No, things are not getting any better.
For October 2022, the latest period covered in the reporting of the Department of Health’s (DOH) HIV/AIDS & ART Registry of the Philippines, a total of 1,383 people tested HIV-positive. This number is already higher than September’s 1,347 confirmed HIV cases, and this brings the total daily cases of the country to 42.
Only in July, the daily cases “only” reached 41, “so this incessant increase should really already worry HIV-related service providers,” said Michael David Tan, executive director of Bahaghari Center for SOGIE Research, Education and Advocacy, Inc. (Bahaghari Center), and concurrent editor in chief of Outrage Magazine, the only LGTQIA publication in the Philippines. “Because seriously, how many cases should we be reporting every day before we admit we’re not doing enough?”
Gem Cabreros, president of the Positive Elders Philippines, seconded this.
“Current efforts to stop the increase in new HIV cases are inadequate, which I hope the AIDS Medium Term Plan 7 will help beef up,” Cabreros said.
Joshua Holboell-Formentera of the Positive Action Foundation Philippines, Inc. (PAFPI): “I don’t see a lot of innovations even if it has been acknowledged that the Philippines has the highest HIV infection rate in the Pacific and Southeast Asia. We need more interventions. Now we need to ask how we’d do this, particularly in ensuring the public know of these interventions.”
Tan added that “instead of sitting on our so-called laurels, or just patting each other on the back for what we may see as ‘tiny successes’, it’s time to actually look at this bluntly – i.e. our efforts are barely scratching the surface, and so we really need to do more fast.”
KEY POPULATIONS
As in the past years, majority of the newly-infected in September were male, totaling 96%. And though the age of the newly-reported cases ranged from 2 to 75 years old, there were six who were less than 15 years old, and 395 who were 15-24 years old. The others were over 24 (i.e. 700 were 25-34 years old; 242 were 35-49 years old; and 40 were 50 years old and older).
That the young is among the sectors greatly affected by HIV has been stressed by DOH, which reported that 29% of the reported cases for October were among the youth aged 15-24 years old. Ninety-eight percent (98%) of them were infected through sexual contact, though there were also infections through vertical transmission (<1%, with the DOH still referring to as “mother-to-child transmission”, an antiquated term that “blames” the mother for supposedly infecting her child).
As noted by the DOH in September: “Following the ratification of the Philippine HIV and AIDS Policy Act (RA 11166) where the age for HIV testing without the need for consent from parent or guardian was lowered to 15 years, the number of reported cases among 15-17 years old has increased by 47% from 2019-2022 compared to 306 total cases reported (among those) aged 15-17 years old before the ratification in 2018.”
The DOH was, of course, late in reporting on other key populations.
Transgender women, for instance, were used to be lumped with “men who have sex with men (MSM)”. Since they were segregated as a key population in 2018, 1,468 were reported to have been infected by DOH; a figure that excludes all other transgender women who tested HIV-positive from 1988-2017. In September, 3% (or 44) of the new HIV cases were transgender women, <1% (or one) was transgender man, 1% (or eight) were agender, and 37% (or 495) had unknown data on gender identity. Particularly among the transgender women, 50% were 25-34 years old, 30% were 15-24 years old, 18% were 35-49 years old, and 2% were 50 years old and older. The DOH’s October report did not have data on transgender women getting infected for the period.
Data on transactional sex was also only included by the DOH in 2012. But in total, 11,356 of the HIV infections from December 2012 to September 2022 were people who engaged in transactional sex. In October alone, 9% of the newly-diagnoses engaged in transactional sex in the past 12 months, with 98% of them male.
And with the DOH gathering data on pregnant women since 2011, 706 diagnosed women were reported pregnant at the time of diagnosis, so that the DOH claimed that “there was an observed increase in the number of diagnosed pregnant women in the past 10 years.” From January to September, 86 HIV positive women reported being pregnant at the time of diagnosis, which is 62% higher than the number for the same period last year. Specifically in October, 10 HIV-positive women were pregnant at the time of diagnosis, bringing the total for this year alone to 96.
STILL A DEATH SENTENCE
In October, 65 HIV-related deaths were reported by DOH, with 11 (17%) of those who died aged 15-24 at the time of death. Fifty-one percent of the newly-reported deaths were from central Visayas, National Capital Region, and Central Luzon. The rest of the country reported 32 (49%) deaths.
This year alone, total deaths already reached 878, though actual numbers may be higher because of under- or non-reporting.
But at least 1,105 people living with HIV (PLHIV) were enrolled to treatment in October. Among them, three were under the age of 15, 323 were 15-24 years old, and 563 were 25-34 years old. To date, only 66,041 PLHIVs are on antiretroviral treatment (ART), only a little over half of the 107,177 total HIV cases in the Philippines.
These trends “should warn us of the urgency of this situation,” said Stephen Christian Quilacio, who helms the Center for HIV and AIDS Responses (CARE), a HIV-centric organization that is based in Cagayan de Oro City. “It is undeniable that we’ve had successes – e.g. the ratification of RA 11166. But what small successes we had seem to be easily negated by everything else that’s lacking.”
THE NEED TO DO MORE, NOW
For Bahaghari Center’s Tan, the “lapses in the HIV services being offered are numerous.”
Bahaghari Center, as an example, has been training Deaf Filipinos on community-based HIV screening (CBS). This is to empower Deaf Filipinos to deal with HIV themselves, instead of relying on Hearing people who may be unfamiliar with dealing with the specific needs of members of the Deaf community. As per Tan, “even now, Deaf organizations are actually not funded to render HIV-related services in the Deaf community. Instead, they continue to be ‘pet projects’ by metro-centric non-government organizations.”
Tan added that the current “centralization of available funding only among supposedly established organizations contradict the message of making HIV-related efforts inclusive.”
Other issues for Tan include: limited rollout of newer medications (e.g. lamivudine, tenofovir and dolutegravir combination); non-uniform services delivered in the treatment facilities accredited by the DOH; delays in rollout of pre-exposure prophylaxis (PrEP outside of metropolitan areas; and the government’s dependence on non-government organizations to promote HIV-related developments (e.g. U=U).
According to Aivan Alvarez, who helms Wagayway Equality, the passing of the Philippine HIV and AIDS Policy Act of 2018 is one of the major steps pushed to better prevent the increase in HIV cases in the country. Aside from lowering the age of people to be tested, it is also more focused on the human rights of key affected populations especially PLHIVs. But “the success of this law is still in its implementation.”
And so while “the country’s HIV responses… have gone far, thanks to previous advocates and their efforts, in my experience, it is also important to look at how to address the wellness of advocates, often members of the community who are more aware of the plight of their fellow affected populations. Put them in front and center of the responses.”
PAFPI’s Holboell-Formentera said: “The HIV crisis in the Philippines is an emergency. Youth education, empowerment of healthcare providers, national access to PrEP and integrase inhibitors, and harm reduction are urgently needed.”
For Wagayway Equality’s Alvarez, there is also a need to “see that HIV is not just a health issue but also a human rights issue. Stigma and discrimination serve as barriers in the access of services. When it is reduced and eliminated, the health-seeking behavior might increase and can reduce new cases of HIV.”
CARE’s Quilacio, for his part, noted the “the continuing lack of services to those in far-flung places.” This is both in prevention (e.g. PrEP) and in treating those who are already living with HIV. As an example for the latter, in Cagayan de Oro City, viral load (VL) machines are not readily available, so that “PLHIVs are forced to go to facilities that have VL machines, making payments on their own (and even if this is supposed to be covered by PhilHealth), or just not get it altogether.”
For Quilacio, “unless these scenarios are dealt with, we’re really expecting for things to just worsen.”
And for Positive Elders Philippines’ Cabreros: “We need to continue to push for an enabling environment to convince and influence high-risk individuals to take the rest, aggressively promote HIV testing, and pick up from where HIV response efforts have stopped due to the Covid-19 pandemic.”
Holboell-Formentera added that the AMTP 7 contains “lessons from the past”. Nonetheless, “do we really need to wait for another over 300% increase (in APAC) before doing something? It has to be asked: What innovative approaches have you done, and you will still do, instead of simply recycling responses?”
*THIS ARTICLE HAS BEEN AMENDED ON DECEMBER 2, 2022, 5:49PM, TO ADD THE STATEMENTS OF JOSHUA HOLBOELL-FORMENTERA OF THE POSITIVE ACTION FOUNDATION PHILIPPINES, INC. (PAFPI).
**THE STATEMENTS OF AIVAN ALVAREZ OF WAGAYWAY EQUALITY WERE ADDED ON DECEMBER 6, 2022, 8:00PM.
