William was only 18 when he went to Metro Manila to study in one of the country’s most prestigious schools. The parents of this Davaoeño wanted him to be a lawyer. William was an outstanding student during his first year. But after meeting some friends, everything changed.
His friends brought William to a pub one evening. There, the young man was introduced to a beautiful guest relation officer. And the rest, as they say, is history. Since then, William was picking up girls here and there.
Lately, however, he started suffering from a chronic cough that lasted for more than a month. He also experienced itching in several parts of his body, aside from having swollen lymph nodes. William decided to see a doctor and told him his problem. After hearing his woes, the doctor asked William about his sexual lifestyle.
Quite surprised at the question, the young man told his story just the same. After conducting several blood tests on William, he was asked to return a week later.
“I am sorry to tell you this William,” the doctor told him when he returned, “but you are positive of HIV.” HIV stands for human immunodeficiency virus, thevirus that causes AIDS (Acquired Immune Deficiency Syndrome).
William felt all the energy drained from him. “I don’t know where I got this disease…” his voice trails off as he recalls his past sex conquests. “Maybe from one of those girls I picked up. Or maybe…”
The HIV epidemic in the Philippines is increasing at an alarming rate. “Our country has the fastest-growing HIV infection rate in the Asia-Pacific region,” bares Dr. Louie Mar A. Gangcuangco, an infectious disease researcher whose expertise in HIV field is recognized internationally. “This is something we should be concerned about.”
The average number of Filipinos newly diagnosed with HIV per day is surging at an alarming rate. Records released by the Epidemiology Bureau of the Department of Health showed there were only two people diagnosed with HIV daily in 2008. It increased to 7 in 2011, 13 in 2013, and 22 in 2015. For this year, the number of people diagnosed everyday with HIV is 32.
“The Philippines has become the country with the fastest growing HIV epidemic in Asia and the Pacific,” the United Nations AIDS pointed out in a report. “The country has also become one of the eight countries that account for more than 85% of new infections in the region.”
The exponential increase in HIV infection, according to Dr. Gangcuangco, is “very alarming because the people who are affected are mostly young individuals.”
In February 2018, about 871 new HIV cases were recorded by the HIV/AIDS and Art Registry of the Philippines. The median age among those reported cases was 27 years old. Half of those infected were 24-35 years old and 29% were 15-24 years old at the time of testing.
HIV is present in all body fluids of an infected person but is concentrated in blood, semen and vaginal fluids. Virtually, it is present in all body tissues and organs including the brain and spinal cord. It can be found in tears, saliva and breast milk although these last three are not considered significant routes of infection.
A DOH report cited sexual intercourse as the leading mode of transmission in the Philippines. Men having sex with men through anal intercourse, where the penis penetrates the anus of the other person, is currently the leading mode of transmission. Vaginal intercourse, where the penis penetrates the vagina, is the second most common route of transmission.
“A single sexual encounter can be sufficient to transmit HIV,” wrote Dr. John Hubley, author of The AIDS Handbook. “Although the risk from an individual sexual act may be low, the more times a person has sex, the greater the likelihood that transmission will take place. Women appear to be more at risk than men from heterosexual sex. The transmission of HIV from man to woman is believed to take place more easily than from woman to man.”
Injection or infusion of contaminated blood, as occurs with blood transfusions, the sharing of needles or syringes, or an accidental prick from an HIV-contaminated needle is another mode of HIV transmission.
Transfer of HIV is also possible from an infected mother to a child before birth, during birth, or after birth through the mother’s milk. “A few children contract HIV infection through sexual abuse,” informs The Merck Manual of Medical Information.
“HIV is a virus that destroys the immune system,” says Dr. Gangcuangco, a Balik Scientist who came to attend the opening of the National Science and Technology Week in Davao City recently. “After about 5 years of not knowing that you are infected, if you engage in unprotected sex, the infected person can unwittingly transmit the virus, infecting more people.”
Currently, there is no cure known for HIV but the virus can be controlled with proper medications called antiretrovirals. “These antiretrovirals are provided for free by the government,” Dr. Gangcuangco says. “With healthy lifestyle and if antiretrovirals are taken every day, people with HIV can have ‘undetectable’ virus in their blood.”
By “undetectable,” he means that the virus is still in the body but in very low amounts that it cannot be detected by the machine.
According to Dr. Gangcuangco, there are two benefits of taking medications for HIV. First, it prevents HIV from destroying the immune system of someone with the virus. Second, it prevents the spread of HIV because the virus will also be very, very low in the semen and other body fluids.
Another good news: there is now a medication, when taken every day, can prevent HIV infection. It is called pre-exposure prophylaxis (PrEP for short). “This medication is a pill that contains antivirals,” explains Dr. Gangcuangco. “When HIV enters the body, a person who takes PrEP is protected against HIV infection. PrEP blocks the virus from reproducing in the body and is effective to prevent HIV transmission by more than 90%.”
Three years ago, the Geneva-based World Health Organization (WHO) issued a statement that said: “people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of comprehensive prevention.”
Dr. Gangcuangco, however, dispel the idea that PrEP can now replace condoms and other preventive measures for HIV. On the contrary, PrEP should be offered together with them. “PrEP is not meant to replace counseling and condom use but should be used as an adjunct to prevent HIV,” he explains.
Unfortunately, PrEP is currently not available nationwide in the Philippines. “PrEP still needs approval by the Philippine Food and Drug Administration and the government needs to procure this to be available nationally,” Dr. Gangcuangco says, adding that it is available but limited in some few HIV treatment hubs.
“I strongly believe that PrEP should be made available nationwide to help prevent HIV transmission,” says Dr. Gangcuangco, who serves as a consultant for the University of the Philippines-Philippine General Hospital study entitled, “Immune Activation Dynamics of HIV-Infected Patients on Antiretroviral Therapy in the Philippines.” “PrEP is one of the missing pieces in HIV control in the Philippines.”
The cost of PrEP varies from different countries, but a genetic version has already been approved although the cost is still relatively high – about US$1.99 per tablet. “Worldwide efforts are exerted to bring the cost down,” he says.
Now, the question is: should PrEP be taken only when one is engaged in unprotected sex? “The recommendation is: people who are at risk should take PrEP everyday to make sure that enough medication is in the system in case the virus enters the body,” Dr. Gangcuangco replies.
Dr. Gangcuangco graduated in 2010 from the prestigious Intarmed Program, a 7-year accelerated Doctor of Medicine program of the University of the Philippines College of Medicine. After a year of working as a junior faculty at the San Beda College of Medicine and the Ateneo School of Medicine and Public Health, he pursued HIV research fellowship in Nagasaki Institute of Tropical Medicine in Japan.
From 2012 to 2014, he worked as a researcher at the Hawaii Center for AIDS. He pursued further training in Internal Medicine at a Yale-affiliated hospital and returned to the University of Hawaii as a researcher in October 2018.
“Although I will return to the University of Hawaii to pursue further HIV research, I will still continue facilitating research collaborations with institutions in the Philippines to help fight the HIV epidemic. I also plan to go back to this country where I grew up for further collaborations with other institutions,” he says.
As a final statement, Dr. Gangcuangco assures: “HIV is not and should not be a death sentence anymore. If HIV is detected early and if the patient takes antiretrovirals early, the virus can be controlled. There is still no cure for HIV but the bad effects of the virus can be prevented if medications are taken early. ”
“I urge everyone who has had unprotected sex to please have an HIV test in your nearest HIV treatment hub/social hygiene clinic. People with HIV need to get tested to prevent damage to their immune system that can cause infections such as pneumonia, tuberculosis, diarrhea that can lead to death.
“It is your responsibility to yourself and to your sexual partner to know your status. The government should urgently bring PrEP and the newer medications such as dolutegravir to the Philippines to help end the HIV epidemic,” he concludes.
