DEPARTMENT OF HEALTH NATIONAL EPIDEMIOLOGY CENTER

JANUARY 2012

Newly Diagnosed HIV Cases in the Philippines

In January 2012, there were 212 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 39% higher compared to the same period last year (n=152 in 2011) [Figure 1].
Table 1. Quick Facts
Demographic Data Total Reported Cases Asymptomatic Cases AIDS Cases Males Females Youth 15-24yo Children <15yo Reported Deaths due to AIDS
January 2012 Cumulative Data: 19842012

212 208 4 203 9 57 1 1

8,576 7, 601 975 7,093* 1,472* 1,974 59 342

Philippine HIV and AIDS Registry

Most of the cases (96%) were males. The median age was 27 years (age range:7-56 years). The 20-29 year (61%) age-group had the most number of cases. Fifty-eight percent (123) of the reported cases were from the National Capital Region (NCR). Reported mode of transmission were sexual contact (208), needle sharing among injecting drug users (3), and mother-to-child transmission (1) [Table 2, page 3]. Males having sex with other Males (90%) were the predominant type of sexual transmission [Figure 2]. Most (98%) of the cases were still asymptomatic at the time of reporting [Figure 3]. AIDS Cases Of the 212 HIV positive cases, four were reported as AIDS cases, all were males. The median age is 34 years (age range: 7-47 years). Three acquired the infection through homosexual contact, and one through motherto-child transmission. Of the AIDS cases, there was one reported death for this month; a seven-year old male. Overseas Filipino Workers (OFW) Thirty-two of the 212 (15%) reported cases were OFWs [Figure 9, page 3]. There were 30 males and 2 females. The median age was 31 years (age range: 19-54 years). All cases acquired the infection through sexual contact (4 heterosexual, 12 homosexual, and 16 bisexual).

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

Figure 1. Number of New HIV Cases per Month (2010-2012)

275

Number of New Cases

250 225 200 175 150 125 100 75 50 25 0 Jan 2010 2011 2012 143 152 212 Feb 130 159 M ar 120 172 A pr 154 171 M ay 153 184 Jun 109 178 Jul 131 204 A ug 108 196 Sep 153 253 Oct 104 200 Nov 112 212 Dec 174 268

Figure 2. Comparison of the Proportion of Types of Sexual Transmission in 2012, 2011 & Cumulative Data (1984-2012)
100%

21 82

Heterosexual

Proportion of Cases

28 2,897 49 1,964

Bisexual Homosexual

80%

60%

40%

20%

105

74

2,993

0%

Januar y 2 0 12

Januar y 2 0 11

C umulat ive

Figure 3. Number of HIV/AIDS Cases Reported in the Philippines by Year, Jan 1984 to January 2012 (N=8,576)
2500 2250 2000 1750 1500 1250 1000 750 500 250 0
T OT A L A sympt omat i c A I DS Deat h '84 2 0 2 2 '85 10 6 4 4 '86 29 18 11 10 '87 38 25 13 12 '88 32 21 11 9 '89 39 29 10 8 '90 66 48 18 15 '91 85 68 17 13 '92 72 51 21 13 '93 102 64 38 11 '94 118 61 57 19 '95 116 65 51 24 '96 154 104 50 27 '97 117 94 23 10 '98 189 144 45 16 '99 158 80 78 17 '00 123 83 40 9 '01 174 117 57 20 '02 184 140 44 11 '03 193 139 54 11 '04 199 160 39 8 '05 210 171 39 16 '06 309 273 36 18 '07 342 311 31 10 '08 528 506 22 7 '09 835 804 31 1 '10 1591 1564 27 2 '11 2, 349 2, 247 102 *17 '12 212 208 4 1

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

Philippine HIV/AIDS Registry

January 2012

AIDS Cases (1984-2012)

From 1984 to 2012, there were 975 AIDS cases reported, 73% (715) were males. Median age was 35 years (range 1-72 years). Of the reported AIDS cases, 342 (35%) had already died at the time of reporting. Sexual contact was the most common mode of HIV transmission, accounting for 93% (910) of all reported AIDS cases. More than half (474) of sexual transmission was through heterosexual contact, followed by homosexual contact (324) then bisexual contact (112). Other modes of transmission include: mother-tochild transmission (19), 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.
Fig 4. Proportion of Modes of Transmission of AIDS Cases by Year, Jan 1984January 2012
100%

75%

Proportion of Cases

50%

25%

0% 1984-2008 Needle Prick Blood Transfusion MTCT IDU Bisexual Contact Homosexual Contact Heterosexual Contact 2 10 16 4 64 245 442 2009 0 0 1 0 8 16 6 2010 0 0 0 0 7 17 3 2011 0 0 1 2 33 43 23 2012 0 0 1 0 0 3 0

*Note: 28 did not report mode of transmission

Demographic Characteristics (1984-2012)

From 1984 to 2012, there were 8,576 HIV Ab sero-positive cases reported (Table 1), of which 7,601 (89%) were asymptomatic and 975 (11%) were AIDS cases. As shown in Figure 5, there is a significant difference in the number of male and female cases reported. Eighty-three percent (7,093) 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 5].
Figure 5. Comparison of the Distribution of Male and Female HIV Cases by Age-Group and Certain Highlighted Years

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

1984-2007

2008

2009

2010

2011

2012

Number of Male Cases

2250 2000 1750 1500 1250 1000 750 500 250 0

1 9yo 5-1 <1 5yo

0 250 500 750 1000

Number of Female Cases

1250 1500 1750 2000 2250

<15yo 2012 2011 2010 2009 2008 1984-2007 1 1 1 1 2 27

15-19yo 3 76 50 22 11 15

20-24yo 52 589 405 179 92 157

25-29yo 73 739 455 227 140 374

30-34yo 43 378 256 124 90 414

35-39yo 14 193 128 90 59 364

40-44yo 6 117 81 41 36 279

45-49yo 8 51 42 18 23 185

50 & older 3 49 48 29 20 176

2012 2011 2010 2009 2008 1984-2007

<15yo 0 2 2 1 0 21

15-19yo 1 3 5 4 0 33

20-24yo 1 36 28 13 8 191

25-29yo 4 44 21 19 14 225

30-34yo 0 23 34 21 8 202

35-39yo 0 21 15 20 10 154

40-44yo 2 10 9 14 9 90

45-49yo 0 8 7 7 3 35

50 & older 1 9 4 5 3 44

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

Philippine HIV/AIDS Registry

January 2012

Geographic Distribution
In January 2012, bulk of the new HIV cases came from NCR, Region 4A, Region 3, Region 11, Region 6, and Region 7 [Figure 6]. The three highest reporting regions were NCR, Region 4A, and Region 3.
Figure 6. Proportion of New HIV Cases by Region, January 2012
Reg1 1% Reg11 7% Reg3 8% Reg12 1% Reg2

Figure 7. Comparison of Proportion of HIV Cases by Region in January 2012, 2007-2011, & Cumulative Data (1984-2012)
100%

75%

Proportion of Cases

50%

25%

0%

Reg4A 12% NCR 58% Reg5

January 2012 Reg1 Reg3 1% 8% 12% 6% 4% 7% 58% 3%

2007-2011 2% 6% 12% 3% 9% 7% 54% 9%

1984-2012 2% 9% 12% 3% 8% 5% 51% 9%

Reg6 6%
Reg7 CAR 4% 1%

Reg4A Reg6 Reg7 Reg11 NCR ROTC*

*Rest of the Country

Modes of Transmission (1984-2012)

In 2012, 98% (208) were infected through sexual contact, 1% (3) through needle sharing among injecting drug users, and <1% (1) through mother-to-child transmission (Table 2). There were 199 males and 9 females infected through sexual transmission. The age range of those infected through sexual transmission was 18-56 years old (median 27 years). Of the 8,576 with HIV from 1984 to 2012, 92% (7,854) were infected through sexual contact, 3% (268) through needle sharing among injecting drug users, 1% (56) 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 4% (375) of the cases.
Table 2. Reported Mode of HIV Transmission
Mode of Transmission Sexual Contact Jan 2012 n=212 208 Cumulative N=8,576 7,854

Heterosexual contact Homosexual contact Bisexual contact

Blood/Blood Products Injecting Drug Use Needle Prick Injury Mother-to-Child No Data Available

21(10%) 105(50%) 82(39%)

0 3 0 1 0

2,897(37%) 2,993(38%) 1,964(25%)

20 268 3 56 375

Cumulative data shows 37% (2,897) were infected through heterosexual contact, 38% (2,993) through homosexual contact, and 25% (1,964) through bisexual contact. From 2007 there has been a shift in the predominant trend of sexual transmission from heterosexual contact (22%) to males having sex with other males (78%) [Figure 9].
Figure 8. Proportion of Types of Sexual Transmission, Jan 1984Jan 2012
100% 90%

Fig 9. HIV Transmission by Age-Group, 2012 (n=212)

140

120

Number of Cases

80%

100

Proportion of Cases

70% 60% 50% 40% 30% 20% 10% 0%

80

60

40

20

<7yo Blood Transfusion - Female Maternal to Child Injecting Drug Use - Female -

7-14yo 1 -

15-17yo -

18-24yo 2 20 35

25-34yo 2 4 8 52 54

35-49yo 1 2 3 10 14

50&older 1 1 2

'84 '85 1 0 0 7 2 1

'86 '87 24 0 4 24 4 3

'88 '89 '90 16 2 4 19 2 6 35 4 8

'91 '92 '93 30 4 15 41 5 5 47 2 16

'94 '95 58 3 20 56 8 21

'96 '97 '98 81 7 30

'99 '00 '01

'02 '03

'04 '05 '06

'07 '08 '09

'10 '11

'12

Injecting Drug Use - Male Heterosexual Contact - Female Heterosexual Contact - Male Bisexual Contact Homosexual Contact

Heterosexual Bisexual Homosexual

82 138 114 93 128 129 129 123 131 193 139 160 216 274 388 21 7 25 9 36 10 30 8 17 5 32 8 46 14 40 12 27 14 47 26 81 74 127 252 467 806 82 107 215 336 680 1036 105

Philippine HIV/AIDS Registry

January 2012

Overseas Filipino Workers (OFW)

In 2012, there were 32 HIV positive OFWs, comprising 15% of cases reported for the year [Figure 10]. Of these, 30 (94%) were males and 2 (6%) were females; all infected through sexual contact. There were 1,826 HIV positive OFWs since 1984, comprising 21% of all reported cases [Figure 10]. Seventy-seven percent (1,405) were males. Ages ranged from 18 to 69 years (median 35 years). Sexual contact (97%) was the predominant mode of transmission (Table 3). Eighty-five percent (1,547) were asymptomatic while 15% (279) were AIDS cases.
Table 3. Mode of HIV Transmission Among OFWs
Mode of Transmission Sexual Transmission Jan 2012 n=32 32 Cumulative N=1,826
2200 2000 1800 1600 1400 1200 1000 800 600 400 200 0
OFW Non-OFW % of OFW '84 1 1 '85 2 8 '86 0 29 '87 3 35 '88 9 23 '89 5 34 '90 10 56 '91 7 78 '92 14 58 '93 29 73 '94 31 87 '95 24 92 '96 35 119 '97 27 90 '98 51 '99 67 '00 60 63 '01 79 95 '02 96 88 '03 94 99 '04 88 '05 94 '06 '07 '08 '09 '10 '11 '12 32

Figure 10. Number of OFWs Compared to Non-OFWs by Year (1984-2012)

Heterosexual contact Homosexual contact Bisexual contact

Blood/Blood Products Injecting Drug Use Needle Prick Injury No Data Available

4(12%) 12(38%) 16(50%)

0 0 0 0

1,107(63%) 368(21%) 289(16%)

10 1 3 48

Number of Cases

1,764

130 106 122 164 175 271

138 91

111 116 179 236 406 671 1416 2078 180

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% 15%

Blood Units Confirmed for HIV

In January 2012, 17 blood units were confirmed positive for HIV by RITM. This was 55% higher compared to the same period last year (Table 4). There is no available data yet on the total number of blood units donated. These are confirmed positive blood units, not blood donors. One donor can donate more than one blood unit. HIV positive blood donors may not be in the HIV & AIDS Registry unless they underwent voluntary counseling and testing as individuals.
Table 4. Number of Confirmed HIV Positive Blood Units Monthly Report January February March April May June July August September October November December Total for the year (Jan only) 17 2012 17 2011 11 15 14 20 10 32 22 18 10 22 17 18 209

PLHIV on Anti-Retroviral Therapy

As of January 2012, there are 2,087 People Living with HIV presently on Anti-Retroviral Therapy (ART).
Table 5. Number of PLHIV on ART Month January February March April May June July August September October November December 2012 2,087*
Treatment Hubs in the Philippines 1. Baguio General Hospital and Medical Center 2. Ilocos Training and Regional Medical Center 3. Cagayan Valley Medical Center 4. Jose B. Lingad Medical Center 5. San Lazaro Hospital 6. Philippine General Hospital 7. Research Institute for Tropical Medicine 8. Makati Medical Center 9. The Medical City 10. Bicol Regional Training and Teaching Hospital 11. Western Visayas Medical Center 12. Corazon Locsin Montelibano Memorial Regional Hospital 13. Vicente Sotto Memorial Medical Center 14. Gov. Celestino Gallares Memorial Hospital 15. Zamboanga City Medical Center 16. Southern Philippines Medical Center

* This is not a cumulative number. It does not include those who already have died, left the country, or decided to stop taking ART.

National HIV/AIDS & STI Strategic Information and Surveillance Unit

Philippine HIV & AIDS Registry

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 verified. An example would be an individuals 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.

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 Email: HIVepicenter@gmail.com Website: http://www.doh.gov.ph