Views to Ponder: A looming disaster waiting to happen

by Admin-Phmp

Let’s travel back in time first. In 1959, the first known case of HIV (which stands for human immunodeficiency virus) in humans occurred in a man who died in the Congo. In 1969, an American teenager named Robert Rayford, died of an illness that baffled his doctors; test samples of his remains were found to have HIV.

Around January in 1984, the first case of HIV infection was reported in the Philippines. But it wasn’t until 1992 when Dolzura Cortez, who was infected with HIV, came out in the open and bared everything to journalist Ceres Doyo about how she got the disease. The said story, which was made into a movie later on, raised national awareness of HIV/AIDS in the country.

The state of the HIV epidemic was described as “low and slow,” in stark contrast to many other countries in the region. Among the likely reasons for the slow development of the disease were: the country’s complicated geography, uncommon injecting drug use, existence of sexual conservatism culture, low clients of sex workers, less anal sex practitioners, and high rate of circumcised males.

But the situation is now changing. “In the past decade, the Philippines has gained notoriety as the country with the fastest-growing HIV epidemic in the Western Pacific region,” wrote Dr. Louie Mar. A. Gangcuangco and Patrick C. Eustaquio, authors of “The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023.”

Dr. Gangcuangco is with the Hawaii Center for AIDS at the John A Burns School of Medicine at the University of Hawaii. Eustaquio is connected with Love Yourself, Inc., which is based in Mandaluyong. Their extensive report was published in Tropical Medicine and Infectious Disease journal. 

“While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines,” the two authors wrote.

Let’s talk about statistics. “In 2012, there were only approximately nine new HIV cases every day,” they noted. “In 2023, however, there have been 46 cases reportedly daily, a stunning 411% increase in daily incidence in 10 years.”

As of January 2023, there were 110,736 HIV cases reported in the country. The two authors predicted the number of people living with HIV (PLHIV) will increase by 200%: from 158,400 in 2022 to 364,000 by 2023.

A “looming disaster.” That’s how a national paper columnist described the situation of HIV (human immunodeficiency virus) infection and AIDS (acquired immune deficiency syndrome) cases in the Philippines.

Dr. Rafael R. Castillo, who writes a regular column for Philippine Daily Inquirer and editor-in-chief of Health and Lifestyle, urged the government to take a hard look at the alarming statistics “and make a serious and willful effort to curb” the alarming situation.

If nothing is done, the Philippines may wake up one day as the “epicenter of a growing HIV epidemic in the region,” according to Dr. Edsel Salvaña, the director of the Institute of Molecular Biology and Biotechnology at the National Institutes of Health at the University of the Philippines.

“If we’re not vigilant, we just might be a few mutations away from a resurgence of the AIDS virus which can cause pandemic spread of the disease,” warned Dr. Salvaña, a molecular epidemiologist who’s one of the few scientists in Asia doing advanced biomolecular or genomic studies to determine the mutation of the HIV.

In the Philippines, most of those affected by HIV are what the two authors described as “key populations,” which comprised 92% of the new infections in 2022, and “vulnerable populations.” Key populations include males having sex with males (MSM), transgender women, sex workers, trafficked women and girls, and people who inject drugs (PWID).

Vulnerable populations include migrant workers, people with disabilities, people in enclosed spaces, and female partners of key populations.

Sexual intercourse, primarily among MSM, is the leading mode of transmission in the country, Dr. Gangcuangco and Eustaquio surmised. They cited data from the Department of Health (DOH) issued in January 2023 which showed that approximately 70% of all HIV cases were among MSM and 17% were among males who have sex with both males and females.

HIV transmission through sharing of infected needles remains relatively low, the two authors contend. The highest figure was in 2010 when it accounted for 9% of all new HIV cases. But since 2011, this mode of transmission has considerably decreased.

What is alarming though is that most new cases involve young people. More than half of these youths were in advance infection of HIV. Ninety-nine percent of the cases were infected through sexual contact.

This phenomenon is not confined to the Philippines alone. “Majority of people newly diagnosed with HIV are among persons between 25 and 34 years old,” Dr. Gangcuangco said in an interview. “This is likely driven by the higher risk of sexual behavior within this age group. The accessibility of casual sex through online platforms is also likely contributing to the increased incidence of HIV in this age group.”

These days, however, being infected with HIV is no longer a death sentence. “HIV is not and should not be a death sentence anymore,” pointed out Dr. Gangcuangco in an interview. “If HIV is detected early and if the patient takes antiretrovirals early, the virus can be controlled.”

However, in order to be treated, you need to know if you have HIV. And you will only find out if you undergo HIV testing. “Testing for HIV and other sexually-transmitted infections is strongly advised for all people exposed to any of the risk factors,” said the World Health Organization (WHO) in its website. “This way people learn of their own infection status and access necessary prevention and treatment services without delay.”

However, all HIV testing services must follow the 5 principles recommended by WHO: consent (informed), confidentiality, counselling, correct test results, and connection (linkage to care, treatment and other services).

In Davao City, there are three facilities where people can go to be tested for HIV: Southern Philippine Medical Center in Bajada, Davao Doctors Hospital in Quirino Street, and Davao Reproductive Health and Wellness Center in Emilio Jacinto Street. In Tagum City, they can go to Davao Regional Medical Center in Apokon.

“HIV testing must be made accessible to everyone,” Dr. Gangcuangco urged. “The Philippines must develop the infrastructure to facilitate HIV self-screening using home-based kits. This would entail a telephone hotline for anyone who has questions about HIV or among those who might test positive using the screening test.

“Clinics must also be able to expand to accommodate HIV testing after office hours and during weekends,” he suggested. “Free HIV testing must be made available and accessible to those who could not afford it.”

According to Dr. Gangcuangco, knowing one’s HIV status is not just a right but also a responsibility. “People with HIV can live normal and productive lives as long as they take their medications and follow-up regularly with your doctor. Getting tested is not only for yourself, but also for your loved ones,” he said.

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