The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

Abstract

In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15–17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine–tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.

HIV epidemic in the Philippines: A multisectoral collaboration

“…The Philippines has witnessed an alarming rate of 411% rise of HIV cases daily from 2012-2023. 2 This correspondence expounds on the need for a multisectoral approach to address the multiple drivers and impact of HIV and AIDS in the Philippines. 3 First, comprehensive sex education in schools should be promoted to provide accurate information about HIV transmission, prevention, and stigma reduction.…”

“…This should include age-appropriate content, addressing diverse sexual orientations and gender identities. 2 Second, there is a need to develop and implement targeted outreach programs focusing on at-risk populations, such as men having sex with men (MSM), transgender individuals, sex workers, and people who inject drugs. 3 These programs should include accessible and nonstigmatizing healthcare services, counseling, and education.…”

“…4 Third, there is a need to expand community-based HIV testing and counseling services to reach remote and underserved areas. 2 Utilize mobile clinics, community health workers, and technology (e.g., telemedicine) to increase access to testing and counseling, reducing late presentation in care. 4 Fourth, increase awareness and accessibility of preexposure prophylaxis (PrEP) for individuals at high risk of HIV infection and for those individual who regularly use dating apps.…”

“…1 Sixth, leverage technology for innovative solutions, such as mobile applications for discreet access to information, testing services, and support networks. 2 Utilize data analytics for targeted interventions and to identify emerging trends in HIV transmission. Integrate HIV services into primary healthcare systems to reduce the separation between general healthcare and HIV care.…”

“…This includes training healthcare professionals in HIV diagnosis, treatment, and counseling. 2 The Philippine Department of Health should integrate HIV services into primary healthcare systems from barrio clinics to municipal level hospitals to reduce the separation between general healthcare and HIV care. 5 This includes training healthcare professionals in HIV diagnosis, treatment, and counseling.…”