• If left unabated, HIV could cause more Filipino deaths than Typhoon Yolanda and the war on drugs combined



    THERE is an unspoken crisis happening in the Philippines—a crisis that could cause more Filipino deaths than Typhoon Yolanda and the war on drugs combined.

    While the rest of the world is seeing a decline in the number of new HIV infections, the trend in the Philippines is going in the opposite direction. Yet there seems to be a slow-paced response to this looming crisis from both government and the Catholic Church.

    Alarming numbers
    At the end of 2016, there were 10,500 Filipinos infected with the human immunodeficiency virus (HIV), up from 4,300 in 2010, Health Minister Paulyn Ubial told a news conference, citing data from UNAIDS. That’s a whopping 148 percent increase just in the last six years. (https://www.reuters.com/article/us-health-aids-philippines/philippines-has-highest-hiv-infection-growth-rate-in-asia-pacific-u-n-idUSKBN1AH3CW)

    The Department of Health (DoH) has been recording cases of HIV/AIDS in the Philippines since January 1984. To date, it has tallied 44,010 cases of Filipinos with HIV/AIDS.

    From 1984 to 2017, over 2,000 HIV/AIDS-related deaths have been reported. While the number is relatively low, what’s greatly alarming is the fact that there are now as many as 30 Filipinos infected with HIV per day.

    But even these official numbers do not tell the whole story. The data is based on records of those who have been tested for the human immunodeficiency virus (HIV) that causes AIDS, as confirmed by a central government laboratory at the San Lazaro Hospital in Manila.

    Testing and screening
    Mandatory HIV testing under any circumstance is unlawful in the Philippines. Some legislators have tried to address the issue, but some proposals seem to be misguided, like Senate Bill 376 introduced by Sen. Risa Hontiveros to allow HIV testing of minors even without parental consent. Some community advocates are concerned about the issues of counseling, stigma and family support for minors who might test positive.

    (HIV testing is mandatory in the US in certain cases, including for: blood and organ donors; military applicants and active duty personnel; federal and state prison inmates under certain circumstances; and newborns in some states.)

    While donated blood in the Philippines is routinely checked for blood-borne diseases including HIV, donors are screened for some specific criteria, but not HIV. Doctors check if the donors have hypertension, are under the influence of alcohol, have tattoos, use injectable drugs, or have had a risky sexual encounter that may affect the blood. However, an HIV test is not included in the screenings.

    Community-based HIV screening (CBS) is performed by several volunteer groups and public testing sites but these are mostly located in urban centers like Manila, Baguio and Cebu.

    Male-to-male sex remains to be the main mode of HIV transmission in the Philippines, according to DoH data. Of 38,114 HIV cases reported from January 1984 to October 2016, a total of 28,947 belonged to the MSM category.

    Even among overseas Filipino workers (OFWs), more than half of the 4,000 plus cases of HIV infection were among those who engaged in male-male sex, as well as those who had sex with both male and female.

    Unlike in the US and other countries, HIV infection via injection drug use is relatively lower in the Philippines. This is due to the fact that despite widespread use of illegal drugs in the country, the drug of choice of users is shabu (crystal meth), which is more commonly smoked or snorted rather than directly injected into the bloodstream.

    Prevention is key
    While testing can be an effective tool to control the spread of HIV/AIDS, prevention is still the key.

    The same prevention tool that has gained increasing popularity in the US, especially among sexually active, HIV-negative men who have sex with men, is now being tried on a pilot basis in the Philippines.

    Called pre-exposure prophylaxis (PReP), it involves a pill that people are expected to take on a daily basis to prevent infection with HIV. Secretary Ubial said PReP was meant to protect members of a particularly vulnerable group who are not yet sick with HIV. The recently started pilot program has enrolled 200 healthy men who have sex with men.

    The reality, however, is that PReP is an expensive regimen, even in the US. Without insurance, PReP could cost as much as $1,300 a month, not including doctor’s visits and lab tests. How viable it is in the Philippines—beyond the pilot program—remains unclear.

    Prevention, however, still is the country’s best tool in averting the potentially deadly HIV crisis.

    Sex education
    Sex education—despite the obvious discomfort it brings to Filipino Catholic families—is still the best defense against the spread of the virus. And education, unfortunately, must be complemented with prevention tools like condoms and family-planning strategies frowned upon by the Church.

    Senate Bill 376, or the Philippine HIV and AIDS Policy bill, which is pending in the legislature, aims to create a more comprehensive and “national multi-sectoral strategy” to address the increase of HIV/AIDS cases in the Philippines.

    Precisely, it is the “multi-sectoral” component that would make this proposed law truly effective. And the Catholic Church must be a willing partner in this national undertaking.

    But given the country’s recent experience with the Reproductive Health Law which created serious divisions among legislators, health advocates and the Catholic Church, SB 376 is sure to face some not-so-easy hurdles.

    (Rene Astudillo was formerly executive director of the Asian American Journalists Association and the Filipino Task Force on AIDS, both based in San Francisco, California.)


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