From the recent IX International Conference on AIDS in Asia and the Pacific

By Rosalia Maria Emanuela Sciortino

HEALTH: Why Is Viagra Popular and the Condom Controversial? by Johanna Son* - TerraViva/IPS BALI, Aug 14 (IPS) - Why is the popular drug Viagra so praised for its virtues, while the condom is vilified by conservative religious groups among others the world over? Both are 'external' technological interventions that relate to sexual activity. They are among the most prominent tools in the area of reproductive health and sexuality. But it is the gender and sexual ideologies behind them - especially when combined with conservative religious forces and aspects of patriarchal culture - that put them on opposite ends of the spectrum of public acceptance. The result is a paradox that has huge implications for public health, especially in relation to the HIV and AIDS pandemic that is now entering its third decade and affects 33 million people worldwide. As Michael Tan, a reproductive health activist and chair of the University of the Philippines anthropology department put it: "Why is Viagra so desired and condoms so repulsive in many cultures?" Tan stressed, condoms are in the World Health Organisation (WHO) list of essentials - unlike Viagra. In other words, the social and institutional acceptance levels of Viagra and condoms are "totally opposite to the biomedical truth." As has been stressed over and over in the hundreds of sessions at the 9th International Conference on AIDS in Asia and the Pacific (ICAAP) that ended here this week, condoms remain the most effective way today to have safer sex, which is key to curbing the transmission of HIV and AIDS. Condom usage campaigns have been central to efforts by countries like Thailand to slow the transmission of the virus and to achieve a reduction in the number of new cases. But in many countries, including in Asia, condoms continue to be a loaded word, a magnet for conservative groups that say they corrupt values and encourage early sexual activity or go against religious teachings that sex should go with procreation. Condoms and pills are also often linked to their contraceptive roles - which are of course absent in marketing for Viagra, packaged by pharmaceutical firms for improved sexual experiences. There is also the argument by many men that condoms diminish sexual pleasure. This feeds into the gender and cultural bias that societies often have, that men's pleasure is most important, Tan added. "Condoms and pills tend to be resisted and demonised, blamed for promoting promiscuity and are sometimes even said to fuel HIV itself," Tan explained at a discussion organised by the Institute of Population and Social Research at Mahidol University. In India, studies show that condom use tends to be linked more to educated men, according to Jayashree Ramakrishna of the National Institute of Mental Health and Neurosciences in Bangalore, India. While religion may not be such a big factor in this debate in India, Ramakrishna added that the focus on condoms in fighting the epidemic eased a bit after the Indian government revised its HIV prevalence figures some years ago. Likewise, she says, taboos remain on the open discussion of sex, which makes it harder to deal with reproductive health and HIV and AIDS. "Women say 'we might have sex, but we don't talk about it,'" she said. Officials argue that sex education materials should not be too frank. Eight states in India have banned sex education in schools, Ramakrishna added. In mainly Roman Catholic Philippines, the Church and religious groups argue that condom use breaks religious and moral values because it prevents pregnancies when sex is for having children within marriage - and that the its health benefits cloak the fact that it promotes free sex. This controversy is the reason why proposed laws on reproductive health in the Philippines - where the population growth rate is a high 2.1 percent in a country of 92.2 million people - ignite a firestorm of campaigns by pro- church groups saying such are "anti-life." In the conservative Catholic context and in Philippine society, Tan explains, the importance attributed to extending the family line is key to male gender roles. Thus, "being 'baog' - the Tagalog word for both impotence and infertility - is to many a fate worse than death" because it is linked to male sexual prowess. But this same focus on the need to reproduce also generates the view that men are the ones 'responsible' for it, and women are mere receptacles in this process. Tan explained, "Males are seen as the source of life and are therefore privileged when it comes to pleasure, and women are seen as a source of pleasure or of men's babies." In sharp contrast to the controversies around the condom, Viagra - a drug that was meant to cure erectile dysfunction but is also used to enhance sexual performance - is widely accepted. It has not drawn attention from conservative quarters that say they are worried about promiscuity or free sex, reproductive health activists say. The most number of spam email messages these days are even about Viagra- type medication, Tan says, pointing out how widely known and popular this has become. The obsession with male reproduction and pleasure in many societies leads to undercutting the usage of "life-saving devices" such as the condom, Tan said. "Shrill voices have been head about condoms, but they have been too silent on Viagra," he argued. Drug approval institutions in countries like the United States and Japan have also been quick in approving Viagra, which is manufactured by Pfizer, but slow in approving other reproductive health-related items. For instance, Tan said, the U.S. Food and Drug Administration took six months to approve Viagra in 1998, but four years to give its approval for the abortion pill. In Japan, authorities approved Viagra for public use in a few months, but it had taken 35 years to approve the use of the oral contraceptive for women. Some published reports allege that Viagra, or sildenafil citrate, was first being clinically tested to treat angina, but that it was finally marketed for erectile dysfunction after trials showed this as the stronger result. Looking into the Viagra versus condom paradox goes far beyond just these two particular products in order to show that "technology is much more than just a tool," explained Rosalia Sciortino, a professor at Thailand's Mahidol University and gender and reproductive health expert who chaired the session on this topic at ICAAP. These two well-known tools offer a lens that show how gender values influence expressions of sexuality and how these can in turn have key impacts on public health risks like HIV and AIDS, Sciortino stressed. *TerraViva at ICAAP 09 (http://www.ipsterraviva.asia) (FIN/2009)