PRESENTATION: HIV in Philippines

Trending Now #HIVinPH
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.
Enrique A. Tayag MD, PHSAE, FPSMID, CESO III

Assistant Secretary of Health and Director IV, NEC
National Epidemiology Center - DOH
Historic
success in bringing HIV programmes to scale combined with the emergence of powerful new tools to prevent people from becoming infected and from dying from AIDS-related causes has enabled the foundation to be laid for the eventual END of AIDS.
Epidemiologic trends are less favourable in several other countries. In at least nine countries, the number of people newly infected in 2011 was at least 25% higher than in 2001.
Quick Glance at HIV in the Philippines

Population: 92.34M (NSO, 2010) Projected Number of People Living with HIV (15-49) as of 2012: 21,837 Total Number of Reported Cases since 1984: 11,125 Total Number of Reported AIDS deaths when reported since 1984: 353 The first reported HIV case in the Philippines in 1984 is a heterosexual male OFW
HIV Data Sources: Philippine HIV/AIDS Registry Philippine Integrated HIV Behavioral & Serological Surveillance EPP/Spectrum, UNAIDS Software
Number of New HIV/AIDS By Year, Philippines

October 1984-October 2012
1,250%
11,125 reported HIV cases

(January 1984 to October 2012)
668% INCREASE
Everyday, 9 people become a patient for life.

275 250
2012*: Nine new case a day
269
Average No. of New Cases
225 200 175 150 125 100 75 50 25
2011: Seven new case a day
196
2010: Four new cases a day
131
2007: One new case a day
2000: One new case every 3 days
10
2000
15
2001
15
2002
16
2003
17
2004
18
2005
26
29
44
63
0
2006 2007 2008 2009 2010 2011 2012
Year
*As of Oct 2012 Philippine HIV Registry - DOH
Growing Number of Infected Young People

100% 90% 80% 70% 60%
35 to 44yo
50% 40% 30% 20% 10% 0% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
25 to 34yo
15 to 24yo
Shift from Female to Male Cases

(1984 to 2012)
2012*
2011
2006-2010
Years
2001-2005
FEMALE
MALE
1996-2000
1991-1995
1984-1990 0% 20% 40% Percentage

60%
80%
100%
From Local to Global back to Local

(January 1984 to October 2012)
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Local OFW
Regions with the most number of reported HIV cases in 2012*

Reg 3 7%
Reg 4A 13% Reg 7 11% Reg 11 6% NCR 51%
ROTC 12%
* ROTC Rest of the Country

Chain of HIV Spread

Female Partner of MSM Female Partner of Male IDU Male IDU Female IDU Baby
Baby
Baby
MSM
Male Client of MSW Male Sex Worker Female Partner of Male Sex Worker
Baby Male Client of FSW

Female Partner of Male Clients
Baby
Baby
Freelance FSW
Registered FSW
Baby
What puts a person at risk for HIV?

Unprotected sex with >1 sexual partner Injecting drugs with used needles & syringes If your birth mother was HIV+ Transfusion of HIV infected blood or blood products
Drivers of Transmission: Infected Needles & Sex

100% 90% 80% 70% 60%
50% 40% 30% 20% 10% 0% Sharing of Infected Needles From Mother to Child
Blood Transfusion
Male-Female Sexual Contact Male-Male Sexual Contact
*As of Aug 2012 Philippine HIV Registry - DOH
Philippine Integrated HIV Behavioral & Serologic Surveillance (IHBSS)

Conducted every 2 years by DOH since 2005
HIV Prevalence among People who Inject Drugs
Source: IHBSS 2005, 2007, 2009, 2011 of 10 Sentinel Sites
HIV Prevalence among Sex Workers & Males who have Sex with Males
Source: IHBSS 2005, 2007, 2009, 2011 of 10 Sentinel Sites
Types of Sexual Act among Males who have sex with Males
Oral sex only 29%
Anal receiver only 21%
Versa 27%
Anal inserter only 23%
Source: 2011 IHBSS
More Risky Sex as They Grow Older

(Anal Sex Positions and Age-Groups, IHBSS 2011)
MSM having anal sex and Condom use during last anal sex
100%
90% 80%
70%
Percentage
62.1%
62.8%
anal sex condom use
60% 50% 40% 30% 20%
54.2% 45.6%
32.5%
31.9%
31.7%
34.1%
10%
0% 2005 2007 Year
Philippine IHBSS, 2005-2011
2009
2011
Condom Use
100%
80%
Percentage who used a condom
64%
60%
40%
36% 24%
20%
14%
0%
FSW
MSM
Male PWID
Female PWID
Key Affected Population

Source: 2011 IHBSS
Reasons why a male who had sex with another male did not use a condom during last anal sex
Reason Percentage of Respondents
Not available Dont like to use condoms Partner objected to using condoms
45% 27% 11%
Thinks it is not necessary Forgot to use a condom

Dont know how to use a condom Condoms too expensive
11% 3% 3% 1%
Philippine IHBSS, 2011
More MSM buy their own condoms when it is easy to access in the community, IHBSS 2011
HIV Prevalence and Percentage who Know their Current HIV Status
Source: 2011 IHBSS
Reasons MSM dont get an HIV test
Afraid to get tested Feels no need to get tested Do not know where to get tested
Percentage of respondents 33% 29% 28%
Testing facility to far No money for testing
1% 6%
Source: 2011 IHBSS
Online Social Networking (OSN) Use and Risks for HIV and/or other Sexually Transmitted Diseases (STD) Among Men Having Sex with Men (MSM) in Manila, 2011
Jobin G. Maestro FETP Fellow
Background
Online Social Networking Use and Risks among MSM 1. MSM can meet without fear of negative social consequences (Burns, 2005) 2. Created new opportunities to meet sex partners (Burns, Hillier, Kurdas, & Horsley, 2001 &
2005)
3. Meeting via the internet higher rates of sexual risk behaviors (Benotsch, 2002)
OSN Date and Sex Profile (N=180)*

Online Social Networking Use and Risks for HIV and/or other Sexually Transmitted Diseases among Men Having Sex with other Men, Manila, September 1 to November 4, 2011
Profile
Usage of ONS Date only Sex only Date and Sex Never Meet the OSN members for DATE Had SEX from OSN members Age started had sex from OSN hook ups Frequency of OSN
All Respondents
18 8 124 30 137 133 14-36 years old (median=21) 87
%
10 4 67 17 76 74
91
Personal Information Put in OSN (N=180)*

Personal Information
age and height location sexual identify work sexual preference built practicing safe sex dick size others infection status 0 20 40 60 80 100
Percent
*multiple answers
OSN sites used for Date and Sex (N=180)*

OSN Websites Lifeout

ManHunt Person.Com others Grinder Chat room websites Man Jam Twitter Downelink Friendster Planet Facebook 0 25 50 75 100 125 150 Date
Sex
175
200
No. of Respondents
*multiple answers
Place of OSN Sex (N=133)*

Variable Place of OSN sex *(multiple answers) Home Hotel Spa/Massage Parlor Clubs/pubs Malls Parks Others(cinema, dark areas)
Frequency 95 71 8 6 5 3 4
% 71 53 6 4 4 2 3
Sexual Activities in OSN (N=133)*

Sexual Activities Time spent to look for Sex 5 minutes more than 24 hours
Number of Sexual Partners from OSN

Number of Sexual Partner (1 time) Number of Sexual Partner (more than once)
1-500 sex partners (average = 82)

1-360 sex partners (average = 43) 1-291 sex partners (average = 43) Frequency % 7 31 12 2
Ever paid a sexual partner from OSN Participated in OSN Group Sex with males Used drugs during OSN sex
12 55 22 3
Shared Needle among OSN members
OSN Sexual Practices (N=180)

Sexual Practices Sexual Practice Oral Only Sex Anal Sex Only Both Never If had ORAL sex: Oral Inserter Oral Receiver Both Never If had Anal sex: Anal Inserter Anal Receiver Both Never Frequency 16 2 159 3 35 18 121 4 43 19 101 14 % 9 1 88 2 14 10 67 2 24 11 56 7
Condom Use (N=180)

1% 4%
16%
Condom Use
Consistency of use (143)
79%
YES
46 (32%)
NO
97 (68%)
Reason for Condom Use To prevent HIV 117 (82%) 26 (18%)
Yes No Dont Know a Condom No Answer
To prevent STI
Laboratory and Examination Results (N=53)

13%
10% 77%
HIV HIV and other STD other STD's
Risk Factors
Risk Factor Odds Ratio Confidence Interval p-value
General Sexual Behavior of Respondents Anal and Oral sex Anal inserter and receiver 4.49 2.9 1.016 19.99 1.44 5.89 0.0237 0.0017
Non consistent use of condom
2.78
1.17-6.83
0.0083
Ejaculation Happened in ANUS
2.22
1.10 4.49
0.0122
So whats causing the increase in HIV cases?
Risky Behavior
Prevention Coverage
Increasing HIV Prevalence among MSMs, PWIDs
Drivers of HIV epidemic

New HIV/AIDS Cases, By Year, Philippines, 1984-2011
Growing number of areas that are vulnerable
High prevalence of unsafe behaviors among Key Populations at higher risk
Widening financial gap to ensure universal access to prevention and treatment
Below-target prevention coverage
Legal barriers that promote discrimination among MARPs
Projected Number of People Living with HIV in the Philippines in 3 years
Source: Philippine PLHIV Estimates, 2012
Best Practices to Attain MDG for HIV

International and National Commitments to ensure Universal Action to Prevention, Care, Treatment and support Universal Health Care Policies and Implementation Rapid Assessment of Vulnerability in New Areas of Concern Updated AIDS Medium Term Plan 2011-2016 Support to Reproductive Health Bill Passage Behavioral studies on Key Populations at higher risk Comprehensive, Focused, Evidence-Informed 5-Year Investment Plan Philhealth Treatment Package for PLHIV
Proposal for Operations Research on Harm Reduction
Priority Areas for HIV Intervention

Category A (22) Paranaque City Muntinlupa City Taguig City Pasay City Makati City Mandaluyong City Marikina City Quezon City Caloocan City Navotas City Las Pinas City Manila City Pasig City San Juan City Malabon City Valenzuela City Pateros Angeles City Davao City Cebu City Mandaue City Danao City Category B (18) Olongapo City Antipolo City, Rizal Bacoor, Cavite Dasmarinas City, Cavite Batangas City, Batangas Cainta, Rizal Imus, Cavite Lipa City, Batangas Puerto Princesa City, Palawan Iloilo City Bacolod City, Negros Occ Lapu-Lapu City, Cebu Talisay, Cebu Zamboanga City Cagayan de Oro City General Santos City Baguio City Butuan City Category C (30) Dagupan City, Pangasinan San Fernando, La Union Tuguegarao City, Cagayan Tarlac City San Fernando, Pampanga Mabalacat, Pampanga Marilao, Bulacan Malolos, Bulacan San Jose del Monte, Bulacan Meycauayan, Bulacan Sta Maria, Bulacan San Pedro, Laguna Sta Rosa, Laguna San Pablo, Laguna Calamba, Laguna Cavite City, Cavite Lucena City San Mateo, Rizal Taytay, Rizal Puerto Galera, Mindoro Or Legazpi City, Albay Naga City, Camarines Sur Malay, Aklan Toledo, Cebu Tagbilaran City, Bohol Tacloban City Iligan City Tagum, Davao del Norte Panabo, Davao del Norte Cotabato City
Philippines AIDS Medium Term Plan 2011-2016

GOAL
By 2016, the country will have maintained a prevalence of less than 66 HIV cases per 100,000 population by preventing the further spread of HIV infection and reducing the impact of the disease on individuals, families, sectors and communities
STRATEGIC OBJECTIVES
To improve the coverage and quality of prevention programs for persons at most risk, vulnerable and living with HIV To improve the coverage and quality of TCS programs for people living with HIV (including those who remain at risk and vulnerable) and their families To enhance policies for scaling up implementation, effective management and coordination of HIV programs at all levels To strengthen capacities of the PNAC and its members to oversee the implementation of the 5th AMTP To strengthen partnerships and develop capacities for the 5th AMTP implementation of LGUs, private sector, civil society, including communities of atrisk, vulnerable, and living with HIV
KEY STRATEGIES
Develop evidence-based, targeted, comprehensive programs

Capacitate service providers Provide equitable access to programs Enhance decentralized implementation
Provide enabling environment
Expand, build, strengthen management, partnerships and collaboration
Develop capacity of partners
Investments Framework
Key populations of higher risk Prevention Priority areas of Hazards and Risks
Catalytic Cost-Effective Core Interventions
Long-term Expanded Low Impact Interventions
Health Systems Strengthening Treatment, Care and Support Real Collaboration and Resource Sharing
Summary of AMTP 5 Investment Plan by Coverage Area and Funding Gap

COVERAGE COST (in Philippine Peso) Estimated Funding Gap Annual Average Gap
Nationwide Category A,B &C Category A & B Category A

Note: in Billion Pesos
18.95 7.84 6.89 5.78
10.65 4.08 4.04 3.50
1.77 0.70 0.67 0.58
Percent distribution of investments
Right Goals, Getting it Right, Respecting Rights

PRESENTATION: HIV in Philippines

Încărcat de

Informații document

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

PRESENTATION: HIV in Philippines

Încărcat de

Drepturi de autor:

Formate disponibile

Trending Now #HIVinPH

Enrique A. Tayag MD, PHSAE, FPSMID, CESO III

National Epidemiology Center - DOH

National Epidemiology Center - DOH

National Epidemiology Center - DOH

Quick Glance at HIV in the Philippines

National Epidemiology Center - DOH

Number of New HIV/AIDS By Year, Philippines

National Epidemiology Center - DOH

11,125 reported HIV cases

National Epidemiology Center - DOH

Everyday, 9 people become a patient for life.

2012*: Nine new case a day

Average No. of New Cases

225 200 175 150 125 100 75 50 25

2011: Seven new case a day

2010: Four new cases a day

*As of Oct 2012 Philippine HIV Registry - DOH

National Epidemiology Center - DOH

Growing Number of Infected Young People

National Epidemiology Center - DOH

Shift from Female to Male Cases

1984-1990 0% 20% 40% Percentage

National Epidemiology Center - DOH

From Local to Global back to Local

*As of Oct 2012 Philippine HIV Registry - DOH

National Epidemiology Center - DOH

Regions with the most number of reported HIV cases in 2012*

* ROTC Rest of the Country

National Epidemiology Center - DOH

Chain of HIV Spread

Baby Male Client of FSW

National Epidemiology Center - DOH

What puts a person at risk for HIV?

National Epidemiology Center - DOH

Drivers of Transmission: Infected Needles & Sex

*As of Aug 2012 Philippine HIV Registry - DOH

National Epidemiology Center - DOH

Philippine Integrated HIV Behavioral & Serologic Surveillance (IHBSS)

National Epidemiology Center - DOH

HIV Prevalence among People who Inject Drugs

Source: IHBSS 2005, 2007, 2009, 2011 of 10 Sentinel Sites

National Epidemiology Center - DOH

Source: IHBSS 2005, 2007, 2009, 2011 of 10 Sentinel Sites

National Epidemiology Center - DOH

Oral sex only 29%

Anal receiver only 21%

Anal inserter only 23%

Source: 2011 IHBSS

National Epidemiology Center - DOH

More Risky Sex as They Grow Older

National Epidemiology Center - DOH

60% 50% 40% 30% 20%

National Epidemiology Center - DOH

Percentage who used a condom

Key Affected Population

National Epidemiology Center - DOH

45% 27% 11%

Thinks it is not necessary Forgot to use a condom

National Epidemiology Center - DOH

Source: 2011 IHBSS

National Epidemiology Center - DOH

Reasons MSM dont get an HIV test

Percentage of respondents 33% 29% 28%