Trending: #HIVinThePhilippines

Trending #HIVinThePhilippines
Enrique A. Tayag MD, PHSAE, FPSMID, CESO III

Assistant Secretary of Health and Director IV, NEC
National Epidemiology Center - DOH
The overall growth of the global AIDS epidemic appears to have stabilized. The annual number of new HIV infections has been steadily declining since the late 1990s.
Several countries do not fit the overall trend. In seven countries, the HIV incidence increased by more than 25% between 2001 and 2009.
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: 10,514 Total Number of Reported AIDS deaths 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
10,514 reported HIV cases

(January 1984 to August 2012)
8000
7000
6000
Number of Cases
5000
587% INCREASE
4000
3000 2000 1000 0 1984-1991 1992-1996 1997-2001 Year 2002-2006 2007-2012
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 Aug 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 August 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 MSM Male Client of MSW Male Sex Worker Female Partner of Male Sex Worker Male Client of FSW
Female Partner of Male IDU

Male IDU Female IDU
Baby
Baby
Baby
Baby
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
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 Thinks it is not necessary
45% 27% 11% 11%
Forgot to use a condom

Dont know how to use a condom Condoms too expensive
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 Testing facility to far No money for testing
Percentage of respondents 33% 29% 28%

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 Number of Sexual Partners from OSN Number of Sexual Partner (1 time) 5 minutes more than 24 hours 1-500 sex partners (average = 82) 1-360 sex partners (average = 43)
Number of Sexual Partner (more than once)
1-291 sex partners (average = 43)

Frequency % 7 31
Ever paid a sexual partner from OSN Participated in OSN Group Sex with males Used drugs during OSN sex Shared Needle among OSN members
12 55
22
3
12
2
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 % 9 1 88 2
35 18
121 4 43 19 101 14
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
Projected Number of People Living with HIV in the Philippines in 3 years
Source: Philippine PLHIV Estimates, 2012
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
#ACTnowStopAIDS Acknowledge the HIV problem and be accountable to someone Care to protect yourself Test Get an HIV test every 6 months
National HIV & STI Surveillance and Strategic Information Unit (NHSSS)
National Epidemiology Center, Department of Health
2nd Floor, Bldg. 19, San Lazaro Compound, Sta. Cruz, Manila 1003, Philippines
HIVepicenter@gmail.com (02) 495-0513 (02) 651-7800 loc 2952

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Trending #HIVinThePhilippines

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

10,514 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

2000: One new case every 3 days

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 Aug 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

Female Partner of Male IDU

Female Partner of Male Clients

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% 11%

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%