In case of Carolina, it took her almost a year to know her real condition. It was 2010, she was finishing her degree, and she was feeling sick and tired all the time. There were days she wasn't able to leave the bed, and she didn't know why. She went to several doctors, depression was the most common diagnosis. She never bought that. Neither her parents. Until one day, she barely could breathe.
Her father took her to the emergency room, and when she was lying on the stretcher, she heard the doctor asked for an HIV test. "No way I got that" she said. Minutes later, the doctor let her know she was wrong. "You are positive, chica." She just couldn't believe it. She was not a gay person, she lost her virginity in her twenties, she wasn't unfaithful, and she was dating the perfect guy by then, a "prince charming" kind of guy. "The illuminated guy," she called him. Later she will realize "the illuminated guy" was the one who transmitted her the virus.
Carolina is one of the 61.000 people living with HIV in Chile, according to latest UN AIDS report. That data also revealed that, meanwhile new HIV infections were declined by 16 percent globally since 2010, Chile was experiencing the otherwise. During the same period, new HIV infections have increased by 35 percent. This also happened in Guatemala, Costa Rica, and Honduras, where new infections rates increased more than 10 percent since 2010, but unlike those countries, Chile — a member country of the OECD group — was the one with the highest percentage of new HIV infections in all Latin America.
However, the picture could be worse. According to the data published by University of Chile on April 2018, the situation is out of control as new cases increased by 96 percent between 2010 and 2017. And even though UN AIDS says they are still checking this new numbers, the local authorities are worried. The centre-right government of Sebastián Piñera, who is in office for the second time, announced they were planning a new strategy to face the problem. HIV went from a taboo to the main topic in the public debate and media agenda.
As soon as the HIV rates were released, media started digging into the reasons behind the increased spread of the disease. Was it because of the lack of public policies aimed to prevent HIV? Or because of the failure of communication campaign launched by the government? Or was it because people stopped using condoms? At the same time, many journalists and researchers focused on the youth's sexual behavior as the rise was particularly high among teens and young adults between 15 and 25 years. Some experts started to point out to the fact that younger generations were living their sex life in a more liberal way. "More like partying," one said.
And even though all these causes are directly related to the rise of the new HIV cases in Chile, there is one major factor that has had an impact on each of them but has not been noted by the media so far. Yet, it explains why the new HIV infection rates in Chile are the highest within the region. A factor embedded in Chilean society: its conservatism.
A Very Catholic Secular Country
According to its Constitution, Chile is a secular country since 1925. However, the Catholic Church still plays a big role in the society. According to the latest GFK Adimark survey conducted by the Pontifical Catholic University of Chile, 59 percent of the population declared themselves Catholic in 2017. Besides, the opinion of the Catholic Church is often considered in the discussion regarding public policies, especially the ones related to sexuality and moral issues.
"Who has decided the sexual policy in Chile is the Catholic Church. They are the ones telling the different governments what they can and cannot do" says sociologist Claudio Duarte. In fact, it is impossible to talk about the history of the communication campaigns regarding HIV in Chile without mention the opposition of the Catholic Church through the years. It happened, for instance, in 2003, during the centre-left government of Ricardo Lagos. Three TV stations with ties to the Catholic Church rejected to broadcast the videos launched by the government because they stressed the use of the condom as the main preventive measure.
The TV stations argued the campaign was promoting risky sexual practices and sending the wrong message undermining traditional family values. One of the TV networks, owned by a well-known Catholic University, decided to make its own propaganda, focusing on the importance of fidelity and abstinence. Basically, the same values promoted by the hierarchy of the Catholic Church when they criticized the government's policy during those years.
This happened again in 2007, during the first government of socialist doctor Michelle Bachelet. Even though that campaign included sentences calling for abstinence and the importance of having a steady partner, it was also the first one showing how to use a condom. For the first time in Chilean history. Once again, these TV stations and the Catholic Church rejected the campaign.
The Role of the Conservative Elite
But not only the Catholic Church has raised its voice. Conservative politicians as well, even when they are in the government. One of the most criticized governmental campaigns in Chile was the one launched during the first months of the first government of Sebastian Piñera, a centre-right politician, in 2010. The same year the rates started to increase.
"To die of old age is funnier than dying of AIDS… And if you die with your partner, it is way better. Be faithful". That was the message people heard during that campaign. There was no mentioning of the use of a condom. It lasted only one month. Until now, there is no reference to an evaluation of this campaign in the official records of the Chilean Health Department.
It is also common to hear the opposition of right-wing politicians regarding public policies such as distributing free condoms at schools. This strong conservative influence is also present in other countries facing elevated HIV rates, like Russia. According to the latest UN AIDS report, Russia is the third country in the world with the highest rate of new infections, behind Nigeria and South Africa. More than 103.000 new cases were reported in 2016. Although the majority of the infections there are transmitted through intravenous drug use, people living with HIV face the stigma and discrimination of society.
There is also a very Orthodox Church-influenced approach to sexual health, supported by the government of Vladimir Putin. Sexual education at schools is forbidden, and gay rights are state-sanctioned. "The last five years of conservative approach led to the doubling of the HIV cases", epidemiologist Vadim Pokrovsky told BBC on 2015.
A Taboo Topic
"No one explained to me that if I had sex without using a condom there was a chance I got HIV" recalls Carolina. Her only concern, by then, was taking the contraceptive pill because she did not want to get pregnant. HIV was not an issue for her, neither something to discuss at home. "Why talking about it if I was in a stable relationship?". She just thought she was not at risk. Besides, in her mind, HIV was something related to gays or sex workers, not people like her. These conservative misconceptions and stigmatization are the reason behind the problem, as sex is still a taboo in Chilean society. Instead of facing HIV like any other disease, Chileans see it as part of a deviant sexuality.
When left-wing politician Michelle Bachelet started her second government in 2014, no campaign was promoted that year. The reason? The political differences among the parties inside the ruling coalition. The Christian Democracy party, a centre-left wing faction close to the Catholic Church and with ties to German CDU, was against the use of a more direct language. And, on the other hand, the more liberal factions of the government argued the campaign should appeal to the high-risk population groups. In order to avoid these political differences, the government decided to hold up the campaign for a year.
Carlos Passarelli, UN AIDS country director for Argentina, Chile, Paraguay and Uruguay, says the prior shows how Chilean conservatism has influenced the current outbreak. "The epidemic doesn't grow equally among the whole population. There are more vulnerable groups. Therefore, prevention campaigns must have a language that appeals to them. We need to talk to young people that have different sexual practices. Otherwise, it is like not telling them the truth regarding the problem".
Chilean Youth Rebellion?
It is precisely in the young population where all the concerns are focused nowadays as they have been targeted as the most exposed group. Experts explain the reason behind this is the fact they tend to experience riskier sexual practices than the older generations, like group sex or others. Besides, they are not afraid of HIV and AIDS. They know there is a treatment now. Anyway, most young people in Chile are living their sexuality in silence.
"People don't talk about this, or they talk about it in a wrong way. Our society doesn't discuss this with younger people and if we don't change this, the problem will continue" says sociologist Claudio Duarte. He points out the experience of other Latin American countries like Uruguay, where sexuality and sexually transmitted diseases (STD) are commonly discussed in schools. New HIV infections have decreased by 57 percent in that country according to UN AIDS data.
In Chile, sexual education is mandatory since 2010 but only for students in high schools. Chile was, indeed, the latest country in Latin America to adopt this policy. However, specialists say is too late considering that, young people in Chile start their sexual life at 15 years old as average. Plus, in the end of the day, schools keep doing things their way. Many private schools in Chile are owned by the Catholic Church, and they tend to avoid discussing this in the classroom or if they do it, they try to promote values as faithfulness or abstinence.
Aware of the lack of sexual education in Chile, Carolina started to do informative talks at schools. "I wanted to contribute to preventing more infections". And that is how she has realized conservatism remains in Chilean society even nowadays. "Once I finished my presentation, some students come to talk to me, they ask me some questions. They tell me they already have an active sex life, but they can't talk about that with their parents because they would never understand it, so they don't know. They ask me what they can do to prevent HIV".
The access to the schools in order to tell her story has not been easier either, especially in the Catholic private ones. "At first, they told me they didn't need it because they thought their students weren't exposed to the disease and because parents were against it. They said talking about sexuality with their children was their duty, not the school's one. But is hard for them to talk about it and when they do, they do it in a very strict way".
"Teenagers are living a repressive and stressed sexuality. You can see it in the families, schools, etc. Therefore, this new HIV cases rates shouldn't surprise us" says sociologist Claudio Duarte, who has specialized in studying young people's behavior. According to him, this is due to a very patriarchal matrix called adultcentrism that lies within Chilean society. In simple terms, young people are taught since the beginning that the real owners of their bodies are their parents. And as the adults should decide how teenagers should live their sexuality, young people's actions are a rebellious response to that conservative matrix. "They are fooling around when they make these decisions. If they did not learn to be the owners of their bodies when they were kids, there is no way they learn it overnight".
Exactly one month after conservative President Sebastián Piñera took office for the second time, the University of Chile made public their numbers regarding HIV in Chile. Quickly, the new Health Secretary announced eight general guidelines in order to face the emergency, like ending the stigmatization, promoting self-protection and improving sexual education, among others. But for the experts, the solution would not be possible if the authorities do not work with the riskiest groups and communities.
Claudio Duarte suggests including youth in the discussion. Carlos Passarelli, from UN AIDS, says Chileans should dare to talk about sexuality and HIV in an open and direct way. As this issue evolves making headlines in the media, Chileans are talking about HIV and sexuality as they never did it before. Now, it is the turn of the society to keep doing it in order to stop the current rise, leaving conservatism in the past.