Judy Ann Santos as host. POGS launched two years ago an STD awareness program aimed at schools, starting from Grade 5 onwards. Some schools have also taken steps toward more informative and grounded discussions on sex. Incoming freshmen at the University of the Philippines now have to take a mandatory course on gender, sexuality, and culture. The class tackles issues such as STIs, unwanted pregnancies, boyfriend battering, and sexual abuse.
The likes of Sobritchea remain hopeful. “Young people today are very responsible,” the professor says. “They just need the proper information.”
Cheryl Chan is Chinese-Filipino and moved to Canada in her teens. She is currently completing a master’s degree in journalism at the University of British Columbia in Vancouver.