essay about hiv aids in the philippines

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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.

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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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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.

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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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New law important boost to HIV response in the Philippines

20 years after the first HIV/AIDS law in the Philippines, the President signed into law the Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166). The WHO welcomes the new law as it helps elevate attention to HIV/AIDS and address some of the critical bottlenecks in the HIV programme in the Philippines. HIV continues to be a serious health threat in the country with a record high of 32 reported infections per day. Republic Act 11166 will help in expanding access to evidence-based HIV prevention strategies. Access to the 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 facilitates 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. This is critical to intensify the response among the youth, who represent 62% 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, labour and breastfeeding. The law also paves the way for urgently needed acceleration of access to free HIV treatment and related illnesses. Treatment coverage in the Philippines remains low with only 36% of people living with HIV getting treatment. Notably the law embeds HIV/AIDS in universal health care by tasking PhilHealth to develop a revised benefit package including medication and diagnostics for in-patients and out-patients. Denial of health, accident and life insurance coverage to people living with HIV is now unlawful. We share the call of the Department of Health to be vigilant in ensuring that the law is fully and properly implemented. The next step of developing the Implementing Rules and Regulations is vital and WHO will support the DOH in this endeavour. We commend the Philippines, including the Department of Health, HIV partners and advocates, for this new HIV law. It is a step in the right direction to reverse the tide of the HIV epidemic and save the lives of many Filipinos.

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Ms Faizza Tanggol

Communications Consultant WHO Regional Office for the Western Pacific

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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 ).

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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.

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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.

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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.

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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.

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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.

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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.

No proper attributions were made to the paper and its authors, and the article’s structure and flow also bore strong similarities with the paper. These were in violation of professional and ethical standards in journalism and research.

We deeply regret this incident, and apologize to Dr. Gangcuangco and Dr. Eustaquio and to our readers for this lamentable editorial lapse.

We value transparency and integrity in our work, and we are taking steps to make sure this does not happen again. Rappler is working toward a just resolution of the incident with the personnel involved who will have to be taken to task and held accountable. Rest assured that corrective measures are being taken.

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LoveYourself Inc.

Leading HIV Advocacy Group offering Free HIV Test

Breaking Stigma with “My HIV Story”

To break stigma and discrimination, this year’s Philippine International AIDS Candlelight Memorial (PIACM) asked the community to share their distinct, and compelling stories of HIV online through a photo essay contest called “Light Up My HIV Story.”

Nearly 50 stories were collected, and most of them are genuinely moving and inspirational. Some talked about their own HIV journey while some talked about how they become a supporter of the community.

The Light Up My HIV Story photo essay contest winners were announced during the celebration part of the PIACM 2020 event last May 17. Winning the first place was Anthony Louie David with his photo essay entitled: “ Unconditional Love .” This entry talks about Anthony’s HIV journey as someone living with HIV. He likened his status into being swallowed up by the waves or play along with it.

Anthony described that he felt like huge waves crashing over him following the death of his partner due to HIV complications and upon knowing that he has HIV. According to him, he was tired and wanted to give up. He was slowly drowning from his thoughts about his HIV status.

“It’s up to us to decide whether to sink to the bottom or to walk on water. But for me, I choose to survive the waves and embrace every splash with a smile in my face,” he said.

Kael Mata’s “ Salamat HIV ” entry took the second spot. His story focused on how he has faced HIV despite many social injustices he has to face.

With his regained strength, he made a promise to himself that he’ll be a voice to the PLHIV to fight against HIV, stigma, and discrimination. He said in Filipino, “I will constantly bring with me the stories of PLHIV that even living with HIV, we deserve to be loved, cared for, and an accepting family.”

Alliah Nicole Tabarangao Sayo, who placed third with her “ Think POZitive ” entry, talked about being optimistic, encouraging, and empowering. Her story revolved around the purpose of her joining the HIV advocacy works.

“In all that I’ve learned from the advocacy, one of the most important things to know is how to become accepting of people no matter who they are,” Alliah said in Filipino.

In this respect, the winners have won ₱25,000.00, ₱15,000.00, and ₱10,000.00.

Judging the photo essay contest are Imee Igpuara Country Product Manager, Camber Pharmaceutical, Inc. by Hetero; Jeffrey Johnson, Senior Vice President – Human Capital Resource Management, Global HR Committee Member, Teleperformance Philippines; Dr. Maria Stella Flores, Senior Program Officer, Pilipinas Shell Foundation, Inc.; Dr. Maria Lorela Averilla, Country Lead for SKPA – Program Australian Federation of AIDS Organisations; and Dr. Ronivin Pagtakhan, a recipient of the 2018 Ten Outstanding Young Persons of the World, Founder and Executive Director of the LoveYourself, Inc.

Light Up was presented by the Department of Health, The Project Red Ribbon Care Management Foundation, and The LoveYourself, Inc.; sponsored by AIDS Healthcare Foundation (AHF), Camber Pharmaceutical Inc. by Hetero, Cepheid, Champion Community Centers, Frontrow Cares, Macare Medicals, Inc., Pilipinas Shell Foundation, Inc., Premiere Condoms, Teleperformance Philippines, and Sustainability of HIV Services for Key Populations in Asia (SKPA); and supported by the Department of Social Welfare and Development, EON Foundation, the National Youth Commission (NYC), Philippine Educational Theater Association (PETA), PhilHealth, Positibong Marino Philippines, Inc., The Red Whistle, Sustained Health Initiatives of the Philippines, and UNAIDS.