Manila, Philippines - On Valentine's Day, Philippine government health workers hit the streets of Manila to hand out roses and condoms to passers-by.
The message was clear in a country with a relatively small but rapidly growing HIV-positive population: Avoid unprotected sex.
It didn't get far. Within days, leaders of the powerful Roman Catholic Church began urging the faithful to reject condoms, reigniting a long-running battle over contraception in the overwhelmingly Catholic nation .
Bishops issued angry statements slamming the Valentine's Day distribution as immoral and called for the resignation of Health Secretary Esperanza Cabral, who ordered the campaign. One archbishop said that Cabral already "has one foot in hell."
The bishops called for a ban on condom advertisements last week.
"The condom business is a multimillion dollar industry that heavily targets the adolescent market at the expense of morality and family life," said Bishop Nereo Odchimar, president of the Catholic Bishops' Conference of the Philippines. He called fidelity and premarital chastity "the only effective way to curb the spread of AIDS."
On Monday, about 100 people protested against the church's position, carrying two baskets of inflated condoms and paper roses as they picketed outside the Bishops' Conference building in downtown Manila. They held a placard reading, "Bless our reproductive right."
The Catholic church is a powerful voice in a nation beset with poverty and political instability. Politicians court bishops' blessings and usually tiptoe around issues such as promoting contraception.
The bishops mobilized protests that toppled late dictator Ferdinand Marcos in 1986 and President Joseph Estrada in 2001 on corruption allegations.
More recently, the church has spearheaded opposition to a reproductive health bill that calls for contraceptives to be provided in government hospitals and sex education to be taught in public schools. The bill is languishing in the House of Representatives.
Cabral, the health secretary, said she doesn't take the church's word lightly. "They are very powerful and they can sometimes be vicious," she said.
But the Harvard-trained cardiologist, who was reshuffled to the Health Department from the Social Welfare Department in January, shrugged off the flak as something that comes with the territory.
"I feel it is just a job that I have to do because as the secretary of health I know that it is going to be very difficult for our country if we let ... (AIDS) become an epidemic," she told The Associated Press.
The number of diagnosed HIV/AIDS cases rose to four a day in November and December, up from one or two during the first 10 months of 2009, according to the Health Department. In January, 143 new cases were diagnosed, the largest number recorded in a month.
Without intervention, the nearly 4,600 cases recorded in the Philippines as of January could soar to 30,000 in three years, Cabral said.
The figures may be the tip of the iceberg. Cabral said health officials estimate that for every new case recorded, 10 are missed. About 95 percent results from sexual transmission.
The Health Department's program follows the ABC formula: abstinence, be faithful and use a condom.
The church rejects contraception, which it says causes abortion. The bishops claim that condoms contribute to the spread of HIV/AIDS, saying they have a high failure rate and create a false sense of security.
According to the World Health Organization, scientific evidence shows that latex condoms provide 80 percent or greater protection against HIV and other sexually transmitted diseases.
Under President Gloria Macapagal Arroyo, the national government does not distribute contraceptives and leaves it to local governments to decide how to deal with HIV/AIDS and reproductive health.
Condoms are sold at grocery and drug stores, but for those who cannot afford them - a third of the country's 90 million people live in poverty - free distribution often depends on where they live.
For now, Cabral has Arroyo's backing, although deputy presidential spokeswoman Charito Planas said the health secretary was reminded to consult the president and the Cabinet on any future condom distributions.
With national elections coming in May, the church is campaigning against politicians who promote birth control. Family planning advocates are calling on voters to ditch candidates opposed to allocating government funds for contraceptives.