The Philippine HIV crisis and the COVID-19 pandemic: a worsening crisis

This paper illustrates that the COVID-19 pandemic may worsen the burden of HIV as manifested in the Philippine context. Even before the pandemic, the Philippines has already had an HIV crisis. It had the fastest-growing HIV epidemic in the western Pacific region between 2010 and 2017, where a 174% increase in HIV incidence was noted.¹ Notably, HIV infection in the Philippines disproportionately affects men who have sex with men (MSM), accounting for more than 80% of all new infections.

Several cultural and health systems factors have also been recognized as barriers in addressing the Philippine HIV crisis.¹ First, HIV stigma was pervasive in the Philippines, wherein HIV infection was equated to sin and immorality.¹ Second, access to medicines for the prevention and treatment of HIV was limited. HIV pre-exposure prophylaxis (PrEP) was limited to Manila. Likewise, Lamivudine-tenofovir-efavirenz (LTE) was the only fixed-dose combination antiretroviral therapy in the Philippines.¹ Last, the accessibility and delivery of services were unevenly distributed across the country. HIV treatment hubs were disproportionately distributed in major urban centers such as the National Capital Region.¹

This HIV crisis in the Philippines has worsened during the COVID-19 pandemic. In 2020, it was noted by the Philippines’ Department of Health (DOH) that HIV testing decreased by 61%.² It was, however, noted that the average number of people newly diagnosed with HIV per day had only decreased by about 37%, from 35 a day in 2019 to 22 a day by the end of 2020.³ This may indicate that a substantial number of individuals was left undetected in 2020. Likewise, it was reported that only 61% of Filipinos living with HIV were on antiretroviral therapy in 2020. Compounding this problem was the decrease in HIV treatment initiation by 28%.² This may signify that there is a delay and decrease in treatment, which may result in a possible increase in Acquired Immunodeficiency Deficiency Syndrome in the future. Likewise, it was reported that there were 105 pregnant women diagnosed with HIV infection. This was the first time that the number of pregnant women living with HIV in the country reached more than a hundred in the past decade.³ This increased cases in pregnant women suggests that the HIV crisis has been increasingly affecting the general population.

The worsened HIV crisis may be a result of the lower accessibility, delivery, and financing of HIV-related health services and programs in the community during the pandemic. Accessibility to a testing center and delivery of HIV-related health services may be decreased due to travel restrictions and limited mass transportation.⁴ Likewise, financing of HIV-related programs may be limited by the re-appropriation and re-alignment of the 2020 Philippine government budget to measures mainly geared at addressing COVID-19.⁴

If let to worsen, the Philippines’ HIV crisis may shift from its concentration in MSM into the general population. This is already manifested by the increasing HIV incidence rate among pregnant women.³ To address this, HIV stigma reduction programs should be strengthened, including the expansion of health communication strategies in popular online mediums such as social media and dating applications. This is to allow the programs to continue despite the limitations in physical interaction and the current social distancing policies. Likewise, there is also a need to increase testing and treatment accessibility and delivery, such as the addition of treatment hubs, provisions for HIV self-testing, and increased PrEP availability. In doing so, individuals at risk may be able to test and protect themselves despite the limited available transportation.

Generally, the COVID-19 pandemic may worsen the HIV situation among countries. In the Philippines, this has already started. If this crisis is left unaddressed during the pandemic, it may present as a significant challenge to pandemic strained healthcare systems. Thus, urgent actions are needed to address it.