The month of February continued to highlight the continuing worsening HIV situation in the Philippines, with 849 new HIV cases reported to the HIV/AIDS & ART Registry of the Philippines (HARP), up 13% compared to the same period last year (751); and with 95 reported AIDS-related deaths.
Most (95%) of those who were newly infected with HIV are male, with the median age of 28 years old. Half belong to the 25-34 year age group, while 30% were youth aged 15-24 years.
Sexual contact remained as the main mode of transmission (828 of the 849 cases), with other modes including needle sharing among injecting drug users (IDU, 19) and mother-to-child transmission (MTCT, 2). Eighty-five percent of infections transmitted through sexual contact were among males who have sex with males (MSM).
The regions with the most number of reported cases were: National Capital Region (NCR) with 310 (37%) cases, Region 4A with 129 (15%) cases, Region 3 with 102 (12%) cases, Region 7 with 79 (9%) cases, and Region 11 with 52 (6%) cases. An additional 177 cases (21%) came from the rest of the country.
Among those who passed away, 91 (96%) were male and four (4%) were female. Fifty-two (55%) of the reported deaths belong to 25-34 year age group, 15 were 15-24 age group, and 25 were adult aged 35-49 years old. All were infected through sexual contact (10 male-female sex, 56 male-male sex, 29 sex with both males and females)
According to Michael David dela Cruz Tan, publishing editor of Outrage Magazine, the only LGBT publication in the Philippines that also has HIV-related efforts, “the (alarming big) number of deaths involving people living with HIV (PLHIVs) seems to belie that oft-repeated claim in HIV advocacy that ‘HIV is no longer a death sentence’.”
And for Tan, this is “reflective of so many failings in the current responses to HIV in the Philippines – e.g. an antiquated HIV-related law (RA 8504); non-implementation of RH Law (that could help curb the spread of HIV via condom distribution and safer sex education); failure in dealing with stigma and discrimination (that eventually affect issues of prevention, HIV testing, access to treatment, et cetera); non-harmonized services to PLHIVs; problems with access to treatment; hijacking of HIV advocacy for profiteering; lack of support for scientifically-proven solutions (e.g. U=U, PEP and PrEP); and so many other issues.”
Tan stressed that “it can’t be emphasized enough that the past and even current efforts continue to be lacking.”
This was seconded by Roxanne Omega Doron of Cebu-based Bisdak Pride Inc., an NGO leading HIV-related efforts in the Visayas. For Doron, the existing responses are obviously “not enough, particularly if we take into consideration the population of the most vulnerable sector vis-à-vis the costs of the response.”
POPULATIONS AT RISK
That the HIV epidemic is affecting more young Filipinos, particularly those who engage in sex was highlighted by the February 2017 figures, with 251 (30%) cases among youth aged 15-24 years (most of them, or 95%, male), and almost all (250) infected through sexual contact (23 male-female sex, 154 male-male sex, 73 sex with both males and females), and one through needle sharing among IDU.
In February 2017, 38 adolescents aged 10-19 years were reported to HARP. All were infected through sexual contact (five male-female sex, 22 male-male sex, 11 sex with both males and females).
Sixty-three OFWs were reported in February 2017, comprising 7% of the total newly diagnosed cases, with 89% (56) of the OFWs males. All were infected through sexual contact (21 male-female sex, 22 male-male sex, and 20 sex with both males and females). Among all the OFW diagnosed in February 2017, most (54%) belonged to the 25-34 years age group.
In the February 2017 HARP report, 11% (92) of the cases engaged in transactional sex. People who engage in transactional sex are those who report that they pay for sex, regularly accept payment for sex, or do both. Most (93%) were male whose ages ranged from 18 to 54 years, while six were female whose ages ranged from 19-35 years.
Two cases of pregnant women with HIV were reported. The cases were from Regions 4A and 7 with ages 23 and 40 years old, respectively.
As per the HARP, “the absolute number of cases among females has also been increasing. Cases of HIV transmission from mother to child are more likely to increase if female patients are not linked to HIV care. Ninety-three percent (2,682) of all female cases were diagnosed when they were between 15-49 years of age.”
In the early years of the epidemic (1984-1990), 62% (133 of 216 cases) were female. From 1991 to present, males comprised 93% (38,327 out of 41,088) of the total number of HIV/AIDS cases in the Philippines in that time period.
Also, from 1984 to 2009, the predominant mode of transmission was male-female sex. But beginning 2010, the trend shifted to male-male sex as the predominant mode of transmission and has continually increased since then. From January 2012 to February 2017, 82% (26,889) of new infections through sexual contact were among MSM.
For Tan, often not highlighted enough is how the HIV epidemic may revert back to mainstream (i.e. heterosexual) population. This is particularly true “when the messaging constantly given out about HIV is it being a ‘gay issue’.” This is because many MSM are “not necessarily homosexual, and so also have sexual contacts with women (aside from men, including their lovers, wives or clients). This means that particularly for those who are unaware of their HIV status, infecting both male AND female partner/s is not impossible.”
Tan said that, “again – and more than anything – this highlights how HIV is everyone’s issue, and that it doesn’t discriminate who it affects. As such, everyone ought to help in dealing with this. We should have been doing something about this years ago; and we should be doing something about this right now (!).”
DEALING WITH THE ISSUE – NOW
In February 2017, 600 patients started on antiretroviral therapy (ART). A total of 18,767 PLHIVs were on ART as of February 2017, most (97%) of them males with the median age of 31 years (range: 8 months-78 years). Ninety-five percent were on first line regimen, 4% were on second line regimen, and 1% were on other regimen.
Nonetheless, the total number of PLHIVs on ART is still not half of the 41,315 cases reported by HARP.
That more efforts need to be done now have been repeatedly stressed – e.g. by National Youth Commission’s Aiza Seguerra, who is pushing to allow people under 18 to get tested for HIV sans parental consent. As Seguerra noted, “it’s already difficult asking permission from our parents to have a night out. What more if you tell your parents, ‘I’m sexually active. I might have HIV. Please go with me.’ So it’s very hard.”
Bisdak Pride’s Doron is pushing for “more enabled local responders”. For instance, “the government should capacitate various barangay health units to expand the labor force in confronting the spread of HIV.”
As it is, and even sans budget, Bisdak Pride is among the NGOs that offer community-based HIV screening (CBS), which Doron said is “anchored on a very fundamental issue: the time issue.” Currently, because of an antiquated law, those who get tested have to legally/officially wait from two weeks to even months before they can get their confirmatory result from SACCL (https://outragemag.com/the-waiting-period/). The CBS allows for those who get tested “to need not wait for a week or more to wait for their results, consequently providing them with timely and relevant response/s.”
For Tan, “we don’t only need to add to our existing responses to HIV; but some of these responses may actually need to be overhauled. We always say that ‘All efforts matter’ in the fight against HIV. But that we need to do more, and we need to do more NOW, cannot be stressed enough.”