The number of new HIV cases reported in the Philippines has surged over the last few years, according the country's health agency. In 2007, fewer than 400 new cases were reported; in 2017, more than 11,000 new cases were identified.
The country had the fastest-growing HIV epidemic in the Asia-Pacific region, according to UNAIDS last year.
At a time like this, the country's leader could encourage safer sex, to prevent further sexually transmitted infections.
Or he could do what Filipino President Rodrigo Duterte did last week — and urge his citizens to forgo condoms during intercourse because "they don't feel good."
The subject arose during a characteristically bizarre digression in a speech to Filipino workers back just from Kuwait. Hundreds of Filipino workers in Kuwait have accepted the Philippines' offer of a free flight home after a Filipino woman's body was found in a freezer of her employer's home in the Gulf state.
Duterte began talking about population growth in the Philippines.
"Filipinos don't know anything else but [mimes gun action] — 110 million, which is why life is hard," he said, according to a translation by CNN. "If we were just 50 million, we could manage food."
He then suggested that women use birth control pills or injectable hormones.
"Pills are free. Don't use condoms because they don't feel good," he continued.
He mimed eating a piece of still-wrapped candy.
"Here, try eating it without unwrapping it," he said, according to The Sydney Morning Herald. "Eat it. That's what a condom is like."
He suggested that women should "get an injection good for six months, so there will be no limit in your libido," Al Jazeera reports.
Senator Risa Hontiveros came out strongly against the president's remarks.
"President Duterte should stop making thoughtless, reckless and irresponsible statements at the expense of public health," Hontiveros said in a statement to the Inquirer. "President Duterte seems to be overly concerned with pleasure. There is nothing pleasurable or funny about the rise in our cases of HIV and teen pregnancy."
"The President's statement is a virtual insistence that women should continue to carry the burden of family planning alone," she added.
The Philippine Commission on Population followed Duterte's comments with a statement on Monday that while family planning methods do involve individual choice, condoms are effective at preventing sexually transmitted diseases.
"For example, the President's own experience with condoms may be the reason for his stated preference, and this cannot be subject to debate," said the commission's Executive Director Juan Antonio Perez III, according to Filipino news outlet Rappler. (Rappler, which has reported aggressively on Duterte, has been the target of government efforts to shut it down.)
"On a technical note, condoms are preferred method for prevention of sexually transmitted disease," Perez added. "When used properly, condoms are the best way to prevent sexual transmitted disease such as HIV."
Condoms are a central tenet of UNAIDS' efforts to prevent HIV, since they are a cost-effective method for preventing STIs as well as unwanted pregnancies.
The majority of new HIV cases in the Philippines are transmitted sexually, primarily among men having sex with men. In its 2017 report on the Philippines' HIV epidemic, UNAIDS said that in 2015, only 35 percent of men who have sex with men and transgender women who have sex with men had correct knowledge on HIV transmission and prevention. Condom use among those two groups increased from 36 percent in 2011 to 50 percent in 2015.
Human Rights Watch called Duterte's statements irresponsible.
"Instead of criticizing condoms as a pleasure inhibitor, Duterte should take meaningful action to protect the health of Filipinos by backing urgently needed policy changes to expand the accessibility and use of condoms in the Philippines," the group's Manila-based researcher wrote in a blog post.
Duterte's remarks came days after he encouraged soldiers to shoot female rebels in their vaginas.
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