HIV/AIDS in the Philippines

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The Philippines has one of the lowest rates of infection of HIV/AIDS, yet has one of the fastest growing number of cases worldwide. [1] The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009. [1]

Contents

Cases are concentrated among men who have sex with men [2] HIV cases among men having sex with men multiplied over 10 times since 2010. [3] HIV cases are getting younger. [1]

The first case of HIV infection in the Philippines was reported in January 1984. [4]

In December 2018, the Philippine HIV and AIDS Policy Act of 2018, was passed. [5] The law repealed the Philippine AIDS Prevention and Control Act of 1998, and made health services for HIV/AIDs more accessible to Filipinos. [6]

Current status

The Philippines is a low-HIV-prevalence country, with 0.1 percent of the adult population estimated to be HIV-positive, but the rate of increase in infections is one of the highest. [7] As of August 2019, the Department of Health (DOH) AIDS Registry in the Philippines reported 69,629 cumulative cases since 1984. [8] In April 2015, 560 new cases were reported showing a 42% increase compared to the same period in the previous year[ year missing ]. In the year 2014, a total of 6,011 cases of HIV were reported with 91% of the cases being asymptomatic at the time of reporting while 543 cases were diagnosed as AIDS. [9] From 2001 to 2015 the number of cases diagnosed per year increased 37 times, from 174 cases diagnosed in 2001 to 6,552 for the first 10 months on 2015. [10]

In the years 2010 to 2015, 91% (22,726) of cases were men with a median age of 28 years, with over half (12,616) in the 25–34 age group.[ citation needed ] 26% (6,529) of men were 20–24 years of age, an increase from 12% in 2005–2009.[ citation needed ] Since the year 2000, the high-prevalence age group has changed from the 30- to 39-year-old age group being the most affected from years 2000–2004, to the 25–34 age group from years 2005 to 2009, and to 20-29 age group from years 2010–2015.[ citation needed ]

The infection rate among men having sex with men has multiplied 10 times from 2010 to 2015. [3] The Department of Health reported in November 2015, that the rate of prevalence has surpassed 5%, the UN's definition of concentrated epidemic, in eight cities Cebu, Cagayan de Oro, Puerto Princesa, Davao, Quezon City, Parañaque and Makati, with Cebu reaching 14%. [3]

Between 1984 and 1990, 62% (133 of 216) of cases were female. From 2010 to 2015, females only comprised 5% (1017) of the 20,512 reported cases.[ citation needed ] [11]

From January 2010 to April 2015, 82% (20,512) of all cases were reported. At the time of reporting, 93% of these cases were still asymptomatic.[ citation needed ]

As of June 2018, 28,045 people living with HIV were undergoing anti-retroviral therapy in 80 treatment hubs. The majority (97%) were males.[ citation needed ]

Overseas Filipino workers account for about 20 percent of all cases. [12]

Means of transmission

Among males, the dominant mode of transmission (84%) was through male to male sexual contact. The next common modes were male-female sex (11%) and sharing of infected needles (4%). Among females, 92% was through male-female sex and 3% through shared needles. For both sexes, mother-to-child transmission occurred in 153 cases.[ citation needed ]

Geographical Distribution

From 1984 to 2015, the region with the most number of reported cases were Metro Manila with 11,081 (44%), Region 4A with 3,230 (13%) cases, Central Visayas 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. [9] The June 2018 report cited regional differences in terms of dominant modes of transmission. Almost half (44%) of infected through MSM came from NCR while most of those that were infected via needles were from Region VII. A third of females that were infected through sex work came from Region III.[ citation needed ]

At-risk groups

MSM

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%). [13]

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 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). [14] [15] Increasing infection rates were also noted in the cities of Angeles, Cebu, and Davao. [13] 1 to 3 percent of MSM's were found to be HIV-positive by sentinel surveillance conducted in Cebu and Quezon cities in 2001.

Injecting drug users

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. Prostitutes, 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 prostitutes interviewed said they used condoms in the last week. As of 2005, HIV prevalence among prostitutes in Cebu City was relatively low, at 0.2 percent. [16]

The threats and effects that AIDS/HIV brings to the population is a severe cause for concern. The prevalence of virus within the Philippine population remains low despite an increase in the number of cases. 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 to 2009. [17]

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. The infection within this age group is more prevalent with homosexual relationships. [17]

A regional population that is greatly affected by AIDS/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 . [18]

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; adverse to publicly discussing issues of a sexual nature; rising levels of sex work, casual sex, unsafe sex, and injecting drug use. [16]

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. [16]

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. [16]

Response

Wary of Thailand's growing epidemic in the late 1980s, the Philippines was quick to recognize its own sociocultural risks and vulnerabilities to HIV/AIDS.[ according to whom? ] 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. [16]

The passing of the Philippine AIDS Prevention and Control Act in 1998 was also a landmark in the country's fight against HIV/AIDS.[ citation needed ] 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. [16]

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. [16]

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. [19]

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. [20]

Treatment

The Philippines uses antiretroviral treatment (ART) to treat people with HIV/AIDS. This treatment involves using different kinds of drugs such as zidovudine, lamivudine, and nevirapine. [21]

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.[ citation needed ]

"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."[ according to whom? ]

"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."[ according to whom? ] [22]

Treatment is also partially covered by PhilHealth (Philippine Health Insurance Corporation), the country's national social health insurance program through the OHAT package. [23]

Legislation

The Philippines passed a legislation on HIV/AIDS during the first decade of Filipino infections. The bill's scope was minimal due to the lack of knowledge regarding the virus in the Philippines at the time. In 2018, a new law was passed, repealing the old one. One of the major changes now allows 15- to 17-year-olds to get HIV testing without parental consent. It also stipulated increased efforts to improve HIV awareness and to fight discrimination of PLHIVs (HIV-positive people). [24]

Related Research Articles

<span class="mw-page-title-main">Epidemiology of HIV/AIDS</span> Pandemic of HIV/AIDS

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The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. Based on 2009 data, about 1.0 percent of the adult population is living with the disease, which is higher than any other region except Sub-Saharan Africa. Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

Since the first HIV/AIDS case in the Lao People's Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.

Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV. Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017. Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART. The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%. Other groups also include discordant couples however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.

Although Senegal is a relatively underdeveloped country, HIV prevalence in the general population is low at around 0.08 per 1000 people, under 1% of the population. This relatively low prevalence rate is aided by the fact that few people are infected every year – in 2016, 1100 new cases were reported vs 48,000 new cases in Brazil. Senegal's death due to HIV rate, particularly when compared it to its HIV prevalence rate, is relatively high with 1600 deaths in 2016. Almost two times as many women were infected with HIV as men in 2016, and while almost three times as many women were receiving antiretroviral therapy (ARV) as men, only 52% of HIV positive people in Senegal received ARV treatment in 2016.

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<span class="mw-page-title-main">HIV/AIDS in Nepal</span>

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Cases of HIV/AIDS in Peru are considered to have reached the level of a concentrated epidemic.

The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total web|url=http://www.avert.org/caribbean-hiv-aids-statistics.htm |title=Caribbean HIV & AIDS Statistics|date=21 July 2015}}</ref> with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.

HIV/AIDS in El Salvador has a less than 1 percent prevalence of the adult population reported to be HIV-positive. El Salvador therefore is a low-HIV-prevalence country. The virus remains a significant threat in high-risk communities, such as commercial sex workers (CSWs) and men who have sex with men (MSM).

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With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year, but in 2012 and 2013, it increased to about 600 new cases, and in 2014, it reached 880 new cases per year. According to 2016 statistics from UNAIDS, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

With an estimated 120,000 people living with HIV/AIDS, the HIV/AIDS epidemic in Colombia is consistent with the epidemic in much of Latin America as a whole, both in terms of prevalence of infection and characteristics of transmission and affected populations. Colombia has a relatively low rate of HIV infection at 0.4%. Certain groups, particularly men who have sex with men, bear the burden of significantly higher rates of infection than the general population. Colombia's health care system and conception of a "right to health", created by the T-760 decision of 2008, have revolutionized access to HIV treatment. Despite this, the quality of health insurance and treatment for HIV has often been disputed.

References

  1. 1 2 3 "HIV and AIDS". UNICEF Philippines. Archived from the original on 6 January 2016. Retrieved 22 December 2015.
  2. ↑ "Addressing a National Health Threat: The Philippine HIV Epidemic" (PDF).
  3. 1 2 3 Uy, Jocelyn R. (November 25, 2015). "HIV an 'epidemic among high-risk groups' in 8 PH cities; P600M sought to stop virus". Philippine Daily Inquirer. Retrieved 22 December 2015.
  4. ↑ Mayol, Ador Vincent S. (December 2, 2015). "Church steps up education drive, reminds public not to shun patients". Cebu Daily News. Retrieved 22 December 2015.
  5. ↑ "RA 11166" (PDF).
  6. ↑ Ranada, Pia (9 January 2019). "Duterte signs law strengthening HIV, AIDS health services". Rappler. Retrieved 2019-01-15.
  7. ↑ "PRESS RELEASE: UNAIDS report indicates new HIV infections in the Philippines have doubled in the past 6 years". August 2017.
  8. ↑ "HIV/AIDS and ART Registry of the Philippines June 2018" (PDF).
  9. 1 2 "Philippine HIV/AIDS Registry Fact Sheet - April 2015" (PDF). Department of Health. Archived from the original (PDF) on November 17, 2015. Retrieved November 6, 2015.
  10. ↑ Crisostomo, Sheila (December 2, 2015). "DOH urges public to join fight vs HIV". The Philippine Star. Retrieved 22 December 2015.
  11. ↑ "House Bill No. 6442" (PDF). 25 September 2017. Retrieved 2021-05-17.
  12. ↑ "Philhealth: Over 2,000 Pinoy workers abroad infected with HIV". GMA News Online. 10 January 2013. Retrieved 10 October 2012.
  13. 1 2 "It's Official: HIV and AIDS Now an Epidemic Among Pinoy MSMs," dela Cruz, Mikee, Outragemag.com, 9 December 2008
  14. ↑ 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
  15. ↑ 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. "International AIDS Society - Abstract - 200739361". Archived from the original on 2013-10-04. Retrieved 2013-10-02.
  16. 1 2 3 4 5 6 7 "Health Profile: Philippines" Archived 2008-09-13 at the Wayback Machine . United States Agency for International Development (March 2008). Accessed August 25, 2008. PD-icon.svg This article incorporates text from this source, which is in the public domain .
  17. 1 2 "UNICEF Philippines - HIV/ AIDS - Issue". www.unicef.org. Archived from the original on 2015-11-17. Retrieved 2015-11-09.
  18. ↑ "Cebu City highest in HIV prevalence". cnn. Archived from the original on 2015-11-17. Retrieved 2015-11-09.
  19. ↑ Garrett, Laurie (2007). "The Challenge of Global Health". Foreign Affairs. 86 (1): 14–38.
  20. ↑ Barawid, Rachel (1 December 2011). "Blowing the whistle on AIDS". Manila Bulletin . Retrieved 13 February 2012.
  21. ↑ "HIV Treatment in The Philippines HIV, AIDS Treatment Cost". HIV Test Kit Philippines - HIV Testing at Home. 99.98% Accuracy with 100% Privacy. Retrieved 2015-11-09.
  22. ↑ "DOH to buy P180M worth of HIV drugs". newsinfo.inquirer.net. 20 April 2015. Retrieved 2015-11-10.
  23. ↑ "OHAT package" (PDF).
  24. ↑ "Duterte signs law strengthening HIV, AIDS health services". 9 January 2019.
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