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Because AIDS is far from over…

Marking the World AIDS Day 2013 in the Philippines means highlighting that the country remains one of only 12 countries with growing rates of HIV infection, which – in turn – highlights how local efforts may be failing in curbing this social concern. Advocates now call not only for intensified advocacy efforts, but also for the political will for the country to reach its much-hyped target of having zero infections the soonest possible.

In the Philippines, 491 new HIV Ab sero-positive cases were reported by the STD/AIDS Cooperative Central Laboratory (SACCL) to the HIV and AIDS Registry for the month of October alone – a 66% increase from the figures for the same period in 2012, when only 295 tested HIV-positive.

In fact, is now estimated that one new Filipino is getting infected with HIV every one hour and 25 minutes, so that from 1984 (when the first HIV case was reported in the country) to 2013, the number of HIV infections continue to balloon in the Philippines. There are now 15,774 HIV Ab sero-positive cases in the country – of these, 14,333 (91%) were reported to be asymptomatic and 1,441 (9%) were AIDS cases. Most of those infected are male (88% or 13,950 of the total number); and the age groups with the most number of cases involved under-40 Filipinos (20-24 years – 22%, 25-29 years – 30%, and 30-34 years – 19%).

According to Dr. Jose Narciso Melchor Sescon, president of the AIDS Society of the Philippines, just under 30 years since the first case was reported in the country and “we still need to intensify advocacy efforts.”

This was the similar sentiment of JVR Prasadao Rao, the United Nation Secretary General’s Special Envoy for HIV and AIDS to Asia and the Pacific. In an earlier exclusive Outrage Magazine interview, he said that “the Philippines has done right in identifying key programs, such as programs in identifying the key affected populations (KAPs), programs on treatment, and all the other important component program. However, the question is on the scaling up of these programs. We have to do more than what we’re doing now.

This is worth highlighting because of the global trends. According to “AIDS by the Numbers”, the 2013 report of Joint United Nations Programme on HIV/AIDS (UNAIDS), globally, HIV infection declined by 33% since 2001; in children, HIV infection declined by 52% since 2001. AIDS-related deaths declined by 29% since 2005; and a 40-fold increase in the access to antiretroviral therapy was noted from 2002-2012.

In fact, according to UNAIDS executive director Michel Sidibé (below), for the first time, “we can see an end to the epidemic… Soon we will be able to announce an AIDS-free generation.”

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However, while newer infections of HIV have been declining in most countries, “the staggering fact remains that the Philippines is one of only 12 countries with increasing HIV prevalence (above 25%) as compared 10 years ago,” said Sescon, adding that this means that in the Philippines, “the fight is just starting and we need to gear up, intensify/scale up both national and local responses against HIV. We have seen the mushrooming of efforts from various private sectors already, yet we still need to intensify the commitment of local government units to commit, to take action.”

According to Philip Castro, program officer for HIV and AIDS and communications team leader at the United Nations Development Programme Philippines (UNDP), “we need to take stock of where we are at in the fight against HIV – and events like the World AIDS Day (WAD) remain relevant in highlighting this”. Particularly in the Philippines, “as long as we’re seeing the continued spread of HIV infection and reported deaths of PLHIV in the Philippines, WAD is all the more relevant in the country,” he said.

For Sescon, “I am seeing another Typhoon Haiyan (Yolanda) scenario here – although now, at the level of epidemic, if we don’t get our acts together.”

FIGURES IN FOCUS

According to the Department of Health – National Epidemiology Center (DOH-NEC), 95% of the 4,072 cases in 2013 were male (3,874). The ages of those newly-infected ranged from four to 79 years old (median 28 years); the 20-29 year old age group had the most (58%) number of cases for 2013. For the male age group, the most number of cases were found among the 20-24 years old (25%), 25-29 years old (34%), and 30-34 years old (20%).

Sescon noted that “the age bracket of Filipinos getting infected with HIV is getting younger and younger, with more (Filipinos coming from the ages of) 15 to 24 getting infected.”

Sexual contact remains the main mode of transmission. Of the 15,774 HIV positive cases reported from 1984 to 2013, 93% (14,648) were infected through sexual contact. In 2013, 94% (3,843) of the cases were infected through sexual contact.

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For 2013, other modes of transmission include: 6% (226) through needle sharing among injecting drug users (IDUs), and <1% (3) through mother to child transmission. There were 3,661 male and 182 female infected through sexual transmission; and the age range of those infected through sexual transmission was 15-79 years old (median 27 years).

IDU as an emerging mode of transmission is a concern in the Philippines. This is because, currently, evidence-based harm reduction program through needles syringe exchange programs is not acceptable to the Philippine Drug Enforcement Agency (PDEA) as this is deemed unlawful and against the Dangerous Act of 2002. As “outlaws”, therefore, IDUs are not openly given services. As such, Sescon lamented the “lack of national policies/laws and ordinances that promote and support public health interest among IDUs and prostituted women and not regarding them as outlaws/outcasts of Philippine society.” And so “we see a fueling HIV epidemic (among IDUs) now in Cebu City. For October 2013, we saw 45 new HIV infections among drug users. What are we waiting for here? Another Haiyan-level catastrophe in the face of HIV epidemic? This is a silent timebomb sitting in front of our very eyes, and our course of actions has yet to be galvanized.”

Already, from January 1984 to October 2013, there were 856 reported deaths among people living with HIV (PLHIV), with 78% (669) of them male. In total, there have already been 90 deaths among youth (15-24 years old) and 15 deaths among children (<15 years old). The annual number of deaths from 1984-2010 ranges from two to 36 cases, with an average of 14 deaths per year. However, starting 2011, an increase in the number of deaths has been recorded. There were 69 in 2011, and 177 in 2012.

Based on submitted reports to the DOH-NEC, there were a total of 148 deaths from January to October 2013. The highest number of deaths occurred in the 25-29 (30%) age group, followed by the 30-34 (28%) and the 35-39 (11%) age groups. For the month of October 2013, there were five deaths.

As of October 2013, only 5,141 PLHIV are on antiretroviral therapy.

STRENGTHENING EXISTING EFFORTS

Castro said that “apparently, the magnitude of the current responses is not sufficient in confronting the increasing HIV infections in the country.” As such, “the country has to innovate and scale up its responses. This is the only way to really deal with this.”

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Sescon noted that “experts said that to curb and halt the HIV epidemic, we need to see coverage and reach of most at risk population (MARPs) at 80% accessing for HIV package of services. This includes 60% of consistent condom use. But what Philippine data shows us is that we have below 50% condom use among MARPs, and only 30% reached and covered for (other) HIV services. So we still have a long way to go before we get to (having) zero new infections,” he said.

As such, while “we have to come up with good estimations, good strategic plans and good operational plans to fights HIV,” said Sescon, “but what we really need is the political will and leadership from our chief executives to take accountability and move this forward.”

There are already good practices in HIV work, yet for Sescon, “what remains to be done is scaling up. Our current efforts for a national HIV response are not enough to curb the epidemic. Key stakeholders – such as politicians, including local officials – have to recognize this impending danger,” Sescon said.

“The end of AIDS is within our power,” said UNAIDS executive director Sidibé.

“We need to galvanize efforts, both at the local and at the national level. We have to make our actions now or it may be too late. I am afraid to see our country, the Philippines, become the ‘Africa of Asia’ with regards to AIDS epidemic in the near future,” Sescon said.

Castro agreed. “The realization of the goal of ‘getting to zero’ necessitates collective action and shared responsibility. All of us – whether you’re from the government, development agencies or affected community, has a role to play. We need to stand up to our responsibilities to realize our shared goal,” he said. “We can’t afford to be ‘business as usual’.”

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