"Tipping point" reached after rise in Philippines HIV/AIDS cases?

Consistent increases in HIV infections in the Philippines cannot be reversed without appropriate interventions, say health experts, following the recent release of the country's highest monthly infection rate recorded thus far.

In May 2013 415 new HIV cases were recorded, with 55 percent of cases being among those aged 20-29.

Since 2007, the Department of Health's National Epidemiology Centre (DOH-NEC) has noted a steady increase in HIV cases. In 2000, there was one case registered every three days; in 2011, this number grew to one case every three hours.

"The nature of the HIV epidemic has changed. Transmission is still primarily through unprotected sex, but infections are now mostly through same sex transmission whereas previously, it was heterosexual," said Teresita Bagasiao, the Joint UN Programme on HIV/AIDS (UNAIDS) country coordinator in the

Philippines.

Concentrated epidemic

Part of the problem is that current interventions have not kept pace with change.

"Most interventions are still focused on heterosexual transmission. There is an opportunity for focused interventions [on men having sex with men and injecting drug users] to reach the recommended 60-80 percent of key affected populations," said Bagasiao.

But even with these interventions, any drop in HIV infections would not occur for another 3-5 years, she added.

Though Philippines is a low-prevalence country with less than 1 percent of the nearly 95 million population infected, Bagasiao said the epidemic is "concentrated" with an average 4-5 percent rate of infection among what donors call "key" populations, including sex workers, men who have sex with men and injecting drug users.

Since 1987 when HIV was first discovered in the Philippines, DOH-NEC has registered 13,594 infections.

"Tip of the iceberg"

But others say this official number is just the "tip of the iceberg". Stigma continues to surround HIV and with less than 1 percent of the general population getting tested for HIV, officially recorded cases most likely do not accurately reflect the epidemic.

"We project that the number of infected will reach 39,000-50,000 by 2015," said Jonas Bagas, executive director of The Library Foundation Sexuality, Health and Rights Educators Collective, Inc (TLF-Share), an NGO member of the Philippine National AIDS Council (PNAC), the country's central advisory body on HIV/AIDS.

"HIV is still considered a gay disease and equated to a death sentence. Prevention messages are mostly scare tactics making people afraid of getting tested. They'd rather not know their status, especially the young people," said Bagas.

Barriers discouraging testing among youths include a provision in the 1998 Philippine AIDS Prevention and Control Act that requires parental consent for anyone under 18 to be tested for HIV.

Advocates are fighting to amend the requirement.

Rather, added Bagas, an appropriate response to halt the spread of HIV is to give youths sex education that focuses on prevention strategies such as delaying first sexual encounters, as well as a nationwide publicity campaign on HIV information and services.

"We have yet to have a nationwide campaign on HIV on the scale that we have for other diseases like dengue," Bagas said. As of early June there have been at least 42,000 dengue infections reported in 2013 nationwide, with nearly 200 deaths.

Concerted effort needed

But budgets for such an HIV prevention campaign are hard to secure.

Though government agencies such as DOH and the Department of Social Welfare and Development have increased spending in recent years for HIV prevention, funds from international agencies for HIV have shrunk dramatically.

In 2009, international donors funded almost 73 percent of the country's budget for HIV prevention and control; in 2010, the contribution barely reached 40 percent.

The 2008 Commission on AIDS Report recommended US$1 per capita annual spending for HIV prevention and control - nearly $95 million based on the current estimated population.

According to the Philippines National AIDS Council 2012 report, $37 million was spent on HIV from 2009-2011, or an average of about $12.4 million per year.

"We need the help of the LGUs [local government units, the country's smallest unit of government] in appropriating funds in their local budgets for HIV and STI [sexually transmitted disease] prevention and information. The DOH cannot do it alone," said Genesis Samonte, the department's chief epidemiologist for HIV.

"We are at a tipping point. We have a choice [to determine] how big this problem will be, but we cannot go back any more. It is our response to HIV that will now dictate its magnitude," Samonte concluded.