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Growing Worry

With 395 new HIV infections among MSMs from January to September 2008 alone, 96% up from 2005’s 210 reported infections, it is now recognized that there is an ongoing HIV and AIDS epidemic among the MSMs.

Already, the DOH is attempting to engage in a dialogue with the MSM communities – problem is, those involved in the MSM community are either "invisible men or closeted," thereby “not open about their sexual activities.” This makes dealing with them problematic, to say the least.

It’s Official: HIV and AIDS Now an Epidemic Among Pinoy MSMs

No beating around the bush.

Figure 1: HIV AND AIDS CASES IN THE PHILIPPINES (JANUARY 1984 TO SEPTEMBER 2008, N=3,456)

With 395 new HIV infections among men who have sex with men (MSMs) from January to September 2008 alone, 96% up from 2005’s 210 reported infections, it is now recognized that there is “an ongoing HIV and acquired immune deficiency syndromeor acquired immunodeficiency syndrome (AIDS) epidemic among the MSM (community).”

Citing the Department of Health’s (DOH) HIV/AIDS Registry, Dr. Eric Tayag, who heads DOH’s National Epidemiology Center (NEC), says (during the Philippine National AIDS Convention, a biannual event of the NGO AIDS Society of the Philippines) that the sudden and steep increase in the number of new cases, particularly in the last three years (309 cases in 2006, and 342 in 2007), is “tremendously in excess of what (is) usually expected,” thus the classifying of the situation as an “epidemic (See Figures 1, 2 and 3).”

Figure 2: SEXUAL TRANSMISSION

It is difficult to OFFICIALLY declare the situation as such, however, just as the DOH declares malarial or dengue epidemics in severe outbreaks, because of the “gay stigma implicit in (such a declaration).” “We cannot predict the level of stigma and discrimination against MSMs when we link the new findings to them,” Tayag says, as quoted by the Philippine Daily Inquirer. “The last thing the (DOH) wants is to label HIV and AIDS as a gay disease.”

Elsewhere, HIV has been dubbed as, among others, “gay plague,” because of the relatively bigger number of homosexuals infected with it that led many to erroneously believe it only affects the GLBTQI community. In the Philippines, however, the situation had been the complete opposite – until 2007, heterosexual intercourse was the main mode of transmission (at 61% last year), followed in descending order by homosexual and bisexual relations, mother-to-child transmission, contaminated blood and blood products, and injecting drug use, according to the United States Agency for International development (USAID, usaid.org).

Figure 3: MSM TRANSMISSION

With the increase in the number of MSMs infected with HIV, the group formerly only considered as one of the most at risk is now the focal point.

There has been no development of this kind “in the 21 years since the government kept an official record of HIV infections (starting in 1984, when the first AIDS case was reported in the Philippines),” Tayag stresses. As such, “the die is cast,” with the epidemic “likely to escalate” in the next five years in the absence of “fearless, aggressive interventions.”

GROWING WORRY

It was actually in 2007 when homosexual and/or bisexual modes of infection surpassed heterosexual transmission — 56% versus 43%, with the figure rising to 67% for the January to September 2008 period, as against 34%. Of the cumulative total of 1,097 infected MSMs from 1984 to 2008, 49% were reported in the last three years alone (72% asymptomatic); 108 have died when reported, and slightly more MSMs were reportedly already with AIDS (28%).

Figure 4: AGE OF MSMS

“Several factors may be responsible (for the balloon in the figures), but we believe MSM has become the new sexual norm (in HIV transmission),” Tayag says, adding that, unfortunately, widespread unsafe sex in this group, such as the nonuse of condoms during penetrative anal sex, as was noted by independent behavioral studies, e.g. a DOH and Family Health International study showed that 11% of 1,204 men in the general population had multiple sexual partners in the previous six months – and only two out of every five of them used a condom with their most recent sex partner; add to that the 2002 Young Adult Fertility and Sexuality Survey, which twice as many males had premarital sex compared to females (31% versus 16%), with 15.1% of the sexually active males having had sexual relations with other men.

Just as surprising is the changing face of those infected, and now affected, by HIV, as there has been a “sudden departure from the sectors that health experts called ‘most-at-risk populations.’”

Figure 5: PROJECTED MSM TRANSMISSION

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) (See Figure 4). The highest number of infections among MSMs is from Metro Manila, though increasing infection rates were also noted in the cities of Angeles, Cebu, and Davao.

Sadly, because the DOH’s HIV/AIDS Registry is a passive surveillance system, Tayag says that the “entire picture of HIV infection in the country (and among MSMs, in particular) is (still) not captured.”

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KNOWLEDGE IS POWER

Already, the DOH is attempting to engage in a dialogue with the MSM communities – problem is, as Tayag notes, those involved in the MSM community are either “invisible men or closeted,” thereby “not open about their sexual activities.” This makes dealing with them problematic, to say the least.

Thus, if the “current rapid increases persist,” as it just may, it is expected for the number of HIV-infected MSMs in the next three to five years to reach from 10,000 to 12,000 (See Figure 5).

Since 1984, only 3,456 HIV and/or AIDS cases were reported in the Philippines, so it is dubbed as “hidden and growing.”  The MSM picture is showing that it isn’t so anymore, and appropriate actions are, indeed, needed to be effected immediately.

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