HIV Epidemic in the Philippines: An Urgent Public Health Challenge

Header photo by Al Jazeera.

The human immunodeficiency virus (HIV) epidemic in the Philippines represents one of the fastest-growing public health concerns in the Asia-Pacific region. HIV is a virus that attacks and weakens the body’s immune system, making a person more susceptible to various diseases. Left untreated, HIV can develop into AIDS or acquired immunodeficiency syndrome. AIDS is the late stage of HIV infection when the immune system is already severely damaged. However, HIV is not a death sentence anymore. Taking HIV treatment or antiretroviral therapy (ART) prevents the development of AIDS and helps people living with HIV (PLHIV) have a normal life span. 

In the Philippines, the escalating HIV crisis is becoming increasingly difficult to ignore and frankly, should not be ignored. Over the past decade, the country has experienced a dramatic increase in the number of new HIV infections, prompting urgent calls for enhanced public health interventions and comprehensive policy responses. The rising numbers tell a story of a public health issue that’s deeply intertwined with social and cultural factors. We’ll take a closer look at the current state of HIV in the country, exploring the underlying causes, the profound impacts on individuals and communities, and the ongoing efforts to combat this urgent situation.

Philippine HIV Cases: Impact and Data

As of 2023, the Philippines has seen a significant surge in HIV cases. According to the Department of Health (DOH), the number of new HIV diagnoses has increased exponentially, from just a few hundred annually in the early 2000s to thousands per year in the last decade.  The Hawaii Center for AIDS and Love Yourself, Inc. reported that the Philippines had the highest growth rate of new infections in the Western Pacific region, with a 411% increase between 2012 and 2023.

Just in the first quarter of 2024, the Philippines reported over 3,400 new HIV cases and 82 related deaths, marking a concerning rise in infections. The Department of Health (DOH) has raised alarms about increasing HIV/AIDS cases in various regions, including Bicol and Zamboanga del Norte. Since 1984, the Bicol region has recorded a total of 117 deaths due to HIV/AIDS-related illnesses, with the most recent death in late 2023. Meanwhile, Zamboanga del Norte has reported 385 people living with HIV and around 12 AIDS-related deaths since 2023.

Vulnerable populations included males who have sex with other males (MSM), transgender women, sex workers including trafficked women, and people who inject drugs (PWID). The most common mode of transmission is still sexual contact, accounting for more than 90% of new infections during the last quarter of 2023. There was also a 55% increase in HIV-positive pregnant women compared to the previous quarter of 2022 and a 126% increase in HIV-positive 15 to 17-year-olds from 2019 to 2023.

On a positive note, the Department of Health says it is possible that there is increased awareness surrounding the use and effectiveness of  ART and noted an increase in consumption of Tenofovir-Lamivudine-Dolutegravir (TLD), a kind of antiretroviral drug in 2023. ART does not cure HIV but it lowers the number of HIV in the blood (viral load) until it becomes undetectable by a viral load test. An undetectable viral load makes for a healthier PLHIV and effectively lowers transmission risk. Our health technologies are also constantly evolving and in the past two decades stem cell transplants have been explored in countries outside the Philippines to try to cure HIV. In a stem cell transplant, doctors replace a patient's immune system with stem cells from a donor who has a natural resistance to the virus. Before the transplant, the patient's existing immune cells are cleared out using chemotherapy. The new stem cells then take over, potentially building an immune system that can better fight or even eliminate HIV. While some patients have experienced long-term remission after such transplants, the procedure is complex, risky, and not yet widely applicable as a cure. Recently, an anonymous German man was announced to be the seventh person to be “cured” of HIV.

Contributing Factors

Several factors contribute to the rapid increase in HIV cases in the Philippines:

1. Stigma and Discrimination due to Cultural and Religious Influences: As a conservative country, open discussions about sexuality and sexual health are very rare. This increases levels of stigma and discrimination, especially in rural areas, against people living with HIV (PLHIV) and other vulnerable populations, such as MSM and transgender individuals. In addition to that, the fear of being judged and shunned also discourages people from seeking testing and treatment.
2. Lack of Comprehensive Sexual Education and Awareness: Many young Filipinos lack access to comprehensive sexual education in general, which is critical in preventing HIV transmission. Lack of knowledge about safe sex, HIV and AIDS, and other matters concerning sexual health leads to a higher risk of exposure to unsafe sex and HIV. The number of young Filipinos who know of HIV and AIDS is at its lowest since 1994 at 76 percent. If there is low awareness of HIV and AIDS itself, it would follow that there is also low awareness about its prevention and therapy.
3. Poverty and Economic Status: Poverty and the need for income also lead people, notably the youth, to engage in sex work with little to no knowledge about sexual health and sex education. “Perhaps due to poverty, many young people, aged 15 to 20, are attracted to offers as low as 50PHP (0.89USD) to 150PHP (2.68USD) in exchange for sexual favours,” Abigail Khio, AIDS/HIV coordinator of the Zamboanga del Norte Health Office, shared.
4. Limited Access to Services: There is a significant gap in access to HIV prevention, testing, and treatment services, especially in rural areas. This is compounded by inadequate healthcare infrastructure and the costs of medications and other treatments. As of May 2024, there are only about 224 treatment hubs and primary HIV care facilities in the Philippines.

Government and Community Response

Various non-governmental organizations (NGOs) and community groups have been working to combat the HIV epidemic through multiple initiatives. There are also notable local and national steps made by Philippine officials.

The Philippine HIV and AIDS Policy Act of 2018 (R.A. 11166): Enacted in 2019, this was the repealed version of the first HIV law in the Philippines, the Philippine AIDS Prevention and Control Act of 1998. This law aims to strengthen the country's response to the HIV epidemic by improving access to prevention, testing, treatment, and support services. It also seeks to reduce stigma and discrimination against PLHIV. In particular, it now allows youth aged 15 and above to get tested without requiring parental consent and it is now against the law to deny PLHIV access to health and life insurance coverage. Though as with most laws in the Philippines, it does sound good on paper but there is much more that needs to be said about the implementation. 

Increased Funding: The government has increased funding for HIV programs, including the procurement of antiretroviral drugs and the establishment of more treatment hubs. In 2023, the proposed budget for HIV programs from 2024 to 2026 is around 45 billion PHP, taking into account the increasing number of newly diagnosed individuals yearly. However, only half of the budget was provided, according to the Joint United Nations Program on HIV/Aids (UNAIDS).*

Awareness Campaigns: Various awareness campaigns have been launched to educate the public about HIV prevention and to encourage testing and safe sexual practices. There have been local and national efforts such as Quezon City’s Zero at 2030 campaign which aims to reach zero new HIV cases by 2030, Project Red Ribbon which promotes HIV awareness in government agencies, and the Philippine Red Cross HIV/AIDS campaign which aims to destigmatize and correct misinformation surrounding HIV and AIDS.

Partnerships with Community and Grassroots Organizations: Collaboration with local and international community organizations has been crucial in reaching key populations and providing essential services, including community-based testing and support programs. As country director of the UNAIDS, Dr. Louie Ocampo said, “There is strong evidence that community responses produce results (but) there is an urgent need for them to be scaled up and fully integrated into the national response.”

PrEP Implementation: Pre-exposure prophylaxis (PrEP), a medication taken by HIV-negative individuals to prevent infection, has been introduced in some areas as part of a comprehensive prevention strategy. PrEP is available at Love Yourself clinics nationwide, a community of volunteers that provides free HIV testing, counselling, treatment, and life coaching in the Philippines and SAIL Clinics in Metro Manila.

Challenges and the Way Forward

Despite these efforts, significant challenges remain. Ensuring sustained funding, reducing stigma, and increasing access to services are critical to reversing the trend of rising HIV infections. To effectively combat the HIV epidemic in the Philippines, a multi-faceted approach is essential. This includes enhancing prevention efforts by expanding access to condoms, PrEP, and harm reduction services including more effort towards awareness campaigns and destigmatization. Strengthening health systems is also crucial, with a focus on improving the capacity of healthcare providers to deliver comprehensive HIV services.

As mentioned, community engagement is key, empowering individuals to actively participate in HIV prevention and care. Policy advocacy plays a vital role as well, pushing for policies that promote human rights, reduce discrimination, and ensure equitable access to healthcare for all.

The HIV epidemic in the Philippines remains a significant public health challenge, driven by various social, economic, and cultural factors. Despite recent progress in prevention, treatment, and awareness efforts, the rapid rise in new infections calls for urgent and sustained action. The country's response must continue to prioritize expanding access to critical services such as condoms, PrEP, and antiretroviral therapy while also addressing the underlying issues of stigma, discrimination, and limited healthcare infrastructure.

Moving forward, a coordinated and multi-faceted approach is crucial to reversing the alarming trends. Strengthening healthcare systems, fostering community involvement, and advancing policy advocacy are key to ensuring equitable access to care and support for those affected by HIV. With continued collaboration between government, non-governmental organizations, and communities, there is hope for mitigating the epidemic and improving the lives of people living with HIV across the Philippines.