Last month, Philippine President Rodrigo Duterte made international headlines citing Hitler and the Holocaust, saying he would happily “slaughter” three million drug addicts. But even before Duterte was elected on a dramatic anti-drug platform, the Philippines’ drug war tactics were fueling one of the fastest growing HIV epidemics in the world.

Despite more than 20 years of relatively low prevalence of HIV infection, the Philippines now has the third highest incidence of HIV, exceeding a 25 percent growth in new infections annually. Cebu City has the highest HIV prevalence rate in the country, at 7.7 percent, where sharing of drug injection equipment is the primary driver.

As in many parts of the United States, sterile syringe programs had been operating in Cebu largely underground since 1993. But in 2009, while many other countries and U.S. states were reforming the paraphernalia laws passed in the 1980’s as a result of scarce injecting supplies leading to the spread of HIV and hepatitis C, the Philippines made syringes without a prescription illegal for the first time. As a result, Cebu’s local public health organizations had to discontinue their needle exchange programs, and people who inject drugs were unable to buy them at pharmacies. The following year, HIV cases among injecting drug users in Cebu jumped from less than 1 percent to a startling 53 percent.

The primary drugs used in the Philippines are methamphetamine (known locally as shabu), marijuana, and to a lesser extent, opiates in the form of the pain killer Nubain, usually injected with shabu. Drug use rates are high for Asia, but lower than in Australia, and on par with the U.S.

The perception that the Philippines has an enormous drug problem, however, is shared by many Filipinos, and Rodrigo Duterte swept into power on a tough-on-drugs platform. During his campaign in April he threatened, “All of you who are into drugs, you sons of bitches, I will really kill you.” A month later, when he was President-elect, Duterte offered medals and cash rewards for citizens who shot dealers dead.

“If you know of any addicts, go ahead and kill them yourself as getting their parents to do it would be too painful,” he said to a crowd on July 1, the day after his inauguration. “Do your duty, and if in the process you kill 1,000 persons because you were doing your duty, I will protect you,” he told police officers the same day.

As a result, more than 3,600 people have been killed in the Philippines between Duterte’s inauguration June 30 and October 10. Of these, 1,375 have been killed by police, who claim they were in self-defense during shoot-outs. In media reports, witnesses say these are extrajudicial killings. An additional 2,233 murders been attributed to vigilantes, some of whom are reportedly state-hired contract killers. And according to an October 4 report by the Guardian, highly orchestrated and trained state-sanctioned police death squads have been created to execute a list of targets: suspected drug users, dealers and criminals.

Meanwhile, over 700,000 Filipinos have ‘volunteered’ to turn themselves in as drug addicts. In early September, news broke that the Chinese government has agreed to build huge drug rehabilitation centers in Philippine military camps. Chinese drug rehabilitation centers are widely critiqued for being no more than forced labor camps, and rarely offer evidence-based drug treatment. Furthermore, these “relentless and draconian countermeasures” have not lessened China’s drug problem, according to a report released last year by the Brookings Institute, a Washington DC-based think tank. It appears that the Philippines are preparing a mandatory detention system for confessed drug users, a brand of treatment the United Nations warns can lead to some of the most egregious forms of human rights abuses.

At the International AIDS Conference in 2010, activists noted that, “The criminalization of illicit drug users is fueling the HIV epidemic and has resulted in overwhelmingly negative health and social consequence,” and passed the Vienna Declaration calling on governments to end drug war tactics as an essential step to ending AIDS. It delineated some of the harmful consequences of drug law enforcement, including forced labor, execution of drug offenders and, “The undermining of public health systems when law enforcement drives drug users away from prevention and care services and into environments where the risk of infectious disease transmission (e.g., HIV, hepatitis C & B, and tuberculosis) and other harms is increased. “

It is early in this extremely deadly version of the “war on drugs” to know what effect it will have on HIV prevalence, but the indicators are grim: Duterte has bankrolled the crackdown by giving huge funding boosts to the police and military while slashing the country’s health budget by 25 percent. The latest Philippines Department of Health figures showed 841 newly diagnosed HIV cases in June — the biggest monthly total since records began in 1984. As Duterte wages a bloody war on his own citizens and defunds public health programs, advocates are deeply concerned about both immediate human rights violations and the long-term implications for people affected by the HIV epidemic.

Despite the chilling effect Duterte’s repressive actions have had on civil society, Philippine advocacy groups, including the anti-poverty coalition Kadamay, and human rights group Karapatan, have protested the extrajudicial killings, and Stop The Killings Philippines Network has emerged in Manila, supporting protests at schools and churches around the country. Over 300 groups, including the Asia Pacific Council of AIDS Service Organizations (APCASO), have called upon the UN drug control agencies to condemn the killings, and the Asian Network of People Who Use Drugs(ANPUD) have called for a global week of action at Philippines embassies and consulates starting October 10.

People in the U.S. can join protests in New York on October 11 and Washington DC on October 13, and petition President Obama and Secretary Kerry to strongly condemn the killing of Filipino drug suspects, and immediately withdraw the US pledge of $32 million in new funding for law enforcement in the Philippines, until President Duterte acts to:

• Immediately end the incitements to kill people suspected of using or dealing drugs,
• Fulfill international human rights obligations, such as the rights to life, health, due process and a fair trial, as set out in the human rights treaties ratified by the Philippines, and
• Promotes evidence-based, voluntary treatment and harm reduction services for people who use drugs instead of compulsory rehabilitation in military camps.

With such rampant human rights violations currently underway and very much out in the open, we have no excuse for sitting idly by and watching as they happen.