How is PH faring in HIV treatment?

‘ZERO DISCRIMINATION’ | In this 2015 photo, a student in Las Piñas City lights a candle to commemorate World AIDS Day on Dec. 1 that year. Health advocates note that the struggle to improve HIV treatment in the country includes erasing the social stigma on people who have tested positive for the virus. (Photo by MARIANNE BERMUDEZ / Philippine Daily Inquirer)

MANILA, Philippines — As he was coping with the feeling of isolation amid the lockdowns prompted by the COVID-19 pandemic, 19-year-old college student Seth (not his real name) was developing skin rashes that soon became so painful he had to see a doctor.

The rashes turned out to be shingles, a viral skin infection which indicated that his immune system was under attack from a virus.

More lab tests ultimately confirmed that Seth was positive for the human immunodeficiency virus (HIV).

He counts himself lucky that his diagnosis was made early enough, “because my CD4 cells, an indication of the health of our immune system, were still high,” he said in an interview.

CD4 cells are a type of white blood cell which helps fight infections, with its count indicating the strength or weakness of an individual’s immune system.

As it enters the body, HIV—an infectious virus for which there is no cure — attacks the CD4 cells by infecting them until their count declines.

Ralph (also not his real name) was diagnosed, too, at an early stage of his HIV infection.

The 43-year-old bank officer said his partner was positive for HIV, but maintained that they had no sexual contact because “we wanted to get tested first.”

Early detection crucial

For Seth, Ralph, and other “People Living with HIV” — or PLHIVs, as this group is referred to in the medical community — early detection is crucial in preventing their condition from worsening into acquired immunodeficiency syndrome (AIDS) if the virus is not managed well.

A person with AIDS means his CD4 cells are at a dangerously low level, which makes his illness more life-threatening.

The presence of HIV in the body can be managed through antiretroviral therapy, a regimen of prescribed maintenance medication.

Patients who test negative but are considered at high risk for HIV are advised to take pre-exposure prophylaxis (PrEP) to reduce the chances of getting infected.

Under that regimen, individuals vulnerable to HIV take one pill every day on top of other prevention measures.

Treatment goal

There are two kinds of PrEP: the daily medication for those who frequently have unplanned sex and “event-driven” PrEP for those who have infrequent, planned anal sex.

According to the AIDS Research Group (ARG) of the Research Institute for Tropical Medicine (RITM), the country is now at 64 percent, or more than halfway through its goal of placing 95 percent of PLHIVs under treatment.

These figures are on track to meet the 2030 goals of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said nurse Roldan Bucal, ARG clinical manager.

Bucal said 95 percent of PLHIVs under treatment are already “virally suppressed.” This means their “viral load” has dropped to as low as 200 copies of HIV per milliliter of blood.

Experts say that level is enough to keep the immune system strong against any illnesses.

Epidemic

But apart from the progress in treatment, the country is still coping with an HIV epidemic — the “fastest-growing” in the Western Pacific, according to UNAIDS.

In 2017, the Department of Health declared the epidemic a national emergency and said it anticipates PLHIVs to reach up to 361,300 by 2030.

The most dominant mode of HIV transmission is sexual contact at 97 percent, the department said, adding that cases are highest among the younger population (the 25-34 age groups, followed by the 15-24 segment) and among “Men who have Sex with Men.”

“Based on the epidemiological data, patients with HIV are getting younger and younger. Most of our clients in clinics are adolescents,” said Dr. Donna Ortiz, an HIV doctor at Laguna Medical Center.

Mental health

“We really have to exert efforts for good counseling. We should empower them to make their own decisions,” she said.

The government has time and again said it intends to make HIV treatment one of its top health priorities.

But Human Rights Watch said in a 2016 report that even establishing low-cost medical interventions has been delayed in the country, apart from healthcare services being nonexistent in some areas.

“Remove current official obstacles to condom access and usage as well as ensure that schools include safer sex and HIV prevention education in the curriculum,” the New York-based advocacy group said.

HIV treatment even became more difficult during the lockdowns in the first two years of the pandemic.

“Services that should be readily accessible to PLHIVs are … treatment and psychosocial care,” said Seth, who noted that some PLHIVs experience “internalized stigma.”

Dr. Anna Dungca-Lorilla, one of the primary HIV physicians at RITM, has an ongoing study that aims to integrate mental health care in HIV clinics.

“As we know, people living with HIV are prone to mental health disorders before and after diagnosis, and it is very important that their mental health is managed and assessed,” she said.

Change messaging

Bucal said health advocates like him are targeting “zero discrimination when it comes to HIV and AIDS.”

For Ralph, “‘messaging about HIV’ should be changed” to remove the stigma that comes with those infected.

“They [health authorities] always make campaigns about HIV to scare people which only adds to the stigma. Campaigns on HIV should be empowering and enabling everyone to fight and prevent HIV,” he said.

“Also, making sexual health a mandatory subject in school should be pursued as the age of those getting diagnosed is getting younger,” he added.

For those who need treatment or psychosocial support, consultations may be scheduled through the official website of support group LoveYourself. Another support group, HASH (HIV & AIDS Support House), offers free PrEP via its Facebook and Twitter pages.

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