DW: While the overall prevalence of HIV is still low in the Philippines, the high increase in infections means the country is facing a serious health problem. What needs to be done to tackle it?
Dr. Louie Ocampo: This is the second wave of the HIV epidemic. During the first wave — from 1984 to the mid-2009 — heterosexual transmission was the main reason behind it. In this second wave, new infections are mostly due to male-to-male transmissions. More than 90 percent of new HIV infections are among men who have sex with men (MSM) and transgender people (TG).
For many years, the Philippines has had HIV services focusing on female sex workers. To deal with this second wave of epidemic, we need to scale-up services tailored to other key populations like MSM, transgender people and people who inject drugs.
It is also true that HIV prevalence is still low in the country. The prevalence or the cumulative number of people living with HIV (PLHIV) against the total population of 100 million is still less than 0.1 percent. But the increase in new infection rates from 2010 to 2016 was recorded at 140 percent. That is the highest in Asia and the Pacific region.
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What are the factors behind this spike in infections?
There are several factors. Low condom use among MSM and transgender women is one of them. In 2015, the condom use among MSM and transgender women was 50 percent and 37 percent, respectively. In comparison, the condom use was recorded at 73 percent among female sex workers.
There is also a low number of high-risk individuals accessing pre-exposure prophylaxis (PrEP), a pill that when taken daily can reduce the risk of HIV infection by up to 92 percent.
Another factor is the low testing rate. As of December 2016, of the estimated 56,000 PLHIV in the Philippines, only 67 percent of them were aware of their HIV status. In 2015, only 16 percent of MSM knew about their HIV status. In 2016, 18,000 people were receiving antiretroviral therapy, which is 32 percent of all people living with HIV, whereas the viral suppression was 29 percent among all people living with HIV.
Apart from the ART treatment that lets a PLHIV live a long, normal life, we also need to look at it as a prevention tool. Generally, three to six months after starting ART, a person living with HIV has an undetectable viral load and cannot transmit HIV to others.
Lastly, society's stigmatizing attitudes toward the LGBT people and widespread discrimination against them in the healthcare sector make MSM and TG individuals less likely to seek information on sexual health or to access condoms or PrEP. Thus, they are also more likely to engage in higher risk sexual behavior. This results in delays in diagnosis and initiation of treatment.
Recently, a study came out about an HIV subtype, AE. Why is it reportedly seen as having the potential to progress faster to HIV and becoming drug resistant? Would you like to clarify the matter?
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The HIV AE subtype is not a new strain; it is found in most Asian countries and other parts of the world. There is no conclusive evidence that the AE strain of the virus found in the Philippines is more infectious nor there is evidence that it is resistant to the current treatment regimens available in the country.
To explain further, we should look at disease progression and drug resistance as two separate issues. Medically, disease progression is related to virulence or the capacity of the virus to create disease. HIV, like any other virus, can mutate and change, but the interaction between the virus and the host, or the person infected with the virus, is still a key determinant of virulence. Two people infected at the same time with the same HIV virus strain may progress differently because of certain factors such as the host's age, nutritional status and presence of other illnesses that impact their immune system.
Meanwhile, drug resistance means the medicine becomes ineffective. If you take your ARV medication every day, the chance of developing drug resistance is very low. But if a PLHIV shows a resistance to one line, we have an armament of two other ARV lines. All the strains that we have in the country are treatable with the regimens that we have.
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What does the Philippines need to do in short and long terms to tackle the growing HIV epidemic?
Condom use remains crucial to prevention. We need to increase condom use by all means possible. We also need to scale up the PrEP program; increase testing that includes community-based screening and early initiation of treatment. The government is now revising HIV testing guidelines to move toward a rapid screening and faster delivery of test results.
We also need to make reproductive health services and HIV testing more accessible to the Philippine youth. But the overarching factor is the persistent stigma and discrimination that prevent people — especially the youth — from accessing health services.
Comprehensive sexuality education is the long-term sustainable intervention vital to combating the ignorance that discrimination feeds on.
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Dr. Louie Ocampo is the UNAIDS' country director of the Philippines.
The interview was conducted by Ana P. Santos in Manila.