Editorial - Dec 1-7, 2010

HIV Epidemic ‘Low and Slow’
by: Recto I. Vidal

KALIBO, Aklan-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, according to a US peace corps volunteer.

In a recent Kapihan sa Aklan media forum held at Smoke Hauz Bar, Jaywork Casey, a US peace corps volunteer, told the local media here that an estimated 8,300 people were living with HIV in the Philippines in 2007. The country as traditionally had a very low HIV prevalence, with under 0.1 percent of the population infected. Even in groups such as sex workers and MSM that are typically associated with higher levels of HI, prevalence rates above 1 percent have not yet been detected.

In the case of sex workers, this is possibly due to efforts to screen and treat those selling sex since the early 1990s. However, there are reasons to believe that this situation may not last. In early 2010, the Department of Health in the Philippines stated that the country was now on the brink of a “concentrated epidemic,” due to a rise in prevalence. Condom use is not the norm in paid sex, drug users commonly share injecting equipment in some areas, and among Filipino youth, there is evidence of complacency about AIDS. National HIV prevalence among the most at risk populations (MARPs) which includes sex workers, men who have sex with men and injecting drug users, has increased more than five fold from 0.8% in 2009.

The National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia 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 the HIV in the Philippines cannot be attributed to any single factor, nor is it necessarily a result of the actions of the Philippine 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 fewer 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 to 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 to 2008). The average age for diagnosis has also significantly decreased, from approximately 36 to 29 years.

Said study have concluded that 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./TE