HIV & AIDS

BELMA K. DUMANGENG, RMT

SURVI
VIRUS
SIAD
AIDS
MENTTEART
TREATMENT
KEYMON
MONKEY
DLOOB
BLOOD
Objectives
• Show worldwide and local statistics of HIV
• Discuss modes of transmission
• Present pathogenesis and clinical
manifestation
• Discuss ways how to prevent HIV
infection
• RA 11166-HIV LAW
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H Human – only infects human beings

Immunodeficiency – HIV weakens immune

I system by killing important cells that fight

disease.

V Virus – infective agent consisting of nucleic

acid in a protein coat
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A Acquired – to get, not inherited

I Immuno – indicating immunity

D Deficiency – inadequacy, shortage > failing

S Syndrome – collection of symptoms, complex

illness
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 Global Summary 2021

Source: UNAIDS Global report, 2017

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HIV TESTING
 Approximately 85% of people with HIV globally
knew their HIV status in 2021. The remaining
15% (about 5.9 million people) did not know
they had HIV and still needed access to HIV testing
services.

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 HIV TREATMENT ACCESS
 As of the end of 2021, 28.7 million people with HIV
(75%) were accessing antiretroviral therapy (ART)
globally. That means 9.7 million people are still
waiting.
 HIV treatment access is key to the global effort to
end AIDS as a public health threat.

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 HIV TREATMENT ACCESS
 People with HIV who are aware of their
status, take ART as prescribed, and get and
keep an undetectable viral load can live long
and healthy lives and will not transmit
HIV to their HIV-negative partners
through sex.
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HIV in the Philippines 36
96,266 PLHIV in the Philippines (January 1984 to February 2022)
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Number of newly 31
diagnosed with HIV
per day 16
9
4
1

Source: HIV/AIDS & ART Registry of the Philippines (HARP), February 2022
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ANTI-RETROVIRAL THERAPY

Source: HIV/AIDS & ART Registry of the Philippines (HARP)

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HIV in the Philippines 36
96,266 PLHIV in the Philippines (January 1984 to February 2022)
33
Number of newly 31
diagnosed with HIV
per day 16
9
4
1

Source: HIV/AIDS & ART Registry of the Philippines (HARP), February 2022
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 HIV in the Philippines 36
Distribution of cases as of February 2022 on specific populations

 Pregnant Women with HIV-7 (5-NCR, 1-V, 1-VII 31

 Overseas Filipino Workers (OFWs) 16-52 (49 were males, 3 females)
 Transactional Sex -78 (759 were males)
 Youth (15-24 years4old)-311 (15-24 yrs old)
 Children 1(<10 yrs old) and Adolescents (10-19 yrs old)-62 (12-
from 15-17 yrs old; 50 (18-19 yrs old)

Source: HIV/AIDS & ART Registry of the Philippines (HARP), February 2022
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HIV in the Bicol Region As of September 2022
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As of February 2022

33
Number of newly 31
diagnosed with HIV
per day 16
9
4
1

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 HIV in the Province of
Camarines Norte33
Number of newly
Last December 2021, the province had 31 total cases, plus 42
134
diagnosed with HIV
cases diagnosed
per day from January to Nov.
16 2022.
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Thus, as of November
1
4 2022, the province has a total of 176
cases of HIV infection.

Source: HIV/AIDS & ART Registry of the Philippines (HARP), February 2022
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 Viral Genome:
• Icosahedral (20 sided),
enveloped virus of the
Lentivirus subfamily of
retroviruses.
• Retroviruses transcribe
RNA to DNA
• Reverse transcriptase
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HIV Source?
 HIV infection in humans came
from a type of chimpanzee in
Central Africa. Studies show
that HIV may have jumped
from chimpanzees to humans
as far back as the late 1800s.
 The first verified case of HIV is from a blood sample taken in
1959 from a man who was living in what is now called
Kinshasa in the Democratic Republic of Congo. cdc.gov
Did AIDS come from
having sex with
monkeys?
ANSWER: NO
 The chimpanzee version of the virus is called simian
immunodeficiency virus (SIV).
 It was passed to humans when humans hunted these
chimpanzees for meat and came in contact with their
infected blood.
cdc.gov
 Scientific evidence: Viral genetic
HIV Source? homology; geography of viruses.

HIV-1: from SIV HIV-2: from SIV

Pan troglodytes (chimpanzee) Cercocebus atys (Sooty mangabey)

Barlow et al., 2003
In 1983, scientists led A year later a team
by Luc Montagnier at led by Robert Gallo
the Pasteur Institute of the United States
in France first confirmed the
discovered the virus discovery of the
that causes AIDS. virus, but they
They called it renamed it human T
lymphadenopathy- lymphotropic virus
associated virus (LAV). type III (HTLV-III).

President Mitterrand of France and President Reagan of the USA

resolved the issue > human immunodeficiency virus (HIV)
Cluster of Differentiation (CD4 cells)
• CD4 T cells or T-helper cells
• White blood cells / Lymphocytes
• HIV damages CD4 cells
• CD4 cells destroyed faster than the
immune system can make them
CD4 cells alerts
• Defend the body against antigens other cells
• Crucial in antibody production
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 Pathogenesis of HIV:
• Loss of CD4+ T cells is mainly because of infection
of the cells and the direct cytopathic effects of
the replicating virus.
• Approximately 100 billion new viral particles are
produced every day, and 1 to 2 billion CD4+ T
cells die each day

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4 Principles of HIV Transmission

HIV is Transmitted Through 4 Body Fluids:

Blood, Semen, Breast milk, and Vaginal fluid
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4 Ways of HIV Transmission

Unprotected From an HIV+ Sharing of HIV Blood transfusion of

penetrative sexual mother to her contaminated HIV contaminated
intercourse with child during needles, syringes, blood and blood
an HIV+ person pregnancy, and other injecting products; organ
delivery, or equipment transplant from HIV+
breastfeeding donor
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HIV is Transmitted Through 4 Body Fluids:
1. Blood
2. Semen
3. Breast milk
4. Vaginal fluid

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“A person with HIV does
not necessarily have AIDS”

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 WHO HIV Clinical stages:
Stage 1: Stage 2 Stage 3 Stage 4
Acute infection Chronic infection
Average 10 years Rapid decline in
•Short, flu-like illness
CD4+ T cells
occurs 1-6 weeks after Patient is Immune system
infection. Opportunistic
asymptomatic or mild deteriorates infections become
•Infected person can severe and cancer
HIV in blood drops Opportunistic
infect other people may develop
to very low levels infections appear
•Negative on
Anti-HIV detectable in
serological tests
blood
(detection of HIV
antibodies)
AIDS

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 Development of AIDS
• CD4 lymphocyte count < 200 cells/ mL
• CD4 lymphocyte percentage < 14 %
• Predisposed to Opportunistic Infections, malignancy (
Pneumocystis ,pneumonia, CNS lymphoma)

Window Period HIV Asymptomatic Stage HIV Symptomatic

HIV /AIDS
3-6 months and AIDS

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 Prevention:
• Abstinence
• Monogamous Relationship
• Protected Sex
• Sterile needles
• New shaving/cutting blades
• Limiting exposure to risk factors

https://kuulpeeps.com/wp-content/uploads/2017/08/Condoms-for-sex.jpg 31
 CD4 / T Helper
HIV Ag Serologic Pattern of HIV
Anti-HIV

1200 107

106
900

HIV RNA copies

CD4 count

105
600
104
Eclipse
300 Seroconversion Late presentation
103
Acute Clinical Latency AIDS
0 102
0 3 6 1 3 5 7 9 11
w e e ks y e a rs
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 HIV Diagnosis: Blood tests
Screening tests Confirmatory Monitoring tests
• High sensitivity tests • CD4 count –
• Category 1 (ELISA) • High specificity predictor of HIV
progression, AIDS
• Category 2 (Rapid) • Western blot
<200 cells
• HIV proficient RMTs • Done by the NRLs
• HIV viral load – test
• Reactive samples • Free of charge for acute infection,
referred to NRLs response to HAART

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 THE HIV REFERRAL SYSTEM
START Referring
lab
patient doctor

counselor Messenger
HIV result
/ courier
Link to care

NRL-
SLH/SACCL
Treatment hub
DOH-EB
https://www.hikeformentalhealth.org/wp-
content/uploads/2014/10/blood-test-tube.jpg
HIV Screening tests
HIV Confirmatory test

Western blot
PCR
(gold standard) (supplemental)
NRL SLH/SACCL 35
 What happens after a Positive test?
Previous

Western Blot Enrollment at

POSITIVE Link to care
treatment hub
•Correlate
clinically •Baseline •Counseling and
diagnostics adherence
• Treat OIs

NEW Link to care • Correlate clinically

Screening test •Treat Ois
REACTIVE •Baseline diagnostics
Refer sample to •Counseling and adherence
NRL SLH/SACCL
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Treatment: Antiretroviral drugs
• 3 or more*
• Controls viral
replication
• Strengthens
immune system

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 Treatment: Antiretroviral drugs
NRTIs NNRTIs Protease Fixed Drug
• Zidovudine (ZDV) • Efavirenz (EFV Inhibitors Combinatio
• Lamivudine (3TC) • Nevirapine (NVP) (PI) ns
• Stavudine (d4T)
• Indinavir (IDV) • Lamivudine +
• Didanosine (ddl) stavudine
• Nelfinavir (NFV)
• Tenofovir (TDF) • Zidovudine +
• Ritonavir (RTV)
lamivudine
• Saquinavir (SQV)
• Lopinavir/ritonavir
(LPV/r)
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“5 Cs”
The “5Cs” principle recommended by WHO:
1. Informed CONSENT
2. CONFIDENTIALITY
3. COUNSELING
4. CORRECT test results
5. CONNECTION (linkage to care, treatment, &
other services)
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“Philippine HIV and AIDS Policy Act”
R.A. 11166

– This Act shall be known as the “Philippine

HIV and AIDS Policy Act”.
Provisions of the Law
Article Title
I The Philippine National AIDS Council
II Information, Education and Communication
III Preventive Measures, Safe Practices and Procedures
IV Screening, Testing and Counseling
V Health and Support Services
VI Confidentiality
VII Discriminatory Acts and Practices and Corresponding
Penalties
VIII Final Provisions

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Article II Information, Education and
Communication
SEC. 12. Education in Learning Institutions
SEC. 16. Education in the Workplace

SEC. 17. Education for Filipinos Going Abroad SEC.

18. Information for Tourists and Transients

SEC. 19. Education in Communities

“Indigenous peoples communities and geographically
isolated and disadvantaged areas shall also be given due focus”

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Article II Information, Education and
Communication
SEC. 13. Education for Parents and Guardians
SEC. 14. Education as a Right to Health and Information
SEC. 15. HIV and AIDS Information as a Heath Service
HIV and AIDS education and information shall form part of the
delivery of health services by health practitioner, workers and personnel.
…it shall likewise be considered a civic duty of health care providers in
the private sector to make available to the public such information
necessary to prevent and control the spread of HIV and AIDS and to
correct common misconception about the disease.
SEC. 20. Education for Key Populations and Vulnerable Communities

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Article IV Screening, Testing and Counseling
SEC. 29 HIV Testing - As a policy, the State shall encourage voluntary HIV
testing. Written consent from the person taking the test must be obtained before
HIV testing.

HIV testing shall be made available under the following circumstances:

(a)… if the person is fifteen (15) to below eighteen (18) years of age, consent to
voluntary HIV testing shall be obtained from the child without the need of consent
from a parent or guardian

(b)…aged below fifteen (15) who is pregnant or engaged in high-risk behavior

shall be eligible for HIV testing and counseling with the assistance of a licensed
social worker or health worker. Consent to voluntary HIV testing shall be
obtained from the child without the need of consent from a parent or guardian

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Article IV Screening, Testing and Counseling
(c) In all other cases not covered by (b) of this section, consent to voluntary
HIV testing shall be obtained from the child’s parents or legal guardian if
the person is below fifteen (15) years of age or is mentally incapacitated.

In cases when the child’s parents or legal guardian cannot be located despite
reasonable efforts, or if the child’s parents or legal guardian refused to give consent,
it shall be obtained from the licensed social worker or health worker. To protect
the best interest of the child, the assent of the minor shall also be required prior to
the testing .
In every circumstance, proper counseling shall be conducted by a social worker, a
health care provider or other health care professional accredited by the DOH or the
DSWD.
HIV testing guidelines issued by the DOH shall include guidance for testing minors
and for the involvement of parents or guardians in HIV testing of minors.
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Article V Health and Support Services
 Section 33. Treatment of Persons Living with HIV and AIDS.
 Section 34. Access to Medical Services by Indigents.
 Section 35. Economic Empowerment and Support
 Section 36. Care and Support for Persons Living with HIV.
 Section 37. Care and Support for Overseas Workers Living with HIV.
 Section 38. Care and Support for Affected Families, Intimate Partners,
Significant Others and Children of People Living with HIV. –
 Section 39. Care and Support Program in Prisons and Others Closed-Setting
Institutions.
 Section 40. Non-discriminatory HIV and AIDS Services
 Section 41. Protection of HIV Educators, Licensed Social Workers, Health
Workers, and Other HIV and AIDS Service Providers from Harrassment.
 Section 42. Health Insurance and Similar Health Services.

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Article VI Confidentiality
 Section 44. Confidentiality. - The confidentiality and privacy of any individual
who has been tested for HIV, has been exposed to HIV, has HIV infection or
HIV- and AIDS-related illnesses, or was treated for HIV-related illnesses shall
be guaranteed.
The following acts violate confidentiality and privacy:

(a) Disclosure of Confidential HIV and AIDS Information.

 it shall be unlawful to disclose, without written consent, information
that a person has AIDS, has undergone HIV-related test, has HIV
infection or HIV-related illnesses, or has been exposed to HIV

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Article VI Confidentiality
The following acts violate confidentiality and privacy:

(b) Media Disclosure. - It shall be unlawful for any editor, publisher, reporter or
columnist, in case of printed materials, or any announcer or producer in case of
television and radio broadcasting, or any producer pr director of films in case of
the movie industry, or any other individual or organization in case of social
media, to disclose the name, picture, or any information that would reasonably
identify persons living with HIV and AIDS, or any confidential HIV and AIDS
information, without the prior written consent of their subjects

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Article VI Confidentiality
Sec. 46. Disclosure of HIV-Related Test Results. – The result of any test related
to HIV shall be disclosed by the trained service provider who conducts pretest and
posttest counseling only to the individual who submitted to the test.

If the patient is below fifteen (15) years old, an orphan, or is mentally incapacitated, the
result may be disclosed to either of the patient’s parents, legal guardian, or a duly assigned
licensed social worker or health worker, whichever is applicable: Provided,

That when a person below fifteen (15) years of age and not suffering from any mental
incapacity, has given voluntary and informed consent to the procedure in accordance
with Section 29 (b) of this Act, the result of the test shall be disclosed to the child.

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Article VI Confidentiality

Section 47. Disclosure to Persons with Potential Exposure to

HIV.
– Any person who, after having been tested, is found to be infected
with HIV, is strongly encouraged to disclose this health condition
to the spouse, sexual partners, and/or any person prior to engaging
in penetrative sex or any potential exposure to HIV.

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Article VII Discriminatory Acts and Practices and
Corresponding Penalties
SEC. 49. Discriminatory Acts and Practices. – The following
discriminatory acts and practices shall be prohibited:
1. Discrimination in the Workplace.
2. Discrimination in Learning Institutions
3. Restriction on Travel and Habitation
4. Restrictions on Shelter.
5. Prohibition from Seeking or Holding Public Office
6. Exclusion from Credit and Insurance Services.

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Article VII Discriminatory Acts and Practices and
Corresponding Penalties

7. Exclusion from health, accident, life insurance, or credit and

loan services, including the extension of such loan or insurance
facilities, of an individual …
8. Discrimination in Hospitals and Health Institutions
9. Denial of Burial Services.
10. Act of Bullying-Bullying in all forms, including name-calling, upon a
person based on actual, perceived, or suspected HIV status, including
bullying in social media and other online portals;

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Article VII Discriminatory Acts and Practices and
Corresponding Penalties
SEC. 50. Penalties. –
Section 22 of this Act penalty of imprisonment ranging from one (1) year but not
on misinformation on more than ten (10) years, a fine of not less than Fifty
HIV and AIDS thousand pesos (P50,000) but not more than Five hundred
thousand pesos (P500,000), or both
if the offender is a manufacturer, importer or distributor of
any drugs, devices, agents, and other health products, the
penalty of at least five (5) years imprisonment but not more
than ten (10) years and a fine of at least Five hundred
thousand pesos (P500,000) but not more than Five million
pesos (P5,000,000) shall be imposed

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Article VII Discriminatory Acts and Practices and
Corresponding Penalties
imprisonment of one (1) year to five (5)
Section 24 of this Act on police operations years and a fine of not less than one
vis-á-vis comprehensive health intervention hundred thousand pesos (P100,000.00) but
not more than five hundred thousand pesos
(P500,000.00):
Administrative sanctions
Any person who knowingly or negligently imprisonment of six (6) years to twelve (12)
causes another to get infected with HIV in years, without prejudice to the imposition of
the course of the practice of profession fines and administrative sanctions, such as
through unsafe and unsanitary practice and suspension or revocation of professional
procedure, or who compelled any person to license.
undergo HIV testing without his or her
consent

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Article VII Discriminatory Acts and Practices and
Corresponding Penalties
SEC. 50. Penalties. –
Section 41 of this Act, on the protection
of HIV educators, licensed social
workers, health workers, and other HIV
and AIDS service providers from
harassment
of Section 42 of this Act on health
insurance and similar services
imprisonment of six (6) months to five (5)
years and a fine of not less than one
hundred thousand pesos (P100,000.00) but
not more than five hundred thousand pesos
(P500,000.00): Administrative sanctions
of imprisonment of six (6) months to five (5)
years and/or a fine of not less than fifty
thousand pesos (P50,000.00),
administrative sanctions
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Article VII Discriminatory Acts and Practices and
Corresponding Penalties
SEC. 50. Penalties. –
Section 44 Six (6) months to two (2) years of imprisonment for any person
Act on who breaches confidentiality and/or a fine of not less than Fifty
Confidentiality thousand pesos (P50,000.00), but not more than One hundred
fifty thousand pesos (P150,000.00)
Two (2) years and one (1) day to five (5) years of imprisonment for
any person who causes the mass dissemination of the HIV status
of a person, including spreading the information online or making
statements to the media and/or a fine of not less than One
hundred fifty thousand pesos (P150,000.00) but not more than
Three hundred fifty thousand pesos (P350,000.00)

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Article VII Discriminatory Acts and Practices and
Corresponding Penalties
SEC. 50. Penalties. –
Section 44 Five (5) years and one (1) day to seven (7) years of
Act on imprisonment for any health professional, medical instructor,
Confidentiality worker, employer, recruitment agency, insurance company,
data encoder, and other custodian of any medical record, file,
data, or test result who breaches confidentiality, and/or a fine
of not less than Three hundred fifty thousand pesos
(P350,000.00) but not more than Five hundred thousand
pesos (P500,000.00)
Administrative sanctions

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Article VII Discriminatory Acts and Practices and
Corresponding Penalties
SEC. 50. Penalties. –
Section 49 on imprisonment of six (6) months to five (5) years and/or
discriminator a fine of not less than fifty thousand pesos
y acts and (P50,000.00) but not more than five hundred
practices thousand pesos (P500,000.00 imposition of
administrative sanctions

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