AND IT JUST KEEPS GETTING WORSE.
There were 1,098 new HIV positive individuals reported to the HIV/ AIDS & ART Registry of the Philippines (HARP) in May 2017, the highest number of HIV infections in the country for a month since monitoring started since 1984. To date, 29 Filipinos now get infected with HIV every day; up from only one HIV infection per day in 2008. Since 2010, however, the number of HIV infections has been rapidly climbing to four every day, nine every day in 2012, 17 every day in 2014, and 26 every day in 2016.
The May 2017 figure is 48% higher as compared with the same reporting period last year, when there were “only” 741 cases reported.
According to Michael David dela Cruz Tan, publishing editor of Outrage Magazine, the only LGBT publication in the Philippines, and which has HIV-related efforts, there are two ways of looking at this.
On the one hand, “we can give this a ‘positive’ spin by saying that more people are getting tested, so now more people know of their HIV status. In a way this is true, and kudos to the efforts of those who’ve been going around to provide much-needed HIV testing,” he said.
But on the other hand, “that people test positive at all is a damning statement of the failure to control the spread of HIV in the Philippines. We went beyond this being a source of worry a long time ago; we should already be panicking.”
Ico Rodulfo Johnson, president of The Red Ribbon Project (TRR), said that “the increased number of HIV cases in the country may be a result of the increased campaign on HIV awareness and testing, as well as the increased number of HIV facilities now accessible to the greater population.”
TRR, for instance, partnered with the National Council of Churches in the Philippines (NCCP) to facilitate community-based screening, thereby reaching populations that well-funded NGOs and even government facilities fail to reach because these are facility-centric.
But Johnson said that “with the monthly increase in the number of Filipinos with HIV, we can assume that we have not reached our target yet. We still have to do more.”
CLOSER LOOK
For May 2017, most (95%) of those who tested HIV positive were male. The median age was 28 years old (age range: 2 years-67 years). More than half were from the 25-34 year age group, while 30% were youth aged 15-24 years.
The reported modes of HIV transmission were: sexual contact (1,068), needle sharing among injecting drug users (IDU) [27] and vertical transmission (formerly known as “mother- to-child transmission”) [3]. Eighty-six percent of infections transmitted through sexual contact were among males who have sex with males (MSM).
From 1984 to 1990, considered the early years of the epidemic, 62% (133 of 216 cases) were female. But from 1991 to present, males comprised 93% (40,890 out of 44,010) of the total number of HIV cases in the Philippines.
But as per HARP, the absolute number of cases among females has also been increasing. Ninety-two percent (2,796) of all female cases were diagnosed when they were between 15-49 years of age.
According to Outrage Magazine’s Tan: “We’ve long recognized, and even constantly stress, that MSM, the population mostly affected by HIV in the Philippines, are NOT NECESSARILY homosexual or bisexual men. There are MSM who have female partners or are in opposite-sex relationships. And so even if the trend now involves a lot of gay and bi men, sooner or later, this problem will reverberate back to the ‘mainstream’ population to mimic the trend in the early years of the epidemic, including women and their children.”
Unfortunately, said Tan, Outrage Magazine has been made aware instances when women were “literally turned away from getting HIV testing because, as they were told, existing projects prioritize, if not actually only focus on MSM.” There are also sub-populations among women who are still not properly reached by HIV-related efforts – e.g. women in prison (WIP).
For Tan, this also highlights how “HIV is not the issue of only a specific population (e.g. of gay and bi men), but of everyone.”
Those who are getting infected with HIV are also getting younger. From 2001 to 2005, the age range of most people reported to have HIV was 35-49 years. Starting from 2006, the age proportion shifted to 25-34 years. The proportion of HIV positive cases in the 15-24 year age group increased from 25% in 2006-2010 to 29% in 2011-2017.
For May 2017, the regions with the most number of reported cases were: National Capital Region (NCR) with 404 (37%) cases, Region 4A with 155 (14%) cases, Region 3 with 108 (10%) cases, Region 7 with 98 (9%) cases and Region 11 with 60 (5%) cases. An additional 273 cases (25%) came from the rest of the country.
KEY POPULATIONS
Pregnant Women Living with HIV (PWLHIV)
For May 2017, eight pregnant women were diagnosed with HIV. Three of the cases were from NCR, two cases from Region 3, and one case each for Regions 4A, 7 and 9.
It was only in 2011 when pregnant women living with HIV were included in the HARP; and thus say, “the number of reported cases continues to increase yearly,” noted HARP.
Since 2011, a total of 178 pregnant cases were reported. More than half (97) were from the age group 15-24 years old and 39% (69) were from 25-34 years old age group.
Children (<10 years old) and Adolescents (10-19 years old)
In May 2017, 64 adolescents aged 10-19 years were infected with HIV. All of them were infected through sexual contact (eight male-female sex, 40 male-male sex, 16 sex with both males and females). Also, three children aged 10 years and below were reported to be HIV positive and were infected through vertical transmission (nee MTCT).
Outrage Magazine already earlier reported on the difficulties encountered by those looking after children living with HIV.
Youth (15-24 years old)
In May 2017, 325 (30%) cases were among youth aged 15-24 years and 95% of the cases were male. All (325) were infected through sexual contact (36 male-female sex, 192 male-male sex, 97 sex with both males and females).
From January 1984 to May 2017, 12,065 (27%) of the reported cases were 15-24 years old. Eighty-four percent (10,148) of all the youth were reported from January 2012 to May 2017.
OFW
Eighty-four OFWs were reported in May 2017, comprising 8% of the total newly diagnosed cases. Ninety-five percent (80) were male. All were infected through sexual contact (24 male-female sex, 30 male-male sex, and 30 sex with both males and females). These OFWs were from 19-55 years old, and 49% of those belonged to the 25-34 year age group.
People who engage in transactional sex
In May 2017, 10% (105) of the total reported cases engaged in transactional sex. As defined by HARP, people who engage in transactional sex are those who report that they pay for sex, regularly accept payment for sex, or do both.
Most (92%) of those who engaged in transactional sex were male, with ages ranging from 16 to 60 years.
It was only in December 2012 when HARP included in the registry people who engage in transactional sex, and since then, a total of 3,941 cases have been reported. Ninety-six percent (3,769) were male and 4% (172) were female.
ACCESS TO TREATMENT
Fifteen persons living with HIV were reported by HARP for May 2017, all of them male. Six (40%) of the reported deaths belonged to the 15-24 year age group, seven (46%) cases were from 25-34 year age group, and one (7%) case belonged for age groups 35-49 and 50. All were infected through sexual contact (eight male-male sex, seven sex with both males and females).
Since 1984, a total of 2,156 deaths have been reported, though – obviously – the figure may be higher because of under-reporting.
Even with the efficacy of treatment in preventing deaths among PLHIVs, and even in curbing the spread of HIV since it could lower the viral load to undetectable levels and make those with HIV no longer transmittable (U=U), still only less than half of the Filipinos with HIV are on ART. In May 2017, there were 683 patients who started on ART; but from 1984 to May 2017, only 20,420 Filipinos were on ART, while the total number of Filipinos with HIV already reached 44,010.
Ninety-five percent were on first line regimen, 4% were on second line regimen, and 1% were on other regimen. Only the first two regimens are PhilHealth-funded, thus readily available to Filipinos living with HIV.
Also, data from HARP does not segregate those who may have been on ART, but already died; or those who started ART but discontinued.
STUCK IN THE MUD?
In a statement released to Outrage Magazine, Rev. Fr. Rex Reyes, General Secretary of the National Council of Churches in the Philippines (NCCP), said that already y, their church members “make efforts in our communities to address sex negativity, patriarchy, homophobia and transphobia that fuel HIV infections.” But “we also call on the government to heed the call for a free, comprehensive and progressive healthcare system.”
For Reyes, “(some) of the effective ways to respond to the global call to end AIDS by 2030 is for the government to allocate at least 5% of the Gross Domestic Product for health in the national budget, stop privatization, address the inequitable distribution of health personnel and resources, and address socio-economic and political factors affecting health.”
For TRR’s Johnson, some of those that need to be done include “stopping the stigma and discrimination related to HIV; creating a curriculum in the educational system for students to know about the disease, and where to get tested or even access treatment; scale up campaigns for condom use; and empower more schools, companies and organizations, and local government units to strengthen their HIV responses.”
For Tan, “numerous issues related to HIV responses have already been highlighted in the past; and yet we ignore them, acting like it’s still business as usual.”
These issues that Tan already noted in the past include:
- Delayed detection (often “blamed” on the PLHIV, with this blaming neglecting that there are still unresolved issues related to stigma and discrimination).
- Bureaucratic deterrent to make new approaches the norm (e.g. rollout of well-funded CBS takes years; ignorance of U=U, thus non-inclusion among existing solutions).
- Lack of information about HIV and AIDS that often lead to stigma and discrimination (e.g. PLHIVs getting kicked out of their homes after their family members discover their status).
- Inability to get tested (e.g. there are fishermen and farmers who have no access to HIV testing facilities; minors who are unable to get tested sans consent from their parents/guardians).
- Inconsistent HIV services offered even by government-owned treatment hubs (e.g. viral load is not available in many of treatment hubs outside of Metro Manila).
- Mismanagement of available resources (e.g. existing projects allocate for some implementers to stay in posh hotels to hobnob with some well-compensated ‘ambassadors’; while some PLHIVs unable to access ARVs because of inability to pay PhilHealth).
“No one wants to be the pessimistic one here. But we have to be realistic and honest that – and this can not be re-iterated enough – unless our responses are changed, not just bettered, expect things to just continue worsening,” Tan ended.
