Newly Diagnosed HIV Cases in the Philippines

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*Note: No data available on sex for eleven (11) cases.

Philippine HIV and AIDS Registry

D E P A R T M E N T O F H E A L T H

N A T I O N A L E P I D E M I O L O G Y C E N T E R

OCTOBER 2011

Table 1. Quick Facts

Demographic Data ^October

2011 Cumulative Data:

1984—2011 Jan-Oct

2011

Total Reported Cases 200 1,869 7,884

Asymptomatic Cases 199 1,797 6,947

AIDS Cases 1 72 937

Males 194 1,743 6,440*

Females 6 126 1,433*

Youth 15-24yo 65 560 1,774

Children <15yo 0 3 58

Reported Deaths due to AIDS 0 15 339

80 51

75 28

1,719

28 24

2,812

2,665

0%

20%

40%

60%

80%

100%

O ct o b er 2 0 11 O ct o b er 2 0 10 C umul at i ve

Proportion of Cases

Het erosexual Bisexual Homosexual

Figure 2. Comparison of the Proportion of Types of Sexual Transmission in 2011, 2010 & Cumulative Data (1984-2011)

0 25 50 75 100 125 150 175 200 225 250 275

Number of New Cases

2009 65 47 59 66 85 40 70 61 56 80 80 126

2010 143 130 120 154 153 109 131 108 153 104 112 174

2011 152 159 172 171 184 178 204 196 253 200

J an Feb M ar A pr M ay J un J ul A ug Sep Oc t Nov Dec

0 150 300 450 600 750 900 1050 1200 1350 1500 1650 1800 1950

T OT A L 2 10 29 38 32 39 66 85 72 102 118 116 154 117 189 158 123 174 184 193 199 210 309 342 528 835 1591 1869

A s y mpt omat i c 0 6 18 25 21 29 48 68 51 64 61 65 104 94 144 80 83 118 140 139 161 171 273 312 506 806 1571 1797

A I DS 2 4 11 13 11 10 18 17 21 38 57 51 50 23 45 78 40 56 44 54 38 39 36 30 22 29 20 72

Deat h 2 4 10 12 9 8 15 13 13 11 19 24 27 10 16 17 9 20 11 11 8 16 18 10 7 1 2 *15

'84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11

Figure 1. Number of New HIV Cases per Month (2009-2011) In October 2011, there were 200 new HIV Ab

sero-positive individuals confirmed by the STD/AIDS Cooperative Central Laboratory (SACCL) and reported to the HIV and AIDS Registry (Table 1). This was 92% higher compared to the same period last year (n=104 in 2010) [Figure 1].

Most of the cases (97%) were males. The median age was 27 years (age range:15-65 years). The 20-29 year (60%) age-group had the most number of cases. Fifty-four percent (108) of the reported cases were from the National Capital Region (NCR).

Reported mode of transmission was sexual contact (183), and needle sharing among injecting drug users (17) [Table 2, page 3]. Males having sex with other Males (85%) were the predominant type of sexual transmission [Figure 2]. Most (199) of the cases were still asymptomatic at the time of reporting [Figure 3].

AIDS Cases

Of the 200 HIV positive cases, only one was reported as an AIDS case, a 27-year-old male. The infection was acquired through bisexual contact. No AIDS- related death was reported for this month.

Overseas Filipino Workers (OFW)

Twenty-one of the 200 (10%) reported cases were OFWs [Figure 9, page 3]. There were 19 males and 2 females. The median age was 31 years (age range:

19-44 years). All cases acquired the infection through sexual contact (9 heterosexual, 7 homosexual, and 5 bisexual).

Figure 3. Number of HIV/AIDS Cases Reported in the Philippines by Year, Jan 1984 to October 2011 (N=7,884)

*Nine initially asymptomatic cases reported in 2011, died due to AIDS that same year.

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AIDS Cases (1984-2011)

Demographic Characteristics (1984-2011)

October 2011 Philippine HIV/AIDS Registry

Of the 1,869 HIV positive cases in 2011, seventy-two were reported as AIDS cases. Eighty-eight percent were males.

Ages ranged from 1-59 years (median 31 years). 96% (69) acquired the infection through sexual contact [heterosexual (18), homosexual (30), and bisexual contact (21)]. Other modes of transmission include: (1) mother-to-child transmission and (2) needle sharing among injecting drug users.

From 1984 to 2011, there were 937 AIDS cases reported, 73% (680) were males. Median age was 35 years (range 1- 72 years). Of the reported AIDS cases, there were 339 (36%) deaths. Sexual contact was the most common mode of HIV transmission, accounting for 93% (873) of all AIDS cases.

More than half (468) of sexual transmission was through heterosexual contact, followed by homosexual contact (306)

then bisexual contact (99). Other modes of transmission include: mother-to-child transmission (18), blood transfusion (10), injecting drug use (6), and needle prick injuries (2) [Figure 4]. Three percent (28) of the AIDS cases did not report mode of HIV transmission.

0%

25%

50%

75%

100%

Proportion of Cases

Needl e P r i c k 2 0 0 0 0

B l ood T r ans f us i on 10 0 0 0 0

M T CT 16 0 1 0 1

I DU 3 1 0 0 2

B i s ex ual Cont ac t 60 4 8 6 21

Homos ex ual Cont ac t 234 10 15 17 30

Het er os ex ual Cont ac t 434 7 6 3 18

1984-2007 2008 2009 2010 2011

Fig 4. Proportion of Modes of Transmission of AIDS Cases by Year, Jan 1984—October 2011

In 2011, there were a total of 1,869 cases reported. 93% of the cases reported were males (1,743). Ages ranged from 1-67 years old (median 27 years). The 20-29 year old age group (60%) had the most number of cases for 2011. For the male age group, the most number of cases were found among the 20-24 years old (27%), 25-29 years old (33%) and 30-34 years old (17%) [Figure 5].

From 1984 to 2011, there were 7,884 HIV Ab sero-positive cases reported (Table 1), of which 6,947 (88%) were asymptomatic and 937 (12%) were AIDS cases. As shown in Figure 6, there is a significant difference in the number of male and female cases reported. Eighty-two percent (6,440) were males. Ages ranged from 1-73 years (median 29 years).

The age groups with the most number of cases were: 20-24 years (20%), 25-29 (27%) and 30-34 years (19%) [Figure 6].

Figure 5. Proportion of Sex & Age-Groups in October 2011 & Jan-Oct 2011

0%

25%

50%

75%

100%

Proportion of Cases

50 & ol der 2 0 42 8

35-49y o 37 0 290 33

25-34y o 93 3 880 53

15-24y o 62 3 530 30

1-14y o 0 0 1 2

Oc t ober 2011 (M ) Oc t ober 2011 (F) 2011 (M al e) 2011 (Femal e)

Figure 6. Comparison of the Distribution of Male and Female HIV Cases by Age-Group and Certain Highlighted Years

*Note: 28 did not report mode of transmission

0 250 500 750 1000 1250 1500 1750 2000

<15yo 15-19yo 20-24yo 25-29yo 30-34yo 35-39yo 40-44yo 45-49yo 50 & o lder

Number of Male Cases

2011 1 60 470 585 295 152 99 39 42

2010 1 50 406 454 256 128 81 42 48

2009 1 22 179 227 124 90 41 18 29

2008 2 11 92 140 90 59 36 23 20

2007 6 1 36 74 54 43 30 15 19

1984-2006 21 14 121 300 360 321 249 170 157

<15y o 15-19y o 20-24y o 25-29y o 30-34y o 35-39y o 40-44y o 45-49y o 50 & ol der

0 250 500 750 1000 1250 1500 1750

Number of Female Cases

1984-2006 2007 2008 2009 2010 2011

2011 2 2 28 34 19 18 8 7 8

2010 2 5 28 21 34 15 9 7 4

2009 1 4 13 19 21 20 14 7 5

2008 0 0 8 14 8 10 9 3 3

2007 3 0 4 16 12 14 6 5 3

1984-2006 18 33 187 209 190 140 84 30 41

<15y o 15-19y o 20-24y o 25-29y o 30-34y o 35-39y o 40-44y o 45-49y o 50 & ol der

*Note: 74 did not report age, 11 did not report sex, 10 did not repot age and sex

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*Data includes January to October2011 only.

0 100 200 300 400 500 600 700 800 900 1000

Number of Cases

Blood Transf usion - Female - - - - - 1 -

Mat ernal t o Child 3 - - - - - -

Inject ing Drug Use - Female - - - 2 - 1 -

Inject ing Drug Use - Male - - 5 22 22 27 1

Het erosexual Cont act - Female - - 1 27 53 31 8

Het erosexual Cont act - Male - - 1 27 100 53 23

Bisexual Cont act - - 2 193 351 92 5

Homosexual Cont act - - 4 275 406 115 13

<7yo 7-14yo 15-17yo 18-24yo 25-34yo 35-49yo 50&older

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Proportion of Cases

Het er os ex ual 1 7 24 24 16 19 35 30 4147 58 56 81 82 138 114 93 128 129 129 123 131 193 139 160 216 271 324

B i s ex ual 0 2 0 4 2 2 4 4 5 2 3 8 7 7 9 10 8 5 8 14 12 14 26 74 127 252 463 643

Homos ex ual 0 1 4 3 4 6 8 15 5 16 20 21 30 25 36 30 17 32 46 40 27 47 81 107 215 336 677 813 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11

Modes of Transmission (1984-2011)

Figure 8. Proportion of Types of Sexual Transmission, Jan 1984—Oct 2011 Figure 7. Proportion of Modes of HIV Transmission by Age-Group, 2011(n=1,869) In 2011, 95% (1,780) were infected through sexual

contact, 4% (80) through needle sharing among injecting drug users, <1% (3) through mother-to-child transmission and <1% (1) through blood transfusion; 5 had no reported data on mode of transmission (Table 2). There were 1,660 males and 120 females infected through sexual transmission. The age range of those infected through sexual transmission was 15-67 years old (median 27 years).

Of the 7,884 with HIV from 1984 to 2011, 91% (7,196) were infected through sexual contact, 3% (235) through needle sharing among injecting drug users, 1% (55) through mother-to-child transmission and <1% (20) through blood transfusion. Other modes of transmission are listed in Table 2. No data is available for 5% (375) of the cases. Cumulative data shows 39% (2,812) were infected through heterosexual contact, 37% (2,665) through homosexual contact, and 24% (1,719) through bisexual contact. From 2007 there has been a shift in the

predominant trend of sexual transmission from heterosexual contact (23%) to males having sex with

other males (77%) [Figure 8].

Table 2. Reported Mode of HIV Transmission Mode of Transmission Oct 2011

n=200 Jan—Oct 2011

n=1,869 Cumulative N=7,884

Sexual Contact 183 1,780 7,196

Heterosexual contact 28(15%) 324(18%) 2,812(39%) Homosexual contact 80(44%) 813(46%) 2,665(37%) Bisexual contact 75(41%) 643(36%) 1,719(24%)

Blood/Blood Products 0 1 20

Injecting Drug Use 17 80 235

Needle Prick Injury 0 0 3

Mother-to-Child 0 3 55

No Data Available 0 5 375

Overseas Filipino Workers (OFW)

In 2011, there were 227 HIV positive OFWs, comprising 12% of cases reported for the year [Figure 9]. Of these, 190 (84%) were males and 37 (16%) were females; all infected through sexual contact.

There were 1,750 HIV positive OFWs since 1984, comprising 22% of all reported cases [Figure 9]. Seventy-six percent (1,336) were males. Ages ranged from 18 to 69 years (median 35 years). Sexual contact (96%) was the predominant mode of transmission (Table 3). Eighty-four percent (1,475) were asymptomatic while 16% (275) were AIDS cases.

Table 3. Reported Mode of HIV Transmission Among OFWs Mode of Transmission Oct 2011

n= 21 Jan– Oct 2011

n= 227 Cumulative N=1,750

Sexual Transmission 21 227 1,688

Heterosexual contact 9(43%) 94(41%) 1,096(65%) Homosexual contact 7(33%) 62(27%) 340(20%) Bisexual contact 5 (24%) 71(31%) 252(15%)

Blood/Blood Products 0 0 10

Injecting Drug Use 0 0 1

Needle Prick Injury 0 0 3

No Data Available 0 0 48

0 200 400 600 800 1000 1200 1400 1600 1800

Number of Cases

OFW 1 2 0 3 9 5 10 7 14 29 31 24 35 27 51 67 60 79 96 94 88 94 130 106 122 164 175 227

Non-OFW 1 8 29 35 23 34 56 78 58 73 87 92 119 90 138 91 63 95 88 99 111 116 179 236 406 671 14161642

% of OFW 50% 20% 0% 8% 28% 13% 15% 8% 19% 28% 26% 21% 23% 23% 27% 42% 49% 45% 52% 49% 44% 45% 42% 31% 23% 20% 11% 12%

'84 '85'86 '87'88 '89'90 '91'92 '93'94 '95'96 '97'98 '99'00 '01'02 '03'04 '05'06 '07'08 '09'10 '11*

Figure 9. Number of OFWs Compared to Non-OFWs by Year (1984-2011*)

*No data available on Modes of Transmission for five (5) cases

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4 Philippine HIV & AIDS Registry

Blood Units Screened for HIV

* One blood donor can donate more than one blood unit.

** These are HIV positive blood units, not donors. Donors of HIV positive blood units may or may not be in the HIV & AIDS Registry.

From January to October 2011, 793 blood units were screened reactive for HIV and referred to RITM for confirmation. All these HIV reactive blood units were immediately sent to RITM and not transfused to anyone.

For October 2011, out of 119 screened HIV reactive blood units referred for confirmation, 22 units were confirmed positive for HIV by RITM, 87 were negative for HIV, and 10 were indeterminate results [Table 4].

National HIV/AIDS & STI Strategic Information and Surveillance Unit

National Epidemiology Center, Department of Health, Bldg. 19, San Lazaro Compound,

Sta. Cruz, Manila 1003 Philippines Tel: +632 651-7800 local 2926, 2952 Fax: +632 495-0513/743 6076 Email: HIVepicenter@gmail.com Website: http://www.doh.gov.ph

Table 4. Results of screened HIV reactive Blood Units

The Philippine HIV & AIDS Registry is the official record of the total number of laboratory-confirmed HIV positive individuals, AIDS cases and deaths, and HIV positive blood units in the Philippines. All individuals in the registry are confirmed by the STD/AIDS Cooperative Central Laboratory (SACCL) at San Lazaro Hospital.

While all blood units are confirmed by the Research Institute for Tropical Medicine (RITM). Both are National Reference Laboratories (NRL) of the Department of Health (DOH).

Mandatory HIV testing is unlawful in the Philippines (RA 8504). The process of reporting to the Registry is as follows: All blood samples from accredited HIV testing facilities that are screened HIV reactive are sent to SACCL (individuals) or RITM (blood units) for confirmation. Confirmed HIV positive individuals and blood units are reported to the DOH-National Epidemiology Center (NEC), and are recorded in the Registry.

The Registry is a passive surveillance system. Except for HIV confirmation by the NRL, all other data submitted to the Registry are secondary and cannot be veri- fied. An example would be an individual’s reported place of residence. The Registry is unable to determine if this reported address is where the person got infected, or where the person lived after being infected, or where the person is presently living, or whether the address is valid. This limitation has major implications to data interpretation. Thus, readers are cautioned to carefully weigh the data and consider other sources of information prior to arriving at conclusions.

Note: The following information is from the National Voluntary Blood Safety Program (NVBSP) which monitors blood safety of donated blood. HIV reactive blood units are referred to the Research Institute for Tropical Medicine (RITM) for confirmation.

RITM is the National Reference Laboratory for the NVBSP.

Program Related Information

Of the 200 HIV positive cases reported in October 2011, one was classified as AIDS. Seventy-five percent of the cases received information on HIV prevention, services available for HIV cases, implications of an HIV positive result from screening and confirmation. Their sources of information were one-on-one counseling, group counseling, pre-departure orientation seminar (PDOS), pamphlets, videos, internet and seminars.

Figure 10. Blood Units Screened Reactive for HIV by Year (2008-2011)

Monthly Report 2011

Blood units*

referred for confirmation

Confirmed Positive

Indetermi- nate

January 85 11 0

February 67 15 2

March 76 14 1

April 74 20 1

May 48 10 0

June 118 32 4

July 78 22 1

August 80 18 2

September 48 10 0

October 119 22 10

November December Total for the year

(Jan –Oct only) 793 174 21

0 50 100 150

2008 73 65 48 47 54 23 52 49 47 58 38 41 595

2009 51 32 72 70 44 72 56 59 60 68 50 33 667

2010 52 89 72 79 43 80 62 46 88 88 52 69 772

2011 85 67 76 74 48 118 78 80 48 119 793

J an Feb M ar c h A pr i l M ay J une J ul y A ug Sep Oc t Nov Dec T ot al