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Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Enrique A. Tayag MD, PHSAE, FPSMID, CESO III
Assistant Secretary of Health and Director IV, NEC

National Epidemiology Center - DOH

“Historic

success in bringing HIV programmes to scale –combined with the emergence of powerful new tools to prevent people from becoming infected and from dying from AIDS-related causes – has enabled the foundation to be laid for the eventual END of AIDS.”

“Epidemiologic trends are less favourable in several other countries. In at least nine countries, the number of people newly infected in 2011 was at least 25% higher than in 2001.”

National Epidemiology Center - DOH

National Epidemiology Center - DOH

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: 11,125 • Total Number of Reported AIDS deaths when reported 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

National Epidemiology Center - DOH

Number of New HIV/AIDS By Year, Philippines
October 1984-October 2012

1,250%

National Epidemiology Center - DOH

11,125 reported HIV cases
(January 1984 to October 2012)

668% INCREASE

National Epidemiology Center - DOH

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 Oct 2012 Philippine HIV Registry - DOH

National Epidemiology Center - 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
*As of Oct 2012 Philippine HIV Registry - DOH

25 to 34yo

15 to 24yo

National Epidemiology Center - DOH

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
*As of Oct 2012 Philippine HIV Registry - DOH

60%

80%

100%

National Epidemiology Center - DOH

From Local to Global back to Local
(January 1984 to October 2012)

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Local OFW

*As of Oct 2012 Philippine HIV Registry - DOH

National Epidemiology Center - DOH

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
*As of Oct 2012 Philippine HIV Registry - DOH

National Epidemiology Center - DOH

Chain of HIV Spread
Female Partner of MSM Female Partner of Male IDU Male IDU Female IDU Baby

Baby

Baby

MSM
Male Client of MSW Male Sex Worker Female Partner of Male Sex Worker

Baby Male Client of FSW
Female Partner of Male Clients

Baby

Baby

Freelance FSW

Registered FSW

Baby

National Epidemiology Center - DOH

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

National Epidemiology Center - DOH

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

*As of Aug 2012 Philippine HIV Registry - DOH

National Epidemiology Center - DOH

Philippine Integrated HIV Behavioral & Serologic Surveillance (IHBSS)
Conducted every 2 years by DOH since 2005

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

HIV Prevalence among Sex Workers & Males who have Sex with Males

Source: IHBSS 2005, 2007, 2009, 2011 of 10 Sentinel Sites

National Epidemiology Center - DOH

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

National Epidemiology Center - DOH

More Risky Sex as They Grow Older
(Anal Sex Positions and Age-Groups, IHBSS 2011)

National Epidemiology Center - DOH

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

National Epidemiology Center - DOH

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

National Epidemiology Center - DOH

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 Don’t like to use condoms Partner objected to using condoms

45% 27% 11%

Thinks it is not necessary Forgot to use a condom
Don’t know how to use a condom Condoms too expensive
National Epidemiology Center - DOH

11% 3% 3% 1%
Philippine IHBSS, 2011

More MSM buy their own condoms when it is easy to access in the community, IHBSS 2011

National Epidemiology Center - DOH

HIV Prevalence and Percentage who Know their Current HIV Status

Source: 2011 IHBSS

National Epidemiology Center - DOH

Reasons MSM don’t get an HIV test

Afraid to get tested Feels no need to get tested Do not know where to get tested

Percentage of respondents 33% 29% 28%

Testing facility to far No money for testing

1% 6%

Source: 2011 IHBSS

National Epidemiology Center - DOH

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
National Epidemiology Center - DOH

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)
National Epidemiology Center - DOH

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

National Epidemiology Center - DOH

Personal Information Put in OSN (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

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

National Epidemiology Center - DOH

OSN sites used for Date and Sex (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

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

National Epidemiology Center - DOH

Place of OSN Sex (N=133)*
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

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

National Epidemiology Center - DOH

Sexual Activities in OSN (N=133)*
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
Sexual Activities Time spent to look for Sex 5 minutes – more than 24 hours

Number of Sexual Partners from OSN
Number of Sexual Partner (1 time) Number of Sexual Partner (more than once)

1-500 sex partners (average = 82)
1-360 sex partners (average = 43) 1-291 sex partners (average = 43) Frequency % 7 31 12 2

Ever paid a sexual partner from OSN Participated in OSN Group Sex with males Used drugs during OSN sex

12 55 22 3

Shared Needle among OSN members

National Epidemiology Center - DOH

OSN Sexual Practices (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
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 35 18 121 4 43 19 101 14 % 9 1 88 2 14 10 67 2 24 11 56 7

National Epidemiology Center - DOH

Condom Use (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

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 Don’t Know a Condom No Answer

To prevent STI

National Epidemiology Center - DOH

Laboratory and Examination Results (N=53)
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

13%
10% 77%

HIV HIV and other STD other STD's

National Epidemiology Center - DOH

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

National Epidemiology Center - DOH

So what’s causing the increase in HIV cases?

Risky Behavior

Prevention Coverage

National Epidemiology Center - DOH

Increasing HIV Prevalence among MSMs, PWIDs

Drivers of HIV epidemic
New HIV/AIDS Cases, By Year, Philippines, 1984-2011

Growing number of areas that are vulnerable

High prevalence of unsafe behaviors among Key Populations at higher risk

Widening financial gap to ensure universal access to prevention and treatment

Below-target prevention coverage

Legal barriers that promote discrimination among MARPs

National Epidemiology Center - DOH

Projected Number of People Living with HIV in the Philippines in 3 years

Source: Philippine PLHIV Estimates, 2012

National Epidemiology Center - DOH

Best Practices to Attain MDG for HIV
International and National Commitments to ensure Universal Action to Prevention, Care, Treatment and support Universal Health Care Policies and Implementation Rapid Assessment of Vulnerability in New Areas of Concern Updated AIDS Medium Term Plan 2011-2016 Support to Reproductive Health Bill Passage Behavioral studies on Key Populations at higher risk Comprehensive, Focused, Evidence-Informed 5-Year Investment Plan Philhealth Treatment Package for PLHIV

Proposal for Operations Research on Harm Reduction

National Epidemiology Center - DOH

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

National Epidemiology Center - DOH

Philippines AIDS Medium Term Plan 2011-2016
GOAL

By 2016, the country will have maintained a prevalence of less than 66 HIV cases per 100,000 population by preventing the further spread of HIV infection and reducing the impact of the disease on individuals, families, sectors and communities
STRATEGIC OBJECTIVES
To improve the coverage and quality of prevention programs for persons at most risk, vulnerable and living with HIV To improve the coverage and quality of TCS programs for people living with HIV (including those who remain at risk and vulnerable) and their families To enhance policies for scaling up implementation, effective management and coordination of HIV programs at all levels To strengthen capacities of the PNAC and its members to oversee the implementation of the 5th AMTP To strengthen partnerships and develop capacities for the 5th AMTP implementation of LGUs, private sector, civil society, including communities of atrisk, vulnerable, and living with HIV

KEY STRATEGIES

• Develop evidence-based, targeted, comprehensive programs
• Capacitate service providers • Provide equitable access to programs • Enhance decentralized implementation

Provide enabling environment

Expand, build, strengthen management, partnerships and collaboration

Develop capacity of partners

National Epidemiology Center - DOH

Investments Framework
Key populations of higher risk Prevention Priority areas of Hazards and Risks

Catalytic Cost-Effective Core Interventions

Long-term Expanded Low Impact Interventions

Health Systems Strengthening Treatment, Care and Support Real Collaboration and Resource Sharing

National Epidemiology Center - DOH

Summary of AMTP 5 Investment Plan by Coverage Area and Funding Gap
COVERAGE COST (in Philippine Peso) Estimated Funding Gap Annual Average Gap

Nationwide Category A,B &C Category A & B Category A
Note: in Billion Pesos

18.95 7.84 6.89 5.78

10.65 4.08 4.04 3.50

1.77 0.70 0.67 0.58

National Epidemiology Center - DOH

Percent distribution of investments

National Epidemiology Center - DOH

Right Goals, Getting it Right, Respecting Rights

National Epidemiology Center - DOH