” Fools rush in where wise men never go”
New HIV case every 1.5 hours in Philippines
The Philippine National AIDS Council (PNAC) has warned lawmakers that HIV is spreading rapidly, with a 523% increase in new cases compared to 2008.
PNAC executive director Ferchito Avelino told a House of Representatives committee on health that the Philippines was seeing a ‘fast and furious’ increase in HIV infections, with a new infection recorded every one and a half hours.
‘We are looking at a certain portion of the population who is now experiencing an increase in HIV cases amongst them … and all generalized epidemics start with a concentrated epidemic,’ Avelino said, warning that the wider population would pay a price if the rate of infections was not checked among gay men and drug users.
Avelino identified 70 Philippines cities that the government should prioritize in addressing the spread of HIV.
‘We need to prioritize and to scale up [the] response in a more coordinated manner,’ he said.
‘What’s important is our government, whether national or local, should lead in the response and be able to accept the fact that we need to do something and we have to do it fast.’
Avelino called for better education around HIV, with some people believing it could be spread by mosquito bites.
‘It’s important to have mandatory education and knowledge dissemination in the community,’ he said, urging greater education around condom use for men who have sex with men.
There are 14,000 known cases of HIV infection in the Philippines but PNAC fears the number may be much higher as many people do not get tested and people can be infected for years before they begin to show symptoms.
Global epidemiology of HIV infection in men who have sex with men
Chris Beyrer et al.
In 2012, HIV epidemics in MSM are expanding in countries of all incomes. Available
incidence data from Thai, Chinese and Kenyan samples of MSM suggest those epidemics
are in rapid expansion phases.
HIV infection rates among MSM are substantially higher than those of general population adult males in every epidemic assessed. A comprehensive review of the burden of HIV disease in MSM worldwide found that pooled HIV prevalence ranged from a low of 3% in the Middle East and North Africa to a high of 25.4% of MSM in the Caribbean.
Biological and behavioral factors make the dynamics of the MSM epidemic different than for general populations.
o The disproportionate HIV disease burden in MSM is explained largely by the high per-act and per-partner transmission probability of HIV transmission in receptive anal sex.
Modeling suggests that If the transmission probably of receptive anal sex was similar
to that associated with unprotected vaginal sex, five year cumulative HIV incidence in
MSM would be reduced by 80-90%.
o Many MSM practice both insertive and receptive roles in sexual intercourse, which helps HIV spread in this population. Were MSM limited to one role, HIV incidence in this population over five years would be reduced 19-55% in high-prevalence
o Taking both factors (per act transmission probability and role versatility) into account explains 98% of the difference between HIV epidemics among MSM and heterosexual populations—behavioral differences account for 2% of the
Successes and challenges of prevention of HIV prevention in men who have sex with men Patrick Sullivan et al.
HIV prevention approaches to date have been insufficient to curb the HIV epidemics in MSM.
Because of the high biological risks of HIV transmission associated with anal intercourse,the bar for HIV prevention may be higher for MSM. To date, no single HIV prevention approach is sufficient to control the expansion of HIV epidemics among MSM.
In most parts of the world, restricted resources and legal barriers complicate delivery of HIV prevention to MSM. Policy changes to align resources with the magnitude of HIV epidemics among MSM, and to allow MSM to safely access medical care and prevention services, are urgently needed to create an enabling environment for prevention, and an adequately resourced prevention response.
Several behavioral interventions are somewhat efficacious in reduction of risk behavior among MSM, but do not effectively decrease the incidence of new HIV infections. Behavioral interventions alone are necessary, but insufficient, to address HIV in MSM.
Coordinated behavioral, biomedical and structural interventions that incorporate efficacious strategies could substantially reduce the incidence of HIV in MSM if delivered at scale.
Modeling suggests that, with sufficient coverage, appropriate “packages” of already available interventions are sufficient to avert at least a quarter of new HIV infections in
MSM in diverse countries in the next decade.
Despite the potential of current prevention tools, we must continue to develop new prevention modalities. For example, we need continued research into a rectal microbicide, into the optimization of oral PrEP, into an HIV vaccine, and into the efficacy of treatment as prevention for HIV positive MSM.
Making an impact in HIV epidemics among MSM will require achieving adequate coverage of packages of prevention interventions. According to our data, it may be necessary to reach more than half of at-risk MSM to have substantial impact. To achieve such coverage, policy reforms, including decriminalization of male-male sex, are needed to create enabling environments in which men can safely access care and prevention services.