Can PrEP Save the Philippines From a National HIV Emergency?

Over the last few years, HIV cases in the Philippines have bucked global trends and risen substantially. Now, the Filipino government wants to use PrEP to combat these soaring infection rates, but will this approach work?

According to data released this past week, the nation has seen a 140 percent increase in HIV cases over the past six years. The health ministry revealed that a total of 1,098 new HIV cases were recorded in May of this year alone — the highest figure for a monthly report since records began in 1984.

Furthermore, figures show that by the end of 2016, 10,500 Filipinos were officially recorded as HIV-positive. Compare that to 2010′s figure — 4,300 Filipinos — and the massive jump becomes all too evident.

The UNAIDS Regional Support Team for Asia-Pacific is tracking these numbers and working with local officials to help fight HIV. Director Eamonn Murphy notes that this is the fastest growing HIV epidemic in the Asia-Pacific region — and time is running out for the Philippines to get a handle on HIV rates:

The Philippines has a small window of opportunity to act now and stop a major HIV epidemic from taking hold. If HIV programming is re-directed to focus on the people most at risk and where they are located, I’m sure the country can not only return to a stable situation but even end the AIDS epidemic as a public health threat by 2030.

This begs the question, why have HIV prevention efforts failed in the Philippines?

HIV in the Philippines

It’s worth noting that when HIV emerged as a public health issue in the Philippines in the 1990s, it predominantly affected sex workers. At the time, the Philippines became a major leader in the HIV fight, as it began aggressively offering condoms to urban areas where they were most needed.

Rather than upping criminalization of sex work —  a common knee-jerk response — the government deployed former sex workers to lead HIV prevention and education initiatives. Health officials also implemented successful safe sex campaigns that, for the time and region, were remarkably sex positive. HIV cases among sex workers noticeably leveled off, and overall rates hovered at a relatively low level.

However, HIV is a wide-ranging infectious disease that can impact all communities – particularly those that are under-served by national health programs. As a result, it comes as no surprise that, by the mid-2000s, the demographics affected by HIV in the Philippines began to shift.

Men who have sex with men began to experience a growing and gravely worrying rate of HIV infections. It is now estimated that 97 percent of new HIV infections are transmitted through sexual contact, the vast majority of them via men who have sex with men.

As Human Rights Watch notes, the Philippines’ embrace of religion as a benchmark for public policy has complicated efforts to control this aspect of the HIV epidemic under control difficult:

The country’s growing HIV epidemic has been fueled by a legal and policy environment hostile to evidence-based policies and interventions proven to help prevent HIV transmission. Such restrictions are found in national, provincial, and local government policies, and are compounded by the longstanding resistance of the Roman Catholic Church to sexual health education and condom use. Government policies create obstacles to condom access and HIV testing and limit educational efforts on HIV prevention. Children may be particularly vulnerable to HIV due to inadequate sex education in schools and misguided policies requiring parental consent for those under 18 to purchase condoms or access HIV testing.

Can relying on PrEP — the breakthrough treatment with upwards of 70-90 percent success in preventing HIV infection — really help? The Filipino government hopes so.

Will PrEP be the answer?

As part of a two-year trial involving a combined 200 MSM and trans women, researchers will monitor participants’ use of PrEP, adherence to the PrEP schedule and resulting HIV infection rate.

PrEP, of course, isn’t foolproof and only guards against HIV-1. Its ability to ward off HIV also plummets when users do not stick to the required schedule. But in trials across the US, the UK and Europe, adherence has generally been good — even among younger men, who appear to be particularly at risk.

The trial is ambitious and, in fact, the first of its kind in the region. It is also a practical work-around for LGBT and HIV groups who have needed a means of circumventing religious dogma.

Compared to condoms, however, PrEP is quite costly. What’s more, at-risk individuals need action on HIV immediately – not in two years time.

Education, testing and condom availability are all proven, relatively low cost interventions that have proven to be successful. And only a multi-pronged approach will give the Philippines the coverage it needs to tackle spiraling HIV infections.

While the trial is much needed and serves as a testament to the persistence of local and international groups, the full suite of HIV prevention methods should be utilized and supported by the government.

Photo Credit: Hector Garcia/Flickr

42 comments

Cen Sored
Cen Soredabout a month ago

Why not purchase PrEP directly from Gilead through Amazon? Oh, this is Europe and Europe dislikes competing US Corporations. Their loss in the name of failed economics and politics.

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Mike R
Mike Rabout a month ago

Thanks

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Mike R
Mike Rabout a month ago

Thanks

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Mike R
Mike Rabout a month ago

Thanks

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Ian C
Ian Crory2 months ago

ruh

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Margie FOURIE
Margie FOURIE3 months ago

If only people would keep it in their pants.

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Danuta W
Danuta W3 months ago

Thanks for sharing.

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Leo Custer
Leo C3 months ago

Thank you for Sharing!

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Jeramie D
Jeramie D3 months ago

Thanks

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Janis K
Janis K3 months ago

Thanks for sharing.

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