II. Overview of the HIV/AIDS Epidemic

HIV prevalence at a glance % of most-at-risk population who are HIV infected: 0.03%5 % of PIP who are HIV infected: 0.036,7 % of MSM who are HIV infected: 0.038,9 % of IDU who are HIV infected: no data obtained as of writing of this Country Report10 % of OFW who are HIV infected: no percentage figures available as of writing of this Country Report11 % of young people aged 15-24 years of age who are HIV infected:12 no percentage figures available as of writing of this Country Report

Most-at-risk and vulnerable populations in the Philippines For this Country Report, the following are included as most-at-risk populations and vulnerable populations: Most-at-risk populations (following the guidelines for core indicators set by UNAIDS for the 2005 Country Report): People in Prostitution (RFSW, FFSW, MSW), Men Having Sex with Men (MSM), and Injecting Drug Users (IDU). Vulnerable Groups (identified under Country-Specific Indicators): Overseas Filipino Workers (OFW), street children, out-of-school youth (OSY) The above groups are regarded as "most-at-risk" and "vulnerable" since they "may be at a higher risk for HIV than others due to economic, social and even biological circumstances."13

A nascent epidemic: from "low and slow"
to a "hidden and growing" phenomenon

For the past decade, the HIV situation in the Philippines has been described as "low and slow," indicating low prevalence rates and slow spread of the infection even among those regarded as most-at-risk populations (classified as "high risk groups"- HRG - in the surveillance surveys).

The 2003 Technical Report of the National Epidemiology Center (hereafter referred to in this report as 2003 NEC Technical Report) cites that there is "[n]o evidence of an explosive increase in HIV prevalence among high risk groups (HRGs), more so, in the general population.

The 2002 Consensus Report on STI, HIV and AIDS Epidemiology (hereafter referred to in this document as the 2002 Consensus Report) published by the World Health Organization (WHO) and the Philippines Department of Health (DOH) identified the following as "possible factors that could explain the slow transmission of HIV/AIDS in the Philippines, based on results of studies:"

• sex workers have few sex partners,
• male population has low exposure to sex workers,
• majority of the general male population have only one sex partner
• few men engaged in anal sex,
• low prevalence of ulcerative STI,
• small IDU population (estimated at 10,000).¹⁴

The 2002 HIV/AIDS Country Profile Philippines adds that "[t]he country's archipelagic nature may have helped slow down the spread of HIV/AIDS in the Philippines. . . . Furthermore, the country's detachment from mainland Asia may have helped to shield it from the rapid cross-border spread of HIV/AIDS observed elsewhere in South East Asia."¹⁵

Another and "more probable cause of the slow transmission of HIV," according to the 2002 Consensus Report is the country's accelerated response to the epidemic. The report stated that the response include:

• organized multisectoral action;
• use of local resources, active engagement of individuals and organizations;
• early institution of surveillance systems; and
• highly creative and concerted intervention effort which include peer outreach, social marketing and advocacy for policy reform to reduce structural and environmental constraints to STI/AIDS prevention.¹⁶

This assessment is echoed in the 2005 Philippine HIV and AIDS Country Profile that cites "the early recognition of the epidemic exemplified by multi-sectoral responses by government agencies and non-government organizations to increase public awareness and fight discrimination" as possible reasons why the country was "able to sustain a fairly low level of the epidemic for a significant number of years."

However, the 2003 NEC Technical Report cautioned that this low and slow characteristic of the HIV/AIDS situation in the country is not a guarantee that the Philippines will be spared from a rapid increase in infections in the future. The NEC Report alerts policymakers and program planners to the fact that the Behavioral Sentinel Surveillance (BSS) showed that "consistent condom use among the HRGs was low, most IDUs still shared injecting equipment, only a small proportion of 'sharers' used bleach and water to share injecting equipment, and the HRGs' health-seeking behavior when confronted with sexually transmitted infections was far from ideal, particularly the MSM."¹⁷

The AMTP III titled, Seizing the Opportunity: The 2000-2004 Medium Term-Plan for Accelerating the Philippine Response to HIV-AIDS (AMTP), described the HIV/AIDS situation in the Philippines as a "nascent epidemic" having the following characteristics:

• the level of confirmed prevalence is considered low, even among those presumed to be most vulnerable to HIV infection;
• the rate of growth in the number of HIV/AIDS cases is considered slow;
• all known routes of transmitting the infection have been observed in the country;
• many of the risky behaviors that are known to drive the spread of the infection are practiced by large numbers of people at significant levels of frequency; and
• the potential for the country to suffer a more serious epidemic exists due to the presence of underlying conditions that are likely to drive the epidemic.¹⁸

According to the AMTP III, "the apparently 'low and slow' character of the epidemic thus far is seen as a transient opportunity for action." The situation allows the country "to act now before it is overwhelmed by a rapid increase in the number of infected persons." It also cautions that if the "high levels of underlying risky behavior are left to fester, [these] are likely to increase the number of infected persons in the future."

On the other hand, the Fourth Medium Term Plan on HIV/AIDS: 2005-2010 (AMTP IV), states that the country is crossing over a "low and slow" situation to a "hidden and growing" HIV/AIDS phenomenon that could escalate to epidemic proportions if left unchecked.¹⁹

In December 2004, the Department of Health (DOH) reported that from a yearly average of 100 cases of new infections for 2001-2002, an average of 200 cases of new infections each year have been posted for 2003 and 2004, indicating that infections are on the rise in terms of actual numbers even if prevalence rates remain low.

Number of HIV and AIDS Cases, Modes of Transmission, and Prevalence Rates

For the month of September 2005, there were 21 new HIV Ab seropositive cases reported. Of these 14 (67%) were males and 7 (33%) were females. The mean age was 35 years (age range 23 to 50 years). Reported mode of transmission was sexual contact [heterosexual (14), homosexual (6), and bisexual 1)].

Of the 21 new HIV Ab seropositive cases, four (4) were reported as AIDS cases. Mean age was 36 years (age range 30 to 43 years). Reported mode of transmission was sexual contact [heterosexual (6) and homosexual (2)].

From January 1984 to September 2005, the National AIDS Registry had posted a total of 2,354 HIV Ab seropositive cases. At the time of the report, 702 (30%) were already symptomatic (AIDS cases). Of the AIDS cases, 273 (39%) were already dead at the time of the report due to AIDS-related complications. Majority of the cases were among the 20-39 age group.

The predominant mode of transmission is still sexual intercourse (86%) for both sexes, with 73% heterosexual, 20% homosexual, and 6% bisexual. There have been a cumulative total of 33 cases of mother-to-child transmission (MTCT) from 1984 to September 2005.

The 2003 national aggregate showed that the HIV seroprevalence among the HRG (PIP, MSM, IDU) in the sentinel sites was 0.03%

Among 3,000 sex workers tested for HIV in the ten (10) surveillance sites, a prevalence of 0.03% was recorded. For MSM, the prevalence was also 0.03% among 3,000 MSM tested for HIV.

Data from the NEC did not include prevalence for IDU, OFW, young people 15-24 years old, and for the general population 15-49 years old.

Estimates of Population Sizes

No official estimates for total population sizes of PIP, MSM, IDU were available for 2003, 2004 and 2005, making computing for percentages difficult. The data obtained mainly came from surveillance reports that included sampling sizes of 3,000 each for PIP and MSM. Further, no HIV Serologic Surveillance (HSS) was conducted in 2004 due to logistical constraints.

The 2002 Consensus Report, on the other hand, had the following estimates for HIV prevalence rates in 2001, including the estimates of population size from which the percentages were based:²⁰

	PIP (sex workers): prevalence of 1%, or 5,400 cases based on estimated population of 540,000 sex workers
	IDUs: prevalence of 2%, or 200 cases based on estimated population of 10,000 IDU
	15-49 population: prevalence of 0.001%, or 402 cases based on estimated population of 40.2 million in 2001

Table 1. Prevalence estimates for most-at-risk populations and general population

HIGH RISK GROUP Prevalence Estimates 2003 Technical Report (NEC) 2002 Consensus Report (WHO and DOH) PIP 0.03% 1% MSM 0.03% no estimate provided IDU no estimate provided 2% General Population 15-49 years old no estimate provided 0.001%*

Sources: 2003 NEC Technical Report and 2002 Consensus Report on STI, HIV and AIDS Epidemiology *based on prevalence of HIV/AIDS from blood donors screened by the Philippine Red Cross(recognizing that it may underestimate the true magnitude)

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