HIV in the Philippines: Still on the Rise. REGINA BERBA MD MSc Philippine General Hospital and The Medical City

Transcription

1 HIV in the Philippines: Still on the Rise REGINA BERBA MD MSc Philippine General Hospital and The Medical City

2 Once upon a time (circa 1984)! The Philippines is one of the exceptional countries that has not faced a large HIV epidemic! It is important to understand the reasons for low and slow rate. For lessons which can be learnt for effective control in similar settings. Farr & Wilson An HIV Epidemic is ready to emerge in the Philippines J Int AIDS Soc :16

3 In 2010 HIV experts were baffled!!! likely reasons for the SLOW development of an HIV epidemic in the Philippines :! Country s geography is complicated! Injecting drug use is relatively uncommon! A Culture of sexual conservattsm! Sex workers tend to have few clients! Anal sex is relatively common Farr & Wilson An HIV Epidemic is ready to emerge in the Philippines J Int AIDS Soc :16

4 2010! Lowest rates of condom use in Asia! Increasing casual sexual activity! Returning overseas Filipino workers from high prevalence settings! Widespread misconception about HIV/AID! High needle-sharing rates among injecting drug users Farr & Wilson An HIV Epidemic is ready to emerge in the Philippines J Int AIDS Soc :16

5 Then in 2017: PHILIPPINES now the FASTEST growing HIV Epidemic in Southeast Asia!!!

6 The HARP Report

7

8 8! Cumulative HIV cases by mode of transmission, January 1984-May 2016 Male-male sex 19% Heterosexual 75% 0% 5% 0% 0% 1% Blood and blood products Sharing of needles Needle prick injury Mother-to-child Source: Prepared by based on National Epidemiology Center Philippines. (2016). Philippines HIV/AIDS Registry: May 2016

9 A CLOSER LOOK into the FACTORS leading to the NON-STOP RISE HIV rates in the Philippines! Biologic: The Changing Virus! Social: The Social Networking! Behavioral: The New Freedom! Public Awareness: The Knowledge Gap! Program Response

10 BIOLOGIC FACTOR: Circulating HIV in the Philippines now MORE AGGRESSIVE than in previous decades Salvana et al 2017

11 Social Factors The Contribution of SOCIAL NETWORKING

12 HIV and AIDS Data Hub for Asia-Pacific! Key POPULATIONS AT RISK size estimates POPULATION SIZE ESTIMATES Populations Estimate Year of estimate PEOPLE WHO INJECT DRUGS 10,000-21, FEMALE SEX WORKERS 66, MALE SEX WORKERS 86, MEN WHO HAVE SEX WITH MEN 531, TRANSGENDER WOMEN 122, Note: Estimates covered those aged 15+ years! Source: Prepared by based on Philippines Global AIDS Response Progress Reporting !

13 HIV and AIDS Data Hub for Asia-Pacific! HIV prevalence among key populations, HIV prevalence (%) FSW MSW MSM PWID TG sex workers Source: Prepared by based on Integrated HIV Behavioral and Serologic Surveillance (IHBSS) ; 13!

14 HIV and AIDS Data Hub for Asia-Pacific! HIV prevalence among key populations, 2015 % FSW MSW TG sex workers MSM PWID Source: Prepared by based on 14!

15 HIV and AIDS Data Hub for Asia-Pacific! High HIV prevalence among key populations in selected cities, 2015 Male PWID Female PWID TG Women M/TSM Freelance FSW % weighted M/TSM = Males or transgenders who have sex with males! Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, Epidemiology Bureau, DOH. (2016) Integrated HIV 15! Behavioral and Serologic Surveillance (IHBSS) Fact Sheets

16 HIV and AIDS Data Hub for Asia-Pacific! HIV prevalence among males who have sex with males in selected cities, % * Quezon Manila Cebu Davao Cayagan de Oro * Data from the 2015 IHBSS is for a mixed survey sample of males or transgenders who have sex with males (M/TSM). In addition it has been adjusted using Time Location Sampling (TLS) weights, therefore it is not directly comparable to previous IHBSS rounds. Source: Prepared by based on Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Reports 16!

17 HIV and AIDS Data Hub for Asia-Pacific! HIV prevalence among males who have sex with males by age group, % yr yr yr NOTE: Data may not reflect national figures, but represent locations sampled in each round! Source: Prepared by based on National HIV/AIDS & STI Surveillance and Strategic Information Unit. Epidemiology Bureau, Department of Health. (2016). The 17! growing HIV epidemic among adolescents in the Philippines.

18 HIV and AIDS Data Hub for Asia-Pacific! HIV prevalence among FSW by age group, 2011 and HIV prevalence (%) RFSW FFSW yr yr 25+ yr All Note: FFSW = Freelance female sex workers; RFSW = Female sex workers in registered entertainment establishments; Data shown represents average HIV prevalence for surveyed sites. For FFSW there were 18 and 9 sites in 2011 and 2013, respectively. For RFSW, there were 17 and 10 sites in 2011 and 2013, respectively.! Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, National Epidemiology Center, DOH. (2014) Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Report. Manila, Philippines. 18!

19 HIV and AIDS Data Hub for Asia-Pacific! HIV prevalence among male PWID by age group, Cebu City and Mandaue City, 2011 and HIV prevalence (%) yr yr 25+ yr All ages Age group Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, National Epidemiology Center, DOH. (2013) IHBBS 19! Briefer. Males who have Sex with Males (MSM) and Male Injecting Drug Users (IDU) - Preliminary report. Manila, Philippines.

20 HIV and AIDS Data Hub for Asia-Pacific! Reported HIV cases by mode of transmission, 1984-May % 80% 60% 40% 20% 0% Needle prick injury Blood and blood products Mother to child transmission Injecting drug use Heterosexual Male-male sex Source: Prepared by based on National Epidemiology Center Philippines. Philippines HIV /AIDS Registries, 2008 May !

21 HIV and AIDS Data Hub for Asia-Pacific! Cumulative HIV cases by mode of transmission, January 1984-May 2016 Male-male sex 19% Heterosexual 75% 0% 5% 0% 0% 1% Blood and blood products Sharing of needles Needle prick injury Mother-to-child No data available Source: Prepared by based on National Epidemiology Center Philippines. (2016). Philippines HIV/AIDS Registry: May !

22 HIV and AIDS Data Hub for Asia-Pacific! Proportion of HIV cases among Overseas Filipino workers (OFWs) compared to Non-OFWs, May % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% * OFW Non-OFW * January - May 2016! Source: Prepared by based on National Epidemiology Center Philippines. (2016). Philippines HIV/AIDS Registry: May !

23 The Contribution of SOCIAL NETWORKING! WHERE DO POPULATIONS AT RISK MEET? SOCIAL MOBILITY Hernandez LI,Imperial RH MSMin the Philippines Identities, Sexualties and Social Mobilities: A Formative Assessment of HIV and AIDS Vulnerabilties ACTA MEDICA PHILIPPINA :3

24 The Filipino Men Having Sex with Men (MSM)! MSM primarily responsible for HIV transmission in the Phil! Defined by their behavior towards SAFE SEX, their Masculinity and their Partner! More sexually active! More sexual partners! Take risks to maintain their machismo image! More likely to refuse to practice safe sex! SAFE SEX is viewed as UNMASCULINE for it hinders sexual provess Hernandez LI,Imperial RH MSM in the Philippines Identities, Sexualties and Social Mobilities: A Formative Assessment of HIV and AIDS Vulnerabilties ACTA MEDICA PHILIPPINA :3

25 Where MSM congregate Hernandez LI,Imperial RH MSMin the Philippines Identities, Sexualties and Social Mobilities: A Formative Assessment of HIV and AIDS Vulnerabilties ACTA MEDICA PHILIPPINA :3

26 Old Theaters was where they convened Hernandez LI,Imperial RH MSMin the Philippines Identities, Sexualties and Social Mobilities: A Formative Assessment of HIV and AIDS Vulnerabilties ACTA MEDICA PHILIPPINA

27 Other places for MSM convergence Hernandez LI,Imperial RH MSMin the Philippines Identities, Sexualties and Social Mobilities: A Formative Assessment of HIV and AIDS Vulnerabilties ACTA MEDICA PHILIPPINA

28 The Sex Clubs Hernandez LI,Imperial RH MSMin the Philippines Identities, Sexualties and Social Mobilities: A Formative Assessment of HIV and AIDS Vulnerabilties ACTA MEDICA PHILIPPINA

29 The Emergence of Bath Houses and Sex Clubs Hernandez LI,Imperial RH MSMin the Philippines Identities, Sexualties and Social Mobilities: A Formative Assessment of HIV and AIDS Vulnerabilties ACTA MEDICA PHILIPPINA

30 Defining MEN

31 The NOW Locate anybody anytime anywhere

32 The Asian MSM

33 BEHAVIORAL FACTORS The NEW FREEDOM

34 HIV and AIDS Data Hub for Asia-Pacific! Proportion of key populations who reported condom use at last sex, % FSW MSW MSM PWID TG sex workers Source: Prepared by based on 1. UNAIDS Report on The Global AIDS Epidemic, 2010; and !

35 HIV and AIDS Data Hub for Asia-Pacific! Proportion of males who have sex with males who reported condom use at last sex with male partner, selected cities, 2015 % weighted Note: Survey included males or transgenders who have sex with males! Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, Epidemiology Bureau, DOH. (2016) Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Fact Sheets. 35!

36 HIV and AIDS Data Hub for Asia-Pacific! Proportion of MSM who reported condom use at last sex with a male partner in the last 12 months, by age group and city, 2014 % yr yr 25+ yr Total Mandaluyong Taguig Parañaque 39 Source: Prepared by based on Special MSM IHBSS 2014 as part of Big Cities Project (BCP) reported in National HIV and STI Surveillance and Strategic Information Unit, National Epidemiology Center, DOH. (2014) IHBSS Report. Manila, Philippines. 36!

37 HIV and AIDS Data Hub for Asia-Pacific! Proportion of male entertainment establishment workers who reported condom use at last sex by partner type and by city, 2015 % weighted Angeles City Manila City Pasay City Quezon City with male client with non-paying male partner with female client Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, Epidemiology Bureau, DOH. (2016) Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Fact Sheets. 37!

38 HIV and AIDS Data Hub for Asia-Pacific! Proportion of males who have sex with males who engaged in transactional sex in the last year, selected cities, Sold sex Bought sex % Weighted Note: Survey included males or transgenders who have sex with males! 38! Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, Epidemiology Bureau, DOH. (2016) Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Fact Sheets.

39 HIV and AIDS Data Hub for Asia-Pacific! Sexual behavior and condom use among MSM in the last 12 months, 2011 and 2013 % NA = data not available! Had sex with a female NA Used a condom during last vaginal sex Sold sex NA Used concom during last paid sex Bought sex NA Used condom during last paying sex Bisexual behavior Engaged in commercial sex as sex worker Engaged in commercial sex as client Source: Prepared by based on National Epidemiology Center Philippines. Integrated HIV Behavioural and Serologic Surveillance Reports for 2011 and !

40 Public Awareness THE VERY WIDE KNOWLEDGE GAP

41 HIV and AIDS Data Hub for Asia-Pacific! Proportion of key populations with comprehensive HIV knowledge, % RFSW * Male PWID ** MSM *** MEW # FFSW ## TG ### * FSW in Registered Entertainment Establishments ( average for 17 sites in 2011, 10 sites in 2013, and$only$manila$city$in$2015) ** Average for 4 sites in 2011, Cebu City in 2013 and 2015 *** Average for 18 sites in 2011, 21 sites in 2013, and 35 sites with mixed samples of MSM and TG in 2015 # Male Entertainment Establishment Workers (only Quezon City in 2011, average for 3 sites in 2013, and 4 sites in 2015)! ## Freelance FSWs (average for 18 sites in 2011, 9 sites in 2013, and$only$cebu$city$in$2015) ### TG SW in Cebu City (2013) and TG women in Cebu City (2015) Note: 2015 data is weighted! Source: Prepared by based on Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Reports 41

42 HIV and AIDS Data Hub for Asia-Pacific! Proportion of key populations with comprehensive knowledge of HIV by age group, 2013 % yr yr 25+ yr Total FFSW RFSW MSM Male PWID * TG sex workers * * In Cebu city ** Male Entertainment Establishment Workers FFSW = Freelance female sex workers RFSW = Female sex workers in Registered Entertainment Establishments! MEW ** Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, National Epidemiology Center, DOH. (2014) Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Report. Manila, Philippines. 42

43 HIV and AIDS Data Hub for Asia-Pacific! Proportion of key populations with comprehensive HIV knowledge, selected cities, Manila Pasay Quezon % weighted Angeles Mandaue * Cebu** Cebu* Cebu Angeles Manila # Cebu ## Pasig Manila Zamboanga Davao Cebu Quezon Angeles MEWs PWID TG Women FSW M/TSM MEWs = Male entertainment establishment workers; M/TSM = Males or transgenders who have sex with males # Female sex workers in registered establishments; ## Freelance female sex workers; * Male PWID; ** Female PWID! Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, Epidemiology Bureau, DOH. (2016) Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Fact Sheets. 43

44 EDUCATION AS STRATEGY needs a lot of support and technical assistance

45 THE MEDICAL CITY PROJECT: DANCE TO THE LIGHT DANCE FOR HOPE

46 THE MEDICAL CITY PROJECT: DANCE TO THE LIGHT DANCE FOR HOPE

47 THE MEDICAL CITY PROJECT: DANCE TO THE LIGHT DANCE FOR HOPE

48 The Government Program

49

50

51

52

53 HIV and AIDS Data Hub for Asia-Pacific! Proportion of key populations reached with HIV prevention programmes, % FSW MSM PWID MSW TG sex workers Source: Prepared by based on 1. National Epidemiology Center Philippines: Integrated HIV Behavioral and Serologic Surveillance (IHBSS) 2007, 2009, 2011 and 2013; 2. UNAIDS. (2012). Annexes - UNAIDS Report on the Global AIDS Epidemic 2012; and !

54 HIV and AIDS Data Hub for Asia-Pacific! Proportion of key populations who received an HIV test in the last 12 months and knew their results, % FSW MSM PWID MSW TG sex workers Source: Prepared by based on 1) UNAIDS Report on the Global AIDS Epidemic, 2010; and 2) 54!

55 HIV and AIDS Data Hub for Asia-Pacific! Proportion of key populations who received an HIV test in the last 12 months, selected cities, % weighted Quezon Angeles Pasay Cebu * Cebu** Mandaue * Cebu Angeles Cebu Taguig Mandaluyong Davao Cagayan de Oro Caloocan Muntinlupa Marikina Pasay MEWs PWID TG Women FFSW M/TSM MEWs = Male entertainment establishment workers; M/TSM = Males or transgenders who have sex with males FFSW = Freelance female sex workers; * Male PWID; ** Female PWID! Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, Epidemiology Bureau, DOH. (2016) Integrated HIV Behavioral 55! and Serologic Surveillance (IHBSS) Fact Sheets.

56 HIV and AIDS Data Hub for Asia-Pacific! Proportion of key populations who know where to get tested for HIV, selected cities, 2015 % weighted M/TSM Transgender women Male PWID Female PWID Registered FSWs Freelance FSWs MEWs Angeles City Cebu City Mandaue City Manila City Pasay City Quezon City M/TSM = Males or transgenders who have sex with males; MEWs = Male entertainment establishment workers! Source: Prepared by based on National HIV and STI Surveillance and Strategic Information Unit, Epidemiology Bureau, DOH. (2016) Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Fact Sheets. 56

57 HIV and AIDS Data Hub for Asia-Pacific! Number of ART sites and number of people on ART, Number of people on ART 14,000 12,000 10,000 8,000 6,000 4,000 2, , Number of ART sites Number of health facilities that offer ART Number of people on ART Source: Prepared by based on 1. UNAIDS. (2016). HIV Estimates ; and 2) Global AIDS Response Progress Reporting 57!

58 ART scale up, HIV and AIDS Data Hub for Asia-Pacific! 15,000 12, , Number 9,000 6,000 3, ART coverage (%) ART coverage (%) Number of people on ART Source: Prepared by based on 1) UNAIDS. (2016). HIV Estimates ; and 2) Global AIDS Response Progress Reporting 58!

59 HIV and AIDS Data Hub for Asia-Pacific! Estimated number of adults living with HIV, adults receiving ARVs, and adult ART coverage, , Number 120, ,000 80,000 60,000 40,000 20,000 42,000 12, % ART coverage 0 Estimated number of adults living with HIV Adults receiving ARVs (number) Adult ART coverage (%) 0 Source: Prepared by based on 1) UNAIDS. (2016). HIV Estimates !

60 HIV and AIDS Data Hub for Asia-Pacific! Estimated number of pregnant women living with HIV, pregnant women receiving ARVs, and PMTCT coverage, Number <500 Estimated number of pregnant women living with HIV 32 Number of pregnant women receiving ARVs * 10 PMTCT coverage * (%) PMTCT coverage (%) * Effective regimen! Source: Prepared by based on 1) UNAIDS. (2016). HIV Estimates !

61 HIV and AIDS Data Hub for Asia-Pacific! Estimated number of children living with HIV, children receiving ARVs, and child ART coverage, Number ART coverage (%) 0 Estimated number of children (0-14 yr) living with HIV Number of children (0-14 yr) receiving ARVs ART coverage (%) 0 Source: Prepared by based on 1) UNAIDS. (2016). HIV Estimates !

62 Other CRITICAL ISSUES

63 HIV and Duterte? Lancet June 2017

64 Well thought of but needs updating

65 Our Catholic Church: An important ally

66 HIV and AIDS Data Hub for Asia-Pacific! Review in slides! Philippines! Last updated: September

67 HIV and AIDS Data Hub for Asia-Pacific! Acknowledgement to: Data shown in this slide set are comprehensive to the extent they are available from country reports. Please inform us if you know of sources where more recent data can be used. Please acknowledge if slides are lifted directly from this site. 67!