Joint WHO and UNAIDS Questions and Answers to HIV Strain and Drug Resistance in the Philippines
Updated 23 March 2018
In light of recent reports about the new HIV strain and drug resistance in the Philippines, WHO and UNAIDS has released some answers to the most frequently asked questions.
What is the current situation of HIV epidemic in Philippines?
Globally, the number of new infections is declining every year. The Philippines is among the few countries where the number of new infections is increasing at a high pace. Between 2010 and 2016, the number of new infections has increased by 140% – representing the highest increase of any country in this period. An average of 31 newly diagnosed cases of HIV infection per day were reported in 2017.
Is HIV drug resistance a problem in Philippines?
HIV is treated with medicines known as antiretroviral drugs. HIV drug resistance develops when people are unable to take their drugs regularly. Individuals with HIV drug resistance may start to fail therapy. Drug resistant HIV may also be transmitted to others.
In order to determine if HIV drug resistance is an issue in a country, periodic surveys are required to obtain nationally representative HIV drug resistance estimates. Concurrently, the country needs to expand the coverage and quality of routine viral load and drug resistance testing as well as monitor the quality of service delivery.
Are there any links between HIV epidemic in Philippines and circulating HIV strains?
The HIV subtype circulating in the Philippines has changed from predominantly B to the circulating recombinant form CRF01_AE. This subtype is predominant in Southeast Asia. Shifts from one subtype to another in a country or region have been previously described. This may occur due to changes in population risk behaviours and other host and human genetic factors. All HIV-1 subtypes can be expected to respond to currently recommended ART regimens.
HIV is an ever evolving virus. Literature reviews suggest possible differences in transmission and disease progression between different HIV-subtypes. However, disease progression depends on many factors such as age, genes, and presence of other infections. The CRF01_AE that is circulating in the Philippines has not been documented to be more infectious than other subtypes or circulating recombinant forms. Insufficient access to prevention and treatment are the main drivers of the HIV epidemic in the Philippines.
How can we control the epidemic?
An HIV programme has three main components: prevention, testing and treatment.
Prevention hinges on raising awareness of the population on HIV and ensuring access to a variety of prevention and treatment modalities. There are many ways to prevent or reduce HIV transmission including: delaying sexual debut, consistent use of condom, pre-exposure prophylaxis (PrEP) and needle-syringe exchange programme for people who inject drugs.
When used properly during every sexual intercourse, condoms are a proven means of preventing HIV infection in women and men. In the Philippines, condom access is a challenge - especially for minors, resulting in low condom use.
As an entry point to treatment, HIV testing, especially for those at high risk of infection, is a critical intervention. From the estimated 67,100 people living with HIV in the Philippines, 41,315 (62%) have been diagnosed as of February 2017.
High treatment coverage among people living with HIV is also a key to reducing the number of new infections. Antiretroviral therapy (ART) in people living with HIV is not only live saving, but also prevents HIV transmission. In the Philippines, only about half of the people who have been diagnosed are receiving ART. This low treatment coverage is contributing to the rapid rise of new infections.
Is there a way to know if patients are responding well to treatment and what happens if they do not?
All patients on treatment need to take their treatment daily. Viral load level needs to be assessed periodically to ensure that the treatment is effective. If a person who takes medicines regularly does not achieve viral load suppression in a certain time frame, s/he may need to be shifted to another treatment regimen.
Where can people access condoms, testing and treatment services?
Condoms are available for free from social hygiene clinics. They can be purchased in drugstores, convenience stores and supermarkets.
Testing is available for free at social hygiene clinics and public treatment sites (see the list below). Some private clinics also offer testing services.
Treatment in the Philippines is free. The list of public and private treatment sites is available from the last page of the HIV/AIDS and ART registry available on the DOH webpage.