I arrive at the Philippine General Hospital early. Stalls outside the building offer fruits and pork skewers for sale. The day is cloudy but heat hangs on the body. My host soon appears: Edsel Salvaña, a clinical associate professor of infectious diseases at the hospital.
We plan to talk about an alarming rise in HIV cases in the Philippines. The number is still small in comparison to that of many African countries. But the Philippines has seen the steepest increase in Asia in recent years. According to the Department of Health’s most recent data, a decade ago two people a day were newly diagnosed with HIV on average. Now the figure stands at 32 people a day.
Dr Salvaña is generous with his time. The hospital was erected more than a century ago, and then largely rebuilt after Manila’s destruction in the second world war. We first admire the huge paintings on the walls (copies of the originals) within the colonial entrance. They depict the history of medicine in the Philippines, from animistic rituals and incantations to Christian ministrations and thence to American interventions and the modern era. Demons disappear, replaced by scrubs and surgical masks.
Walking through corridors beside crumbling courtyards, Dr Salvaña jokes that it looks like a war zone. The hospital has 1,500 beds, and people in need of help queue outside from 4am. The doctors can only see so many people in a day: usually the staff send home those people who are still outside after four hours. Patients who make it inside lie on rickety beds, drips in their skinny arms. In mixed wards “watchers”—relatives or sometimes hired helpers—attend to patients more often than nurses. Flattened cardboard underneath the beds of the sick hints at where they sleep.
Up a steep set of slippery green stairs, we come to the HIV clinic. It is quieter and darker here, with those waiting to be seen sitting meekly on stools lining the corridor. Inside the clinic, flimsy curtains separate consulting spaces from each other. Privacy is a privilege rarely afforded.
Dr Salvaña returned from America a decade ago to find that HIV, almost unheard of while he studied at medical school in Manila, had come back. Precisely why is hard to know. One hypothesis is that attitudes to homosexuality have become more relaxed even as condom use in this largely Catholic country continues to be discouraged: those who sit in the cubicles, often fearful and alone, are almost always young men. Employment patterns may also provide an explanation. As call centres have boomed in the country over the past two decades—the industry now employs more people in the Philippines than it does in India—large groups of young people have grown used to working late en masse, giving them more opportunity to pair up.
A law signed by President Rodrigo Duterte in December boosts the provision of free treatments to those affected; it also aims to eliminate stigma surrounding the virus, such as the inaccurate stereotype that only sex workers contract HIV. But these measures only go so far. “Better drugs are available to richer countries but they are not yet available in the Philippines,” laments Dr Salvaña.
What’s more, a particular subtype of the virus, different to that which is most common in America and Europe, is plaguing the Philippines. Mounting data suggest it develops resistance to existing treatment drugs more quickly than other strains, and that it is also more easily transmitted and progresses to AIDS more rapidly. Important research into this subtype occurs at the hospital itself.
But progress comes too slowly to help patients who show strong resistance to treatment today. “We keep them on the medication and I basically just watch them die,” concedes the physician. At the entrance to the hospital’s medical school, a statue of a torch-bearing maiden stands on top of a skull, representing the triumph of science over death. In the Philippines’ fight against HIV, that battle is too often lost.