HIV/AIDS in the Philippines
HIV/AIDS in the Philippines is underreported due to sexuality taboos in the largely Catholic nation, strong family ties, and quickly spreading gossip that makes people wary of even setting foot in an std clinic. Despite what was a very low base rate of HIV incidence, Philippines continues to have among the fastest growing HIV epidemics in the world, highly concentrated among MSM but also problematic among female sex workers and generally at-risk groups. Equally disturbing is the trend towards HIV at younger ages.
Current status of HIV/AIDS in the Philippines
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 April 2015, the Department of Health (DOH) AIDS Registry in the
Philippines reported 24,936 cumulative cases. In the month of April, 560 new cases were reported showing a 42% increase compared to the same period in the previous year. In the year 2014, a total of 6,011cases of HIV were reported with 91% of the cases being asymptomatic at the time of reporting while 543 cases were diagnosed as AIDS.
91% (22,726) of the cases were males within the median age of 28 years old with over half of this number (12,616) falling under the 25-34 age group. 26% (6,529) of men were youth, 15–24 years of age in the years 2010-2015. This number increased from 12% in 2005-2009. The age group with the largest proportion of cases has shown a decreasing trend since the year 2000 with the 30-39 year old age group being the most affected from yeas 2000-2004, the 25-34 age group from years 2005 to 2009, and 20-29 age group from years 2010-2015.
62% (133 of 216) cases between 1984 and 1990 were female. From 2010 to 2015, females only comprised 5% (1017) of the 20,512 reported cases.
82% (20,512) of all cases were reported in the past five years from January 2010 to April 2015. 93% of these cases were still asymptomatic at the time of reporting
9,838 People Living with HIV (PLHIV) were undergoing Anti-Retroviral Therapy in 23 treatment hubs as of April 2015.
List of treatment hubs
- 1. Ilocos Training and Regional Medical Center
- 2. Cagayan Valley Medical Center
- 3. Baguio General Hospital and Medical Center
- 4. Jose B. Lingad Medical Center
- 5. James L. Gordon Memorial Hospital
- 6. Makati Medical Center
- 7. Philippine General Hospital
- 8. Research Institute for Tropical Medicine
- 9. San Lazaro Hospital
- 10. The Medical City
- 11. Marikina City Satellite Treatment Hub
- 12. Bicol Regional Training and Teaching Hospital
- 13. Corazon Locsin Montelibano Memorial Regional Hospital
- 14. Western Visayas Medical Center
- 15. Gov. Celestino Gallares Memorial Hospital
- 16. Vicente Sotto Memorial Medical Center
- 17. Zamboanga City Medical Center
- 18. Southern Philippines Medical Center
- 19. Northern Mindanao Medical Center
- 20. Eastern Visayas Regional Medical Center
- 21. Butuan Medical Center
- 22. CARAGA Regional Hospital
- 23. CADUCEUS medical multi-specialty clinic
Means of transmission
Of the 24,936 HIV positive cases reported from 1984 to 2015, 93% (23,291) were infected through sexual contact of which 79% (18,023) was through homosexual and bisexual contact while heterosexual contact comprised the remaining 14% (3,273). 5% (1,096) of cases was caused by needle sharing among injecting drug users, 0.3% (73) through mother-to-child transmission, <0.1% (20) through blood transfusion and needle prick injury <0.1% (3). No data is available for 1.7% (375) of the cases.
Cumulative data shows 24% (5,268) were infected through heterosexual contact, 47% (11,023) through homosexual contact, and 30% (7,000) 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%)
From 1984 to 2015, the region with the most number of reported cases were NCR with 11,081 (44%), Region 4A with 3,230 (13%) cases, Region 7 with 2,260 (9%) cases, Region 3 with 2,025 (8%) cases and Region 11 with 1,460 (6%) cases. 3,734 (15%) of cases were distributed around the rest of the country while 1,146 (5%) had no data on the region.
Overseas workers from the Philippines (e.g., seafarers, domestic helpers, etc.) account for about 20 percent of all HIV/AIDS cases in the country.
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%).
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). Increasing infection rates were also noted in the cities of Angeles, Cebu, and Davao. 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.
The threats and effects that AIDS/HIV brings to the population is a severe cause for concern. However, the prevalence of virus within the Philippine population remains low despite an increase in the number of cases. In fact, the Philippines qualifies as one of the few countries where the growth of AIDS/HIV cases has approximately increased to 25% from in a span of a couple of years from 2001-2009.
The rise in the number of cases can be best categorized by specific groups in the population. First, the age group that is most affected are 15–24 years old. Young professionals engaging in unprotected sexual intercourse is the main cause for the contraction and it accounts for one third of the AIDS/HIV-infected population. Furthermore, the infection within this age group is more prevalent with homosexual relationships .
The regional population that is greatly affected by AID/HIV is in Cebu. The prevalence rate is at 7.7% which is greater than the major cities of Manila at 6.7% and Quezon City at 6.6%. Recent data show that the surge is not caused by transmission through sexual intercourse but through an increase of people injecting drugs. It is not the injectable drugs but the sharing of needles, which opens the risk of transmission of fluids, greatly exposing the risk of contracting the virus .
National risk profile
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.
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.
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.
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.
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.
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. 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.
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.
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.
Current treatment in the Philippines : ART
The Philippines still uses the antiretroviral treatment/therapy or ART to address the HIV/AIDS patients. This treatment involves using different kinds of drugs such as Zidovudine, Lamivudine, Nevirapine, and more. The main focus of this treatment is to boost the patient’s immune system.
Another method that is being used is lab examination, which will help monitor the patient’s ART or antiretroviral drug level. Since treatment for HIV/AIDS is based on a case to case level, this will determine how the patient will be treated.
Duration of treatment : Lifetime
The antiretroviral drug does not kill the virus that causes the disease. It’s simply a way to help fight infection. This way, the patient prolongs his/her life even with the disease. With this being said, patients have to go undergo lab examinations depending on their respective cases and receive this treatment throughout their existence. It is a form of therapy that they would have to undergo.
The cost of treatment: N/A
The government will handle most of the costs in association with the disease. The initial treatment will costs the government P7,920 a year. As of April 20th, 2015, the Department of Health (DOH) mentioned that they plan to buy P180 million worth of ARV or antiretroviral drugs to be used in ART.
Nowadays, UNICEF is working closely with Philippine government agencies such as the Department of Health and Department of Education in order to raise HIV/AIDS awareness in the Philippines. UNICEF, through the Department of Education, is also collaborating with churches and several catholic high schools in the Philippines to advance their cause. They are implementing programs that encourage both teenagers and young adults to not only get tested for HIV/AIDS but also to be safer and more careful about their sex life. In addition, they are also working together in order to reduce stigma and eliminate the negative connotations that this disease possesses. Some of the said programs include the following:
- Allowing for anyone, no matter how old, to get tested for HIV without needing the consent of a legal guardian
- Improved monitoring systems and seeing to it that cases of HIV/AIDS are reported as early as possible
- Ensuring that people who are at a higher risk of HIV (teenagers and young adults) are well-aware of the requirements and implications of safe and responsible sex
- Reducing stigma through proper information dissemination
- Encouraging and advocating the government to increase the time, effort, and money that it spends in order to address and increase awareness regarding this issue
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