The nation’s HIV status

By Zsarlene B. Chua

Fewer people are becoming infected with HIV (Human Immunodeficiency Virus) around the world but the Philippines is, worryingly, trending in the opposite direction. A 2014 country progress report available on the UNAIDS Web site tells us that in 2000, only one new case every three days was diagnosed; by the end of 2013, there was one new case every two hours. In addition, UNICEF noted that the Philippines was “one of only seven countries globally where the number of new HIV cases increased by over 25% from 2001 to 2009.”

The first person with HIV in the Philippines was diagnosed in 1984. In the 32 years since, 33,419 people were diagnosed as having contracted the virus. While the prevalence is still low at 0.1% of the population, the number of people diagnosed daily has been rising steadily. In 2014, 17 people were newly diagnosed with HIV every day. In 2016, that number went up to 27 a day, according to a study released by the Health department this April.

The Health department estimates that there are 42,000 people living with HIV in the country, which means that around 9,000 remain undiagnosed and untreated.

USE CONDOMS
A graph of newly diagnosed HIV cases shows a steep rise beginning in 2007. “I think because that was when Asia started to become more integrated and people had access to the internet and mobile phones, etc.,” said Dr. Genesis Samonte, head of the health department’s HIV surveillance unit, told ����ý in a phone interview on June 27.

Internet access coupled with apps like Grindr, a social network exclusively for gay, bi and curious men, has made it easier to find potential partners. “Sex is so accessible, even more so with dating apps,” said Renen Bautista, a volunteer at Love Yourself — a Philippine non-profit organization focusing on testing, treatment, and support for people living with HIV (PLHIV) — during an interview with ����ý on June 23 at their testing center in Mandaluyong City.

Rather than demonize gay sex, Dr. Samonte pointed out that it’s sexual risk behaviors that are responsible for the steep rise in cases: “If you’re using a condom, it doesn’t matter how many partners you have,” she said. “It’s the combination of the ease of finding partners and unprotected sex that’s driving the increase in numbers.”

According to the Health department, 772 people were diagnosed with HIV this April, representing a 38% increase in the number of cases reported in the same period last year.

Of those 772 cases, 94% are men with a median age of 28 — more than half of the 94% are between the ages of 25 and 34, while 29% are just 15 to 24 years old. The highest number of reported cases came from the National Capital Region (41%) followed by Calabarzon (17%).

“Reported modes of transmission were sexual contact (730), needle sharing among injecting drug users (40), and mother-to-child transmission (two). Eighty-six percent of those transmitted through sexual contact were among males who have sex with males (MSM),” said the report.

Historically MSMs is the population most at risk of contracting HIV as AVERT.org — a UK-based HIV information organization — figured that MSMs are “19 times more likely to be living with HIV than the general population.”

This is mostly because of biological factors (“unprotected anal sex carries a higher risk of transmission than vaginal sex” since the walls of the anus are thin and more easily torn), behavioral factors (access to condoms is inadequate and thus these are not always used), legal factors (“a third of countries in the world still criminalize same-sex conduct”), and social/cultural factors (homophobia, etc.).

DON’T SHARE NEEDLES
Aside from MSMs, another group at risk are composed of people who inject drugs with shared needles. The Health department noted that the cases among Injecting Drug Users (IDU) spiked in 2010 (comprising 9% [147] of the total cases reported), though it has decreased to less than 5% in the succeeding years.

The spike — or outbreak as Dr. Samonte called it — was seen in Cebu. “Right now, in Cebu, the number of people with HIV among injecting drug users is around 45%. Almost one in every two IV drug users is infected already,” she said, noting that the increase was due to drug users who started sharing needles when they didn’t have access to clean ones.

A Jan. 5 article by the Atlantic titled “The City at the Heart of the Philippines’ HIV Epidemic” stated that the reason for the rise was the 2009 amendment to Dangerous Drugs Act, which criminalized the possession and distribution of drug paraphernalia like syringes. “As a result,” the article continues, “Cebu’s local public-health organizations had to discontinue their needle-exchange programs; the city also passed an ordinance limiting the sales of needles and syringes without a prescription.” The same article noted that a single shared syringe can infect four to six people.

Added Dr. Samonte: “It’s very hard for a drug user to stop… rehabilitation takes years, and if you suddenly stop giving them access to clean needles, then what are they supposed to do? They shared needles and it is unfortunate that somebody they shared needles with had HIV… that started a huge outbreak.”

Intervention was difficult. The Health department did not receive the political support it needed to restart its “harm-reduction program” (a needle-exchange program) as its efforts to provide clean syringes were misinterpreted as promoting drug use. “It wasn’t that. They were already injecting. We didn’t want them to get HIV but nobody believed us,” Dr. Samonte said before adding that what they are trying to do now is to get people living with HIV to undergo treatment “so they won’t die.”

TAKE ANTIRETROVIRAL DRUGS
“HIV is most definitely not a death sentence,” said Ronivin G. Pagtakhan, executive director of Love Yourself, before likening being infected to having hypertension or diabetes.

“There’s no cure for it but if you take antiretroviral drugs, you can live an almost normal life. Of course, you have to be more careful with your health as you’re immune system is weaker than normal,” he said.

HIV is a virus that can only be transmitted via these body fluids — blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk — and attacks the body’s immune system, specifically the CD4 cells (which help the body fight infections).

If left untreated, the virus will reduce the number of these cells and make a person more susceptible to infections or infection-related cancers. At its worst, it can turn into full-blown AIDS (Acquired Immunodeficiency Syndrome) once a patient contracts an opportunistic infection (e.g. tuberculosis, recurrent pneumonia). Opportunistic infections, according to www.aids.gov, “are the most common cause of death for people with HIV/AIDS.”

In the early stages of infection — within two to four weeks after infection — a person may develop “the worst flu ever” which is the body’s natural response to the infection. At this stage, the person is at high risk of transmitting HIV to other people because of the large amount of virus in the body.

Afterwards, the virus enters a stage of clinical latency where a person living with HIV will still carry the virus but will not have symptoms. A person not undergoing Antiretroviral Therapy (ART) might see this stage last for 10 years (and it might progress to AIDS), but those who undergo ART can live with this latency for decades and with the reduced risk of transmission.

“International studies show that you will live through your life expectancy minus 10 years… and the reason for the 10 year thing is because you still have a very weak immune system and are prone to infections and non-communicable diseases — more prone than a person without a weak immune system. It doesn’t prevent you from living a full life,” Dr. Samonte said of those undergoing ART.

ART is given for free by the government and can be accessed in satellite treatment centers like Love Yourself (although there are more than 1,000 testing centers in the country, both public and private, not all offer ART).

Love Yourself currently has two centers: one on Shaw Boulevard in Mandaluyong City, and another at Taft Avenue Ext., Pasay City. Love Yourself offers free HIV testing, counselling, and ART. Last year, out of the 16,000 people they tested, 1,505 were diagnosed as HIV positive. Around 50% of the reported newly diagnosed cases of HIV in Metro Manila had been tested at the center in Mandaluyong.

LIVE A FULL LIFE
Love Yourself also provides life coaches for people living with HIV and currently has 600 people enrolled in the program. The program offers support for those infected to encourage them to continue living a full life.

Mr. Bautista, who also volunteers as a life coach at Love Yourself, said that like many antibiotics, ART drugs like Tenofovir and Efevirenz come with side effects including vertigo, fatigue, and allergies.

“I always tell them that it will get worse before it gets better,” he said, as after a while the body returns to an almost normal state. He also stressed the need for judicious use of the drugs as persons living with HIV will be taking them for their whole lives.

Because those undergoing treatment for HIV will be able to live almost normal lives, it also includes the possibility that they will have families. People taking antiretroviral drugs will see their viral load (the amount of virus present in the body) decrease to very low — undetectable — levels.

“Undetectable doesn’t mean you don’t have the virus… it just means that the virus is suppressed because of the ART. And when it’s suppressed then the likelihood of you transmitting [it] to another person is very low,” Dr. Samonte said, before adding that mother-to-child HIV transmission in general is 30% but the risk can be lessened if the parent is taking ART.

Usually babies are given ART as prophylaxis to suppress the virus. “So far we have a number of babies born to HIV-positive mothers who are HIV-negative,” she said, though she couldn’t give specific numbers just yet.

It is important to note that the Philippine AIDS Prevention and Control Act of 1998 forbids any form of discrimination against people living with HIV, so they cannot be fired from their jobs due to having HIV, among others.

This law was most famously upheld in 2014 when salon owner Ricky Reyes was ordered by the National Labor Relations Commission to reinstate Renato Nocos, a hairdresser at one of his salons, and pay him all his back wages after he allegedly fired Nocos because of his HIV status.

Dr. Samonte said that they have filed many cases like this with the Commission on Human Rights, and that they are winning these cases.

KNOW WHAT HIV IS
Will this epidemic end anytime soon?

“No. It will get worse before it gets better,” said Dr. Samonte.

“If we do great this year, we’ll still see new infections for the next 10 years, but if we don’t do great this year, it will continue on for 20, 30, 40 years,” she explained.

“What we’re pushing is that the next generation of Filipinos should know what HIV is — what it is, importance of treatment, etc. It’s an epidemic the next generation will have to face. It’s not acceptable for this generation to grow up ignorant of HIV,” Dr. Samonte said.

She pointed out that the average male in the Philippines has sex for the first time at 16 (thus the increasing number of younger Filipinos getting HIV) and being a minor makes it hard for them to have access to condoms.

“And by the time they do have access, they have already been having sex for two to three years,” she said, explaining why many Filipinos are unused to using condoms which contributes to the spread of HIV.

The embattled Reproductive Health Law prohibits minors from having access contraceptives or “modern methods of family planning without written consent from their parents or guardian/s except when the minor is already a parent or has had a miscarriage.”

“Which child would ask permission from their parents for a condom?,” Dr. Samonte pointed out.

The Health department, she said, is pushing for schools to teach students about HIV/AIDS, stressing the importance of prevention, of getting tested, and of getting treatment (and where to get these services).

“It’s a very scientific way of explaining HIV… it doesn’t go against anything moral, but it still isn’t taught because teachers don’t feel comfortable teaching it, or don’t know how to teach it. So what we’re doing right now is helping teachers understand what HIV is,” she said.

In the same vein, the department is also educating doctors and nurses as many of them “don’t understand what HIV is because it wasn’t in our curriculum” in order to equip the medical professionals with enough knowledge so they know how to take care of a person living with HIV.

“The epidemic in the Philippine context wasn’t even discussed in med school,” she said.

Dr. Samonte also said that there’s a need to increase the budget for HIV prevention and treatment as the current budget stands at P600 million, with P400 million going to ART alone.

“Two-hundred million pesos for prevention is not enough to cover the population for a country with 100 million people… to treat an epidemic,” she said before adding: “A person living with HIV today will need ART for 20 years now, so the number of people needing ART will increase every year — it’s not going to go down unless they die.

“Our projection is that we will need P1.2 billion by the end of [President] Duterte’s term. It may be more as it will depend on how fast the epidemic spreads and that’s just for ART alone. I’m not even talking about prevention,” she noted. She then stressed that investment should be focused on prevention so the cost of ART would lessen.

Asked about her confidence that the needed budget would be given during the Duterte Presidency, she said: “We’re always optimistic. We’re always hopeful, but we never know.”

The Love Yourself community center has two branches: at 715-A Shaw Blvd, Mandaluyong, Metro Manila, with phone number 0915-366-5683; and at 2028 Taft Avenue Extension, Pasay City, with phone number (02) 256-9384. For more information visit www.loveyourself.ph.