The Philippines has earned the unenviable — and embarrassing — title of “the country with the fastest rising rates of HIV in Asia and the Pacific.” While the region overall has experienced a 13% drop in the number of cases since 2010, the Philippines has reported a 550% increase between 2010 and 2024, prompting the DOH to push for declaring HIV a public health emergency.
This is not an overnight development — the epidemic has been simmering for decades, having transitioned from “low and slow” in the early 2000s to “fast and furious” in the past two decades, with no signs of slowing down.
The latest DOH HIV quarterly report, covering April-June 2025, confirms once again the upward trajectory of HIV in the country: 5,000 new cases were recorded — an average of 56 new cases per day are being diagnosed, or one every 25 minutes. In 2010, approximately six new cases per day were reported.
Even if we have fewer cases in total compared to countries like Thailand, Cambodia, and Vietnam, these countries have managed to rein in their new cases, with rates dropping overall.
Back in 2018, HIV surveillance findings in so-called “key populations,” showed that between 4% to 6% of all young men having sex with men (MSM), and transgender — with a sample of over 4,000 respondents — tested positive for HIV. That’s about one in 20. People who injected drugs, measured in “hot spots” in Cebu, had very high HIV prevalence — 29%, (roughly over one person in four) in 2015.
But why declare it a public health emergency only now? I believe this is due to a drying up of funding for HIV (and for general development assistance) from the US Government. The decapitation of the US Agency for International Development (USAID) by the Trump administration, to the “sun setting” (rather facetious term for closure) of the Joint United Nations Program on AIDS (UNAIDS) has led to major shortfalls in an already underfunded global HIV response.
This ultimately affects other programs such as PEPFAR (President’s Emergency Plan for AIDS Relief, to the GFATM (Global Fund for AIDS, TB and Malaria). All these agencies have been strong supporters of the HIV responses in the Philippines for decades now. The Philippine government has gradually taken on a larger share of funding for HIV, particularly with regards to medications, and domestic resources are now the major source of funding.
However, most of the critical strategies and innovative responses, particularly those related to advocacy and working with CSOs, “key” populations such as drug users, sex workers, MSM and transgender people, are funded through international donors. Understandably, government staff and clinics are less able to reach these — and during the drug war, many simply became unreachable.
HIV is mostly sexually transmitted, and relatively difficult to acquire
There are specific ways of HIV transmission: unprotected sexual intercourse with someone who is able to transmit; sharing of unclean needles and injecting equipment, through transfusion of infected blood products, from a pregnant HIV positive mother to her unborn child, or during breastfeeding.
Virtually all transmission through the blood, needles, pregnancy and breastfeeding routes have been practically eliminated — by effective screening of blood, during pregnancy, through prophylaxis, and ensuring that needles and injecting equipment are sterile, single-use, and sharing eliminated. Both HIV and Hepatitis B are transmitted in identical ways, but a vaccine for Hep B is available, and none so far for HIV.
In the Philippines, 90% to 95% of all reported cases of HIV are due to sexual transmission; in some areas in Cebu, sharing of unclean needles by people who inject drugs is a significant route. Around 85% to 90% of all the new cases are among young men and trans women who report sexual contact with other men or trans.
One possible reason for rapid spread is the variant of HIV that is causing infection. Studies by Salvaña et al show that a particular HIV strain, (CRFo1AE) was seen in over 70% of all newly diagnosed cases of HIV between 2016-2018. This subtype was associated with higher viral loads, lower CD 4 counts on diagnosis, and faster progression to AIDS. It may also be a more “aggressive” subtype.
Only three of five Pinoys with HIV have had a test; Late diagnosis and treatment start is also a problem
Currently there are an estimated 250,000 people with HIV in the Philippines, of which only approximately 57% know their HIV status. In Iloilo province, the percentage of those who know their HIV positive status is even lower — 45%, according to the Provincial Health Office. Of the 57%, just two thirds (66%) are on life-saving Anti-Retroviral Therapy (ART). Of those on ART, 47% have viral suppression — or levels of the virus that are so low that HIV transmission is no longer a possibility.
Late reporting and limited availability of testing for viral load may explain this low reported rate, as the drugs are very effective and generally viral suppression rates are over 95%.
The country is thus very unlikely to reach the “95-95-95” targets for HIV, which will lead to elimination of HIV as a public health threat by 2030. The first 95 refers to the % of people with HIV who know their status; the second 95 refers to the % of people with HIV who are on ART; and the last 95 refers to the % of people on ART with viral suppression.
Philippine figures, as of 2025, are merely 57-66-47. The pace of putting people on life-saving treatment cannot keep up with the pace of new infections being diagnosed each month.
Meanwhile, of those newly diagnosed, 25% are in an advanced stage of HIV disease — meaning, they have acquired HIV years ago, the immune system has deteriorated, with opportunistic infections, such as tuberculosis and pneumocystis. CD 4 counts are very low and viral loads high.
Late diagnosis and treatment means more complications, longer times for recovery, more misery, and higher death rates. In the country, 22% or 1 in 5 people on ART has been “lost to follow up,” a rate that should also be cause for alarm. Many who start treatment do not continue, or they drop out. Inadequate treatment leads to drug resistance and treatment failures.
Knowledge about HIV, instead of increasing, is deteriorating
Young peoples’ levels of knowledge about HIV have been declining over the years, as reported from the 2021 Young Adult Fertility Surveys (YAFS). AIDS awareness declined from 95% in 1994 and 2002, to 83% in 2013, and 76% in 2021.
In 2021, 70% of respondents think they have no chance of getting HIV, a mere 15% know a place for HIV testing, and only 19% of the youth have comprehensive knowledge of HIV prevention and transmission. We must remember that every year, a new cohort of young people become sexually active, and lack the right information about HIV, and how to prevent it. All the prevention messages bear repeating year after year.
Not engaging in penetrative sex (i.e., vaginal or anal) reduces risk. Oral sex, sex with condoms and many forms of masturbation are considered low-risk, compared to unprotected (i.e., condom-less, or “bareback”) sex. However, one does not indulge in a single sexual practice during an encounter. It can start with kissing, foreplay, other forms of stimulation leading to oral, vaginal and/or anal intercourse, and may culminate in an orgasm.
But even if people do know about safer sex, it is always not easy to say “no,” particularly if one is in the throes of emotions, or conflicted, or excited to try out new things and experiences. There may also be a sense of denial, coupled with rationalizations — “I won’t get infected,” “he is so healthy looking, he could not possibly have HIV,” ”I won’t let him ejaculate in me,” “condoms reduce pleasure,” “it’s only one person that I’ve had sex with,” or ”I did it only once naman,” etc.
Complicating the mix are sex parties, having numerous sexual partners, the concurrent use of alcohol, stimulants, and “chemsex” — when under the influences of such substances, one may completely forget protection, or may be too incapacitated to resist or say “no.”
As one young yuppie put it, “it is difficult to control carnal desires” and so in the heat of sexual attraction, defenses crumble.
The fact is that Pinoys, of all genders, sexual orientations, religions and regions, are having sex, and bearing children. In the 2021 YAFS, 28% of male youth and 16% of females reported having sex before marriage. One in five young women between 15-24 has already had a child, or is currently pregnant. A third of these pregnancies are unwanted — despite all the admonitions about early pregnancy, or not having premarital sex.
Tools for HIV prevention are available, but are they accessible to all, and being used properly?
For someone sexually active now, the traditional “ABCD” messages — Abstain-Be Faithful-Condoms-Don’t inject drugs/share needles — from the ’80s and ’90s are supplemented by other methods.
PrEP (Pre-exposure prophylaxis), and self-testing for HIV (tests for HIV are available at drug stores, much like the pregnancy test kits). Condoms, used consistently, properly, and with the right type of lubricants, protect against other sexually transmitted infections (STI) and pregnancy. There are ways of negotiating safer sex practices that reduce the risks of HIV.
The slogan “U=U” (Undetectable=Untransmittable) means that a person with adequate treatment whose viral load is undetectable, is, for all practical purposes, no longer able to infect other people. This has enabled discordant partners (one HIV positive and the other HIV negative) to have a fulfilling sexual relationship, and have children, without the fear of possible transmission.
Accessibility of the prevention and treatment tools for ALL youth — including those in and out of school, those in prison or in rehab, with sensory and learning difficulties — need to be available. There are young people who are deaf, or have disabilities, and they are also having sexual lives; some may even be subjects of abuse and sexual exploitation.
There is virtually no information on HIV for those with hearing disabilities, or with little comprehension of English or Tagalog. There are but a few groups that provide sexual health education for those who cannot hear, see, or who have physical and learning disabilities. Information is not available in different local languages, including braille and sign language, and there are very few trained interpreters.
There are physical barriers to access, especially for people who may have mobility issues. Companions are needed when services are being accessed; transportation costs are higher for those with disabilities. Health workers express surprise and even disapproval at youth who are sexually active and not married, and may not be prepared to discuss sex and reproduction with those who have disabilities.
Expansion of ART Treatment facilities
The number of facilities offering ART treatment in Panay has increased. Apart from the West Visayas Medical Center (WVMC), there are now 20 HIV treatment hubs and outpatient HIV facilities in Panay, compared to six in 2021. San Jose de Buenavista and Culasi in Antique; Aklan has Boracay, Kalibo, New Washington while Capiz province has Roxas City and Dao. Iloilo has the most: Alimodian, Cabatuan, Calinog, Guimbal, Concepcion, Barotac Nuevo, Balasan, Janiuay, and Pototan.
In Iloilo City, treatment hubs are in St. Paul’s Hospital, The Medical City, WVSU Medical Center and the FPOP (Family Planning Organization of the Philippines).
People have a choice where they can seek treatment. Many do not wish to receive treatment in their own hometowns for fear of discovery. Some may be having treatment with private practitioners and in other countries.
A listing of 300 treatment hubs and primary HIV care facilities nationwide is available from the DOH and the PIA website. ART continues to be free of charge.
Stigma and discrimination are major barriers – a comprehensive approach is needed to combat it
Stigma and discrimination are major barriers to access. Stigma comes from the perception of HIV as a terminal illness (which it no longer is), contagious (which it is not) and association with people who are considered immoral, deviant, someone who is looked down on and ridiculed — a relic from the years when the then unknown, wasting illness was linked to the 4 Hs — homosexuals, hemophiliacs, heroin users, and haitians.
Stigma may be external or/and internalized. Discrimination that reduces a person’s access to information and services is the most damaging; they may be reluctant to go to clinics or join community activities.
If there is much stigma about being queer or gay, or being HIV positive, and use of drugs considered illegal, people are unlikely to come forward, get tested for HIV, and will hide or deny their status. They may not want to be seen in a facility that is frequented by people with HIV. Mandatory HIV testing is prohibited by law, but is still practiced.
NGOs, CSOs and various community groups are uniquely positioned to support counseling, testing and treatment for young persons who may be at risk for HIV. They have peer educators, innovative outreach services, drop-in centers, and various activities to engage the youth, which clinics are unable to provide.
Some of the more prominent NGO-run clinics in the city include FPOP, which offers family planning, laboratory services and primary health care, ARV treatment and a transgender health service. Team Dugong Bughaw (TDB) has the “Yuhum” (Smile) Community Center.
Both TDB and FPOP provide HIV screening and counseling, and PrEP. They have volunteers and facilitators whom young people can relate to, and run open, welcoming spaces where young people can feel more safe, confident and comfortable, enabling them to discuss concerns around sexual health and rights, including mental health issues. Contrast this with a room in a crowded hospital corridor, where most HIV treatment facilities can be found.
Enabling policy environments need to be sustained; resources for implementation are lacking
Finally, while the country has an enabling policy on HIV education in schools (through RA 11166, the HIV and AIDS Policy Act) and for Sexual and Reproductive Health education in (mandated by the 2012 RH law), both remain unevenly resourced and implemented.
In a study done in an unnamed Philippine city, Kim et al found that “local stakeholders have different concepts of Reproductive Health (RH) and delivered their own perceived concept of RH; teachers lack RH pedagogy and training while they also tend to minimize and modify their teaching in fear of further stimulating student interest in sex.”
The RH law, though over a decade old, continues to be controversial and is perceived to be in conflict with Filipino social and cultural norms.
In a Department of Education order in September 2025, “Policy on the Implementation of Reproductive Health Education for Adolescent learners in Basic Education,” Secretary Sonny Angara directed the department to “integrate basic and age-appropriate instruction on the causes, modes of transmission and ways of preventing the spread of HIV and AIDS and other STIs into the curricula of public and private learning institutions, including alternative and indigenous learning systems, in accordance with the HIV and AIDS Policy Act.” More specific implementing guidelines need to be developed, though.
So there are really quite complex reasons for our rising HIV rates — more testing means more cases, and better early detection and treatment, in the long run. Being ready to discuss sexuality, safer sexual behaviors, HIV prevention and transmission openly and in a non-judgmental way, reducing stigma, doing outreach, increasing condom use and PrEP, and strengthening reproductive health education for youth — in and out of school, could help in blunting the rise of HIV in the country.
We need more open discussions with young people, especially young LGBTQ, to find out what they’re thinking, and what might be acceptable and effective interventions to reduce risk. We also need to work closely with non-government organizations, youth organizations, organizations working on sexual and reproductive health and rights.
We need innovative ways of reaching young people who may be at extra risk for early sexual activity. How do we make sure they see the prevention messages, recall and practice them, seek out services, and know their HIV status? How do we ensure they are comfortable going to clinics, meeting with health workers, peer educators/counselors, doing telehealth? How do we support people with HIV so that they continue to receive treatment, and not drop off the radar?
This is one public health emergency that will be here for decades to come. – Rappler.com
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