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The Philippines’ formidable hidden enemy

A time bomb is smoldering in the shadows of Philippine society. The problem is the country’s exposure to HIV/ Aids epidemic — for years, under resourced, played down and its potential to spread, grossly underestimated.

A time bomb is smoldering in the shadows of Philippine society. Potentially as lethal as its drugs problem which only now is being addressed in a comprehensive fashion, this one has the same power to destroy life – particularly among the young – and rack up a massive bill in any effort to defeat it.

The problem is the country’s exposure to HIV and Aids – for years, under resourced, played down and its potential to spread, grossly underestimated.

Figures are very sketchy, but based on empirical data from around Southeast Asia and other regions, there is a very strong possibility that the level of infection in the Philippines is multiples of official Department of Health (DOH) figures.

Presently, the DOH estimates that 10,000 Filipino adolescents – that’s 15 to 19 year olds – have HIV, though only 1,000 have actually been diagnosed. The department’s official 2015 figure for the total number of people living with HIV in the Philippines is 42,000.

At the same time, the DOH is aware that there is a crisis brewing and has estimated that some 133,000 Filipinos could be Aids-positive by 2022. But as it takes up to 10 years for HIV patients to acquire Aids, the 42,000 statistic – today’s number of cases – doesn’t tally as it would account for less than one third of the cases that could emerge in six years time.

Globally, HIV claims a new adolescent victim every hour. Out of the Philippine’s total population of 102,345,154, around 15 million fall within this age bracket. Based on the DOH estimate, that would mean that just 0.006% of Filipino 15-19 year olds are HIV positive. According to the World Health Organisation, 15 to 24 year olds account for 40% of all new HIV infections among young adults worldwide: there are 19,375,121 Filipinos in this age group.

Within the Association of Southeast Asian Nations (Asean), the Joint United Nations Programme on HIV and Aids reported the following HIV estimates, for all age groups, in 2015: Indonesia, 690,000 cases; Vietnam, 260,000; Myanmar, 220,000; Malaysia, 92,000; Cambodia, 74,000. This would mean that the Philippines has by far the lowest HIV rate of all Asean states where data are available.

While we don’t have any better statistics than the DOH, what is plain is either that the Philippines is completely bucking the regional and global trends with regard to new infections, not least among its youth and young-adult populations, or the DOH data is at a loss to better estimate the level of the problem right now.

What actually seems to be happening is that hard facts about the true scale of the Philippines’ HIV problem is only just starting to emerge – 84% of all diagnosed cases in the country were reported in the last five years. In 2009 there were 835 HIV cases reported in the Philippines; from January to October last year there were 6,552 – a 37-fold increase from the 174 HIV-diagnosed cases in 2001.

There is no doubt that the DOH is concerned. In April 2015 it warned that a “concentrated epidemic” in six cities could reach “uncontrollable” levels unless it is comprehensively tackled with the help of the public. Here it looked at the most at-risk sub group of young Filipinos – males who have sex with males. The trigger point for concern is 5% for this population. DOH studies showed the prevalence rate in the six cities as: Cebu 7.7%, Manila 6.7%, Quezon City 6.6%, Caloocan 5.3%, Davoa City 5.0%, Cagayan de Oro City 4.7%.

Also regarded as high risk are sex-garden cities such as Angeles and Olongapo which have long derived income from sex tourism. Safe sex is not routinely practiced by Filipino sex workers; sexually transmitted infections (STIs) are high in the Philippines – not just among sex workers where close to half have had STIs, but also within the general population. Lack of knowledge about STIs and their treatments and fear are given as the reasons for these high levels.

Here though are the real problems which the DOH faces in getting a handle on this situation. First and foremost is its the lack of opportunity to make enough diagnoses. The reason for this is that HIV and Aids still remain taboo subjects for much of the Philippine population. Furthermore, outdated laws which require parental consent for under 18s to be tested for the disease and to receive free condoms from public health clinics put the 15-19 year olds practically out of range. Plus, the country’s Roman Catholic Church which for years has fought to restrict sex education, safe-sex programmes and the distribution of condoms to at-risk groups maintains a strong moral influence – through its pulpits, its schools, its hospitals and its health clinics – over much of society and continues to stigmatise victims.

And the other problem is cash. Last year the DOH had a budget of US$10.6 million (PHP500 million) for its HIV/STI prevention programmes – 60% of which was earmarked for treatments. That would be just enough to treat 10,000 cases for the whole year.

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