[DASH OF SAS] Is HIV going out of fashion?
“In light of other pressing issues like urban terrorism, climate change, and the global recession, is HIV still newsworthy? Is HIV still ‘fashionable’ to talk about?”
At last November’s International Conference on AIDS in Asia and the Pacific (ICAAP11), a regional conference attended by more than 3,000 delegates from government, public health institutions and NGOs, that was the question posed by the journalist who was acting as moderator of a panel discussion.
That question probably has to be put into context. In the 20-30 something years since HIV was first discovered, remarkable progress has been made in gaining knowledge about the virus and how it works. This knowledge has given rise to even more remarkable breakthroughs in terms of prevention and treatment.
An estimated 5.3 million people living with HIV around the world are receiving antiretroviral therapy (ART) under the Global Fund; 5.3 million people living with HIV are able to live healthy and productive lives because of ART.
Promising results in the reduction of mother-to-child transmission of HIV have pushed for the development of more aggressive plans to virtually eliminate mother-to-child transmission of HIV.
Earlier this year, the World Health Organization (WHO) released guidelines on the use of ART for the treatment and prevention of HIV. The guidelines were based on evidence that showed that “earlier ART will help people with HIV to live longer, healthier lives, and substantially reduce the risk of transmitting HIV to others.”
According to the WHO, administering ART as a mode of prevention could potentially avert an additional 3 million deaths and prevent 3.5 million more new HIV infections between now and 2025.
“On this World AIDS Day, let us commemorate it by celebrating the progress made. We've come a long way since the beginning of the epidemic. HIV is no longer a death sentence. In fact the CDC classifies it as a chronic manageable disease. With treatment and care, people with HIV are living full and healthy lives. It's time to update the way we think about the virus. We're not in 1984 anymore,” Michel Sidibé, executive director for the Joint United Nations Programme for HIV/AIDS (UNAIDS) said in his 2013 World AIDS Day message.
It was clear at the ICAAP11 conference and from Sabide’s message that overall, HIV is past the emergency phase and has moved on to making more advancements in terms of coverage and innovation, making ART available to more people, developing more innovative prevention modes like vaccines and even ambitiously finding a cure.
Philippines: State of Emergency
In the Philippines, the emergency state of HIV has just begun.
It was in 2007 when a spike in HIV cases was first noted. From the year 2000 to 2006, there was one new HIV case reported every three days or about 10 new cases a month.
In 2007, this number grew to an average of 25 new cases per month and has continued to grow. In 2011, there was an average 7 new cases reported per day. In 2012, this number grew to 9 new cases per day. (READ: Is HIV going viral?)
We end 2013 with close to 5,000 new infections for this year alone. (The latest data from the DOH National Epidemiology Center as of November 30, 2013 there were 4,456 new registered HIV cases) That’s an estimated 16 new HIV cases per day—and these are only the reported infections; the Philippines holds on to its distinction of being one of seven countries classified with a growing HIV epidemic. (READ: Indonesia and Others See ‘Embarrassing’ Rise in H.I.V. Infections)
The rates of HIV infection in the Philippines also tell another story; the story of the inaction and complacency of the previous years, the lukewarm and sporadic support for HIV and AIDS prevention programs and the chronic denial of the consequences of a full-blown epidemic.
Former Health Secretary Dr. Alberto Romualdez (who passed away this year) put it in the proper context when he said: “AIDS patients require a steady supply of expensive medicines and they can live a long time. Because of this, the disease can put a tremendous burden on our health care system. Our country cannot afford to have a full-blown AIDS epidemic on top of the usual diseases like tuberculosis and dengue.”
“Another problematic issue is the fact that some HIV positive mothers will pass the HIV virus on to their children. In the next few years, we may have to contend with a growing number of HIV positive children.”
Managing HIV instead of HIV managing us
“We still have what is known as a concentrated epidemic. It has not spread to the general public,” said Terestia Bagasiao, Philippines country director of UNAIDS. “The absolute number of HIV infections in the Philippines is relatively low, but the rate of increase in the number of cases is the cause for concern.”
“We have to know and address what is driving the increase in infections to properly and efficiently channel our intervention efforts,” she added.
The DOH shows that newly reported HIV infections are mostly among men who have sex with men (MSM). Because of the sexual fluidity of MSM (some identify as gay, but others identify themselves as straight men and may have wives or girlfriends, or identify as bi-sexual-apart), identifying and reaching out to this population is challenging. Young MSM (usually defined as starting age 10-15) are particularly vulnerable to bullying and risky sexual behavior.
Also of note are increasing infections among people who inject drugs and the transgender (TG) population.
“Drug users, young MSM, TGs --these are not politically palatable groups,” said Jonas Bagas, executive director of The Library Foundation (TLF) Share. “The current framework for HIV intervention is still based on OFWs and needs to be adjusted to include these emerging most at risk populations.”
Bagas goes on to explain that there are some local government units (LGUs) that, under the devolved health system, have funded their own HIV prevention programs, but “what we need now is scale”.
“Even outside the Philippines, deprioritizing HIV could reverse the gains that we have made over the last decades,” added Bagas.
The writing’s on the wall
There was and there will be no panacea for HIV, or for any other virus, for that matter. What is needed are targeted intervention and prevention campaigns for most at risk populations and drawing these up to scale. General awareness campaigns for the general public to combat myths and misconceptions about HIV to fight stigma and discrimination.
Affording better access to confidential HIV testing, treatment and services starting with the repeal of the clause in the HIV law that requires individuals below 18 years old to get written parental consent before getting an HIV anti-body test. Stronger political will that will recognize that the positive side of HIV is that it is a virus that can be prevented, managed and controlled through a cohesive, collective effort among the government, private institutions, NGOs and the public.
The writing has been on the wall for many years now but we continue to ignore it and deprioritize it over more pressing issues like climate change, urban terrorism and the global recession.
But in the Philippines, HIV is a pressing issue.
The alarm has been tripped and the bells have been raging since 2007. We know what needs to be done. We just actually have to do it. – Rappler.com
From being a sex and relationship columnist for a men’s magazine, Ana P. Santos moved on to write about sex (still) and gender issues. She is a regular contributor for Rappler apart for her DASH of SAS column, which is a spin off of her website, www.SexAndSensibilities.com (SAS). Follow her on Twitter at @iamAnaSantos.