HIV/AIDS infection in the Philippinesislowbutgrowing.

ThecurrentincidenceofHIV/AIDSinthe
countryremainsunder10.1%ofthetotalpopulationin2015.[1]ThePhilippineshasoneofthe
lowestratesofinfection,yethasoneofthefastestgrowingnumberofcasesworldwide.[2]The
Philippinesisoneofsevencountrieswithgrowthinnumberofcasesofover25%,from2001to
2009.[2]
Casesareconcentratedamongmenwhohavesexwithmen,[3]andsecondarily,amongfemale
sexworkers.HIVcasesamongmenhavingsexwithmenmultipliedover10timessince2010.[4]HIV
casesaregettingyounger.[2]
ThefirstcaseofHIVinfectioninthePhilippineswasreportedinJanuary1984.[3]

Current status of HIV/AIDS in the Philippines

Officially,thePhilippinesisalowHIVprevalencecountry,withlessthan0.1percentoftheadult
populationestimatedtobeHIVpositive.AsofApril2015,theDepartmentofHealth(DOH)AIDS
RegistryinthePhilippinesreported24,936cumulativecases.InApril2015,560newcaseswere
reportedshowinga42%increasecomparedtothesameperiodinthepreviousyear.Intheyear
2014,atotalof6,011casesofHIVwerereportedwith91%ofthecasesbeingasymptomaticat
thetimeofreportingwhile543caseswerediagnosedasAIDS.[5]From2001to2015thenumber
ofcasesdiagnosedperyearincreased37times,from174casesdiagnosedin2001to6,552
forthefirst10monthson2015.[6]
Intheyears2010to2015,91%(22,726)ofcasesweremenwithamedianageof28years,
withoverhalf(12,616)inthe2534agegroup.26%(6,529)ofmenwere1524yearsofage,
anincreasefrom12%in20052009.Sincetheyear2000,thehighprevalenceagegrouphas
changedfromthe3039yearoldagegroupbeingthemostaffectedfromyears20002004,
tothe2534agegroupfromyears2005to2009,andto2029agegroupfromyears2010
2015.
Theinfectionrateamongmenhavingsexwithmenhasmultiplied10timesfrom2010to2015.[4]
TheDepartmentofHealthreportedinNovember2015,thattherateofprevalencehas
surpassed5%,theUN'sdefinitionofconcentratedepidemic,ineightcitiesCebu,Cagayande
Oro,PuertoPrincesa,Davao,QuezonCity,ParaaqueandMakati,withCebureaching14%.[4]
Between1984and1990,62%(133of216)ofcaseswerefemale.From2010to2015,females
onlycomprised5%(1017)ofthe20,512reportedcases.

FromJanuary2010toApril2015,82%(20,512)ofallcaseswerereported.Atthetimeof
reporting,93%ofthesecaseswerestillasymptomatic.
AsofApril2015,9,838peoplelivingwithHIVwereundergoingAntiRetroviralTherapyin23
treatmenthubs.
OverseasFilipinoworkersaccountforabout20percentofallcases.[7]

Means of transmission
Ofthe24,936HIVpositivecasesreportedfrom1984to2015,93%(23,291)wereinfected
throughsexualcontactofwhich79%(18,023)wasthroughhomosexualandbisexualcontact
whileheterosexualcontactcomprisedtheremaining14%(3,273).5%(1,096)ofcaseswas
causedbyneedlesharingamonginjectingdrugusers,0.3%(73)throughmothertochild
transmission,<0.1%(20)throughbloodtransfusionandneedleprickinjury<0.1%(3).Nodatais
availablefor1.7%(375)ofthecases.
Cumulativedatashows24%(5,268)wereinfectedthroughheterosexualcontact,47%(11,023)
throughhomosexualcontact,and30%(7,000)throughbisexualcontact.From2007therehas
beenashiftinthepredominanttrendofsexualtransmissionfromheterosexualcontact(20%)to
maleshavingsexwithothermales(80%)[5]

Geographical Distribution
From1984to2015,theregionwiththemostnumberofreportedcaseswereMetroManilawith
11,081(44%),Region4Awith3,230(13%)cases,CentralVisayaswith2,260(9%)cases,Region
3with2,025(8%)casesandRegion11with1,460(6%)cases.3,734(15%)ofcaseswere
distributedaroundtherestofthecountrywhile1,146(5%)hadnodataontheregion.[5]

At-risk groups
Mostatriskgroupsincludemenwhohavesexwithmen,with395newhumanimmunodeficiency
virus(HIV)infectionsamongwithinthisgroupfromJanuarytoFebruary2013alone,96%upfrom
2005s210reportedinfections.AspokespersonoftheNationalEpidemiologyCenter(NEC)of
theDepartmentofHealthsaysthatthesuddenandsteepincreaseinthenumberofnewcases
withintheMSMcommunity,particularlyinthelastthreeyears(309casesin2006,and342in
2013),is"tremendouslyinexcessofwhat(is)usuallyexpected,"allowingclassificationofthe
situationasan"epidemic".Ofthecumulativetotalof1,097infectedMSMsfrom1984to2008,

49%werereportedinthelastthreeyears(72%asymptomatic)108havediedwhenreported,
andslightlymoreMSMswerereportedlyalreadywithAIDS(30%).[8]
AmongMSM's,ninetypercentofthenewlyinfectedaresingle(upto35%ofpastcasesreported
involvedoverseasFilipinoworkersorOFWsand/ortheirspouse),withthemostoftheaffected
peoplenowonly20to34yearsold(from45to49yearsoldinthepast).Thehighestnumber
ofinfectionsamongMSMsisfromMetroManila.AnHIVsurveillancestudyconductedbyDr.
LouieMarGangcuangcoandcolleaguesfromtheUniversityofthePhilippinesPhilippine
GeneralHospitalshowedthatoutof406MSMtestedforHIVfromentertainmentareasinMetro
Manila,HIVprevalenceusingtherapidtestwas11.8%(95%confidenceinterval:8.715.0).[9][10]
IncreasinginfectionrateswerealsonotedinthecitiesofAngeles,Cebu,andDavao.[8]1to3
percentofMSM'swerefoundtobeHIVpositivebysentinelsurveillanceconductedinCebuand
Quezoncitiesin2001.
Anotheratriskgroupareinjectingdrugusers(IDUs),1percentofwhomwerefoundtobeHIV
positiveinCebuCityin2005.AhighrateofneedlesharingamongIDUsinsomeareas(77
percentinCebuCity)isofconcern.Sexworkers,becauseoftheirinfrequentcondomuse,high
ratesofsexuallytransmittedinfections(STIs),andotherfactors,arealsoconsideredtobeatrisk.
In2002,just6percentofsexworkersinterviewedsaidtheyusedcondomsinthelastweek.Asof
2005,however,HIVprevalenceamongsexworkersinCebuCitywasrelativelylow,at0.2
percent.[11]
ThethreatsandeffectsthatAIDS/HIVbringstothepopulationisaseverecauseforconcern.
However,theprevalenceofviruswithinthePhilippinepopulationremainslowdespitean
increaseinthenumberofcases.Infact,thePhilippinesqualifiesasoneofthefewcountries
wherethegrowthofAIDS/HIVcaseshasapproximatelyincreasedto25%frominaspanofa
coupleofyearsfrom20012009.[12]
Theriseinthenumberofcasescanbebestcategorizedbyspecificgroupsinthepopulation.
First,theagegroupthatismostaffectedare1524yearsold.Youngprofessionalsengagingin
unprotectedsexualintercourseisthemaincauseforthecontractionanditaccountsforone
thirdoftheAIDS/HIVinfectedpopulation.Furthermore,theinfectionwithinthisagegroupismore
prevalentwithhomosexualrelationships.[12]
TheregionalpopulationthatisgreatlyaffectedbyAID/HIVisinCebu.Theprevalencerateisat
7.7%whichisgreaterthanthemajorcitiesofManilaat6.7%andQuezonCityat6.6%.Recent
datashowthatthesurgeisnotcausedbytransmissionthroughsexualintercoursebutthrough
anincreaseofpeopleinjectingdrugs.Itisnottheinjectabledrugsbutthesharingofneedles,
whichopenstheriskoftransmissionoffluids,greatlyexposingtheriskofcontractingthevirus.[13]

National risk profile

SeveralfactorsputthePhilippinesindangerofabroaderHIV/AIDSepidemic.Theyinclude
increasingpopulationmobilitywithinandoutsideofthePhilippineislandsadversetopublicly
discussingissuesofasexualnaturerisinglevelsofsexwork,casualsex,unsafesex,andinjecting
druguse.[11]
ThereisalsohighSTIprevalenceandpoorhealthseekingbehaviorsamongatriskgroups
genderinequalityweakintegrationofHIV/AIDSresponsesinlocalgovernmentactivities
shortcomingsinpreventioncampaignsinadequatesocialandbehavioralresearchand
monitoringandthepersistenceofstigmaanddiscrimination,whichresultsintherelative
invisibilityofPLWHA.LackofknowledgeaboutHIVamongtheFilipinopopulationistroubling.
ApproximatelytwothirdsofyoungwomenlackcomprehensiveknowledgeonHIVtransmission,
and90percentofthepopulationofreproductiveagebelieveyoucancontractHIVbysharing
amealwithsomeone.[11]
ThePhilippineshashightuberculosis(TB)incidence,with131newcasesper100,000peoplein
2005,accordingtotheWorldHealthOrganization.HIVinfects0.1percentofadultswithTB.
AlthoughHIVTBcoinfectionislow,thehighincidenceofTBindicatesthatcoinfectionscould
complicatetreatmentandcareforbothdiseasesinthefuture.[11]

Response
WaryofThailandsgrowingepidemicinthelate1980s,thePhilippineswasquicktorecognizeits
ownsocioculturalrisksandvulnerabilitiestoHIV/AIDS.Earlyresponsesincludedthe1992
creationofthePhilippineNationalAIDSCouncil(PNAC),thecountryshighestHIV/AIDS
policymakingbody.MembersoftheCouncilrepresent17governmentalagencies,including
localgovernmentsandthetwohousesofthelegislaturesevennongovernmentalorganizations
(NGOs)andanassociationofPLWHA.[11]
ThepassingofthePhilippineAIDSPreventionandControlActin1998wasalsoalandmarkin
thecountrysfightagainstHIV/AIDS.However,thePhilippinesisfacedwiththechallengeof
stimulatinggovernmentleadershipactioninalowHIVprevalencecountrytoadvocatefora
strongerandsustainableresponsetoAIDSwhenfacedwithothercompetingpriorities.One
strategyhasbeentopreventSTIsingeneral,whicharehighlyprevalentinthecountry.[11]
ThePNACdevelopedthePhilippinesAIDSMediumTermPlan:20052010(AMTPIV).TheAMTP
IVservesasanationalroadmaptowarduniversalaccesstoprevention,treatment,care,and

support,outliningcountryspecifictargets,opportunities,andobstaclesalongtheway,aswell
asculturallyappropriatestrategiestoaddressthem.In2006,thecountryestablishedanational
monitoringandevaluationsystem,whichwastestedinninesitesandisbeingexpanded.
Antiretroviraltreatmentisavailablefreeofcharge,butonly10percentofHIVinfectedwomen
andmenwerereceivingitasof2006,accordingtoUNAIDS.[11]Thislackofdistributioncanbe
attributedtothefocusofhealthspendingtowardsdiseasespecificprogramsinsteadof
spendingonpublichealthwhichismorecomprehensiveandaddressesmultiplediseases.By
spendingonpublichealthingeneral,thecountrywouldbeabletostrengthenthehealthsystem
bycreatingeffectivehealthinfrastructuresthatcouldcarryoutverticalprogramswithout
creatingbraindrainorhinderingtheeconomicdevelopmentofthecountry.Withoutpassable
localinfrastructure,healthimprovementswouldnotbepossibleasdistributionofmedicalcare
andmedicineswouldbeverylimitedincidenceandprevalencereportsmaynotbeaccurate,
andprogressofhealthinitiativescouldnotbetracked.[14]
PhotographerNiccoloCosmelaunchedtheRedWhistlecampaignin2011,inspiredbyred
disasterpreparednesswhistles,toraiseawarenessandunderstandingofHIV/AIDsinthe
Philippines.[15]

Current treatment in the Philippines: ART

ThePhilippinesstillusestheantiretroviraltreatmentorARTtoaddresstheHIV/AIDSpatients.This
treatmentinvolvesusingdifferentkindsofdrugssuchasZidovudine,Lamivudine,andNevirapine
toboostthepatientsimmunesystem.[16]
Anothermethodthatisbeingusedislabexamination,whichwillhelpmonitorthepatientsARTor
antiretroviraldruglevel.SincetreatmentforHIV/AIDSisbasedonacasetocaselevel,thiswill
determinehowthepatientwillbetreated.
"Theantiretroviraldrugdoesnotkillthevirusthatcausesthedisease.Itssimplyawaytohelp
fightinfection.Thisway,thepatientprolongshis/herlifeevenwiththedisease.Withthisbeing
said,patientshavetogoundergolabexaminationsdependingontheirrespectivecasesand
receivethistreatmentthroughouttheirexistence.Itisaformoftherapythattheywouldhaveto
undergo."
"Thegovernmentwillhandlemostofthecostsinassociationwiththedisease.Theinitial
treatmentwillcoststhegovernmentP7,920ayear.AsofApril20th,2015,theDepartmentof
Health(DOH)mentionedthattheyplantobuyP180millionworthofARVorantiretroviraldrugs
tobeusedinART."[17]

References