DEPARTMENT OF HEALTH NATIONAL EPIDEMIOLOGY CENTER

JUNE 2011

Newly Diagnosed HIV Cases in the Philippines

In June 2011, there were 178 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 was a 63% increase compared to the same period last year (n=109 in 2010) [Figure 1]. Most of the cases (94%) were males. The median age was 28 years (age range:15-58 years). The 20-29 year (60%) age-group had the most number of cases. Sixty-two percent (111) of the reported cases were from the National Capital Region (NCR). Reported mode of transmission was sexual contact (173). Five did not report mode of transmission [Table 2, page 3]. Males having sex with other Males (83%) were the predominant type of sexual transmission [Figure 2]. Most (99%) of the cases were still asymptomatic at the time of reporting [Figure 3]. There were no reported deaths for this month. AIDS Cases Of the 178 HIV positive cases, one was reported as AIDS case. A single, 38 year old male who acquired the infection through homosexual contact. Overseas Filipino Workers (OFW) Twenty-two of the 178 (12%) reported cases were OFWs [Figure 9, page 3]. There were 18 males and 4 females. The median age was 34 years (age range: 24-57 years). All cases acquired the infection through sexual contact (10 heterosexual, 5 homosexual, and 7 bisexual).
Proportion of Cases

Table 1. Quick Facts

Demographic Data Total Reported Cases Asymptomatic Cases AIDS Cases Males Females Youth 15-24yo Children <15yo Reported Deaths due to AIDS June 2011 178 177 1 167 11 59 0 0 Jan-June 2011 1,016 998 18 944 72 290 2 2 Cumulative Data: 19842011 7,031 6,156 875 5,643* 1,377* 1,504 57 325

Philippine HIV and AIDS Registry

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

Figure 1. Number of New HIV Cases per Month (2009-2011)

200 175 150

Number of New Cases

125 100 75 50 25 0 J an 2009 2010 2011 65 143 152 Feb 47 130 159 M ar 59 120 172 A pr 66 154 171 M ay 85 153 184 J un 40 109 178 J ul 70 131 A ug 61 108 Sep 56 153 Oc t 80 104 Nov 80 112 Dec 126 174

Figure 2. Comparison of the Proportion of Types of Sexual Transmission in 2011, 2010 & Cumulative Data (1984-2011)
100%

Het erosexual

30
80%

20 2660 35 1421

Bisexual Homosexual

60%

74

40%

20%

69

41

2298
C umul at i ve

0%

June 2 0 11

June 2 0 10

Figure 3. Number of HIV/AIDS Cases Reported in the Philippines by Year, Jan 1984 to June 2011 (N=7,031)
1650 1500 1350 1200 1050 900 750 600 450 300 150 0
T OT A L A s y mpt omat i c A I DS Deat h '84 2 0 2 2 '85 10 6 4 4 '86 29 18 11 10 '87 38 25 13 12 '88 32 21 11 9 '89 39 29 10 8 '90 66 48 18 15 '91 85 68 17 13 '92 72 51 21 13 '93 102 64 38 11 '94 118 61 57 19 '95 116 65 51 24 '96 154 104 50 27 '97 117 94 23 10 '98 189 144 45 16 '99 158 80 78 17 '00 123 83 40 9 '01 174 118 56 20 '02 184 140 44 11 '03 193 139 54 11 '04 199 161 38 8 '05 210 171 39 16 '06 309 273 36 18 '07 342 312 30 10 '08 528 506 22 *7 '09 835 806 29 1 '10 1591 1571 20 2 '11 1016 998 18 2

*Five initially asymptomatic cases reported in 2008, died due to AIDS that same year.

Philippine HIV/AIDS Registry

June 2011
Fig 4. Proportion of Modes of Transmission of AIDS Cases by Year, Jan 1984June 2011
100%

AIDS Cases (1984-2011)

Of the 1,016 HIV positive cases in 2011, eighteen were reported as AIDS cases. Eighty-three percent were males. Ages ranged from 22-59 years (median 36 years). All acquired the infection through sexual contact [heterosexual (6), homosexual (8), and bisexual contact (4)]. From 1984 to 2011, there were 875 AIDS cases reported, 71% (625) were males. Median age was 35 years (range 1-72 years). Of the AIDS cases, there were 325 (37%) deaths during the reported period. Sexual contact was the most common mode of HIV transmission, accounting for 93% (814) of all AIDS cases. More than half (454) of sexual transmission was through heterosexual contact, followed by homosexual contact (280) then bisexual contact (80). Other modes of transmission include: mother-to-child transmission (17), blood transfusion (10), injecting drug use (4), and needle prick injuries (2) [Figure 4]. Three percent (28) of the AIDS cases did not report mode of HIV transmission.

75%

Proportion of Cases

50%

25%

0% 1984-2007 N eedl e P r i ck B l ood T r ansf usi on MTCT IDU B i sexual C ont act H o mo s e x u a l C o n t a c t H et er osexual C ont act 2 10 16 3 60 234 433 2008 0 0 0 1 4 10 7 2009 0 0 1 0 8 14 6 2010 0 0 0 0 4 14 2 2011 0 0 0 0 4 8 6

*Note: 28 did not report mode of transmission

Demographic Characteristics (1984-2011)

In 2011, there were a total of 1,016 cases reported. 93% of the cases reported were males (944). Ages ranged from 1-67 years old (median 28 years). The 20-29 year old age group (60%) had the most number of cases for 2011. For the male age group, the most number of cases were found among the 20-24 years old (27%), 25-29 years old (34%) and 30-34 years old (19%) [Figure 5]. From 1984 to 2011, there were 7,031 HIV Ab sero-positive cases reported (Table 1), of which 6,156 (88%) were asymptomatic and 875 (12%) were AIDS cases. As shown in Figure 6, there is a significant difference in the number of male and female cases reported. Eighty percent (5,643) were males. Ages ranged from 1-73 years (median 30 years). The age groups with the most number of cases were: 20-24 years (19%), 25-29 (26%) and 30-34 years (19%) [Figure 6].
Figure 5. Proportion of Sex & Age-Groups in June 2011 & Jan-June 2011
100%

75%

Proportion of Cases

50%

25%

0% J une 2011 (M ) 50 & ol der 35-49y o 25-34y o 15-24y o 1-14y o 6 23 83 55 0 J une 2011 (F) 1 3 3 4 0 2011 (M al e) 26 145 497 276 0 2011 (Femal e) 2 21 33 14 2

Figure 6. 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 9yo 5-1

1984-2006

2007

2008

2009

2010

2011

Number of Male Cases

1750 1500 1250 1000 750 500 250 0

<1 5yo
0 250 500 750

Number of Female Cases

1000 1250 1500 1750

<15y o 2011 2010 2009 2008 2007 1984-2006 0 1 1 2 6 21

15-19y o 19 50 22 11 1 14

20-24y o 257 406 179 91 36 121

25-29y o 321 454 227 141 74 300

30-34yo 176 256 124 90 54 360

35-39yo 81 128 90 59 43 321

40-44y o 46 81 41 36 30 249

45-49y o 18 43 19 23 15 170

50 & ol der 26 48 29 20 19 157

<15y o 2011 2010 2009 2008 2007 1984-2006 2 2 1 0 3 18

15-19y o 1 5 4 0 0 33

20-24y o 13 28 13 8 4 187

25- 29yo 22 21 19 14 16 209

30-34y o 11 34 21 8 12 190

35- 39y o 8 15 20 10 14 140

40-44y o 7 9 14 9 6 84

45-49y o 6 6 6 3 5 30

50 & ol der 2 4 5 3 3 41

Philippine HIV/AIDS Registry

June 2011

Modes of Transmission (1984-2011)

In 2011, 96% (973) were infected through sexual contact, Figure 7. Proportion of Modes of HIV Transmission by Age-Group, 2011(n=1,016) 2% (17) through needle sharing among injecting drug users, <1% (2) through mother-to-child transmission and <1% (1) through blood transfusion; 2% (23) had no reported data on mode of transmission (Table 2). There were 906 males and 67 females infected through sexual transmission. The age range of those infected through sexual transmission was 15-67 years old (median 27 years).
600 500 400 300 200 100

Of the 7,031 with HIV from 1984 to 2011, 91% (6,379) were infected through sexual contact, 2% (172) through needle sharing among injecting drug users, 1% (54) through mother-to-child transmission and <1% (20) through blood transfusion . Other modes of transmission are listed in Table 2. No data is available for 6% (403) of the cases. Cumulative data shows 42% (2,660) were infected through heterosexual contact, 36% (2,298) through homosexual contact, and 22% (1,421) through bisexual contact. From 2007 there has been a shift in the predominant trend of sexual transmission from heterosexual contact (24%) to males having sex with other males (76%) [Figure 8].
Table 2. Reported Mode of HIV Transmission

<7yo Blood Tr ansf usion Mat ernal t o Child Inject ing Drug Use - Female Inject ing Drug Use - Male Het er osexual Cont act - Female Het er osexual Cont act - Male Bisexual Cont act Homosexual Cont act 2 -

7-14yo -

15- 17yo 1 1 3

18- 24yo 4 13 14 98 153

25- 34yo 35- 49yo 50&older 4 33 50 200 230 1 1 7 18 28 48 57 1 2 15 3 6

*No data available on Modes of Transmission for twenty-three (23) cases

Figure 8. Proportion of Types of Sexual Transmission, Jan 1984June 2011

100% 90% 80%

Proportion of Cases

Mode of Transmission Sexual Contact Heterosexual contact

June 2011 n=178 173 30 (17%)

JanJune 2011 n=1,016 973 175 (18%)

Cumulative N=7,031 6,379 2,660 (42%)

70% 60% 50% 40% 30% 20% 10% 0% '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11

Homosexual contact Bisexual contact Blood/Blood Products Injecting Drug Use

Needle Prick Injury Mother-to-Child No Data Available

69 (40%) 74 (43%) 0 0
0 0 5

449 (46%) 349 (36%) 1 17

0 2 23

2,298 (36%) 1,421 (22%) 20 172

3 54 403

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

1 0 0

7 2 1

24 0 4

24 4 3

16 2 4

19 2 6

35 4 8

30 41 4 15 5 5

47 2 16

58 3 20

56 8 21

81 7 30

82 138 114 93 128 129 129 123 131 193 139 160 216 271 175 7 25 9 36 10 30 8 17 5 32 8 46 14 40 12 27 14 26 74 127 252 463 349

47 81 107 215 336 677 449

Overseas Filipino Workers (OFW)

In 2011, there were 126 HIV positive OFWs, comprising 12% of cases reported for the year [Figure 9]. Of these, 109 (87%) were males and 17 (13%) were females; all infected through sexual contact. There were 1,648 HIV positive OFWs since 1984, comprising 23% of all reported cases [Figure 9]. Seventy-six percent (1,254) were males. Ages ranged from 18 to 69 years (median 35 years). Sexual contact (96%) was the predominant mode of transmission (Table 3). Eighty-four percent (1,379) were asymptomatic while 16% (269) were AIDS cases.
Table 3. Reported Mode of HIV Transmission Among OFWs
Mode of Transmission Sexual Transmission June 2011 n= 22 22 Jan June 2011 n= 126 126 Cumulative N=1,648
Number of Cases

Figure 9. Number of OFWs Compared to Non-OFWs by Year (1984-2011*)

1400 1200 1000 800 600 400 200 0
'84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11*

1,586

Heterosexual contact Homosexual contact Bisexual contact

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

10 (45%) 5 (23%) 7 (32%)

0 0 0 0

49 (39%) 33 (26%) 44 (35%)

0 0 0 0

1,050 (66%) 311 (20%) 225 (14%)

10 1 3 48

OFW Non-OFW % of OFW

1 1

2 8

0 29

3 35

9 23

5 34

10 56

7 78

14 58

29 73

31 87

24 92

35

27

51

67

60 63

79 95

96 88

94 99

88

94

130 106 122 164 174 126

119 90

138 91

111 116 179 236 406 671 1417 890

50% 20% 0% 8% 28% 13% 15% 8% 19% 28% 26% 21% 23% 23% 27% 42% 49% 45% 52% 49% 44% 45% 42% 31% 23% 20% 11% 12%

*Data includes January to June 2011 only.

Philippine HIV/AIDS Registry

June 2011

Program Related Information

Of the 178 HIV positive cases reported in June 2011, one was classified as AIDS. Fifty-eight percent of the cases received information on HIV prevention, services available for HIV cases, implications of an HIV positive result from screening and confirmation. Their sources of information were one-on-one counseling, group counseling, pre-departure orientation seminar (PDOS), pamphlets, videos, internet and seminars.

Blood Units Screened for HIV

Note: The following information is from the National Voluntary Blood Safety Program (NVBSP) which monitors blood safety of donated blood. HIV reactive blood units are referred to the Research Institute for Tropical Medicine (RITM) for confirmation. RITM is the National Reference Laboratory for the NVBSP.

From January to June 2011, 102 blood units were confirmed to be positive for HIV by the RITM. Table 4. Results of Blood Units Referred for HIV Confirmation For June 2011, out of the 118 blood units referred for HIV confirmation, 32 units were positive for HIV, 4 units had indeterminate results and 82 were negative for HIV [Table 4].
Monthly Report Blood units* referred January February 85 67 76 74 48 118 2011 Positive 11 15 14 20 10 32 Indeterminate 0 2 1 1 0 4

Figure 10. HIV Positive Blood Units by Month & Year (2008-2011)
35 30
Number of Positive Blood Units

March April May June July August September October

25 20 15 10 5 0
J an 2008 2009 2010 2011 10 5 9 11 Feb 7 5 12 15 M ar 4 10 15 14 A pr 8 10 15 20 M ay 8 7 9 10 J un 2 5 17 32 Jul 9 7 11 A ug 6 7 6 Sep 7 9 10 Oc t 7 12 20 Nov 4 3 11 Dec 2 9 11 T ot al 74 89 146 102

November December Total for the year (Jan June only) 468 102 8

* One blood donor can donate more than one blood unit. ** These are HIV positive blood units, not donors. Donors of HIV positive blood units may or may not be in the HIV & AIDS Registry.

National HIV/AIDS & STI Strategic Information and Surveillance Unit

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.

National Epidemiology Center, Department of Health, Bldg. 19, San Lazaro Compound, Sta. Cruz, Manila 1003 Philippines Tel: +632 651-7800 local 2926, 2952 Fax: +632 495-0513/743 6076 Email: HIVepicenter@gmail.com Website: http://www.doh.gov.ph