DEPARTMENT OF HEALTH NATIONAL EPIDEMIOLOGY CENTER

JANUARY 2014

Newly Diagnosed HIV Cases in the Philippines

In January 2014, there were 448 new HIV Ab sero-positive individuals confirmed by the STD/AIDS Cooperative Central Laboratory (SACCL) and reported to the HIV and AIDS Registry (Table 1). This is 18% higher
Table 1. Quick Facts
Demographic Data Total Reported Cases Asymptomatic Cases AIDS Cases Males Females
January 2014 Cumulative 19842014

448 391 57 434 14 118 0

16,964 15,401 1,563 15,094* 1,859* 4,307 65

Philippine HIV and AIDS Registry

compared to the same period last year (n=380 in 2013) [Figure 1] .

Table 2. Percentage of HIV Cases per Region (January 2014)
Region I II III IVA IVB V VI VII VIII IX X XI XII CAR CARAGA ARMM NCR % of Cases 2% 2% 9% 16% <1% 1% 4% 2% <1% 2% 1% 7% 2% 1% 1% <1% 50%

Most of the cases (97%) were male. The median age was 28 years (age range: 17-73 years). The 20-29 year (56%) age group had the most number of cases.

Youth 15-24yo Children <15yo

*Note: No data available on sex for (11) cases.

Figure 1. Number of New HIV Cases per Month (2012-2014)

500

Number of New Cases

Reported modes of transmission were sexual contact (444) and needle sharing among injecting drug users (4) [Table 3, page 2]. Males having sex with other males (85%) were the predominant type of sexual transmission [Figure 2]. Most (87%) of the cases were still asymptomatic at the time of reporting [Figure 3]. In January 2014, 86% of the new

450 400 350 300 250 200 150 100 50 0 Jan 2012 2013 2014 212 380 448 Feb 274 339 M ar 313 370 A pr 233 388 M ay 273 415 Jun 295 431 Jul 278 449 A ug 272 382 Sep 316 427 Oct 295 491 Nov 284 384 Dec 293 358

Figure 2. Comparison of the Proportion of Types of Sexual Transmission in 2014, 2013 & Cumulative Data (1984-2014)
100%

Heterosexual

Proportion of Cases

HIV cases came from NCR, Region 4A, Region 3, Region 11 and Region 6 [Table 2].

68
75%

69 118

4,142

Bisexual Homosexual

152
50%

4,545

25%

224

189

7,102

0%

Januar y 2 0 14

Januar y 2 0 13

C umulat ive

Figure 3. Number of HIV/AIDS Cases Reported in the Philippines by Year, January 1984 to January 2014 (N=16,964)
5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0
T OT A L A sympt omat i c A I DS '84 2 0 2 '85 10 6 4 '86 29 18 11 '87 38 25 13 '88 32 21 11 '89 39 29 10 '90 66 48 18 '91 85 68 17 '92 72 51 21 '93 102 64 38 '94 118 61 57 '95 116 65 51 '96 154 104 50 '97 117 94 23 '98 189 144 45 '99 158 80 78 '00 123 83 40 '01 174 117 57 '02 184 140 44 '03 193 139 54 '04 199 160 39 '05 210 171 39 '06 309 273 36 '07 342 311 31 '08 528 505 23 '09 835 804 31 '10 1591 1562 29 '11 '12 '13 '14 448 391 57

2, 349 3, 338 4, 814 2, 239 3, 152 4, 476 110 186 338

Philippine HIV/AIDS Registry

January 2014

Demographic Characteristics (1984-2014)

From 1984 to 2014, there were 16,964 HIV Ab sero-positive cases reported (Table 1), of which 15,401 (91%) were asymptomatic and 1,563 (9%) were AIDS cases. As shown in Figure 4, there is a significant difference in the number of male and female cases reported. Eighty-nine percent (15,094) were male. Ages ranged from 1-81 years (median 28 years). The age groups with the most number of cases were: 20-24 years (22%), 25-29 (30%), and 30-34 years (19%) [Figure 4]. Figure 4. Comparison of the Distribution of Male and Female HIV Cases by Age-Group and Certain Highlighted Years
50 & o lder 45-49yo 40-44yo 35-39yo 30-34yo 25-29yo 20-24yo 1 5-1 9yo

1984-2009

2010

2011

2012

2013

2014

Number of Male Cases

5000 4750 4500 4250 4000 3750 3500 3250 3000 2750 2500 2250 2000 1750 1500 1250 1000 <15yo 2014 2013 2012 2011 2010 1984-2009 0 1 3 1 1 30 15-19yo 13 147 95 76 50 48 20-24yo 102 1, 169 774 589 405 428 25-29yo 147 1, 559 1, 090 739 455 741 30-34yo 100 906 622 378 256 628 35-39yo 32 363 289 193 128 513 40-44yo 23 209 153 117 81 356 750 500 250 0 45-49yo 9 127 89 51 42 226 50 & ol der 8 103 71 49 48 225

<1 5yo
0 250 <15yo 2014 2013 2012 2011 2010 1984-2009 0 2 1 2 2 22 500

Number of Female Cases

750 1000 1250 1500 1750 2000 2250 2500 2750 3000 3250 3500 3750 4000 4250 4500 4750 5000 15-19yo 1 11 8 3 5 37 20-24yo 2 48 20 36 28 212 25-29yo 1 57 39 44 21 258 30-34yo 4 43 23 23 34 231 35-39yo 0 29 24 21 15 184 40-44yo 2 16 13 10 9 113 45-49yo 1 11 12 8 7 45 50 & ol der 3 13 12 9 4 80

*Note: 74 did not report age, 11 did not report sex, 10 did not report age and sex

Modes of Transmission (1984-2014)

In January 2014, ninety-nine percent (444) were infected through sexual contact and 1% (4) through needle sharing among injecting drug users (Table 3). There were 430 male and 14 female infected through sexual transmission. The age range of those infected through sexual transmission was 17-73 years old (median 28 years). Of the 16,964 HIV positive cases reported from 1984 to 2014, 93% (15,789) were infected through sexual contact, 4% (715) through needle sharing among injecting drug users, <1% (62) through mother-to-child transmission, <1% (20) through blood transfusion and needle prick injury <1% (3) [Table 3]. No data is available for 2% (375) of the cases. Figure 5. Proportion of Types of Sexual Transmission, January 1984January 2014
100% 90% 80%

Table 3. Reported Mode of HIV Transmission

Mode of Transmission Sexual Contact January 2014 n=448 444 Cumulative N=16,964 15,789

Heterosexual contact Homosexual contact Bisexual contact

Blood/Blood Products Injecting Drug Use Needle Prick Injury Mother-to-Child No Data Available
300

68(15%) 224(50%) 152(34%)

0 4 0 0 0

4,142(26%) 7,102(45%) 4,545(29%)

20 715 3 62 375

Figure 6. HIV Transmission by Age-Group, 2014 (n=448)

250

Number of Cases

200

Proportion of Cases

150

70% 60% 50% 40%

100

50

30% 20% 10% 0%

Blood Transfusion - Female Maternal to Child Injecting Drug Use - Female Injecting Drug Use - Male
'84 1 0 0 '85 '86 7 2 1 24 0 4 '87 '88 24 4 3 16 2 4 '89 19 2 6 '90 '91 35 4 8 30 4 15 '92 41 5 5 '93 '94 47 2 16 58 3 20 '95 '96 56 8 21 81 7 30 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14

<7yo -

7-14yo -

15-17yo 1

18-24yo 3 10 35 69

25-34yo 1 5 34 92 120

35-49yo 3 3 9 23 29

50&older 3 1 2 5

Heterosexual Contact - Female Heterosexual Contact - Male Bisexual Contact Homosexual Contact

Het er os ex ual B i s ex ual Homos ex ual

82 138 114 7 25 9 36 10 30

93 128 129 129 123 131 193 139 160 216 274 388 480 717 68 8 17 5 32 8 46 14 40 12 27 14 47 26 74 127 252 467 806 992 152 152

81 107 215 336 680 104 169 230 224

Philippine HIV/AIDS Registry

January 2014
Figure 7. Percentage of HIV Cases by Region, January 1984- January 2014
R OTC 14 % Reg 3 8% Reg 4A 13 %

Geographic Distribution (1984-2014)

Since 1984 to present, there were 16,964 cases reported. Half (7,843) came from the National Capital Region. [Figure 7]. Thirteen percent (2,065) came from region 4A, followed by 9% (1,419) from Region 7, 8% (1,310) from Region 3, 6% (956) from Region 11 and the rest of the country comprises 14% (2,233) of all the cases.

Reg 7 9%

*Note: 1,137 or 7% of the cases had no reported data on their address at the time of diagnosis
R e g 11 6% NCR 50%

AIDS Cases (1984-2014)

Of the 448 HIV positive cases in January 2014, fifty-seven were reported as AIDS cases. All were male. Ages ranged from 19-57 years (median 29 years). All acquired the infection through sexual contact (30 homosexual, 23 bisexual and 4 heterosexual). From 1984 to 2014, there were 1,563 AIDS cases reported. Eighty-two percent (1,278) were male. Median age is 33 years (age range: 1-81 years). Sexual contact was the most common mode of HIV transmission, accounting for 95% (1,489) of all reported AIDS cases. Forty-two percent (630) of sexual transmission was through homosexual contact, followed by heterosexual contact (580) then bisexual contact (279). Other modes of transmission include: mother-to-child transmission (20), injecting drug use (14), blood transfusion (10), and needle prick injuries (2). Two percent (28) of the AIDS cases did not report mode of HIV transmission.

Overseas Filipino Workers (OFW)

In January 2014, there were 49 HIV positive OFWs, comprising 11% of cases reported for the month [Figure 8]. Of these, 42 (86%) were male and 7 (14%) were female. All acquired the infection through sexual contact (21 heterosexual, 19 homosexual and 9 bisexual). There were 2,687 HIV positive OFWs since 1984, comprising 16% of all reported cases [Figure 8]. Eighty-one percent (2,164) were males. Ages ranged from 18 to 78 years (median 34 years). Sexual contact (98%) was the predominant mode of transmission (Table 4). Eighty-eight percent (2,355) were asymptomatic while 12% (332) were AIDS cases.

Table 4. Mode of HIV Transmission Among OFWs

Mode of Transmission Sexual Transmission January 2014 n=49 49 Cumulative N=2,687

Figure 8. Number of OFWs and the Proportion of OFWs among the Total HIV Cases by Year
600

Heterosexual contact Homosexual contact Bisexual contact

Blood/Blood Products Injecting Drug Use Needle Prick Injury No Data Available

21(43%) 19(39%) 9(18%)

0 0 0 0

1,376(52%) 701(27%) 545(21%)

10 4 3 48

Number of Cases

2,622

450

300

150

0
OFW % of OFW

'8 4 1

'8 5 2

'8 6 0

'8 7 3 8%

'8 8 9

'8 9 5

'9 0 10

'9 1 7 8%

'9 2 14

'9 3 29

'9 4 31

'9 5 24

'9 6 35

'9 7 27

'9 8 51

'9 9 67

'0 0 60

'0 1 79

'0 2 96

'0 3 93

'0 4 86

'0 5 92

'0 6 13 0

'0 7 10 6

'0 8 12 2

'0 9

'10

'11

'12

'13

'14 49

16 4 17 4

271 342 509

50% 20% 0%

2 8 % 13 % 15 %

19 % 2 8 % 2 6 % 2 1% 2 3 % 2 3 % 2 7 % 4 2 % 4 9 % 4 5 % 5 2 % 4 8 % 4 3 % 4 4 % 4 2 % 3 1% 2 3 % 2 0 % 11% 12 % 10 %

11% 11%

Philippine HIV/AIDS Registry

Report on Deaths, PLHIV on ART, & Blood Units

Table 5. Demographic data of reported deaths among People with HIV
Demographic Data Jan 2014 7 7 0 0 0 Jan-Dec 2013 223 214 9 30 1 Cumulative* (1984-2014) 938 749 189 107 15

Deaths among People with HIV

From January 1984 to January 2014, there were 938 reported deaths among people with HIV [Table 5]. Eighty percent (749) were male. In total, there have been 107 deaths among youth (15-24 years old) and 15 deaths among children (<15 years old). The annual number of deaths from 1984-2010 ranges from 2 to 36 cases with an average of 14 deaths per year. Beginning 2011, there has been an increase in the number of recorded deaths (69 in 2011, 177 in 2012 and 223 in 2013). The DOH-NEC established an official reporting form in 2012. In January 2014, there were a total of 7 deaths. All were male

Total Reported Deaths Males Females Youth 15-24yo Children <15yo

*Note: No year of death reported for 44 cases

Figure 9. HIV Transmission by Age-Group of Reported Deaths among People with HIV, January 2014 (n=7)

[Table 5]. The highest number of deaths occurred in the 25-29 (57%) age-group, followed by the 20-24 (14%), 30-34 (14%) and the 50 and older (14%) age-group [Figure 9]. Among the reported deaths in 2014, sexual contact (100%) was the main mode of HIV transmission (2 homosexual, 3 bisexual, 2 heterosexual). There were no cases of infections through injecting drug use, maternal to child transmission and blood transfusion [Figure 9].

PLHIV on Anti-Retroviral Therapy (ART)

As of January 2014, there are 5,756* People Living with HIV presently on AntiRetroviral of adult and accessing Therapy. These pediatric paare the combined numbers tients currently enrolled and Anti-Retroviral drugs in the 18 treatment hubs listed on the right.
Treatment Hubs in the Philippines 1. Ilocos Training and Regional Medical Center 2. Cagayan Valley Medical Center 3. Baguio General Hospital and Medical Center 4. Jose B. Lingad Medical Center 5. James L. Gordon Memorial Hospital 6. Makati Medical Center 7. Philippine General Hospital 8. Research Institute for Tropical Medicine 9. San Lazaro Hospital 10. The Medical City 11. Bicol Regional Training and Teaching Hospital 12. Corazon Locsin Montelibano Memorial Regional Hospital 13. Western Visayas Medical Center 14. Gov. Celestino Gallares Memorial Hospital 15. Vicente Sotto Memorial Medical Center 16. Zamboanga City Medical Center 17. Southern Philippines Medical Center 18. Northern Mindanao Medical Center

Blood Units Confirmed for HIV

In January 2014, 40 blood units were confirmed positive for HIV by RITM. There is no available data yet on the total number of blood units donated. These are confirmed positive blood units, not blood donors. One donor can donate more than one blood unit. HIV positive blood donors may not be in the HIV & AIDS Registry unless they underwent voluntary counseling and testing as individuals.

Table 6. Number of Confirmed HIV Positive Blood Units Month January February March April May June July August September October November December Total 40 2014 40

* This is not a cumulative number. It does not include those who already have died, left the country, lost to follow up or decided to stop taking ART.

National HIV/AIDS & STI Strategic Information and Surveillance Unit

National Epidemiology Center, Department of Health, Bldg. 19, San Lazaro Compound, Sta. Cruz, Manila 1003 Philippines Tel: +632 651-7800 local 2926, 2952 Fax: +632 495-0513 Email: HIVepicenter@gmail.com Website: http://www.doh.gov.ph

Philippine HIV & AIDS Registry Report Editorial Team:

Philippine HIV & AIDS Registry

The Philippine HIV & AIDS Registry is the official record of the total number of laboratory-confirmed HIV positive individuals, AIDS cases and deaths, and HIV positive blood units in the Philippines. All individuals in the registry are confirmed by the STD/AIDS Cooperative Central Laboratory (SACCL) at San Lazaro Hospital. While all blood units are confirmed by the Research Institute for Tropical Medicine (RITM). Both are National Reference Laboratories (NRL) of the Department of Health (DOH). Mandatory HIV testing is unlawful in the Philippines (RA 8504). The process of reporting to the Registry is as follows: All blood samples from accredited HIV testing facilities that are screened HIV reactive are sent to SACCL (individuals) or RITM (blood units) for confirmation. Confirmed HIV positive individuals and blood units are reported to the DOH-National Epidemiology Center (NEC), and are recorded in the Registry. The Registry is a passive surveillance system. Except for HIV confirmation by the NRL, all other data submitted to the Registry are secondary and cannot be verified. An example would be an individuals reported place of residence. The Registry is unable to determine if this reported address is where the person got infected, or where the person lived after being infected, or where the person is presently living, or whether the address is valid. This limitation has major implications to data interpretation. Thus, readers are cautioned to carefully weigh the data and consider other sources of information prior to arriving at conclusions.