A non-epidemic of epidemic proportions: HIV in the Philippines

There have been a recent spate of articles asserting that there is an upward trend in the number of HIV cases in the Philippines, a trend that portends a ‘HIV epidemic’, especially among adolescents. In 2010, there were 1,591 new HIV cases diagnosed, which is a 90 percent increase from the reported 835 infections in 2009, itself a 58 percent increase over the previous year. From 1984 to December 2009, there were 4,424 HIV cases reported and of these, 90% were infected through sexual contact. As of 2007, the main source of transmission is among men who have sex with men (MSM).

Such claims of an impending HIV epidemic in the Philippines are not new, with warnings that it would spread through Asia since the 1980s, after the first individual diagnosed with HIV was reported in 1984. However, according to the UNAIDS, ‘no significant epidemic HIV transmission has yet been detected in the Philippines and, as a result, the official national HIV prevalence estimate has been reduced from an initial 50 000 in the early 1990s to 26 000 a few years ago and, most recently, in 2003, to about 9 000.’ Although seemingly troubling, the rising trend is not indicative of a problem of epidemic proportions. It could reflect the increasing ability of the public health service to conduct HIV tests amongst populations who could not access health facilities previously.

According to the UNAIDS, as of 2009 the national prevalence of HIV remains at about 1% of the population but amongst most at-risk populations (MARP), it increased from 0.08% in 2007 to 0.47% in 2009. The prevalence of individuals who have been infected through sexual contact suggests the need for more awareness and education about the disease and the methods of transmission, while increasing the availability of contraceptives. However, in order to maximise gains, such a strategy should be more specific, targeting MARP rather than a nationwide plan of dissemination that some may favour as they fear a widespread HIV epidemic. Repeated warnings of an HIV epidemic may prompt people to be more aware of the disease, but it is more likely to create an overinflated sense of dread and panic that does not address the problem but may increase stigmatisation of the disease and of affected populations. A more measured attitude towards countering the spread of HIV may encourage directed plans that could more effectively address the dominant means of transmission in various countries, in order to achieve the MGD on reducing the rates of HIV transmission globally.