essay about hiv in the philippines

HIV in the Philippines: A Persisting Public Health Crisis Closely Tied To Social Stigma

By Emily Mrakovcic

Illustration by Ella Olea

Introduction

Human immunodeficiency virus, also known as HIV, is present in several regions around the world. Although the virus has the same transmission mechanisms and symptoms regardless of its locality, HIV is experienced very differently across the globe.¹ This is due to several cultural and social factors impacting how HIV is viewed and treated. The Philippines is one country where the way individuals view HIV heavily impacts its transmission and treatment. 2 Due to stigma and discrimination surrounding HIV, the Philippines is currently experiencing the fastest-growing HIV epidemic in the Western Pacific. 3   Specifically, stigma and discrimination against men who have sex with men (MSM) and HIV-positive MSM have significantly boosted the proliferation of the virus. 4 MSM with HIV in the Philippines face an intersection of stigma: on the one hand they experience stigma toward their sexual orientation, and on the other hand, they experience stigma toward their HIV status. 4   Because of the stigma MSM encounter, they face several barriers to HIV prevention, testing and treatment. 5 Approximately 70 percent of HIV cases in the Philippines are among MSM, 3 yet over three-quarters of MSM in the Philippines have never obtained an HIV test. 2   Not only do MSM feel discouraged from seeking care, but healthcare facilities are failing to provide adequate services for this at-risk population. 4  Understanding the social determinants of HIV transmission in the Philippines is needed to provide insight as to why MSM are disproportionately infected with the virus. 

In a country where discrimination is still legal in some contexts, and only 73 percent of Filipinos say society should accept homosexuality, 6  discrimination against MSM is not uncommon. Homosexuality is legal, but LGBTQ+ individuals cannot adopt children, conversion therapy is not banned, and gay marriage is not recognized. 6 Overall, Philippine views of homosexuality reflect an attitude that is tolerant, but not accepting, of LGBTQ+ individuals. This view often results in discrimination within workplaces and social circles. 3 Attitudes toward HIV-positive individuals are also stigmatized, as HIV infection is often equated to sin and immorality. 5 Strong roots in Catholicism coupled with poor HIV education are some of the main drivers of both HIV and sexual orientation-related stigma. 4  Together, this array of stigma and discrimination solidify as barriers to HIV testing and treatment within the health care system. 

Individuals with HIV have viral loads, which are measurements of the amount of virus present inside the body. 7 A high viral load indicates a large amount of HIV in the blood. When an individual has a high viral load, they are very contagious. Conversely, when an individual has a low viral load, they have a low amount of HIV in their blood and are unlikely to transmit the virus. 8 In the Philippines, where treatment services such as antiretroviral therapy (ART) are not sufficiently provided and made accessible, a failure to treat is also a failure to prevent. When treatment services do not successfully suppress the viral loads of affected populations, not only do infected individuals become sicker, but they also have the potential to spread the virus. 7

The research question I will address in this paper is: How do stigma and discrimination toward MSM in the Philippines impact their access to prevention, testing, and treatment services for HIV? Through this question, two general ideas can be explored through peer-reviewed literature. Firstly, the question will explore how the desire of MSM to seek prevention, testing, and treatment is affected by experiences of stigma and discrimination in multiple capacities. The question will also explore how discrimination within healthcare facilities, in addition to the failure of healthcare facilities to accommodate for discrimination experienced outside of the healthcare setting, contributes to the lack of appropriate HIV care for MSM. 

When conducting a literature search, I used the PubMed and Embase search engines. Through these search engines, I accessed peer-reviewed articles from the Multidisciplinary Digital Publishing Institute, National Library of Medicine, Guilford Journals, BMC Public Health, and Taylor & Francis Online. Keywords I used to search for material were “HIV/AIDS,” “HIV,” “MSM” and “the Philippines.” Generally, I looked for articles published in the last five years to capture the most recent updates on the epidemic.

HIV Infection Incidence Among MSM

For the past two decades, the Philippines’ HIV epidemic has been driven by sexual transmission among MSM. 9 However, the incidence of HIV infection among MSM was not extensively evaluated until a study titled “HIV incidence among men who have sex with men (MSM) in Metro Manila, the Philippines: A prospective cohort study 2014-2018” was conducted by Rossana Ditangco and Mary Lorraine Mationg. The purpose of this study was to determine the incidence of HIV infection and its associated risk factors among MSM in Metro Manila, the largest metropolitan area in the Philippines. By understanding the epidemiology of the outbreak, Ditangco and Mationg hoped to assist in the formulation of relevant biomedical and socio-behavioral interventions. Participants were 18 or older, Metro Manila residents, and confirmed HIV-negative. All participants had anal or oral sex in the past 12 months. The researchers administered in-person questionnaire interviews and HIV tests every 3 months to all 708 participants. Data was collected on participant knowledge, attitudes, and practices regarding HIV and AIDS. During the follow-up period, 56 new cases were recorded, resulting in an incidence rate of 2.7 cases per 100 patient years. 9 The study found that having two or more sexual partners and having anal sex without a condom in the past 3 months were factors significantly associated with HIV infection. 9  High incidence was also recorded among the 18-24 year age range; 9 Ditangco and Mationg hypothesized that this may reflect the sexually active nature of young MSM. Overall, there was a high HIV incidence rate among Filipino MSM. 9  The findings from this study highlight the need for effective HIV prevention, surveillance, and treatment strategies. Additionally, based on these findings, younger MSM aged 18-24 should be a focus of interventions. Although this study provides limited insight into the stigma and discrimination faced by MSM, baseline effects of certain risk factors, such as sexual activity and condom use, were established. Understanding HIV incidence among this key population provides a strong epidemiological foundation to build upon with social and cultural context.

Drivers and Experiences of Stigma and Discrimination

At a time of explosive HIV transmission in the Philippines, there was little understanding of MSM experiences with HIV-related stigma. 10 In 2017, a study titled “‘An Evil Lurking Behind You’: Drivers, Experiences, and Consequences of HIV-Related Stigma Among Men Who Have Sex With Men With HIV in Manila, Philippines” was conducted by Alexander C. Adia et al. to understand MSM experiences with HIV-related stigma and how these experiences subsequently influence their behaviors and qualities of life. The study consisted of 21-hour-long interviews of both MSM living with HIV and community-based organization workers. Participants resided in Manila and were required to be able to communicate in English. The interviews were designed to capture specific patterns of stigma that MSM living with HIV experienced and internalized. Stigma resulting in mental health issues, delays in HIV testing, and avoidance of health services were the main points qualitatively measured during the interviews. The study found that a majority of MSM participants were affected by an intersection of HIV-related stigma and sexual orientation-related stigma. 10 These stigmas were often rooted in ideas of morality, dirtiness, and sin. 10  Participant #4 reported difficulty seeking treatment due to peers blaming them for their diagnosis and labeling them as promiscuous, and a sex addict, because of their serostatus and sexual orientation. Participant #16 mentioned that, due to being HIV-positive, they were ostracized from communities they were formerly a part of. Additionally, several participants expressed signs of internalized stigma, stating that they deserved to get HIV as a consequence of their wrongdoings, such as identifying as gay. 10 Overall, the study identified three main ways that stigma serves as a barrier to HIV treatment: detering MSM from seeking treatment despite its availability, creating attitudes that reduce the urgency to take HIV medication, and impeding disclosure of HIV status, thus resulting in HIV-positive MSM not promptly receiving the treatment they need. 10  The study concluded that public health strategies must be developed to address discrimination at both societal and individual levels to reduce stigma-related harms.

Law and policy are powerful tools capable of improving the lives of people facing discrimination due to a diagnosis. Attempting within the law to reform existing structural inequalities may have a positive impact on societal attitudes toward HIV-positive individuals. 11 However, before this study, there was minimal research on the role legal protections in the Philippines play in improving the well-being of people living with HIV (PLHIV). 11 In 2019, Alexander C. Adia et al. conducted a study titled “Sword and Shield: Perceptions of law in empowering and protecting HIV-positive men who have sex with men in Manila, Philippines” that aimed to examine how MSM living with HIV perceive HIV-related legal protections, and how these protections subsequently influence their lives. Currently, the Philippines has a law, Republic Act 11166, that contains several anti-discrimination provisions. 11 The study conducted one hour-long semi-structured interviews with 21 participants to gauge how MSM living with HIV experience the impacts of Republic Act 11166. The participants were HIV-positive MSM living in Metro Manila, aged 18 years and above, and able to communicate in English. The study identified two overarching feelings experienced by participants as a result of the law: empowerment and protection. 11 Participants reported that the law helped them feel normal in social settings they previously felt disconnected from. 11 Additionally, participants derived empowerment from the law because it displayed government commitment to deterring discrimination. 11 The law also allowed for more positive and beneficial discussions regarding HIV to occur among MSM living with HIV. 11  However, the interviews also highlighted some participant concerns, such as the efficacy of the aforementioned legal protections. They worried that companies and local governments may only treat the law as a suggestion. 11 Additionally, concerns were raised about the law lacking the authority to counter social discrimination in the workplace or social circles. 11  Overall, however, the findings show that Republic Act 11166 has alleviated internalized stigma and feelings of powerlessness among MSM in the study. The necessity of legal justice and human rights advocacy in HIV treatment highlights the role stigma plays in shaping the HIV epidemic in the Philippines.

Although HIV is mainly transmitted through MSM, HIV testing uptake among this demographic remains low. 12 This is mainly due to poor coordination of care within the Philippines’ health care system. 12 A study conducted by Jan W. de Lind van Wijngaarden et al., titled “‘I am not promiscuous enough!’: Exploring the low uptake of HIV testing by gay men and other men who have sex with men in Metro Manila, Philippines,” aims to explain why a significant proportion of Metro Manila-based MSM lacked access to HIV testing and treatment services. The goal of collecting this data was to reform health services to be more accessible, effective, efficient, equitable, and MSM-friendly. 12  48 MSM from Metro Manila were recruited by their level of engagement with the HIV care cascade. The HIV care cascade consists of four levels: diagnosis, linkage to care, receipt of care, and retention of care. 12 Case series interviews were designed to explore barriers to the uptake of HIV services. The study found that the main reasons to postpone treatment were higher socioeconomic class, feelings of moral superiority to other gay-identifying men, lack of proximity to the testing facility, fear of what will happen once infected, fear of stigma pertaining to serostatus or sexual orientation, fear of ART side effects, and fear of high health care expenses. 12 Misconceptions regarding HIV and ART were also observed. Some participants believed that feeling physically fit meant that they could not be sick. 12 Additionally, if a potential sexual partner appeared healthy, participants reported feeling less inclined to use a condom. Social stigma excludes HIV from health education conversations, thus contributing to the aforementioned misconceptions. However, other concerns expressed by participants were not misconceptions, but striking realities. Participants feared loss of support from friends or family upon receiving an HIV diagnosis. 12 Additionally, fear of discrimination often translated into concerns regarding testing confidentiality, 12 which was of the utmost importance to most participants. The data overall shows that most participants did not see a need to get tested, despite significant risk. Even participants who acknowledged their high-risk status did not feel compelled to get tested. 12 A major determining factor in this choice was fear of what would happen upon testing positive. 12  Potential solutions outlined by the researchers were increasing testing locations, hiring non-medical outreach workers to enhance service delivery, and providing cost-free knowledge of HIV to help tackle commonly held misconceptions. All of these solutions aim to bridge existing gaps within the current healthcare system, thus enhancing the transition from one level of the HIV care cascade to the next.  

The HIV Health Care System

Healthcare providers are essential to curbing any epidemic, and the way providers structure their delivery of care can have lasting effects on the healthcare system as a whole. The purpose of Arjee J. Restar’s study, “Prioritizing HIV Services for Transgender Women and Men Who Have Sex With Men in Manila, Philippines: An Opportunity for HIV Provider Interactions,” was to examine healthcare provider attitudes, perceived competencies, and abilities to prioritize the provision of HIV-related services to MSM. One-on-one qualitative interviews examined factors that may have impacted HIV prevention and treatment services for MSM. 15 HIV providers residing in Manila were interviewed. All providers were over the age of 18 and had a history of serving MSM. Restar et al. found that a majority of providers had overall positive attitudes toward all patients in their practices. Most providers valued equality for all of their patients but reported that despite their willingness to provide care to MSM, their actual competencies to provide context-specific care were not up to par. 13  This lack of competency was often due to one of three main reasons: not knowing the health needs of MSM, having little training with HIV, or having difficulty being sensitive to patient gender and sexual orientation. 13 Some providers expressed interest in learning more about LGTBQ+ individuals in their practices but lacked knowledge of the lived experiences of these patients. 13 Additionally, some providers reported that their facilities did not offer training specifically tailored to providing HIV services to MSM. 13  The study conveys an overall lack of preparedness among many providers regarding delivering MSM and HIV-specific care. The findings of this study also indicate the importance of not just patient-focused interventions, but provider-focused interventions as well. Healthcare providers require cultural competence to deliver HIV-sensitive services. This study indicates the need for a shift to more specific interventions tailored to meet the needs of key populations. 

The HIV care cascade, designed to examine the engagement of PLHIV with medical care, previously lacked sufficient data on non-heterosexual populations, despite MSM being disproportionately affected by the epidemic. 14 A study conducted by Marisse Nepomuceno et al., titled “A descriptive retrospective study on HIV care cascade in a tertiary hospital in the Philippines,” sought to describe the HIV care cascade at the tertiary level in a hospital-affiliated HIV clinic after the adoption of the test-and-treat strategy. The test-and-treat strategy screens patients for HIV infection and provides treatment soon after a positive test result, thus bridging the gap between testing and treatment. 14 A descriptive, retrospective cohort study was conducted. Researchers reviewed the medical records of patients enrolled at the University of the Philippines’ Philippine General Hospital in Manila. Demographic and clinical data relevant to each stage of the HIV care cascade were collected in order to understand the linkage to care, ART initiation, retention in care, and virologic suppression. 584 participants were included; all were receiving treatment from the Philippine General Hospital and were aged 18 or older. Ninety one percent were male, and 55.6 percent contracted HIV from male-male sex. 14 Ninety-nine point five percent of patients were linked to care following diagnosis, 95 percent of patients initiated ART, 78.8 percent of patients were retained in care and maintained ART, 47.9 percent of patients had their HIV viral load tested in follow-up, and 45.5 percent of patients achieved viral suppression. 14 Additionally, of the 99.5 percent of patients who were linked to care, 10 percent of these patients were linked to care more than 12 months following their diagnosis. 14  This is especially concerning with HIV, as failure to achieve viral suppression allows for further transmission. Overall, this study captured the substantial loss of patients throughout the HIV care cascade. The study concluded that many gaps are remaining in the cascade. Nepomuceno et al. suggested the use of outreach programs and telemedicine to enhance adherence to ART and viral load testing. Traditional medical facilities may lack the capacity to fulfill all medical needs of MSM living with HIV, but these needs can still be met if some responsibility for care is shifted to informal care settings, such as community-based programs.

The Intersection of Health Care and Stigma

Structural, social, and behavioral factors all impact HIV service uptake among MSM. 15 Understanding these factors is critical when developing culturally competent care models. A study conducted by Arjee J. Restar et al., “Differences in HIV risk and healthcare engagement factors in Filipinx transgender women and cisgender men who have sex with men who reported being HIV negative, HIV positive or HIV unknown,” aimed to understand HIV risk and health care engagement among at-risk individuals. An online cross-sectional survey examined the structural, social, and behavioral factors impacting HIV service uptake among cisgender MSM. The survey assessed factors typically associated with HIV status, such as demographics, social marginalization, HIV risk, healthcare engagement, and substance abuse. 15 The study found that the most prominent barriers to healthcare engagement were discrimination by healthcare workers, clinic wait time, inconvenient location, and concerns about disclosing HIV status. 15  Roughly a third of participants reported sexual orientation, gender identity, or a lack of anti-LGBT discrimination policies as reasons for avoidance of HIV services. 15 The study also found that only 16 percent of cis-MSM participants had ever received an HIV test and knew of their HIV status. 15 Concurrently, MSM are more likely to engage in HIV-risk behaviors including drug and alcohol use, condomless sex, and sex work. 15  Restar et al. suggest harm reduction services, testing outreach, and community partner involvement to increase MSM engagement with HIV services. These solutions, both inside and outside the healthcare setting, acknowledge the social determinants responsible for MSM behaviors that increase their risk of HIV and decrease their odds of healthcare engagement. 

Testing rates among MSM, especially young MSM, remain low despite high rates of transmission. 16 The main model of HIV testing, facility-based testing, has proven to be unsuccessful in providing sufficient means of testing to MSM. 16 HIV self-testing (HIVST) is an alternative strategy to address this gap in testing. HIVST allows individuals to conduct their own rapid diagnostic tests and maintain result confidentiality. 16 So far, HIVST has successfully increased testing in other Asian countries, including China, Hong Kong, and Vietnam. 16 Jesal Gohil et al. conducted a study titled “Is the Philippines ready for HIV self-testing?” to measure perceived acceptability, feasibility, and challenges of HIVST among key informants and target users. Semi-structured interviews qualitatively assessed potential barriers, opportunities, and challenges regarding HIVST policy and regulation. Focus group discussions took place with 42 target users and 15 individuals involved with the provision of HIV testing programs. All participants resided in Metro Manila. The study found that MSM were receptive to HIVST due to its elements of convenience and privacy. 16 Linkage to HIV care following a positive test result was a point of concern for participants, but they also worried about stigma-related barriers they would face within the health care system upon initiation of care. 16 The study also found that pharmacies and community-based facilities, not traditional medical facilities, were popular choices for picking up tests. 16  Based on these findings, the study concluded that one of the largest problems associated with HIVST is not MSM willingness, but HIV-related stigma within the health care system. While HIVST allows individuals to take responsibility for their testing, they still lack control over what they will experience within the healthcare system following a positive diagnosis.

A key principle to treating HIV, U=U, asserts that if HIV is undetected, it is also untransmittable. 17 If an HIV-positive individual adheres to their ART regimen, then their viral load will remain low enough to prevent transmission. 17 This idea highlights the importance of viewing treatment as prevention. Thus, supporting adherence to ART is crucial to managing HIV. Cara O’Connor et al. conducted a study titled “Risk factors affecting adherence to antiretroviral therapy among HIV patients in Manila, Philippines: a baseline cross-sectional analysis of the Philippines Connect for Life Study” to measure treatment adherence and to identify whether ART adherence requires additional interventions to increase its effectiveness. Such an analysis would provide the groundwork for adherence interventions specifically tailored to MSM. A cross-sectional analysis was conducted using a framework that gathered information on HIV-related risk behaviors and adherence to ART. To guide data collection, questions were framed around demographics, clinical characteristics, HIV knowledge, risk behaviors, and adherence or lack thereof. 17 All 426 participants were HIV-positive and attending a clinic in Metro Manila that was a part of the Connect for Life Cohort Study. All participants were required to speak English and have a mobile phone. The study found that 100 percent adherence in the last 30 days was only achieved by 52.1 percent of participants. 17 Longer time on treatment, inconsistent condom use, and injection drug use were all associated with reduced adherence. 17 The most common reasons for missing medication were being too busy, forgetting, falling asleep, being away from home, or having a change in their daily routine. 17 Additionally, 44 percent of patients who skipped a pill at some point did so because they did not want to be seen taking their medication. 17 On the other hand, being in a relationship with an HIV-negative partner was associated with increased adherence. 17  These findings indicate a similarity between HIV-risk behaviors and nonadherence behaviors. The data also indicates a positive association between HIV knowledge and ART adherence. The data collected from this study underscores the need for interventions addressing treatment fatigue and social stigma. Interventions may accomplish this through the implementation of social support and harm reduction programs centered specifically around the struggles of MSM. 

Pre-exposure prophylaxis (PrEP) is the primary prevention mechanism for HIV. 18 To be effective, the pill must be taken once a day. Although PrEP has proven to be extremely successful in preventing HIV transmission, the uptake of HIV prevention services among MSM in the Philippines remains low. 18 Awareness and interest in PrEP are key determinants of successful uptake, but current levels of these feelings among MSM were unknown 18 until a study was conducted by Arjee Restar et al., titled “Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men.” The purpose of this study was to examine levels of PrEP awareness and interest among cisgender MSM in the Philippines. The results of this study have the potential to guide the future rollout of PrEP programs. A quantitative web-based survey was designed to examine the relationship between PrEP awareness/interest and factors such as socioeconomic status, healthcare experiences, and access to HIV services. The study found overall high levels of awareness and interest in taking PrEP. While only 56.4 percent of participants had high HIV knowledge, 74.9 percent of participants were aware of PrEP, and 88.8 percent of participants were interested in taking the medication. 18 PrEP knowledge was more common than a high level of HIV knowledge. 18 The most frequently recorded reasons for lack of interest in PrEP were needing to know more information first and not liking medication in the form of pills. 18 Factors associated with greater odds of PrEP awareness were a college education or higher, having had an HIV test in the past, high HIV knowledge, and having discussed PrEP among friends. 18 Factors associated with lower odds of PrEP awareness were being straight-identified, experiencing health care discrimination due to sexual identity, and avoiding HIV services due to cost, sexual identity, or a lack of LGBT anti-discrimination policies. 18 Restar et al. concluded that there is a growing demand for PrEP in the Philippines. However, those who were less aware of PrEP either came from poorer, less educated backgrounds or encountered barriers in the HIV health care system. 18  To increase the likelihood of successful PrEP interventions, future actions must be taken to provide HIV education and reduce discrimination within the healthcare system.

Discussion 

Limitations: Assessment of the studies reveals some flaws among study designs and collected data. All of the studies were based in urban areas, primarily Manila. The lack of regard for rural areas may result in conclusions not entirely representative of all MSM in the Philippines. HIV knowledge and risk behaviors may vary among urban and rural areas depending on what resources and funding are available. Additionally, legal protections of Republic Act 11166 may be weaker in regions with less government oversight. Another weakness of some studies was that participation requirements potentially favored the participation of individuals from a higher socioeconomic class. Having to speak English or possess a phone may deter some individuals from partaking in the study, thus failing to assess the entirety of the target population. Bias could have also occurred in the studies that used self-reporting surveys and questionnaires, as participants may have misremembered information or been untruthful to avoid judgment. A final critique of many of these studies is a lack of specific, thorough solutions. After conducting extensive analyses of the HIV epidemic in the Philippines, many of the studies provided only brief and general descriptions of potential interventions.

Strengths: A significant strength of the research in this field is the high volume of qualitative studies conducted. When examining stigma and discrimination, no statistic can accurately capture the unique experiences of MSM pertaining to their serostatus and sexual orientation. The use of interviews and informal questioning provides a space for participants to openly share their experiences without being confined to black-and-white, yes-or-no questions. Additionally, the interviewing of healthcare providers by Restar et al. provided an alternative perspective that was beneficial to comprehensively understanding the HIV healthcare system.

The HIV epidemic among MSM in the Philippines continues to be a pressing public health issue, despite the growing body of research working to understand HIV in this specific context and provide potential solutions. Overall, the studies addressed in this synthesis had similar findings, thus reinforcing the idea that MSM in the Philippines receive inadequate HIV health care due to stigma and discrimination surrounding serostatus and sexual identity. I believe the studies in this synthesis provide sufficient, relevant data and evidence that adequately answer my research question. Stigma and discrimination are encountered by MSM among family, friends, peers, coworkers, and health providers alike. 11 All of these experiences of discrimination summate into trends of hesitancy to seek HIV health care, including but not limited to PrEP, 18  facility-based HIV testing, HIVST, ART, and follow-up viral load testing. 14 Additionally, just as MSM experience discrimination that deters them from seeking treatment, there are also factors within the health care system limiting MSM engagement with HIV services. Inadequate skills and knowledge of providers, 13 insufficient anti-discrimination policies, 18 and gaps of continuity within the HIV care cascade 14 are all shortcomings of the HIV health care system that serve as barriers to care for MSM. Stigma and discrimination may result in avoidance of testing, avoidance of treatment, nonadherence to treatment, or a lack of knowledge of available preventative and treatment services. 10 Additionally, several misconceptions resulting from HIV stigma further contribute to the aforementioned behaviors. 12  

Context-specific and community-based interventions that put patient-centeredness, convenience, and confidentiality at the forefront of their work have the potential to successfully reach a larger scale of MSM who are in need of preventative, testing, and treatment services. Future directions should incorporate these elements of care into both traditional medical facilities and outpatient clinics, community-based organizations, and educational programs. Stigma and discrimination toward these individuals are deeply rooted within Filipino culture, thus requiring solutions that are dispersed among a variety of support outlets accessible to MSM. Restructuring views toward MSM and PLHIV within both society and the health care system are critical for enacting meaningful change. Future research efforts may benefit from using already collected data to propel implementation-focused studies that aim to craft interventions specifically centered around both at-risk MSM and HIV-positive MSM.

• Aids I of M (US) C on a NS for. International Aspects of AIDS and HIV Infection . National Academies Press (US); 1986. https://www.ncbi.nlm.nih.gov/books/NBK219140/
• Sison OT, Baja ES, Bermudez ANC, et al. Association of anticipated HIV testing stigma and provider mistrust on preference for HIV self-testing among cisgender men who have sex with men in the Philippines. BMC Public Health . 2022;22(1). doi: https://doi.org/10.1186/s12889-022-14834-x
• Gangcuangco LMA, Eustaquio PC. The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023. Tropical Medicine and Infectious Disease . 2023;8(5):258. doi: https://doi.org/10.3390/tropicalmed8050258
• Bustamante J, Plankey MW. Identifying Barriers to HIV Testing Among Men Who Have Sex with Men (MSM) in the Philippines. Georgetown Medical Review . Published online July 18, 2022. doi: https://doi.org/10.52504/001c.36967
• Alibudbud R. The Philippine HIV crisis and the COVID-19 pandemic: A worsening crisis. Public Health . Published online September 2021. doi: https://doi.org/10.1016/j.puhe.2021.09.008
• Equaldex. LGBT Rights in Philippines | Equaldex. Equaldex.com. Published June 19, 2018. https://www.equaldex.com/region/philippines
• What Does HIV Viral Load Tell You? WebMD. https://www.webmd.com/hiv-aids/hiv-viral-load-what-you-need-to-know
• Centers for Disease Control and Prevention. HIV Basics. CDC. Published 2019. https://www.cdc.gov/hiv/basics/index.html
• Ditangco R, Mationg ML. HIV incidence among men who have sex with men (MSM) in Metro Manila, the Philippines: A prospective cohort study 2014–2018. Medicine . 2022;101(35):e30057. doi: https://doi.org/10.1097/MD.0000000000030057
• Adia AC, Bermudez ANC, Callahan MW, Hernandez LI, Imperial RH, Operario D. “An Evil Lurking Behind You”: Drivers, Experiences, and Consequences of HIV–Related Stigma Among Men Who Have Sex With Men With HIV in Manila, Philippines. AIDS Education and Prevention . 2018;30(4):322-334. doi: https://doi.org/10.1521/aeap.2018.30.4.322
• Adia AC, Restar AJ, Lee CJ, et al. Sword and Shield: Perceptions of law in empowering and protecting HIV-positive men who have sex with men in Manila, Philippines. Global Public Health . 2019;15(1):52-63. doi: https://doi.org/10.1080/17441692.2019.1622762
• de Lind van Wijngaarden JW, Ching AD, Settle E, van Griensven F, Cruz RC, Newman PA. “I am not promiscuous enough!”: Exploring the low uptake of HIV testing by gay men and other men who have sex with men in Metro Manila, Philippines. Melendez-Torres GJ, ed. PLOS ONE . 2018;13(7):e0200256. doi: https://doi.org/10.1371/journal.pone.0200256
• Restar AJ, Chan RCH, Adia A, et al. Prioritizing HIV Services for Transgender Women and Men Who Have Sex With Men in Manila, Philippines. Journal of the Association of Nurses in AIDS Care . 2019;31(4):1. doi: https://doi.org/10.1097/jnc.0000000000000131
• Nepomuceno M, Abad CL, Salvaña EM. A descriptive retrospective study on HIV care cascade in a tertiary hospital in the Philippines. Santella AJ, ed. PLOS ONE . 2023;18(1):e0281104. doi: https://doi.org/10.1371/journal.pone.0281104
• Restar AJ, Jin H, Ogunbajo A, et al. Differences in HIV risk and healthcare engagement factors in Filipinx transgender women and cisgender men who have sex with men who reported being HIV negative, HIV positive or HIV unknown. Journal of the International AIDS Society . 2020;23(8). doi: https://doi.org/10.1002/jia2.25582
• Gohil J, Baja ES, Sy TR, et al. Is the Philippines ready for HIV self-testing? BMC Public Health . 2020;20(1). doi: https://doi.org/10.1186/s12889-019-8063-8
• O’Connor C, Leyritana K, Calica K, et al. Risk factors affecting adherence to antiretroviral therapy among HIV patients in Manila, Philippines: a baseline cross-sectional analysis of the Philippines Connect for Life Study. Sexual Health . 2021;18(1):95. doi: https://doi.org/10.1071/sh20028
• Restar A, Surace A, Adia A, et al. Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men. Journal of Medical Internet Research . 2022;24(1):e24126. doi: https://doi.org/10.2196/24126

• Feature stories /

Strengthening the fight against HIV in the Philippines

On World AIDS Day, the World Health Organization (WHO) is calling for new action and stronger commitment from the global health community for the fight against HIV/AIDS.

With 22 new cases of HIV infection reported every day, the Philippines has one of the fastest growing HIV epidemics, an anomaly to the declining HIV prevalence trends observed across the world. The national HIV prevalence remains less than 0.1%, but is rapidly expanding among key populations such as men who have sex with men (MSM) and people who inject drugs (PWID). In 2015 the HIV prevalence among MSM reached as high as 14%, and one out of two people who inject drugs (PWID) are HIV positive. A large number of HIV negative MSM and PWID as well as their spouses and partners are at an increased risk for infection by sexual transmission of HIV.

To counter the high rates of infection, new and innovative prevention strategies are arguably needed. Oral pre-exposure prophylaxis (PrEP) has demonstrated efficacy in reducing HIV incidence among MSM, serodiscordant couples (where one partner is HIV negative and the other is HIV positive), women and PWID. Oral PrEP for HIV requires daily dosage of antiretroviral (ARV) drugs by an uninfected person before potential exposure to block the acquisition of HIV. When taken as directed, PrEP is estimated to be over 90% protective against HIV.

WHO recommends offering PrEP to all population groups at substantial risk such as serodiscordant couples, inconsistent use of condoms and sharing of needles among injecting drug users. High quality evidence shows the level of protection from PrEP to be strongly correlated with adherence in those at risk.

Managing the HIV burden – Treatment as Prevention

The Philippines Health Sector Plan for HIV and STI 2015-2020 set the goal to maintain HIV infection below 66 HIV cases per 100,000 populations by preventing HIV transmission. Recent rapid rises in HIV prevalence among key populations across the Philippines reveal that prevention strategies currently employed have been inadequate to control the epidemic.

WHO is supporting the HIV clinic of the Research Institute of Tropical Medicine (RITM) of the Department of Health (DOH) to implement a PrEP pilot project in a peer-driven HIV testing clinic in Manila. In November 2015, WHO conducted site assessments and meetings with relevant government and nongovernment stakeholders, including DOH, Philippines Food and Drug Administration, The Joint United Nations Programme on HIV and AIDS, Love Yourself Inc. Showing strong motivation and willingness to test new strategies for preventing HIV , all recognized the important role that ARV chemoprophylaxis could play in curbing the HIV epidemic in the Philippines, and reducing new infections among key populations.

The pilot project will assist the DOH in identifying drivers for PrEP supply and demand, evaluate efficient and effective delivery, estimate goals for scaling up services and support the development of WHO guidance for PrEP implementation. HIV testing is required before and throughout PrEP in order to minimize the likelihood of acquiring HIV drug resistance. Therefore it presents an opportunity to increase HIV testing uptake and testing frequency and link those diagnosed HIV positive to treatment and care. PrEP can indirectly reduce HIV drug resistance by decreasing the number of HIV infections, thereby removing the potential for drug resistance caused by patient non-adherence to treatment.

On World AIDS Day, WHO calls on the government, civil society organizations, affected communities, health care providers and international partners to join in advocating, implementing and rolling out this new strategy to prevent the further spread of this preventable disease.

WHO (2015) recommends that oral PrEP containing tenofovir disoproxil fumarate (TDF) should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches.

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The state of the hiv epidemic in the philippines: progress and challenges in 2023.

1. Introduction

2. populations disproportionately impacted by hiv, 2.1. men having sex with men, 2.2. persons who inject drugs, 2.3. transgender populations, 2.4. other vulnerable groups, 3. the “abcs” of hiv prevention, 5. hiv counseling and testing, 6. hiv pre-exposure prophylaxis (prep), 7. hiv post-exposure prophylaxis (pep), 8. hiv treatment and care delivery, 8.1. access to hiv services, 8.2. antiretroviral therapy (art), 8.3. tuberculosis and hepatitis b co-infection, 8.4. treatment as prevention, 8.5. maternal–child transmission, 9. viral load monitoring, genotyping, and resistance testing, 10. changing molecular epidemiology of hiv, 11. conclusions, author contributions, conflicts of interest.

• Gangcuangco, L.M.A. HIV crisis in the Philippines: Urgent actions needed. Lancet Public Health 2019 , 4 , e84. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Tan, M.; De Leon, A.; Stoltzfus, B.; O’Donnell, C. AIDS as a political issue: Working with the sexually prostituted in the Philippines. Community Dev. J. 1989 , 24 , 186–193. [ Google Scholar ] [ CrossRef ]
• Farr, A.C.; Wilson, D.P. An HIV epidemic is ready to emerge in the Philippines. J. Int. AIDS Soc. 2010 , 13 , 16. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• GBD 2017 HIV Collaborators. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: A systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Lancet HIV 2019 , 6 , e831–e859. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• DOH Epidemiology Bureau. HIV/AIDS and ART Registry of the Philippines. January 2023. Available online: https://doh.gov.ph/sites/default/files/statistics/HARP-Report_January-AIDSreg2023_withAdvisory.pdf (accessed on 10 March 2023).
• Philippine Statistics Authority. Age and Sex Distribution in the Philippine Population (2020 Census of Population and Housing). Available online: https://psa.gov.ph/population-and-housing/node/167965 (accessed on 20 February 2023).
• Philippine National AIDS Council. 7th AIDS Medium Term Plan 2023–2028 Philippines: Fast Tracking towards 2030 ; Philippine National AIDS Council: Metro Manila, Philippines, 2023; Press Release. Available online: https://doh.gov.ph/press-release/DOH-LAUNCHES-7TH-AIDS-MEDIUM-TERM-PLAN-EMPHASIZES-EQUALITY-TO-ADDRESS-HIV (accessed on 29 April 2023).
• Gangcuangco, L.M.; Tan, M.L.; Berba, R.P. Prevalence and risk factors for HIV infection among men having sex with men in Metro Manila, Philippines. Southeast Asian J. Trop. Med. Public Health 2013 , 44 , 810–817. [ Google Scholar ]
• DOH Epidemiology Bureau. HIV/AIDS Registry of the Philippines. December 2022. Available online: https://doh.gov.ph/sites/default/files/statistics/EB_HARP_December_AIDSreg2022.pdf (accessed on 20 February 2023).
• DOH Epidemiology Bureau. The State of the Philippine HIV Epidemic 2016. Available online: https://doh.gov.ph/sites/default/files/publications/publication__nonSerials_State%20of%20HIV%20Epidemic%20in%20the%20Philippines.pdf (accessed on 10 April 2023).
• Lasco, G.; Yarcia, L.E. The Politics of Drug Rehabilitation in the Philippines. Health Hum. Rights 2022 , 24 , 147–158. [ Google Scholar ]
• Hurley, S.F.; Jolley, D.J.; Kaldor, J.M. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet 1997 , 349 , 1797–1800. [ Google Scholar ] [ CrossRef ]
• Philippine National Trade Repository. RA 9165 Comprehensive Dangerous Drugs Act of 2002. Available online: https://www.pntr.gov.ph/wp-content/uploads/2021/04/RA-9165.pdf (accessed on 10 February 2023).
• Department of Labor and Employment. Current Real Minimum Wage Rates. 2022. Available online: https://nwpc.dole.gov.ph/stats/current-real-minimum-wage-rates/ (accessed on 12 March 2023).
• Lasco, G. Decolonizing harm reduction. Harm Reduct. J. 2022 , 19 , 8. [ Google Scholar ] [ CrossRef ]
• Evaluation of harm reduction service delivery in Cebu City, Philippines (2013–2015). 2016. Available online: https://documents1.worldbank.org/curated/en/413401468197106125/pdf/106126-WP-P132149-PUBLIC-ACS.pdf (accessed on 12 March 2023).
• Restar, A.J.; Jin, H.; Ogunbajo, A.; Adia, A.; Surace, A.; Hernandez, L.; Cu-Uvin, S.; Operario, D. Differences in HIV risk and healthcare engagement factors in Filipinx transgender women and cisgender men who have sex with men who reported being HIV negative, HIV positive or HIV unknown. J. Int. AIDS Soc. 2020 , 23 , e25582. [ Google Scholar ] [ CrossRef ]
• Regencia, Z.J.G.; Castelo, A.V.; Eustaquio, P.C.; Araña, Y.S.; Corciega, J.O.L.; Rosadiño, J.D.T.; Pagtakhan, R.G.; Baja, E.S. Non-uptake of HIV testing among trans men and trans women: Cross-sectional study of client records from 2017 to 2019 in a community-based transgender health center in Metro Manila, Philippines. BMC Public Health 2022 , 22 , 1755. [ Google Scholar ] [ CrossRef ]
• Eustaquio, P.C.; Castelo, A.V.; Araña, Y.S.; Corciega, J.O.L.; Rosadiño, J.D.T.; Pagtakhan, R.G.; Regencia, Z.J.G.; Baja, E.S. Prevalence and Factors Associated With Gender-Affirming Surgery Among Transgender Women & Transgender Men in a Community-Based Clinic in Metro Manila, Philippines: A Retrospective Study. Sex Med. 2022 , 10 , 100497. [ Google Scholar ] [ PubMed ]
• The Global Database on HIV Related Travel Restrictions. Available online: https://www.hivtravel.org/Default.aspx?pageId=150 (accessed on 15 April 2023).
• Ditangco, R. HIV/AIDS in the Philippines. J. AIDS Res. 2006 , 8 , 12–16. [ Google Scholar ]
• Yanase, Y.; Ohida, T.; Kaneita, Y.; Agdamag, D.M.; Leaño, P.S.; Gill, C.J. The prevalence of HIV, HBV and HCV among Filipino blood donors and overseas work visa applicants. Bull. World Health Organ. 2007 , 85 , 131–137. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ofreneo, M.A.; Canoy, N. Falling into poverty: The intersectionality of meanings of HIV among overseas Filipino workers and their families. Cult. Health Sex 2017 , 19 , 1122–1135. [ Google Scholar ] [ CrossRef ]
• University of the Philippines Population Institute (2022, October 14). Zoom in, Zoom out: Filipino Youth in Focus. Population Institute, College of Social Sciences and Philosophy, University of the Philippines. Available online: https://www.uppi.upd.edu.ph/sites/default/files/pdf/YAFS5_National_Dissemination_Slides_FINAL.pdf (accessed on 15 April 2023).
• Santiago, M.L.; Santiago, E.G.; Hafalla, J.C.; Manalo, M.A.; Orantia, L.; Cajimat, M.N.; Martin, C.; Cuaresma, C.; Dominguez, C.E.; Borromeo, M.E.; et al. Molecular epidemiology of HIV-1 infection in the Philippines, 1985 to 1997: Transmission of subtypes B and E and potential emergence of subtypes C and F. J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 1998 , 18 , 260–269. [ Google Scholar ] [ CrossRef ]
• DOH Epidemiology Bureau, National HIV/AIDS & STI Surveillance and Strategic Information Unit. 2018 Integrated HIV Behavioral & Serological Surveillance (IHBSS) Factsheets. Available online: https://www.aidsdatahub.org/resource/factsheets-2018-integrated-hiv-behavioral-serologic-surveillance-ihbss (accessed on 10 April 2023).
• Lasco, G. Call Boys: Drug Use and Sex Work Among Marginalized Young Men in a Philippine Port Community. Contemp. Drug Probl. 2018 , 45 , 33–46. [ Google Scholar ] [ CrossRef ]
• Wamoyi, J.; Stobeanau, K.; Bobrova, N.; Abramsky, T.; Watts, C. Transactional sex and risk for HIV infection in sub-Saharan Africa: A systematic review and meta-analysis. J. Int. AIDS Soc. 2016 , 19 , 20992. [ Google Scholar ] [ CrossRef ]
• Oldenburg, C.E.; Perez-Brumer, A.G.; Reisner, S.L.; Mattie, J.; Bärnighausen, T.; Mayer, K.H.; Mimiaga, M.J. Global burden of HIV among men who engage in transactional sex: A systematic review and meta-analysis. PLoS ONE 2014 , 9 , e103549. [ Google Scholar ] [ CrossRef ]
• Urada, L.A.; Silverman, J.G.; Cordisco Tsai, L.; Morisky, D.E. Underage youth trading sex in the Philippines: Trafficking and HIV risk. AIDS Care 2014 , 26 , 1586–1591. [ Google Scholar ] [ CrossRef ]
• Williams, T.P.; Alpert, E.J.; Ahn, R.; Cafferty, E.; Konstantopoulos, W.M.; Wolferstan, N.; Castor, J.P.; McGahan, A.M.; Burke, T.F. Sex trafficking and health care in Metro Manila: Identifying social determinants to inform an effective health system response. Health Hum. Rights 2010 , 12 , 135–147. [ Google Scholar ]
• Palma, D.M.; Parr, J. Behind prison walls: HIV vulnerability of female Filipino prisoners. Int. J. Prison Health 2019 , 15 , 232–243. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Commission on Audit. Consolidated Annual Audit Report on the Bureau of Jail Management and Penology 2021. Available online: https://www.coa.gov.ph/wpfd_file/bureau-of-jail-management-and-penology-consolidated-annual-audit-report-2021/ (accessed on 29 April 2023).
• Yarcia, L. Kalusugan sa Kulungan: Examining the Policy for People Living with HIV/AIDS and Hepatitis C in Philippine Prisons ; International Drug Policy Consortium: London, UK, 2018. [ Google Scholar ]
• Alonso, A.; de Irala, J. Strategies in HIV prevention: The A-B-C approach. Lancet 2004 , 364 , 1033. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Lucea, M.B.; Hindin, M.J.; Gultiano, S.; Kub, J.; Rose, L. The context of condom use among young adults in the Philippines: Implications for HIV prevention. Health Care Women Int. 2013 , 34 , 227–248. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Adia, A.C.; Bermudez, A.N.C.; Callahan, M.W.; Hernandez, L.I.; Imperial, R.H.; Operario, D. “An Evil Lurking Behind You”: Drivers, Experiences, and Consequences of HIV-Related Stigma Among Men Who Have Sex With Men With HIV in Manila, Philippines. AIDS Educ. Prev. 2018 , 30 , 322–334. [ Google Scholar ] [ CrossRef ]
• Dale, S.K.; Safren, S.A. Gendered Racial Microaggressions Associated with Depression Diagnosis among Black Women Living with HIV. J. Urban Health 2020 , 97 , 377–386. [ Google Scholar ] [ CrossRef ]
• Mahajan, A.P.; Sayles, J.N.; Patel, V.A.; Remien, R.H.; Sawires, S.R.; Ortiz, D.J.; Szekeres, G.; Coates, T.J. Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. Aids 2008 , 22 (Suppl. 2), S67–S79. [ Google Scholar ] [ CrossRef ]
• Hatzenbuehler, M.L.; Pachankis, J.E. Stigma and Minority Stress as Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender Youth: Research Evidence and Clinical Implications. Pediatr. Clin. North Am. 2016 , 63 , 985–997. [ Google Scholar ] [ CrossRef ]
• Rueda, S.; Mitra, S.; Chen, S.; Gogolishvili, D.; Globerman, J.; Chambers, L.; Wilson, M.; Logie, C.H.; Shi, Q.; Morassaei, S.; et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: A series of meta-analyses. BMJ Open 2016 , 6 , e011453. [ Google Scholar ] [ CrossRef ]
• McCall, C. Philippines president continues his brutal war on drugs. Lancet 2017 , 389 , 21–22. [ Google Scholar ] [ CrossRef ]
• Urada, L.A.; Simmons, J.; Wong, B.; Tsuyuki, K.; Condino-Enrera, G.; Hernandez, L.I.; Simbulan, N.P.; Raj, A. A human rights-focused HIV intervention for sex workers in Metro Manila, Philippines: Evaluation of effects in a quantitative pilot study. Int. J. Public Health 2016 , 61 , 945–957. [ Google Scholar ] [ CrossRef ]
• Sison, O.T.; Baja, E.S.; Bermudez, A.N.C.; Quilantang, M.; Irene, N.; Dalmacion, G.V.; Guevara, E.G.; Garces-Bacsal, R.M.; Hemingway, C.; Taegtmeyer, M.; et al. Association of anticipated HIV testing stigma and provider mistrust on preference for HIV self-testing among cisgender men who have sex with men in the Philippines. BMC Public Health 2022 , 22 , 2362. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Koirala, S.; Deuba, K.; Nampaisan, O.; Marrone, G.; Ekström, A.M. Facilitators and barriers for retention in HIV care between testing and treatment in Asia-A study in Bangladesh, Indonesia, Lao, Nepal, Pakistan, Philippines and Vietnam. PLoS ONE 2017 , 12 , e0176914. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Laguna, E.; Villegas, J. The Philippine People Living with HIV Stigma Index 2.0 ; Demographic Research and Development Foundation, Inc.: Quezon City, Philippines, 2019. [ Google Scholar ]
• Magno, L.; Silva, L.; Veras, M.A.; Pereira-Santos, M.; Dourado, I. Stigma and discrimination related to gender identity and vulnerability to HIV/AIDS among transgender women: A systematic review. Cad. Saude Publica 2019 , 35 , e00112718. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• World Health Organization. Regional Office for the Western Pacific. Regional Assessment of HIV, STI and Other Health Needs of Transgender People in Asia and the Pacific. World Health Organization: Geneva, Switzerland. Available online: https://apps.who.int/iris/handle/10665/207686 (accessed on 30 March 2023).
• Jackson-Best, F.; Edwards, N. Stigma and intersectionality: A systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 2018 , 18 , 919. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• World Health Organization. Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach ; World Health Organization: Geneva, Switzerland, 2021. [ Google Scholar ]
• Bustamante, J.; Plankey, M.W. Identifying Barriers to HIV Testing among Men Who Have Sex with Men (MSM) in the Philippines. Georgetown Medical Review. Available online: https://gmr.scholasticahq.com/article/36967-identifying-barriers-to-hiv-testing-among-men-who-have-sex-with-men-msm-in-the-philippines (accessed on 30 March 2023).
• De Lind van Wijngaarden, J.W.; Ching, A.D.; Settle, E.; van Griensven, F.; Cruz, R.C.; Newman, P.A. “I am not promiscuous enough!”: Exploring the low uptake of HIV testing by gay men and other men who have sex with men in Metro Manila, Philippines. PLoS ONE 2018 , 13 , e0200256. [ Google Scholar ] [ CrossRef ]
• Congress of the Philippines. Republic Act 8504 The Philippine AIDS Prevention and Control Act of 1998. Available online: https://www.aidsdatahub.org/sites/default/files/resource/ra-8504-philippines-aids-prevention-and-control-act-1998-10th-congress.pdf (accessed on 15 February 2023).
• Congress of the Philippines. Republic Act No. 11166. Available online: https://lawphil.net/statutes/repacts/ra2018/ra_11166_2018.html#:~:text=REPUBLIC%20ACT%20No.-,11166,the%20Purpose%20Republic%20Act%20No (accessed on 15 February 2023).
• Department of Health Philippines. Department Memorandum No. 2020-0276: Interim Guidelines on Community Based HIV Screening. Metro Manila, Philippines. Available online: https://www.ship.ph/wp-content/uploads/2020/07/dm2020-0276.pdf (accessed on 10 March 2023).
• Department of Health Philippines. Administrative Order No. 2022-0035: Guidelines in the Implementation of Differentiated HIV Testing Services. Available online: https://www.ship.ph/ao-2022-0035-hiv-testing-services/ (accessed on 10 March 2023).
• Eustaquio, P.C.; Figuracion, R.; Izumi, K.; Morin, M.J.; Samaco, K.; Flores, S.M.; Brink, A.; Diones, M.L. Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: A retrospective cohort study. BMC Public Health 2022 , 22 , 366. [ Google Scholar ] [ CrossRef ]
• Rosadiño, J.D.T.; Pagtakhan, R.G.; Briñes, M.T.; Dinglasan, J.L.G.; Cruz, D.P.; Corciega, J.O.L.; Pagtakhan, A.B.; Regencia, Z.J.G.; Baja, E.S. Implementation of Unassisted and Community-Based HIV Self-Testing (HIVST) during the COVID-19 pandemic among Men-who-have-sex-with-Men (MSM) and Transgender Women (TGW): A Demonstration Study in Metro Manila, Philippines. medRxiv 2021 , arXiv:2021.11.13.21266310. [ Google Scholar ] [ CrossRef ]
• Department of Health Philippines Epidemiology Bureau. Impact of the COVID-10 Pandemic to the Philippine HIV Epidemic Annual Report 2020. Available online: https://doh.gov.ph/sites/default/files/publications/2020%20Annual%20HIV%20Report.pdf (accessed on 12 February 2023).
• Dinglasan, J.L.G.; Rosadiño, J.D.T.; Pagtakhan, R.G.; Cruz, D.P.; Briñes, M.T.; Regencia, Z.J.G.; Baja, E.S. ’Bringing testing closer to you’: Barriers and facilitators in implementing HIV self-testing among Filipino men-having-sex-with-men and transgender women in National Capital Region (NCR), Philippines—A qualitative study. BMJ Open 2022 , 12 , e056697. [ Google Scholar ] [ CrossRef ]
• Gohil, J.; Baja, E.S.; Sy, T.R.; Guevara, E.G.; Hemingway, C.; Medina, P.M.B.; Coppens, L.; Dalmacion, G.V.; Taegtmeyer, M. Is the Philippines ready for HIV self-testing? BMC Public Health 2020 , 20 , 34. [ Google Scholar ] [ CrossRef ]
• Mugumba, E.; Kagwa, M.; Muhumuza, D.; Namukwaya, R.; Amunyongire, R.; Maling, S. Prevalence and correlates of intimate partner violence following partner notification among index HIV clients attending primary healthcare facilities in Uganda. AIDS Care 2022 , 1–8, Online ahead of print . [ Google Scholar ] [ CrossRef ]
• Stangl, A.L.; Sebany, M.; Kapungu, C.; Jessee, C.; Ricker, C.L.; Chard, E. Is HIV index testing and partner notification safe for adolescent girls and young women in low- and middle-income countries? J. Int. AIDS Soc. 2020 , 23 (Suppl. 5), e25562. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Philippine Statistics Authority (PSA) and ICF. Philippines National Demographic and Health Survey 2017 ; PSA and ICF: Quezon City, Philippines; Rockville, MD, USA, 2018. [ Google Scholar ]
• Reyes, M.; Alday, C.; Aurellano, J.; Escala, R.; Hernandez, E.; Matienzo, J.E.P.; Panaguiton, K.M.R.; Panaguiton, A.C.C.; Zsila, A. Minority Stressors and Attitudes toward Intimate Partner Violence among Lesbian and Gay Individuals. Sex. Cult. 2022 , 1–21. [ Google Scholar ] [ CrossRef ]
• Department of Health Philippines. Administrative Order No. 2019-0001. Guidelines on the Implementation of Rapid HIV Diagnostic Algorithm (rHIVda). Available online: https://www.ship.ph/wp-content/uploads/2020/08/AO-No.-2019-0001-Guidelines-on-the-Implementation-of-Rapid-HIV-Diagnostic-1.pdf (accessed on 12 February 2023).
• Telan, E. Developing Rapid HIV Testing Diagnostic Algorithms (rHIVda) for the Philippines ; National Reference Laboratory—San Lazaro Hospital/SACCL: Manila, Philippines, 2018. [ Google Scholar ]
• Department of Health Philippines. Department Circular No. 2022-0535. Updated List of DOH-Licensed Certified Rapid HIV Diagnostic Algorithm (rHIVda) Confirmatory Laboratory as of September 20, 2022. Available online: https://dmas.doh.gov.ph:8083/Rest/GetFile?id=728934 (accessed on 12 February 2023).
• Department of Health Philippines. Rapid HIV Diagnostic Algorithm (rHIVda): Information Brief ; Department of Health: Manila, Philippines, 2018.
• World Health Organization. Differentiated and Simplified Pre-Exposure Prophylaxis for HIV Prevention: Update to WHO Implementation Guidance 2022. Available online: https://www.who.int/publications/i/item/9789240053694?fbclid=IwAR2_qSlp1pG9a4bLO370X86U8zHhC_9mhCFEaF3c_xE6WnPEctM_IzEtbso (accessed on 29 April 2023).
• Department of Health Philippines. Department Memorandum No. 2021-0017: Interim Guidelines on Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV Infection in the Philippines. Available online: https://www.prepwatch.org/wp-content/uploads/2022/03/Philippines-Interim-National-PrEP-Guidelines-2021.pdf (accessed on 12 March 2023).
• PrEP Innovation and Implementation in Asia and the Pacific: Virtual Regional Discussion. Joint United Nations Programme in HIV and AIDS, World Health Organization, and Institute of HIV Research and Innovation. 2020. Available online: https://unitaid.org/assets/PrEP-innovation-and-implementation-in-Asia-and-the-Pacific-Meeting-Report-2020.pdf (accessed on 15 March 2023).
• Conniff, J.; Evensen, A. Preexposure Prophylaxis (PrEP) for HIV Prevention: The Primary Care Perspective. J. Am. Board Fam. Med. 2016 , 29 , 143–151. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Schaefer, R.; Amparo da Costa Leite, P.H.; Silva, R.; Abdool Karim, Q.; Akolo, C.; Cáceres, C.F.; Dourado, I.; Green, K.; Hettema, A.; Hoornenborg, E.; et al. Kidney function in tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis users: A systematic review and meta-analysis of published literature and a multi-country meta-analysis of individual participant data. Lancet HIV 2022 , 9 , e242–e253. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Baranek, B.; Wang, S.; Cheung, A.M.; Mishra, S.; Tan, D.H. The effect of tenofovir disoproxil fumarate on bone mineral density: A systematic review and meta-analysis. Antivir. Ther. 2020 , 25 , 21–32. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• De Clercq, E. Tenofovir alafenamide (TAF) as the successor of tenofovir disoproxil fumarate (TDF). Biochem. Pharmacol. 2016 , 119 , 1–7. [ Google Scholar ] [ CrossRef ]
• Kauppinen, K.J.; Kivela, P.; Sutinen, J. Switching from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide Significantly Worsens the Lipid Profile in a Real-World Setting. AIDS Patient Care STDs 2019 , 33 , 500–506. [ Google Scholar ] [ CrossRef ]
• Mallon, P.W.; Brunet, L.; Hsu, R.K.; Fusco, J.S.; Mounzer, K.C.; Prajapati, G.; Beyer, A.P.; Wohlfeiler, M.B.; Fusco, G.P. Weight gain before and after switch from TDF to TAF in a U.S. cohort study. J. Int. AIDS Soc. 2021 , 24 , e25702. [ Google Scholar ] [ CrossRef ]
• World Health Organization. WHO Recommends the Dapivirine Vaginal Ring as a New Choice for HIV Prevention for Women at Substantial Risk of HIV Infection (January 2021). Available online: https://www.who.int/news/item/26-01-2021-who-recommends-the-dapivirine-vaginal-ring-as-a-new-choice-for-hiv-prevention-for-women-at-substantial-risk-of-hiv-infection (accessed on 12 March 2023).
• World Health Organization. Guidelines on Long-Acting Injectable Cabotegravir for HIV Prevention ; World Health Organization: Geneva, Switzerland, 2022. [ Google Scholar ]
• Sultan, B.; Benn, P.; Waters, L. Current perspectives in HIV post-exposure prophylaxis. HIV AIDS 2014 , 6 , 147–158. [ Google Scholar ]
• Philippine Society for Microbiology and Infectious Diseases. Guidance on the Management of HIV-infected Healthcare Workers in the Philippines. 2017. Available online: https://www.ship.ph/wp-content/uploads/2018/11/FINAL_INSIDE_PSMID-Guidelines-of-HIV-Infected-Healthcare-Workers-Pocket-Card-1.pdf (accessed on 29 April 2023).
• Department of Health Philippines. Philippine Health Sector HIV Strategic Plan 2020–2022 ; Department of Health: Manila, Philippines, 2020.
• Gangcuangco, L.M.A.; Izutsu, S. Medical School Hotline: Dying of AIDS in 2018: Urgent Interventions to Curb the Fastest-Growing HIV Epidemic in the Western Pacific. Hawaii J. Med. Public Health A J. Asia Pac. Med. Public Health 2019 , 78 , 108–110. [ Google Scholar ]
• Philippine Health Insurance Corporation. PhilHealth Circular 2021-0025: Outpatient HIV /AIDS Treatment (OHAT) Package (Revision 2). Available online: https://www.philhealth.gov.ph/circulars/2021/circ2021-0025.pdf (accessed on 10 March 2023).
• Congress of the Philippines. Republic Act 11223: An Act Instituting Universal Health Care for All Filipinos, Prescribing Reforms in the Health Care System, and Appropriating Funds Therefor. February 2019. Available online: https://www.officialgazette.gov.ph/2019/02/20/republic-act-no-11223/ (accessed on 10 March 2023).
• Allers, K.; Schneider, T. CCR5Delta32 mutation and HIV infection: Basis for curative HIV therapy. Curr. Opin. Virol. 2015 , 14 , 24–29. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Haworth, K.G.; Peterson, C.W.; Kiem, H.P. CCR5-edited gene therapies for HIV cure: Closing the door to viral entry. Cytotherapy 2017 , 19 , 1325–1338. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Deeks, S.G.; Overbaugh, J.; Phillips, A.; Buchbinder, S. HIV infection. Nat. Rev. Dis. Primers 2015 , 1 , 15035. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Colby, D.J.; Trautmann, L.; Pinyakorn, S.; Leyre, L.; Pagliuzza, A.; Kroon, E.; Rolland, M.; Takata, H.; Buranapraditkun, S.; Intasan, J.; et al. Rapid HIV RNA rebound after antiretroviral treatment interruption in persons durably suppressed in Fiebig I acute HIV infection. Nat. Med. 2018 , 24 , 923–926. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kenedi, C.A.; Goforth, H.W. A systematic review of the psychiatric side-effects of efavirenz. AIDS Behav. 2011 , 15 , 1803–1818. [ Google Scholar ] [ CrossRef ]
• World Health Organization. WHO Recommends Dolutegravir as Preferred HIV Treatment Option in All Populations. News Release. 22 July 2019 ; WHO: Mexico City, Mexico; Available online: https://www.who.int/news/item/22-07-2019-who-recommends-dolutegravir-as-preferred-hiv-treatment-option-in-all-populations (accessed on 15 February 2023).
• Llibre, J.M.; Pulido, F.; Garcia, F.; Garcia Deltoro, M.; Blanco, J.L.; Delgado, R. Genetic barrier to resistance for dolutegravir. AIDS Rev. 2015 , 17 , 56–64. [ Google Scholar ]
• World Health Organization Representative Office for the Philippines. Scale-up of Dolutegravir-Containing Antiretroviral Therapy Regimens in the Philippines ; WHO: Manilla, Philipines, 2021. [ Google Scholar ]
• Department of Health Philippines. Tenofovir-Lamivudine-Dolutegravir for Treatment-naive and Treatment-Experienced Adolescents and Adults Living with HIV. Health Technology Assessment Council. 2021. Available online: https://hta.doh.gov.ph/2021/09/01/tenofovir-lamivudine-dolutegravir-tld-for-treatment-naive-and-treatment-experienced-adolescents-and-adults-living-with-hiv/ (accessed on 29 April 2023).
• Department of Health. Administrative Order No. 2022-0024: Guidelines on Differentiated Treatment for People Living with Human Immunodeficiency Virus (PLHIV) and Prophylaxis for HIV-Exposed Infants ; DOH: Manilla, Philippines, 2022. [ Google Scholar ]
• Markham, A. Cabotegravir Plus Rilpivirine: First Approval. Drugs 2020 , 80 , 915–922. [ Google Scholar ] [ CrossRef ]
• U.S. FDA. Cabenuva (Cabotegravir Extended-Release Injectable Suspension; Rilpivirine Extended-Release Injectable Suspension) Highlights of Prescribing Information. Available online: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/212888s005s006lbl.pdf (accessed on 15 February 2023).
• Gangcuangco, L.M.A.; Sawada, I.; Tsuchiya, N.; Do, C.D.; Pham, T.T.T.; Rojanawiwat, A.; Alejandria, M.; Leyritana, K.; Yokomaku, Y.; Pathipvanich, P.; et al. Regional Differences in the Prevalence of Major Opportunistic Infections among Antiretroviral-Naive Human Immunodeficiency Virus Patients in Japan, Northern Thailand, Northern Vietnam, and the Philippines. Am. J. Trop. Med. Hyg. 2017 , 97 , 49–56. [ Google Scholar ] [ CrossRef ]
• FDA. Dolutegravir highlights of Prescribing Information. Available online: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213983s000lbl.pdf (accessed on 12 February 2023).
• StopTB.org. Tuberculosis Situation in 2020: Philippines. Available online: https://www.stoptb.org/static_pages/PHL_Dashboard.html (accessed on 12 February 2023).
• Maartens, G.; Decloedt, E.; Cohen, K. Effectiveness and safety of antiretrovirals with rifampicin: Crucial issues for high-burden countries. Antivir. Ther. 2009 , 14 , 1039–1043. [ Google Scholar ] [ CrossRef ]
• Gish, R.G.; Sollano, J.D.; Jr Lapasaran, A.; Ong, J.P. Chronic hepatitis B virus in the Philippines. J. Gastroenterol. Hepatol. 2016 , 31 , 945–952. [ Google Scholar ] [ CrossRef ]
• Vaswani, P.P.M.; Senga-Tang, I.R.; Catapia, J.R.M.; Abad, C.L.R.; Dumagay, T.E. The hematologic profile of Filipino HIV-infected individuals and its association with CD4 counts. Hematol. Transfus. Cell Ther. 2022 , 44 , 307–313. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hoffmann, C.J.; Thio, C.L. Clinical implications of HIV and hepatitis B co-infection in Asia and Africa. Lancet Infect. Dis. 2007 , 7 , 402–409. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Bellini, C.; Keiser, O.; Chave, J.P.; Evison, J.; Fehr, J.; Kaiser, L.; Weber, R.; Vernazza, P.; Bernasconi, E.; Telenti, A.; et al. Liver enzyme elevation after lamivudine withdrawal in HIV-hepatitis B virus co-infected patients: The Swiss HIV Cohort Study. HIV Med. 2009 , 10 , 12–18. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Eisinger, R.W.; Dieffenbach, C.W.; Fauci, A.S. HIV Viral Load and Transmissibility of HIV Infection: Undetectable Equals Untransmittable. JAMA 2019 , 321 , 451–452. [ Google Scholar ] [ CrossRef ]
• Ferguson, L.; Jardell, W.; Gruskin, S. Leaving No One Behind: Human Rights and Gender as Critical Frameworks for U=U. Health Hum. Rights 2022 , 24 , 1–11. [ Google Scholar ]
• Okoli, C.; Van de Velde, N.; Richman, B.; Allan, B.; Castellanos, E.; Young, B.; Brough, G.; Eremin, A.; Corbelli, G.M.; Mc Britton, M.; et al. Undetectable equals untransmittable (U = U): Awareness and associations with health outcomes among people living with HIV in 25 countries. Sex Transm. Infect. 2021 , 97 , 18–26. [ Google Scholar ] [ CrossRef ]
• Ford, O.G.; Rufurwadzo, T.G.; Richman, B.; Green, I.; Alesi, J. Adopting U=U to end stigma and discrimination. J. Int. AIDS Soc. 2022 , 25 , e25891. [ Google Scholar ] [ CrossRef ]
• Department of Health Philippines. Administrative Order 2019-0026: National Policy in the Provision of Birthing Assistance to Primigravid and Grand Multigravid Women. Metro Manila, Philippines. 2019. Available online: https://doh.gov.ph/sites/default/files/health_programs/AO-2019-0026.pdf (accessed on 29 April 2023).
• Joint United Nations Programme on HIV/AIDS. Danger: UNAIDS Global AIDS Update 2022 ; UNAIDS: Geneva, Switzerland, 2022. [ Google Scholar ]
• Department of Health Philippines. Administrative Order 2009-0016: Policies and Guidelines on the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus ; Department of Health Philippines: Metro Manila, Philippines, 2009.
• Ehrenkranz, P.; Rosen, S.; Boulle, A.; Eaton, J.W.; Ford, N.; Fox, M.P.; Grimsrud, A.; Rice, B.D.; Sikazwe, I.; Holmes, C.B. The revolving door of HIV care: Revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals. PLoS Med. 2021 , 18 , e1003651. [ Google Scholar ] [ CrossRef ]
• Eustaquio, P.C.; Docken, S.S.; Leyritana, K.T.; Wulandari, L.P.L. HIV care cascade among cisgender men who have sex with men in a key population-led community center in the Philippines. Int. J. STD AIDS 2021 , 32 , 718–728. [ Google Scholar ] [ CrossRef ]
• Nepomuceno, M.; Abad, C.L.; Salvaña, E.M. A descriptive retrospective study on HIV care cascade in a tertiary hospital in the Philippines. PLoS ONE 2023 , 18 , e0281104. [ Google Scholar ] [ CrossRef ]
• Department of Health Philippines. Administrative Order 2022-0010. Available online: https://doh.gov.ph/sites/default/files/health_programs/ao2022-0010.pdf (accessed on 14 February 2023).
• Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. Available online: https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv (accessed on 14 February 2023).
• SahBandar, I.N.; Samonte, G.; Telan, E.; Siripong, N.; Belcaid, M.; Schanzenbach, D.; Leano, S.; Chagan-Yasutan, H.; Hattori, T.; Shikuma, C.M.; et al. Ultra-Deep Sequencing Analysis on HIV Drug-Resistance-Associated Mutations Among HIV-Infected Individuals: First Report from the Philippines. AIDS Res. Hum. Retrovir. 2017 , 33 , 1099–1106. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Salvana, E.M.; Schwem, B.; Penalosa, C.; Arevalo, G.; Dungca, N.; Lim, J.; Leyritana, K.; Destura, R. HIV Transmitted Drug Resistance in the Philippines: The Case for Baseline Genotyping and Drug Resistance Testing. Open Forum Infect. Dis. 2017 , 4 (Suppl. S1), S423. [ Google Scholar ] [ CrossRef ]
• Salvana, E.M.T.; Samonte, G.M.J.; Telan, E.; Leyritana, K.; Tactacan-Abrenica, R.J.; Ching, P.R.; Arevalo, G.M.; Dungca, N.T.; Peñalosa-Ramos, C.; Mendoza, K.A.R.; et al. High rates of tenofovir failure in a CRF01_AE-predominant HIV epidemic in the Philippines. Int. J. Infect. Dis. 2020 , 95 , 125–132. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Salvana, E.M.T.; Schwem, B.E.; Ching, P.R.; Frost, S.D.W.; Ganchua, S.K.C.; Itable, J.R. The changing molecular epidemiology of HIV in the Philippines. Int. J. Infect. Dis. 2017 , 61 , 44–50. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Chen, Y.; Hora, B.; DeMarco, T.; Berba, R.; Register, H.; Hood, S.; Carter, M.; Stone, M.; Pappas, A.; Sanchez, A.M.; et al. Increased predominance of HIV-1 CRF01_AE and its recombinants in the Philippines. J. Gen. Virol. 2019 , 100 , 511–522. [ Google Scholar ] [ CrossRef ]
• Song, H.; Ou, W.; Feng, Y.; Zhang, J.; Li, F.; Hu, J.; Peng, H.; Xing, H.; Ma, L.; Tan, Q.; et al. Disparate impact on CD4 T cell count by two distinct HIV-1 phylogenetic clusters from the same clade. Proc. Natl. Acad. Sci. USA 2019 , 116 , 239–244. [ Google Scholar ] [ CrossRef ]
• Ng, O.T.; Lin, L.; Laeyendecker, O.; Quinn, T.C.; Sun, Y.J.; Lee, C.C.; Leo, Y.S. Increased rate of CD4+ T-cell decline and faster time to antiretroviral therapy in HIV-1 subtype CRF01_AE infected seroconverters in Singapore. PLoS ONE 2011 , 6 , e15738. [ Google Scholar ] [ CrossRef ]

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Gangcuangco, L.M.A.; Eustaquio, P.C. The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023. Trop. Med. Infect. Dis. 2023 , 8 , 258. https://doi.org/10.3390/tropicalmed8050258

Gangcuangco LMA, Eustaquio PC. The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023. Tropical Medicine and Infectious Disease . 2023; 8(5):258. https://doi.org/10.3390/tropicalmed8050258

Gangcuangco, Louie Mar A., and Patrick C. Eustaquio. 2023. "The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023" Tropical Medicine and Infectious Disease 8, no. 5: 258. https://doi.org/10.3390/tropicalmed8050258

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The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

Affiliations.

• 1 Hawaii Center for AIDS, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA.
• 2 Love Yourself, Inc., Mandaluyong 1552, Metro Manila, Philippines.
• PMID: 37235306
• PMCID: PMC10224495
• DOI: 10.3390/tropicalmed8050258

In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. 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. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15-17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine-tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.

Keywords: AIDS; HIV; Philippines; human immunodeficiency virus; public health.

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Conflict of interest statement

The authors declare no conflict of interest. The views and opinions expressed in this article do not reflect the views and opinions of the authors’ affiliations.

Estimated annual new HIV infections…

Estimated annual new HIV infections among individuals 15 years old and above from…

Traditional versus rapid HIV diagnostic…

Traditional versus rapid HIV diagnostic algorithm in the Philippines. Abbreviations: rHIVda: rapid HIV…

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An HIV epidemic is ready to emerge in the Philippines

Anna c farr.

1 National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia

David P Wilson

The state of the HIV epidemic in the Philippines has been described as "low and slow", which is in stark contrast to many other countries in the region. A review of the conditions for HIV spread in the Philippines is necessary.

We evaluated the current epidemiology, trends in behaviour and public health response in the Philippines to identify factors that could account for the current HIV epidemic, as well as to review conditions that may be of concern for facilitating an emerging epidemic.

The past control of HIV in the Philippines cannot be attributed to any single factor, nor is it necessarily a result of the actions of the Filipino government or other stakeholders. Likely reasons for the epidemic's slow development include: the country's geography is complicated; injecting drug use is relatively uncommon; a culture of sexual conservatism exists; sex workers tend to have few clients; anal sex is relatively uncommon; and circumcision rates are relatively high.

In contrast, there are numerous factors suggesting that HIV is increasing and ready to emerge at high rates, including: the lowest documented rates of condom use in Asia; increasing casual sexual activity; returning overseas Filipino workers from high-prevalence settings; widespread misconceptions about HIV/AIDS; and high needle-sharing rates among injecting drug users.

There was a three-fold increase in the rate of HIV diagnoses in the Philippines between 2003 and 2008, and this has continued over the past year. HIV diagnoses rates have noticeably increased among men, particularly among bisexual and homosexual men (114% and 214% respective increases over 2003-2008). The average age of diagnosis has also significantly decreased, from approximately 36 to 29 years.

Conclusions

Young adults, men who have sex with men, commercial sex workers, injecting drug users, overseas Filipino workers, and the sexual partners of people in these groups are particularly vulnerable to HIV infection. There is no guarantee that a large HIV epidemic will be avoided in the near future. Indeed, an expanding HIV epidemic is likely to be only a matter of time as the components for such an epidemic are already present in the Philippines.

Southeast Asia is experiencing numerous and diverse HIV epidemics that are evolving at varying rates, in different population groups, and in different geographical areas. Approximately 5 to 10 million people are living with HIV in Asia, with prevalence estimates of well over 1% among adults in numerous countries [ 1 ]. Yet there are some settings in which HIV prevalence has remained relatively very low.

The Philippines is one of the exceptional countries that has not faced a large HIV epidemic. It is important to understand the reasons for the disparate nature of HIV in this country in order to ascertain whether lessons can be learnt for effective control in other settings and to ensure that a large HIV epidemic does not emerge in the Philippines. The first recorded case of HIV infection in the Philippines was in 1984 [ 2 - 10 ]. Since then, the country has maintained an HIV prevalence of less than 0.1%, even among populations at high risk [ 3 , 5 , 7 , 9 ], with a cumulative total number of HIV diagnoses of just over 3300 [ 11 ]. In this paper, we attempt to evaluate the current epidemiology and public health response to identify factors which could account for the "low and slow" development of the HIV epidemic in the Philippines, as well as to review behavioural and epidemiological conditions that may be of concern for facilitating an emerging epidemic.

The geography of the Philippines may be one of the first reasons for the slow spread of HIV. The Philippines is an archipelago of more than 7000 islands and islets; its complicated geography and separateness from mainland Asia could aid in shielding it from the larger regional epidemic [ 5 , 9 , 12 , 13 ].

Additionally, the initial core group of people usually affected with HIV in Asian epidemics is not present to a large extent in the Philippines. Most HIV epidemics in southeast Asian settings initially establish among injecting drug users (IDUs) [ 14 ]. However, there are very low numbers of IDUs in the Philippines compared with most other southeast Asian countries [ 5 , 9 , 13 , 15 ]. At present, there are only an estimated 10,000 IDUs in the Philippines [ 13 ] (out of its population of ~90 million people; that is, 0.01%). In comparison, neighbouring Thailand, China and Indonesia have estimated IDU populations sizes (and population proportions) of 160,000 (0.38%), 1,800,000 (0.25%) and 219,000 (0.14%), respectively [ 16 ].

There also exists a culture of relative sexual conservatism in the Philippines [ 9 , 17 ]. There are limited data available on sexual partner acquisition in the Philippines, and detailed behavioural sentinel surveillance data are not widely released [ 18 ]. The only reference to sexual partner rates of which we are aware is from a previous Philippines National AIDS Council Report, which indicates that the majority of the male population has only one sexual partner at any time and relatively low partnership breakup rates [ 19 ]. Although the validity of this statement should be questioned until solid data have been evaluated, this suggests that sexual conservatism exists in the Philippines relative to neighbouring countries.

The limited reporting available from behavioural surveillance conducted a number of years ago suggests that Filipinos tend to have fewer sexual partners than their counterparts in countries with higher HIV/AIDS rates [ 20 ]. For example, sex workers in the Philippines tend to have fewer clients, an average of between two and four per week compared with ~15 in many other settings [ 5 , 13 , 15 , 21 , 22 ]. Although this does not indicate levels of sexual activity in the general population, it is indicative of less sexual mixing outside regular partnerships.

However, fewer sexual partners is not necessarily a clear indicator of a smaller epidemic as reflected in China's expanding HIV epidemic despite reported sexual partner acquisition rates being similarly low [ 23 ]. One could expect different sexual behaviour across different social strata and thus an HIV epidemic sustained at low levels may not necessarily be a reflection of low average rates of partner change across a population.

There has also been the establishment of social hygiene clinics to allow for regular examination and sexually transmitted infection (STI) treatment for establishment-based female sex workers [ 5 , 15 , 22 ]. The prevalence of ulcerating STIs, which are believed to facilitate HIV transmission [ 24 , 25 ], is relatively low [ 13 ]. There is also a low occurrence of penile-anal sex in the Philippines [ 13 ] and a high rate of circumcision, ~93% [ 9 , 26 ], which is known to reduce the risk of males acquiring HIV in heterosexual intercourse [ 27 - 29 ].

Some countries, such as Vietnam, Indonesia and Papua New Guinea, have shown that a delayed HIV epidemic is possible [ 6 , 30 ]. While HIV prevalence has remained "low and slow" [ 5 , 6 , 31 ], the presence of many conditions for a large, increasing and generalized HIV epidemic are in place in the Philippines. These include: a low rate of condom use; unsafe injecting practices among IDUs; large migration rates; increasing trends in extramarital and premarital sex; a lack of education and common misconceptions about HIV/AIDS; and cultural factors that inhibit public discussion of issues of a sexual nature [ 10 ]. We will now expound these factors.

The Philippines has the lowest documented rates of condom use in Asia [ 2 , 32 ], at 20-30% among groups at highest risk of HIV (including sex workers) [ 4 , 5 , 8 , 17 , 21 , 33 , 34 ]. This is concerning since the vast majority of HIV transmission in the Philippines is through sexual contact [ 10 , 13 , 17 , 32 ]. A survey published in 2003 found that 63% of male respondents said that they had never used a condom [ 2 ]. Condom use among any extramarital partners is also rare [ 8 ].

There are various factors that may contribute to low condom use in the Philippines. A common perception is that condoms are only for birth control and not for protection against HIV and other STIs [ 8 ]. This perception is reinforced by the view that condoms are discouraged by the Roman Catholic Church. Government family planning programmes have policies against supplying condoms to unmarried people [ 4 , 35 ].

The cost of condoms is also relatively high [ 18 ]. The majority of the supply of condoms is from international aid agencies (e.g., USAID) [ 8 , 35 ]. Many female sex workers assert that "knowing" their client was reason enough to not use a condom [ 8 ]. Filipino women also tend to believe that the decision to use a condom is up to the man [ 8 ]. Men tend to feel the need to maintain their machismo image to the extent that they refuse to practice safe sex [ 36 ]. Culturally-sensitive but influential promotion of condoms appears to be an obvious gap in the Philippines HIV/AIDS response.

There is anecdotal evidence among numerous media sources and organizational reports that casual sexual activity, particularly among the male population aged 15-25, has been increasing. A study from over a decade ago estimated that 55% of young men have engaged in premarital sex compared with 23% of young women [ 4 ]. While most premarital sex in the Philippines is with the person who becomes a future spouse, men are more likely to have at least one additional partner compared with women [ 2 , 4 , 8 ]. Most casual sexual encounters are unprotected [ 21 , 37 , 38 ].

However, all of this evidence is based on relatively old data. There is a great need for behavioural surveillance data to be collected and reported systematically and regularly in order to monitor risk activities, particularly around casual sex, associated with transmission.

Injecting drug users

The most recent estimates of the size of the IDU population in the Philippines suggests that the number is relatively low [ 39 ]. However, serosurveillance of IDUs has only been available at one site, in Cebu City, and no data exist for other cities. It is possible that the actual number of IDUs is considerably greater than previously thought.

A 2004 report by the Philippines National AIDS Council estimated that only 48% of IDUs reported using sterile injecting equipment the last time they injected, and most IDUs reported that they regularly share injecting equipment [ 6 ]. A 2008 report published by the Joint United Nations Programme on HIV/AIDS (UNAIDS) indicated that the prevalence of sharing injecting equipment is still very high, with 29% of IDUs self-reporting use of an unsterile needle/syringe the last time they injected [ 39 ]. Sharing HIV-contaminated injecting equipment is an efficient mode of HIV transmission [ 40 , 41 ]. Given the experience of neighbouring countries, IDUs could be an important population group for the spread of HIV in the Philippines if the size of the IDU population increases.

Overseas Filipino workers

There are approximately 7.5 million Filipinos working in 170 countries around the world, with more than 2000 workers departing from the country daily [ 32 , 42 ]. By participating in casual unprotected sex or other risky behaviour while overseas in higher prevalence settings, overseas Filipino workers (OFWs) become a substantial source of new HIV cases in the Philippines upon their return home.

Of all the HIV/AIDS cases reported in the Philippines, OFWs account for ~30-35% of all cases (this level has remained relatively steady over the past decade) [ 5 , 13 , 32 ]. Heterosexual sex is the dominant mode of transmission for OFWs, and the main occupations of OFWs who are infected with HIV are seafarers and domestic helpers. OFWs may be a bridge population for the spread of HIV and other STIs [ 32 , 43 , 44 ]. This population will undoubtedly be important in any HIV epidemic in the Philippines.

HIV/AIDS education and social factors

Even though awareness of the disease is high [ 5 ], misconceptions of HIV/AIDS are widespread among health workers, as well as in the general population [ 2 ]. For example, a survey of 1200 males found that many respondents believed that antibiotics, prayer and keeping fit would protect against HIV/AIDS [ 32 ]. Many young people also believe that HIV/AIDS can be prevented or treated by a concoction of drinks, douching with detergents, interrupting coitus and washing the penis [ 5 ]. The Young Adult Fertility Survey found that a large proportion (60%) of young people believed that there was now a cure for HIV/AIDS and, as such, they could become more complacent [ 45 ].

Women in the Philippines are not largely empowered to protect themselves and negotiate for safe sex due to cultural, physiological and socio-economic factors. An estimated 43% of women have admitted to being forced into sex, and 15% believed that they were obligated to have sex with their partners [ 5 ].

Condom use is also low among the population of men who have sex with men (MSM) [ 5 , 6 ]. Unprotected penile-anal sex is a highly efficient mode of HIV transmission [ 46 - 51 ]. Discrimination, harassment and intolerance of homosexuality, particularly male homosexuality, have resulted in MSM becoming a "hidden" population group, even though 20% of reported HIV cases involve male-to-male transmission [ 5 ]. With intolerance still high, it is difficult to provide MSM with HIV/AIDS information, education and treatment.

The current epidemiological state of HIV in the Philippines

In this section, we present HIV/AIDS surveillance data in the Philippines and analytical findings based on monthly diagnoses reported from March 2003 to June 2008 [ 11 ]. There is a steady increase in the cumulative number of HIV notifications in the Philippines (Figure ​ (Figure1 1 ).

Cumulative number of HIV diagnoses in the Philippines by month from March 2003 to June 2008 . Year on figure indicates data at the start of the year.

However, the trends in HIV notifications differ between the genders. The cumulative number of HIV notifications among females has been increasing at a steady rate (p < 0.0001), suggesting that incidence is approximately constant and at an endemic equilibrium. In contrast, the trend among males is not constant, incidence levels are substantially greater than in females, and the rate of new notifications is increasing (evidenced by the curvature away from linear). This suggests that there may be an emerging HIV epidemic among Filipino MSM.

The emergence of an increasing HIV epidemic in the Philippines is evident from trends in monthly reported HIV diagnoses (Figure ​ (Figure2). 2 ). In mid-2003, there were 10 to 15 monthly HIV notifications and there are currently 30 to 50 notifications per month; that is, a three-fold increase over five years. The trend has increased even further from 528 notifications in 2008 to 835 in 2009 (a 58.1% increase in one year) [ 52 ]. This suggests that the epidemic could be approaching a large expansion phase.

Cumulative number of HIV diagnoses in the Philippines by month to June 2008, by gender .

However, the divergence in HIV diagnosis rates between men and women could also reflect possible differences in testing rates. There are no data to suggest differences in testing rates, and the Philippine AIDS Prevention and Control Act of 1998 encourages HIV testing of all individuals at high risk of contracting HIV, with informed consent [ 53 ]. But this alternate explanation for the epidemic trends cannot be ruled out until reliable testing data are available.

Diagnoses of HIV in the Philippines are notified according to various categories of likely route of exposure. These include: heterosexual contact; male homosexual contact; bisexual contact; blood transfusion; injecting drug use; needle prick injury; or perinatal exposure. Bisexual contact refers to men who have had sex with both men and women. It cannot be determined whether the initial actual transmission event was male-to-male sexual contact or transmission from an infected woman. It is more likely that the transmission was via male-to-male sexual contact due to biologically higher transmission rates, but the bisexual category accurately reflects a degree of uncertainty in the route of exposure.

The dominant mode of HIV transmission in the Philippines is sexual (~92%). But the largest increases in the rate of new HIV notifications are due to homosexual and bisexual contact, and not heterosexual contact (Figure ​ (Figure3). 3 ). Over the period, 2003-2008, there was an increase in the monthly number of diagnoses, from 328 for homosexual contact and 92 for bisexual contact to 704 and 289, respectively; that is, respective increases of 114% and 214%. Therefore, there appears to be an increasing epidemic of HIV among men who have sex with men. The increase among bisexual men also has important consequences for the spread of HIV to the general heterosexual population. However, data on testing rates would help to elucidate the extent to which these diagnoses rates are reflective of underlying incidence.

The cumulative number of HIV diagnoses in the Philippines by month to June 2008, by route of exposure .

It should be noted that some of the rise in HIV diagnoses could be attributable to an increase in testing rates. This is evident by the decreasing proportion of all HIV cases that are detected with AIDS disease: ~33% of diagnoses in 2003 were in AIDS stage disease and this has decreased to ~24%. However, the disproportionate trend in diagnoses between genders and between different routes of exposure strongly suggests that the trends in diagnoses reflect actual trends in population incidence. But since a substantial proportion of infections is detected in late-stage disease, it is likely that the majority of all HIV cases are currently undiagnosed in the Philippines [ 5 ].

The cumulative number of AIDS deaths is increasing approximately constantly (p < 0.0001), suggesting that AIDS death rates are relatively constant (Figure ​ (Figure4). 4 ). It could be expected that there will be a delay of a number of years before the rise in HIV diagnoses translates to a rise in AIDS-related deaths.

Cumulative number of AIDS deaths by month from March 2003 to June 2008 .

AIDS is now a reversible HIV-related condition due to combination antiretroviral therapy (ART). The number of people receiving ART in the Philippines has been increasing since 2004, with a rate of approximately 10% of diagnosed cases receiving treatment in 2006, and ART coverage has now increased to approximately 30% [ 10 , 54 ]. But this is still considerably less than desirable levels. Universal treatment access for HIV-infected people is becoming a reality in some of the poorest countries of the world. Since HIV is relatively contained in the Philippines, there is the opportunity to substantially scale up treatment access before the number of HIV cases increases out of control. Treatment should be universal for HIV-positive pregnant women for preventing mother to child transmission (PMTCT) [ 55 ]. However, PMTCT is relatively uncommon in the Philippines.

One of the reasons for such low rates of ART is that funding for such care and treatment of HIV-infected persons makes up a mere 1.6% of the Philippines HIV/AIDS budget [ 56 ]. While expenditure on treatment and care is currently low, the Philippine National AIDS Council's 4 th AIDS Medium Term Plan and its country report for the period, January 2006 to December 2007, to the United Nations General Assembly Special Sessions (UNGASS) states that it will endeavour to improve access to treatment, care and support to HIV-infected persons [ 13 , 21 ]. Treatment not only sustains life among HIV-infected people, but by reducing their viral loads, it reduces infectiousness. At the population level, this would likely prevent considerable numbers of secondary transmissions of HIV [ 57 - 59 ].

The average age at HIV diagnosis in the Philippines was ~35-36 years prior to 2005, but recently, the average age at diagnosis has been decreasing (p = 0.0067) (Figure ​ (Figure5). 5 ). It is now ~29 years of age. Although it is possible that increased testing rates mean infections are detected earlier, the extent of decrease in ages cannot be attributable to changes in testing rates.

Trend in the average age at HIV diagnosis for three-monthly notifications in the Philippines .

The trend in decreased age at diagnosis is likely to reflect a decrease in age at infection. Younger age groups tend to have greater sexual activity. The fact that the average age is decreasing is a strong indicator that HIV incidence could increase substantially in the future in the Philippines. This trend is also in contrast to most other settings where epidemics are being controlled [ 60 ]. However, younger age is not necessarily indicative of greater sexual activity among all population groups, particularly among men who have sex with men, as suggested from other settings [ 61 ]. As men who have sex with men are the population group greatest affected with HIV in the Philippines, the decreasing age at diagnoses may not necessarily suggest a future increase in HIV.

The Filipino government and other stakeholders have responded to the HIV/AIDS threat in the Philippines in a number of ways in order to circumvent a large HIV epidemic from arising. The Philippine National AIDS Council (PNAC) was created in 1992 to act as an advisory body to the President for the development of policy for the control of AIDS. The PNAC consists of members from the government, public, civil society, private sector and non-governmental organizations (NGOs), and is the central advisory, planning and policy-making body for the comprehensive and integrated HIV/AIDS prevention and control programme [ 5 ]. But its small budget has limited its ability to instigate implementation of large intervention and education campaigns.

The official response of the Philippines Government to the HIV threat was to enact the Philippine AIDS Prevention and Control Act of 1998 (Republic Act No. 8504) [ 53 ]. This Act was enacted by Congress after a long process of deliberation and advocacy by the PNAC and other stakeholders [ 19 ]. The Act called for: a comprehensive nationwide HIV/AIDS educational and information campaign; full protection of the human rights of known and suspected HIV-infected persons; promotion of safe and universal precautions in practices and procedures that carry risks of HIV transmission; the eradication of conditions that aggravate spread of HIV infection; and recognition of the important role that affected individuals could have in promoting information and messages about HIV/AIDS. The Act also states that local governments are to provide community-based HIV/AIDS prevention, control and care services.

While the Act is a step in the right direction, it is far from effective due to a lack of monetary commitment from the government, relying heavily on NGOs for funding for HIV/AIDS education and prevention programmes, and the current government's seemingly unwilling attitude to promote wide condom use for fear of angering the Roman Catholic Church [ 35 ]. Its statements are also broad and do not outline targeted strategies with specific goals.

Other programmes have also been established for monitoring the spread, understanding key epidemic drivers and planning the control of HIV in the Philippines. There are currently four types of surveillance systems in place in the Philippines:

1. The HIV/AIDS Registry was established in 1987 and is a passive surveillance system. It continuously records Western Blot-confirmed HIV cases reported by hospitals, laboratories, blood banks and clinics that are accredited by the Department of Health.

2. The HIV Sentinel Surveillance System (HSSS) was established in 1993 with a grant from the USAgency for International Development (USAID). It monitors 10 key cities: Baguio City, Angeles City, Iloilo City, Zamboanga City, Pasay City, Quezon City, Cebu City, Cagayan de Oro City, Davao City and General Santos City. It pays particular attention to establishment-based female sex workers, freelance female sex workers, MSM and IDUs [ 3 , 6 , 32 ].

3. Behavioral Sentinel Surveillance was added at the 10 HSSS sites in 1997 and is a systematic and repeated cross-sectional survey of behaviour related to the transmission of HIV and other STIs [ 3 , 32 , 62 ]. Its major purpose is to detect trends among vulnerable populations and groups at high risk whose behavioural change would have the greatest impact on the HIV epidemic.

4. The Sentinel STI Etiologic Surveillance System was set up in December 2001, but made operational in 2003. It monitors STI trends that could guide programme interventions to prevent the transmission of HIV.

These surveillance systems have been monitoring the progress of HIV in the Philippines and have provided valuable data to inform appropriate response measures.

The PNAC's 4 th AIDS Medium Term Plan for 2005 to 2010 is one of the plans that utilized data from the surveillance systems [ 5 , 21 ]. This plan aligns with the Philippines AIDS Prevention and Control Act, with the aims of scaling up and improving the quality of preventive interventions and the quality of treatment, care and support services for people infected with and affected by HIV/AIDS. It also aims to integrate stigma reduction measures in the preventive treatment, care and support services and in the design of management systems.

The current state of HIV in the Philippines is not attributable to any one factor. While the Philippines response is associated with effectively controlled levels of HIV, there is no guarantee that a large HIV epidemic will be avoided in the near future. Indeed, an expanding HIV epidemic is likely to be only a matter of time as the components for such an epidemic are already present in the Philippines.

Mathematical modelling studies have shown that even in countries where overall HIV prevalence has remained relatively low (e.g., Bangladesh), moderate changes in behaviour or HIV infections could initiate a large epidemic that may otherwise have taken numerous decades to develop [ 63 , 64 ]. Current data from the PNAC show that young adults, men who have sex with men, male and female sex workers, injecting drug users, overseas Filipino workers, and the sexual partners of people in these groups are particularly vulnerable to HIV infection [ 13 ].

The current behavioural, social and epidemiological conditions suggest that an HIV epidemic in the Philippines may be unavoidable in the near future. The number of diagnoses is increasing, particularly due to homosexual and bisexual contact; there are low condom-use rates; and the age at diagnosis is decreasing. The underlying cause of these symptoms needs to be addressed in order to prevent an emergent epidemic. The promotion of HIV prevention and education messages is underfunded and has been relatively ineffective. It is recommended that more investment be made into these programmes in order to maintain the "low and slow" development of HIV in the Philippines.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

ACF conducted the extensive literature search, collated available data, produced the figures and wrote the first draft of the manuscript. DPW conceived and supervised the review project and contributed to the writing of the manuscript. Both authors read and approved the final manuscript.

• Joint United Nations Programme on HIV/AIDS (UNAIDS) Report on the global HIV/AIDS epidemic 2008. . Geneva. 2008.
• Aquino C, D'Agnes L, Castro J, Borromeo M, Schmidt K, Gill K. Community Outreach and Peer Education for HIV and AIDS Prevention: The AIDS Surveillance and Education Project in the Philippines. Makati City, Philippines; Program for Appropriate Technology in Health (PATH); 2003. [ Google Scholar ]
• Asian Development Bank. ADB Supporting Philippines in Combating Spread of HIV/AIDS. http://www.adb.org/Media/Articles/2007/11996-philippines-combating-hiv-aids/default.asp
• Balk D, Brown T, Cruz G, Domingo L. Are Young People in the Philippines Taking Chances with HIV/AIDS? Asia-Pacific Population and Policy. 1997; 13 :1–4. [ PubMed ] [ Google Scholar ]
• Caccam EM. In: "The Philippines", Fighting a Rising Tide: The Response to AIDS in East Asia. Yamamoto T, Itoh S, editor. Japan Center for International Exchange; 2006. Current State and Future Projections of the Spread of HIV/AIDS; pp. 207–225. [ Google Scholar ]
• Mateo R, Sarol JN, Poblete R. HIV/AIDS in the Philppines. AIDS Education and Prevention. 2004; 13 :43–52. doi: 10.1521/aeap.16.3.5.43.35519. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dore GJ, Ungchusak K, Martin TE. Epidemiology of HIV and AIDS in the Asia Pacific region. Med J Aust. 1996; 13 :494–498. [ PubMed ] [ Google Scholar ]
• Gacad E, Aquino C, Tempongko S, Corcega T, Gonzales R, Salva E, Cruz M. In: Sexually Transmitted Diseases in Asia and the Pacific. Brown T, Chan R, Mugrditchian D, Mulhall B, Plummer D, Sarda R, Sittitrai W, editor. Venereology Publishing, Australia; 1998. Philippines; pp. 257–279. [ Google Scholar ]
• USAID. Country Profile: HIV/AIDS - Philippines. Pasai City, Philippines; United States Agency for International Development (USAID) - Bureau for Global Health; 2003. [ Google Scholar ]
• USAID. Philippines: HIV/AIDS Health Profile. Pasay City, Philippines; United States Agency International Development (USAID); 2008. [ Google Scholar ]
• Philippines Department of Health. Philippine HIV and AIDS Registry - March 2003-June 2008 Monthly Reports. Manila; Philippine Department of Health, National Epidemiology Center; 2003. [ Google Scholar ]
• Health Action Information Network (HAIN) In the Shadows Men Who Have Sex with Men. Antipolo City: National Economic and Development Authority, and UNDP; 2002. [ Google Scholar ]
• Philippes National AIDS Council (PNAC) Follow-up to the Declaration of Commitment on HIV AIDS United Nations General Assembly Special Session (UNGASS): Country Report of the Philippines January 2006 to December 2007. . Manila. 2008.
• Weniger BG, Limpakarnjanarat K, Ungchusak K, Thanprasertsuk S, Choopanya K, Vanichseni S, Uneklabh T, Thongcharoen P, Wasi C. The epidemiology of HIV infection and AIDS in Thailand. AIDS. 1991; 13 (Suppl 2):S71–85. [ PubMed ] [ Google Scholar ]
• Philippines Department of Health. Status and Trends of HIV/AIDS in the Philippines; the 2002 Technical Report of the National HIV/AIDS Sentinel Surveillance Sytem. . Manila. 2002.
• Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, Wodak A, Panda S, Tyndall M, Toufik A, Mattick RP. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008; 13 :1733–1745. doi: 10.1016/S0140-6736(08)61311-2. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bosch X. HIV mystery in the Philippines. The Lancet Infectious Diseases. 2003; 13 :320. doi: 10.1016/S1473-3099(03)00640-6. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Evidence to Action HIV & AIDS Data Hub. Philippines. UNAIDS; 2009. Key Data Issues and Suggestions: . http://aidsdatahub.org/files/philippines_key_data_issues.pdf Accessed 16 February 2010. accessed 16 February 2010) [ Google Scholar ]
• Philippine National AIDS Council (PNAC) The PNAC Report 1999-2004. 2004.
• WHO. HIV and Behavioural Surveillance in the Philippines. . Manila. 2000.
• Philippine National AIDS Council (PNAC) 4th AIDS Medium Term Plan (2005-2010) Philippines. . Manila. 2005.
• Philippine National AIDS Council (PNAC) 2004 Accomplishment: Towards the Next Phase of the Response. . Manila. 2004.
• Parish WL, Laumann EO, Cohen MS, Pan S, Zheng H, Hoffman I, Wang T, Ng KH. Population-based study of chlamydial infection in China: a hidden epidemic. JAMA. 2003; 13 :1265–1273. doi: 10.1001/jama.289.10.1265. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999; 13 :3–17. doi: 10.1136/sti.75.1.3. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Galvin SR, Cohen MS. The role of sexually transmitted diseases in HIV transmission. Nature Reviews Microbiology. 2004; 13 :33–42. doi: 10.1038/nrmicro794. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Castellsague X, Peeling RW, Franceschi S, Sanjose Sd, Smith JA, Albero G, Diaz M, Herrero R, Munoz N, Bosch FX. Chlamydia trachomatis infection in female partners of circumcised and uncircumcised adult men. Am J Epidemiol. 2005; 13 :907–916. doi: 10.1093/aje/kwi284. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS medicine. 2005; 13 :e298. doi: 10.1371/journal.pmed.0020298. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, Williams CF, Campbell RT, Ndinya-Achola JO. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007; 13 :643–656. doi: 10.1016/S0140-6736(07)60312-2. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wawer MJ, Makumbo F, Kigozi G, Serwadda D, Watya S, Nalugoda F, Buwembo D, Ssemoijja V, Kiwanuka N, Moulton LH, Sewankambo NK, Reynolds SJ, Quinn TC, Opendi P, Ia B, Ridzon R, Laeyendecker O, Gray RH. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007; 13 :657–666. doi: 10.1016/S0140-6736(07)60313-4. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• PNG National AIDS Council (NAC) UNGASS 2008 Country Progress Report. Reporting Period: January 2006-December 2007. . Boroko. 2008.
• Leano PS, Kageyama S, Espantaleon A, Maniar J, Iwasaki M, Saple D, Yoshihara N, Kurimura T, Agdamag DM. Introduction of Human Immunodeficiency Virus Type 2 Infection in the Philippines. Journal of Clinical Microbiology. 2003; 13 :516–158. doi: 10.1128/JCM.41.1.516-518.2003. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Filipinos Face Up to a Brutal Reality. Blood Weekly. 1995. pp. 22–24. [ PubMed ]
• Monitoring the AIDS Pandemic Network (MAP) AIDS in Asia: Face the Facts. A comprehensive analysis of the AIDS epidemic in Asia. . Bangkok. 2004.
• WHO. Global Tuberculosis Control - WHO Report. Country Profile: Philippines. 2008. pp. 137–140.
• Human Rights Watch. The Philippines - Unprotected: Sex, Condoms and The Human Right to Health. 2004. p. C1606. http://www.unhcr.org/refworld/docid/412ef1a74.html accessed 23 March 2010.
• Lim-Quizon MC, Roces MC, Cuenco W, Ghee AE, Poumerol G, Omi S. HIV in the Philippines: analysis of data from the National HIV Sentinel Surveillance System. XII International AIDS Conference. Geneva, Switzerland. 1998. p. 946.
• PATH. First Annual Report. PATH and the AIDS Surveillance and Education Project. 1994.
• Brown T, Chan R, Mugrditchian D, Mulhall B, Plummer D, Sarda R, Sittitrai W. Sexually Transmitted Diseases in Asia and the Pacific. Australia: Venereology Publishing; 1998. [ Google Scholar ]
• Philippines: Country profile report. UNAIDS; 2008. http://www.aidsdatahub.org/countries/profile/philippines Accessed 16 February 2010. [ Google Scholar ]
• Baggaley RF, Boily MC, White RG, Alary M. Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis. AIDS. 2006; 13 :805–812. doi: 10.1097/01.aids.0000218543.46963.6d. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hudgens MG, Longini IM Jr, Vanichseni S, Hu DJ, Kitayaporn D, Mock PA, Halloran ME, Satten GA, Choopanya K, Mastro TD. Subtype-specific transmission probabilities for human immunodeficiency virus type 1 among injecting drug users in Bangkok, Thailand. Am J Epidemiol. 2002; 13 :159–168. doi: 10.1093/aje/155.2.159. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Valencia AGF, Nicomedes GLA. Impact of HIV/AIDS on an overseas Filipino worker and his family. Asia Pacific Family Medicine. 2003; 13 :120–125. doi: 10.1046/j.1444-1683.2003.00066.x. [ CrossRef ] [ Google Scholar ]
• Kramer MA, van Veen MG, de Coul EL, Geskus RB, Coutinho RA, Laar, Prins M. Migrants travelling to their country of origin: a bridge for HIV transmission? Epidemiology. 2008; 13 :554–555. [ PubMed ] [ Google Scholar ]
• Suñas LP, Mateo R. The Vulnerabilities of Filipino Seafarers to HIV/STIs. . Pasay City. 2002.
• Health Action Information Network (HAIN) HIV/AIDS Country Profile Philippines. . Manila. 2003.
• Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. Am J Epidemiol. 1999; 13 :306–311. [ PubMed ] [ Google Scholar ]
• DeGruttola V, Seage GR, Mayer KH, Horsburgh CR Jr. Infectiousness of HIV between male homosexual partners. J Clin Epidemiol. 1989; 13 :849–856. doi: 10.1016/0895-4356(89)90098-X. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Dis. 2002; 13 :38–43. doi: 10.1097/00007435-200201000-00007. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chesson HW, Pinkerton SD, Voigt R, Counts GW. HIV infections and associated costs attributable to syphilis coinfection among African Americans. Am J Public Health. 2003; 13 :943–948. doi: 10.2105/AJPH.93.6.943. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Royce RA, Sena A, Cates W Jr, Cohen MS. Sexual transmission of HIV. N Engl J Med. 1997; 13 :1072–1078. doi: 10.1056/NEJM199704103361507. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Johnson AM, Petherick A, Davidson SJ, Brettle R, Hooker M, Howard L, McLean KA, Osborne LE, Robertson R, Sonnex C, Tchamouroff S, Shergold C, Adler MW. Transmission of HIV to heterosexual partners of infected men and women. AIDS. 1989; 13 :367–372. [ PubMed ] [ Google Scholar ]
• Philippines Department of Health (DOH) Philippine HIV and AIDS Registry - December December 2009 Monthly Reports. Manila. 2008.
• Republic Act No. 8504. The Philippine AIDS Prevention and Control Act. . Manila. 1998.
• WHO. Philippines: Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections. . Geneva. 2006.
• UNAIDS. Philippines: Progress towards Universal Access and The Declaration of Commitment on HIV/AIDS. UNAIDS; 2007. http://cfs.unaids.org/country_factsheet.aspx?ISO=PHL Accessed 16 February 2010. [ Google Scholar ]
• UNAIDS. AIDS spending by categories and financing sources. UNAIDS; 2008. http://www.aidsdatahub.org/countries/profile/philippines Accessed 16 February 2010. [ Google Scholar ]
• Wilson DP, Law MG, Grulich AE, Cooper DA, Kaldor JM. Relation between HIV viral load and infectiousness: a model-based analysis. Lancet. 2008; 13 :314–320. doi: 10.1016/S0140-6736(08)61115-0. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wilson DP, Hoare A, Regan DG, Law MG. Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men. Sex Health. 2009; 13 :19–33. doi: 10.1071/SH08081. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2008. [ PubMed ]
• Wilson DP. Modelling based on Australian HIV notifications data suggests homosexual age mixing is primarily assortative. Journal of Acquired Immune Deficiency Syndromes. 2009; 13 :356–360. [ PubMed ] [ Google Scholar ]
• Jin F, Crawford J, Prestage GP, Zablotska I, Imrie J, Kippax SC, Kaldor JM, Grulich AE. Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS. 2009; 13 :243–252. doi: 10.1097/QAD.0b013e32831fb51a. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• USAID. Final Evaluation of the AIDS Surveillance and Education Project. Manila. 2001.
• Saidel TJ, Des Jarlais D, Peerapatanapokin W, Dorabjee J, Singh S, Brown T. Potential impact of HIV among IDUs on heterosexual transmission in Asian settings. Int J Drug Policy. 2003; 13 :63–74. doi: 10.1016/S0955-3959(02)00209-8. [ CrossRef ] [ Google Scholar ]
• Wilson DP, Gray R, Heymer KJ, Hoare A, Kwon JA, Thein HH, Worth H, Kaldor J. Evaluation of the potential impact of the global economic crisis on HIV epidemics in Southeast Asia. Sydney: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales; 2009. [ Google Scholar ]

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As AIDS, HIV awareness among PH youth declines, cases, deaths rise

INQUIRER FILE PHOTO

MANILA, Philippines—The HIV and AIDS epidemic in the Philippines is worsening, but the percentage of young Filipinos who are aware of the disease had fallen to its lowest since 1994.

This was revealed in the 2021 Young Adult Fertility and Sexuality Study (YAFS5) conducted by the University of the Philippines Population Institute (UPPI), which said that last year, only 76 percent of 15 to 24 year olds have heard of HIV and AIDS.

It was a 19-percentage point drop from 95 percent in 1994. HIV and AIDS awareness was still 95 percent in 2002, but a decrease was seen in 2013, when the share of youth who have heard of the virus and the disease fell to 83 percent.

UPPI said this was concerning since a low level of awareness and insufficient knowledge of HIV and AIDS can stall efforts to arrest the increasing number of infections in the Philippines.

As mentioned by the Department of Health (DOH), the Philippines has the fastest-growing HIV epidemic in the Asia-Pacific region, with a 237 percent increase in annual new infections from 2010 to 2020.

READ: HIV spread fastest in PH – study

HIV—human immunodeficiency virus—is a virus that attacks the body’s immune system, the US Centers for Disease Control and Prevention said. If HIV is not treated, it can lead to AIDS—acquired immunodeficiency syndrome.

GRAPHIC: Ed Lustan

AIDS is the most severe stage of HIV, next to acute HIV infection (first stage) and chronic HIV infection (second stage). People with AIDS can have a high viral load and may easily transmit the virus. Without treatment, AIDS can lead to death.

Based on DOH data, AIDS-related deaths in the Philippines have increased by 315 percent—from 200 in 2010 to 820 in 2020. In 10 years, 4,890 in the Philippines had died of the disease.

Lack in deep knowledge of HIV, AIDS

According to Karger, a Switzerland-based publishing company that focuses on health and science, increasing knowledge and awareness about HIV and AIDS is one of the most crucial strategies in the prevention of infections and the disease.

This was the reason that UPPI said the low level of awareness and insufficient knowledge of HIV and AIDS could become a hindrance in preventing the spread of infections.

Out of those who have heard of HIV and AIDS, the UPPI also examined the percentage of those with comprehensive knowledge of the virus, based on five standardized statements consisting of a mix of right and wrong knowledge about HIV.

UPPI revealed that based on the results of the YAFS5, only one in five youth has comprehensive knowledge of the virus. The percentage significantly changed in women—from 16 percent in 2013 to 19 percent in 2021.

While there was a slight change in the percentage of men who have comprehensive knowledge of HIV, UPPI stressed that it was not statistically significant—from 18 percent in 2013 to 19 percent in 2021.

YAFS5 found that 52 percent of young Filipinos incorrectly believed that a person can get HIV by sharing food with someone who is infected. About two in five did not believe that a healthy-looking person can have the virus.

Some 35 percent also did not believe that a person can reduce the risk of getting infected with HIV by using a condom every time they have sex. YAFS5 data revealed that among youth who have ever had sex, only a fifth have ever used a condom.

Likewise, 27 percent did not believe that the risk of transmission can be lessened by having sex with only one partner who is not infected and who has no other sexual partners, while 24 percent incorrectly believed that a person can get HIV from mosquito bites.

Not enough awareness in BARMM

YAFS5 found that awareness of HIV and AIDS is highest in Central Visayas at 87.4 percent, but lowest in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), where knowledge of the virus and the disease stood at only 38.8 percent.

According to the University Research Co., a company dedicated to improving the quality of health care, social services, and health education all over the world, the armed conflict in BARMM contributed to its present socio-economic condition.

“The region suffers from a lack of equitable access to health care and weaknesses in the quality of health care. Inequitable gender norms have also undermined health outcomes,” it said.

Soccsksargen’s 46.5 percent is next to BARMM as the region with the lowest level of awareness of HIV and AIDS. The next lowest was Zamboanga Peninsula at 63.3 percent and Ilocos Region at 64.7 percent.

The regions next to Central Visayas in terms of awareness were Northern Mindanao (87.1 percent), Caraga Region (85.8 percent), Cordillera Administrative Region, or CAR (85.2 percent), Mimaropa (84.7 percent) and Metro Manila (84.5 percent).

Calabarzon has 82.6 percent level of awareness, while Davao Region has 81.9 percent. Western Visayas has 79.3 percent, Bicol Region has 76.6 percent, Cagayan Valley has 72.1 percent, Central Luzon has 70.8 percent, and Eastern Visayas has 69.3 percent.

Rise in cases, deaths concerning

The DOH had said while the total HIV prevalence in the Philippines is less than one percent, the total estimated number of people living with HIV (PLHIV) in 2020 hit the 115,100 mark, an increase from 99,600 in 2019.

According to data from the department, there were 5,000 new infections in 2010, 5,100 in 2011, 5,900 in 2012, 7,200 in 2013, 8,700 in 2014, 9,800 in 2015, 10,700 in 2016, 12,300 in 2017, 13,900 in 2018, 15,200 in 2019, and 16,700 in 2020.

It stressed that if the rapid increase in new infections will persist, the estimated number of persons with HIV was expected to reach 331,500 by 2030. Back in 2019, out of the 99,600, 73 percent knew their status but only 44 percent were receiving antiretroviral treatment.

The DOH in 2020 had categorized a total of 118 local government units as “high burden areas” which have a median HIV case-infected population ratio of 10.5 for every 10,000 individuals.

RELATED STORY: Advocate: HIV still ‘silent epidemic’ amid COVID-19 threat

Out of the 115,100 persons with HIV in 2020, 38,700 were from Metro Manila, 19,300 were from Calabarzon, 11,900 were from Central Luzon, 11,400 were from Central Visayas, and 6,900 were from Davao Region.

The regions with the least number of infected persons were BARMM (300), CAR (1,300), Caraga Region (1,300), Mimaropa (1,600), Cagayan Valley (1,700), Eastern Visayas (1,700), and Zamboanga Peninsula (1,700).

Intervention important

As stressed by the DOH in its “A Briefer on the Philippine HIV Estimates,” a total of 152,300 HIV infections were averted by the Philippines because of interventions established in HIV response since 2005.

“If no interventions were put in place between 2005 and 2020, the total cumulative HIV infections for 2020 would have reached 274,800, double the amount projected for the current estimates which is at 122,500,” it said.

The DOH stressed that with continued improvement in the country’s HIV response, more HIV infections could be averted and more lives saved from the virus and the disease.

But as of 2020, the Philippines is still far from accomplishing the 95-95-95 targets, which aims to diagnose 95 percent of cases, provide antiretroviral treatment for 95 percent of those diagnosed and achieve viral suppression for 95 percent of those treated by 2030.

Based on DOH data as of December 2020, a total of 78,291 persons out of 115,100 have been diagnosed based on HARP data, indicating that the diagnosis coverage for the Philippines that year was 68 percent.

READ: How is PH faring in HIV treatment?

Out of the 78,291 at least 59,933 were enrolled in treatment and 47,977 are presently on antiretroviral treatment. From the first pillar to the last, a total of 67,123 persons with HIV were lost along the cascade of care, and were therefore not given access to life-saving treatment.

Breaking barriers

With antiretroviral treatment, HIV is no longer a death sentence, however, the stigma, which is stirred by misconceptions about the virus, persists.

READ: No longer a death sentence

It was in 2018 when then President Rodrigo Duterte signed Republic Act No. 11166, or the Philippine HIV and AIDS Policy Act.

The World Health Organization welcomed the new law, saying that it will help elevate attention to HIV and AIDS and address some of the critical bottlenecks in the HIV program in the Philippines.

This, as HIV continues to be a serious health threat in the country with a record high of 32 reported infections per day.

The law, it said, will help in expanding access to evidence-based HIV prevention strategies. Access to means to prevent sexual transmission of HIV and transmission associated with drug use—such as condoms and other commodities—remains a critical need for curbing the rising epidemic.

Likewise, the new law will facilitate easier access to learning about one’s HIV status, in particular for young people aged 15 years old and above who can now undergo an HIV test without parental or guardian consent.

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“This is critical to intensify the response among the youth, who represent 62 percent of new HIV infections in the country. HIV testing is now also a routine procedure of prenatal care to prevent HIV infection from mother to child during pregnancy, labor and breastfeeding,” it said.

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'Not a death sentence': People with HIV slowly winning the battle vs stigma | ABS-CBN News

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The state of HIV epidemic in the Philippines

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This is AI generated summarization, which may have errors. For context, always refer to the full article.

Rappler has taken down the article, titled, “The state of HIV epidemic in the Philippines,” which was originally published on this page on December 1, 2023, under the byline of Jezreel Ines. 

Our internal investigation found that considerable parts of the article had plagiarized a research paper authored by Louie Mar A. Gangcuangco and Patrick C. Eustaquio, titled,  “The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023,”  published on April 30, 2023. 

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