By Nickky Faustine P. de Guzman
While #LoveWins in the Philippines, the country is losing the war against the human immunodeficiency virus (HIV). According to July-October data from the Department of Health (DoH), 26 people are infected with HIV every day, with a majority of the infections coming from men having sex with men (MSM).
“Is the country doing enough to prevent HIV? The answer is no,” said Dr. Gundo Weiler, the country representative of the World Health Organization (WHO), in a press conference on Nov. 29. “We have around two million people who newly contracted HIV last year, [but it is] much more dramatic in the Philippines, where it is increasing in exponential manner. From year to year, we have diagnosed more and more transmissions. So no, we are not doing enough.”
From July to October 2016, there were 3,112 new HIV antibody sero-positive individuals reported to the HIV/AIDS & ART Registry of the Philippines. According to the same DoH report, most (96%) were male. The median age was 28 years old (age range: 1 year — 75 years). More than half belong to the 25-34 year age group while 28% were youth aged 15-24 years.
The numbers, however, may not be as accurate because there are still people who are afraid to get tested because of myriad reasons: ignorance, fear, or shame from social stigma. According to Dr. Tony Evangelista of DoH, there could be an estimated 55,005 Filipinos who are living today with HIV. “The challenge is to bridge the gap between diagnosis and treatment,” said Ms. Evangelista.
Senator Risa Hontiveros, chairperson of the Senate Committee on Health and Demography, meanwhile said in previous news reports that if not curbed, the country will have 133,000 people infected with HIV by 2022. Ms. Hontiveros said: “We need to break down this barrier that prevents Filipinos from getting tested, especially that one in two persons living with HIV is not diagnosed.”
Two private organizations recently launched projects that aim to alleviate the HIV epidemic in the country: the first involves PrEP (Pre-Exposure Prophylaxis), or “the use of anti-HIV medication that keeps HIV negative people from becoming infected”; while the other is a computer system called Connect for Life, which sends text messages to patients to remind them to take their medicine.
PREVENTION IS STILL THE BEST CURE
With the support of WHO and DoH, Love Yourself, a prevention advocacy group for MSMs formed in 2011, introduced on Nov. 29 the new HIV prevention process called Pre-Exposure Prophylaxis (PrEP).
PrEP involves taking a pill every day to prevent contracting HIV. According to the Love Yourself infomercial, it has 99% efficacy and is recommended together with proper condom use.
The group will initially open 200 slots early next year for those interested in PrEP. Applicants should be of legal age, have an active sex life, or be a sexual worker.
“PrEP is the same medicine that is being used for the treatment of HIV. PrEP, by definition, is taken when you are not yet affected with HIV; taking it before they get exposed so they are not affected once they get exposed with HIV infection,” said Dr. Rossana Ditangco of DoH’s Research Institute for Tropical Medicine.
The PrEP pill, which a combination of tenofovir and emtricitabine, is available for the first 200 people who line up at the Love Yourself hub in Shaw Boulevard. It is for free.
While PrEP is recommended for daily use, the effects of skipping aren’t clear. “There is no hard and fast rule if you miss a pill,” said Ms. Ditangco. “The longer you take the pill, the longer it takes for the drug to wane off once you stop [or forget] to take it.
Prevention — no matter how many times we are reminded — is still the best cure. Here then enters the Love Yourself advocacy called “triangle of self-care,” which plays on the three letters C-S-T, which stands for “correct condom use” (always check the expiration date); “safe sex” (always use condom), and “timely treatment” (always have yourself checked every three months).
“We need to have more HIV prevention interventions since more than half of MSMs are not using condoms,” said Love Yourself co-founder, Chris Lagman.
The PrEP pill is part of the #PrEPPilipinas program, with initial interventions in Metro Manila, which, according to the DoH report, has the most number of newly diagnosed cases at 1,275 individuals, (41%), followed by regions IV-A (15%), VII (9%), and III (9%). According to the DoH July-October report, 87% of these infections were through MSMs, while the rest are from needle sharing and mother-child transmission.
“It’s a question of key populations affected. In the Philippines, it is the MSMs and LGBT. Over the years, these communities have been disenfranchised before. They need to stand up and mobilize and take control of their own health and lives,” said Mr. Weiler.
HIV IS MANAGEABLE
Once infected with HIV, a person can manage his or her condition through lifetime medication.
“You may die with HIV, but not because of HIV,” said Dr. Edsel Salvana, director of the Institute of Molecular Biology and Biotechnology of the National Institute of Health, pertaining to the drug availability in the country.
He said the Philippines is actually in a good position because antiretroviral therapy (ART) is free, unlike, for example, in the United States where it is expensive. According to the AIDS Info Web site (www.aidsinfo.nih.gov), the monthly average wholesale prices of commonly used ARTs range from $230 to $4,097.
While there are 41 treatment hubs and facilities in the Philippines offering HIV care, one of the challenges is a person’s drug coherence.
Today, HIV patients need to take just one pill a day, whereas before, they were required to drink 16 pills in 24 hours. Despite the significant decrease in the pill requirement, a “pill burden” still remains.
According to Dr. Kate Leyritana, medical director of Sustained Health Initiatives of the Philippines (SHIP) at Philippine General Hospital (PGH), Filipinos with HIV have low medication adherence. According to Ms. Leyritana, the top three excuses given by patients are: “nakalimutan” (have forgotten about it), “hindi nagising” (didn’t wake up on time to take the medicine), and “naiwan ang gamot” (left the medicine) based on the survey she conducted in 2011 among the PGH patients.
Skipping your medication, in this case, is dangerous since the virus could mutate and become resistant to the pill you are taking. In the Philippines, there are seven locally available ARTs: AZT, 3TC, TDF, D4T, NVP, EVF, and LPV, and one medication, which you ought to take for a lifetime, uses three drug combinations. If you constantly miss taking your prescription, you’re left with few combinations to save your life.
To help people with medication adherence, SHIP, in partnership with Johnson & Johnson Philippines Inc., launched Connect for Life, a mobile-phone-based support service that acts as a virtual assistant. A daily text message reminds users to take their pills and to see a doctor. It is also a symptom recorder, and a health tip provider.
The cloud-based virtual assistant was first rolled out three years ago, in Uganda and India. The Philippine initiative currently has 50 HIV patients enrolled through PGH’s computer servers. SHIP and J&J plan to present their project to DoH, in order to broaden reach and remind more HIV patients to take their pills in order to save their lives.