As more new HIV cases are reported, the emerging trend is that majority of these infections result from male-to-male sexual contact.

Why are MSMs (males having sex with males) more prone to being infected with the human immunodeficiency virus? The Epidemiology Bureau (EB) under the Department of Health explains the disturbing situation.

The HIV/AIDS and ART Registry of the Philippines (HARP), which is under the EB, noted in its May report on HIV/AIDS that 86 percent of new infections from January 2012 to May 2017, or 19,154, were through sexual contact among males.

Further, the report stated that beginning 2010, the trend shifted to MSM contact as the dominant mode of transmission, whereas between 1984 and 2009, this was predominantly spread through male-female contact.

The May report is significant in that it was the first time that HIV cases reported breached the thousand mark at 1,098, and 95 percent of those infected were males.

Making matters worse are the UNAIDS global report on HIV epidemics stating that the number of new infections in the Philippines more than doubled in the past six years (from 4,300 in 2010 to 10,500 in 2016); and the fact that the country became the “fastest growing” in Asia-Pacific in the number of new infections.

There is a bit of good news, however: in spite being the fastest growing, the numbers reported in the Philippines is still “not as high as in several countries” in the region, which is said to record tens of thousands of new cases annually.

Early sexual initiation

So, why are males - specifically those who have sexual contact with other males - at high risk for HIV infection?

One important factor is they start risky sexual behaviour early.

Dr Genesis May Samonte, manager of the HIV Unit under the EB, first clarified that MSM does not only refer to those who are openly homosexual. “What we are saying is that any male who has sex with another male - for whatever reason - is at risk for getting HIV,” she said during a press conference at the DOH Central Office.

She goes on to explain that the first sexual contact typically happens at 16 years old, although risky behaviour starts to increase between 13 and 16, and 16 is the peak age, then is followed by the first anal sexual contact at 17. “But condom use [just] starts 2 years after,” Dr Samonte noted.

Based on information gathering among patients, they commonly resort to using protection during sexual contact two years after they start becoming sexually active.

Meanwhile, these young patients only get tested for HIV at 22, about six years from their first sexual contact. A 6-year time lag means warrior cells are quickly being depleted unless treatment is started immediately. Still, the timeline for progression of HIV to AIDS ranges from 5 to 10 years, depending on the strain.

“The window for prevention is very small. We have to reach this age group if we want to prevent this infection,” Dr Samonte stressed.

In May 2017 alone, 30 percent of the cases or 325 patients, belonged to the 15-24 age-group and 95 percent of them were males.

All cases were infected through sexual contact - 36 involved male-female contact, 192 male-male contact, and 97 cases for both male and female contact.

Since January 1984, more than a fourth of all reported infections belonged to the 15-24 age group, accounting for 12,065 patients, or 27 percent of total cases.

Lacking in information

The second factor that makes young men vulnerable to HIV infection is their lack of proper knowledge about the virus, and its end stage AIDS.

“Very few young MSM have correct knowledge about HIV and available services,” Dr Samonte siad, , putting emphasis on ‘correct knowledge.’

Only 35 percent of MSMs in the Philippines are armed with proper information about what HIV is, how it can infect people and access to screening and treatment. And the number is even more dismal (6 percent) when it comes to knowing where they can get antiretroviral therapy.

Dr Samonte underscored that the goal is not just to get tested, but to undergo treatment with antiretroviral therapy (ART). This amounts to “treatment as prevention.”

“[But] the treatment as prevention is a challenge at the moment because few MSMs are aware of their HIV status,” she said. Those submitting to HIV screening are rising, but the tests among high-risk group are not increasing at the rate they want to.

“The rate of testing among MSMs has gone from 5 percent to 9 percent and to 16 percent, but the data was from 2015. We hope to see improved numbers next year,” she said.

Presently, there are 50 treatment hubs and satellites scattered in the country’s 17 regions. There are 11 centers in NCR including San Lazaro Hospital, Philippine General Hospital, The Medical City/ i-REACT Clinic, Makati Medical Center and St. Luke’s Medical Center (Global City), among others.

There are three other facilities in Region 4A and 11 others in NCR including social hygiene clinics.

Four-pronged reduction strategy

In the battle to curb HIV infection, health authorities are looking at a number of strategies. The first is to increase the public’s knowledge regarding HIV transmission, prevention and services by 90 percent. Second is to prevent new infections in the 15 to 42 age group, and third is to test and treat 90 percent of people living with HIV (PLHIV).

The fourth objective is to eliminate mother-to-child transmission.

“Our problem with HIV [is that] it will not go away. We will reach 142,000 PLHIV by the end of 2022” Dr Samonte warned.

Epidemiology Bureau's Dr Genesis May Samonte (in black): Our problem with HIV will not go away if we do not invest in prevention and treatment.
Epidemiology Bureau's Dr Genesis May Samonte (in black): Our problem with HIV will not go away if we do not invest in prevention and treatment.

Last year alone saw 56,000 cases, an additional 86,000 is expected in only 5 years’ time. More alarming is that two out of three new infections will come from the 15-24 age group of MSMs.

Essentially, the Health department hopes to strengthen both prevention and treatment, and for those already infected, protect them from unnecessary death through treatment. At the same time, health authorities are pushing to encourage more people to abstain from early sexual contact, but for those already having sex to protect themselves, at least through consistent condom use.. 

On antiretroviral therapy

“HIV tests in not the end goal, [but] only a bridge to life saving treatment. The issue that we are facing right now is that many people are getting tested but not accessing the treatment,” Dr Samonte reminded.

According to the World Health Organization (WHO), majority of people infected with HIV will develop signs of related illness within a span of 5 to 10 years. AIDS diagnosis could come within the next five years, sometimes longer.

The ART slows the disease progression by preventing replication, which decreases the viral load.

Among PLHIV who are aged 30 and above, 70 percent of them are on ART. On the other hand, only 3 percent of those under the 15 -19 age group are on treatment, while the 20 to 24 age group, only has 11 percent on ART, she said.

“If under ART, the [an infected] person will have a normal life,” according to Dr Samonte. MIMS

Read more:

May 2017 HIV cases highest recorded since 1984
HIV epidemic in PH has fastest growth rate in Asia-Pacific
WHO: Drug resistance against HIV increasing