HIV/AIDS in the Philippines

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Prevalence[edit]

Officially, the Philippines is a low-HIV-prevalence country, with less than 0.1 percent of the adult population estimated to be HIV-positive. As of January 2013, the Department of Health (DOH) AIDS Registry in the Philippines reported 10,514 people living with HIV/AIDS.[1]

Means of transmission[edit]

Of the 10,514 HIV positive cases reported from 1984 to 2013, 92% (9,637) were infected through sexual contact, 4% (420) through needle sharing among injecting drug users, 1% (59) through mother-to-child transmission, <1% (20) through blood transfusion and needle prick injury <1% (3). No data is available for 4% (375) of the cases.

Cumulative data shows 33% (3,147) were infected through heterosexual contact, 41% (3,956) through homosexual contact, and 26% (2,534) through bisexual contact. From 2007 there has been a shift in the predominant trend of sexual transmission from heterosexual contact (20%) to males having sex with other males (80%)[1]

Overseas workers from the Philippines (e.g., seafarers, domestic helpers, etc.) account for about 20 percent of all HIV/AIDS cases in the country.[2]

At-risk groups[edit]

Most-at-risk groups include men who have sex with men (MSM), with 395 new human immunodeficiency virus (HIV) infections among within this group from January to February 2013 alone, 96% up from 2005’s 210 reported infections. A spokesperson of the National Epidemiology Center (NEC) of the Department of Health says that the sudden and steep increase in the number of new cases within the MSM community, particularly in the last three years (309 cases in 2006, and 342 in 2013), is “tremendously in excess of what (is) usually expected,” allowing classification of the situation as an “epidemic". Of the cumulative total of 1,097 infected MSMs from 1984 to 2008, 49% were reported in the last three years (72% asymptomatic); 108 have died when reported, and slightly more MSMs were reportedly already with AIDS (30%).[3]

Among MSM's, ninety percent of the newly infected are single (up to 35% of past cases reported involved overseas Filipino workers or OFWs and/or their spouse), with the most of the affected people now only 20 to 34 years old (from 45 to 49 years old in the past). The highest number of infections among MSMs is from Metro Manila. An HIV surveillance study conducted by Dr. Louie Mar Gangcuangco and colleagues from the University of the Philippines-Philippine General Hospital showed that out of 406 MSM tested for HIV from entertainment areas in Metro Manila, HIV prevalence using the rapid test was 11.8% (95% confidence interval: 8.7- 15.0).[4][5] Increasing infection rates were also noted in the cities of Angeles, Cebu, and Davao.[3] 1 to 3 percent of MSM's were found to be HIV-positive by sentinel surveillance conducted in Cebu and Quezon cities in 2001.

Another at-risk group are injecting drug users (IDUs), 1 percent of whom were found to be HIV-positive in Cebu City in 2005. A high rate of needle sharing among IDUs in some areas (77 percent in Cebu City) is of concern. Sex workers, because of their infrequent condom use, high rates of sexually transmitted infections (STIs), and other factors, are also considered to be at risk. In 2002, just 6 percent of sex workers interviewed said they used condoms in the last week. As of 2005, however, HIV prevalence among sex workers in Cebu City was relatively low, at 0.2 percent.[6]

National risk profile[edit]

Several factors put the Philippines in danger of a broader HIV/AIDS epidemic. They include increasing population mobility within and outside of the Philippine islands; a conservative culture, adverse to publicly discussing issues of a sexual nature; rising levels of sex work, casual sex, unsafe sex, and injecting drug use.[6]

There is also high STI prevalence and poor health-seeking behaviors among at-risk groups; gender inequality; weak integration of HIV/AIDS responses in local government activities; shortcomings in prevention campaigns; inadequate social and behavioral research and monitoring; and the persistence of stigma and discrimination, which results in the relative invisibility of PLWHA. Lack of knowledge about HIV among the Filipino population is troubling. Approximately two-thirds of young women lack comprehensive knowledge on HIV transmission, and 90 percent of the population of reproductive age believe you can contract HIV by sharing a meal with someone.[6]

The Philippines has high tuberculosis (TB) incidence, with 131 new cases per 100,000 people in 2005, according to the World Health Organization. HIV infects 0.1 percent of adults with TB. Although HIV-TB co-infection is low, the high incidence of TB indicates that co-infections could complicate treatment and care for both diseases in the future.[6]

National response[edit]

Wary of nearby Thailand’s growing epidemic in the late 1980s, the Philippines was quick to recognize its own sociocultural risks and vulnerabilities to HIV/AIDS. Early responses included the 1992 creation of the Philippine National AIDS Council (PNAC), the country’s highest HIV/AIDS policymaking body. Members of the Council represent 17 governmental agencies, including local governments and the two houses of the legislature; seven nongovernmental organizations (NGOs); and an association of PLWHA.[6]

The passing of the Philippine AIDS Prevention and Control Act in 1998 was also a landmark in the country’s fight against HIV/AIDS. However, the Philippines is faced with the challenge of stimulating government leadership action in a low-HIV-prevalence country to advocate for a stronger and sustainable response to AIDS when faced with other competing priorities. One strategy has been to prevent STIs in general, which are highly prevalent in the country.[6]

The PNAC developed the Philippines’ AIDS Medium Term Plan: 2005–2010 (AMTP IV). The AMTP IV serves as a national road map toward universal access to prevention, treatment, care, and support, outlining country-specific targets, opportunities, and obstacles along the way, as well as culturally appropriate strategies to address them. In 2006, the country established a national monitoring and evaluation system, which was tested in nine sites and is being expanded. Antiretroviral treatment is available free of charge, but only 10 percent of HIV-infected women and men were receiving it as of 2006, according to UNAIDS.[6] This lack of distribution can be attributed to the focus of health spending towards disease specific programs instead of spending on public health which is more comprehensive and addresses multiple diseases. By spending on public health in general, the country would be able to strengthen the health system by creating effective health infrastructures that could carry out vertical programs without creating brain drain or hindering the economic development of the country. Without passable local infrastructure, health improvements would not be possible as distribution of medical care and medicines would be very limited; incidence and prevalence reports may not be accurate, and progress of health initiatives could not be tracked.[7]

The Government of the Philippines participates in international responses to the HIV/AIDS epidemic. Most recently, in January 2007, the Philippines hosted the 12th Association of Southeast Asian Nations Summit, which had a special session on HIV/AIDS.[6]

The Philippines is a recipient of three grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (2004 third round, 2006 fifth round, and 2007 sixth round) to scale up the national response to HIV/AIDS through the delivery of services and information to at-risk populations and PLHIV. These programs are executed by AIDS Society of the Philippines, Inc. for HIV prevention and control and Positive Action Foundation, Inc for treatment, care and support.[6] Aid money should be used to scale-up the public health capacity instead of only providing treatment and education for HIV/AIDS as this spending could be used to benefit all the niches of health related issues. Additionally, aid money is detrimental to local manufacturing as well as the economic development of the Philippines, and could escalate the problems of malnutrition and homelessness.[7]

Campaigns[edit]

Photographer Niccolo Cosme launched the Red Whistle campaign in 2011, inspired by red disaster preparedness whistles, to raise awareness and understanding of HIV/AIDs in the Philippines.[8]

References[edit]

  1. ^ a b "Philippine HIV/AIDS Registry Fact Sheet - August 2012". Department of Health. Retrieved January 10, 2013. 
  2. ^ "Philhealth: Over 2,000 Pinoy workers abroad infected with HIV". GMA News Online. 10 January 2013. Retrieved 10 October 2012. 
  3. ^ a b "It's Official: HIV and AIDS Now an Epidemic Among Pinoy MSMs," dela Cruz, Mikee, Outragemag.com, 9 December 2008
  4. ^ Gangcuangco LM, Tan ML, Berba RP. Prevalence and risk factors for HIV infection among men having sex with men in Metro Manila, Philippines. Southeast Asian Journal of Tropical Medicine and Public Health. 2013 Sept; 44(5): 810-816. http://www.tm.mahidol.ac.th/seameo/2013-44-5/10-5743-12.pdf
  5. ^ Gangcuangco LM, Sumalapao DE, Tan ML, Berba RP. (2010). Changing Risk Factors for HIV Infection among Filipino Men Having Sex with Men in Manila, Philippines. Poster presented at: XVIII International AIDS Conference; Vienna, Austria. http://www.iasociety.org/Abstracts/A200739361.aspx
  6. ^ a b c d e f g h i "Health Profile: Philippines". United States Agency for International Development (March 2008). Accessed August 25, 2008.  This article incorporates text from this source, which is in the public domain.
  7. ^ a b Garrett, Laurie (2007). "The Challenge of Global Health". Foreign Affairs 86 (1): 14–38. 
  8. ^ Barawid, Rachel (1 December 2011). "Blowing the whistle on AIDS". Manila Bulletin. Retrieved 13 February 2012.