DEPARTMENT OF HEALTH NATIONAL EPIDEMIOLOGY CENTER

NOVEMBER 2012

Newly Diagnosed HIV Cases in the Philippines

In November 2012, there were 284 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 34% higher compared to the same period last year (n=212 in 2011) [Figure 1]. Most of the cases (97%) were males. The median age was 28 years (age range: 17-59 years). The 20-29 year (52%) age-group had the most number of cases. Forty-seven percent (134) of the reported cases were from the National Capital Region (NCR). Reported mode of transmission were sexual contact (282) and needle sharing among injecting drug users (2). [Table 2, page 3]. Males having sex with other males (82%) were the predominant type of sexual transmission [Figure 2]. Most (92%) of the cases were still asymptomatic at the time of reporting [Figure 3]. AIDS Cases Of the 284 HIV positive cases, twenty-four were reported as AIDS cases, all were males. The median age is 29 years (age range: 20-45 years). Ninety-six percent (23) acquired the infection through sexual contact (15 homosexual, 4 heterosexual and 4 bisexual) and 1 acquired through needle sharing among injecting drug users There was no reported death for this month.
Proportion of Cases

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
Nov 2012 Jan-Nov 2012 Cumulative 19842012

284 260 24 275 9 70 0 0

3,045 2,873 172 2,903 142 818 4 11

11,409 10,255 1,154 9,793* 1,605* 2,735 62 353

Philippine HIV and AIDS Registry

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

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

350

Number of New Cases

300 250 200 150 100 50 0 J an 2010 2011 2012 143 152 212 Feb 130 159 274 M ar 120 172 313 A pr 154 171 233 M ay 153 184 273 Jun 109 178 295 Jul 131 204 278 A ug 108 196 272 Sep 153 253 316 Oc t 104 200 295 Nov 112 212 284 D ec 174 268

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

Het erosexual

Overseas Filipino Workers (OFW) Thirty-five of the 284 (12%) reported cases were OFWs [Figure 11, page 4]. There were 32 males and 3 females. The median age was 32 years (age range: 21-52 years). All acquired the infection through sexual contact (12 heterosexual, 16 homosexual and 7 bisexual).

52
75%

31 3,306 76 2,773

Bisexual Homosexual

80
50%

25%

150

105

4,438

0%

N o v 2 0 12

N o v 2 0 11

C umul at ive

Figure 3. Number of HIV/AIDS Cases Reported in the Philippines by Year, Jan 1984 to November 2012 (N=11,409)
3250 3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0
T OT A L A sympt omat i c A I DS D eat 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 8 '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 '08 528 505 23 7 '09 835 804 31 1 '10 1591 1562 29 3 '11 2, 349 2, 239 110 *19 '12 3, 045 2, 873 172 11

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

Philippine HIV/AIDS Registry

November 2012

AIDS Cases (1984-2012)

Of the 3,045 HIV positive cases in 2012, one hundred seventy-two were reported as AIDS cases. Of these, 166 were males and 6 were females. Ages ranged from 7-81 years (median 31 years). Ninety-eight percent (169) acquired the infection through sexual contact (98 homosexual, 41 bisexual and 30 heterosexual), 1% (2) mother-to-child transmission, and 1% (1) injecting drug use. From 1984 to 2012, there were 1,154 AIDS cases reported. Seventy-seven percent (888) were males. Median age is 34 years (age range: 1-81 years). Of the reported AIDS cases, 353 (31%) had already died at the time of reporting. Sexual contact was the most common mode of HIV transmission, accounting for 94% (1,087) of all reported AIDS cases. Almost half (504) of sexual transmission was through heterosexual contact, followed by homosexual contact (424) then bisexual contact (159). Other modes of transmission include: mother-to-child transmission (20), blood transfusion (10), injecting drug use (7), and needle prick injuries (2) [Figure 4]. Two percent (28) of the AIDS cases did not report mode of HIV transmission.
Figure 4. Proportion of Modes of Transmission of AIDS Cases by Year, Jan 1984November 2012
100%

75%

Proportion of Cases

50%

25%

0% 1984-2008 N eedl e P r i ck B l ood T r ansf usi on M T CT I DU B i sex ual C ont act H omosexual C ont ac t H et er osex ual Cont act 2 10 16 4 64 246 442 2009 0 0 1 0 8 16 6 2010 0 0 0 0 7 19 3 2011 0 0 1 2 39 45 23 2012 0 0 2 1 41 98 30

*Note: 28 did not report mode of transmission

Demographic Characteristics (1984-2012)

Ninety-five percent of the 3,045 cases were males (2,903). Ages ranged from 2 to 81 years old (median 28 years). The 20-29 year old age group had the most (58%) number of cases for 2012. For the male age group, the most number of cases were found among the 20-24 years old (24%), 25-29 years old (34%), and 30-34 years old (19%) [Figure 6]. From 1984 to 2012, there were 11,409 HIV Ab sero-positive cases reported (Table 1), of which 10,255 (90%) were asymptomatic and 1,154 (10%) were AIDS cases. As shown in Figure 6, there is a significant difference in the number of male and female cases reported. Eighty-six percent (9,793) were males. Ages ranged from 1-81 years (median 29 years). The age groups with the most number of cases were: 20-24 years (21%), 25-29 (29%), and 30-34 years (19%) [Figure 6].
Figure 5. Proportion of Sex & Age-Groups in Nov 2012 & Jan-Nov 2012
100%

Proportion of Cases

75%

50%

25%

0% Nov 2012 (M ) 50 & ol der 35-49yo 25-34yo 15-24yo 1-14yo 6 56 144 69 0 Nov 2012 (F) 1 3 4 1 0 2012 ( M al e) 59 493 1, 557 791 3 2012 (Femal e) 11 45 58 27 1

Figure 6. 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 1 5-19yo

1984-2007

2008

2009

2010

2011

2012

Number of Male Cases

3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0

<1 5yo
0 250 500 750 1000 1250 1500

Number of Female Cases

1750 2000 2250 2500 2750 3000 <15y o 15-19yo 8 3 5 4 0 33 20-24yo 19 36 28 13 8 191 25-29y o 37 44 21 19 14 225 30- 34yo 21 23 34 21 8 202 35-39yo 22 21 15 20 10 154 40-44yo 11 10 9 14 9 90 45- 49y o 12 8 7 7 3 35 50 & ol der 11 9 4 5 3 44

<15yo 2012 2011 2010 2009 2008 1984- 2007 3 1 1 1 2 27

15- 19y o 85 76 50 22 11 15

20-24yo 706 589 405 179 92 157

25-29yo 993 739 455 227 140 374

30-34y o 564 378 256 124 90 414

35- 39y o 265 193 128 90 59 364

40-44yo 144 117 81 41 36 279

45-49yo 84 51 42 18 23 185

50 & ol der 59 49 48 29 20 176

2012 2011 2010 2009 2008 1984- 2007

1 2 2 1 0 21

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

Philippine HIV/AIDS Registry

November 2012

Geographic Distribution
Region I II III IVA IVB V VI VII VIII IX X XI XII CAR CARAGA ARMM NCR % of Cases 2% 1% 8% 17% 1% 0 4% 6% 1% 0
0%

Figure 7. New HIV Cases by Region, November 2012

R OT C 14 % R eg 3 8% R eg 4 A 17%

Proportion of Cases

In November 2012, bulk of the new HIV cases came from NCR, Region 4A, Region 3, Region 11, and Region 7 [Fig 7]. The three highest reporting regions were NCR, 4A and 3

Fig 8. Comparison of Proportion of HIV Cases by Region & Year

100%

75%

50%

25%

1% 8% 2% 1% 2% 0 47%

2012

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

1984-2012 2% 9% 12% 3% 9% 6% 51% 8%

R eg 7 6% R eg 11 8%

R eg1 R eg3 R eg4A R eg6 R eg7 R eg11

2% 7% 13% 3% 9% 7% 51% 8%

NCR 4 7%
*ROTC: Rest of the Country

N CR R OT C*

Modes of Transmission (1984-2012)

In 2012, 94% (2,871) were infected through sexual contact, 6% (170) through needle sharing among injecting drug users, and <1% (4) through mother-to-child transmission (Table 2). There were 2,747 males and 124 females infected through sexual transmission. The age range of those infected through sexual transmission was 15-81 years old (median 28 years). Of the 11,409 HIV positive cases reported from 1984 to 2012, 92% (10,517) were infected through sexual contact, 4% (435) through needle sharing among injecting drug users, 1% (59) through mother-to-child transmission, <1% (20) through blood transfusion and needle prick injury <1% (3) [Table 2]. No data is available for 3% (375) of the cases.
Table 2. Reported Mode of HIV Transmission
Mode of Transmission Sexual Contact Heterosexual contact Homosexual contact Bisexual contact Blood/Blood Products Injecting Drug Use Needle Prick Injury Mother-to-Child No Data Available Nov 2012 n=284 282 52(18%) 150(53%) 80(28%) 0 2 0 0 0 Jan-Nov 2012 n=3,045 2,871 430(15%) 1,550(54%) 891(31%) 0 170 0 4 0 Cumulative N=11,409 10,517 3,306(31%) 4,438(42%) 2,773(26%) 20 435 3 59 375

Cumulative data shows 31% (3,306) were infected through heterosexual contact, 42% (4,438) through homosexual contact, and 26% (2,773) through bisexual contact. From 2007 there has been a shift in the predominant trend of sexual transmission from heterosexual contact (20%) to males having sex with other males (80%) [Figure 9].
Figure 9. Proportion of Types of Sexual Transmission, Jan 1984November 2012
100% 90% 80%

Figure 10. HIV Transmission by Age-Group, 2012 (n=3,045)

1650 1575 1500 1425 1350 1275 1200 1125 1050 975 900 825 750 675 600 525 450 375 300 225 150 75 0 <7yo B l ood T r ans f us i on - Femal e M at er nal t o C hi l d 1 7- 14y o 3 15-17y o 1 2 2 7 18-24yo 3 55 23 28 243 454 25-34y o 9 51 49 168 498 840 35-49yo 4 43 41 87 137 226 50&ol der 2 11 23 11 23

Proportion of Cases

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

'84 '85 '86 7 2 1 24 0 4 '87 '88 24 4 3 16 2 4 '89 '90 19 2 6 35 4 8 '91 '92 30 4 15 41 5 5 '93 '94 47 2 16 58 3 20 '95 '96 56 8 21 81 7 30 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12

I nj ect i ng Dr ug U se - Femal e I nj ect i ng Dr ug U se - M al e Het er osexual C ont act - Femal e Het er osexual C ont act - M al e B i s exual Cont ac t Homos exual Cont ac t

H eterosexual Bisexual H omosexual

1 0 0

82 138 114 93 7 25 9 36 10 30 8 17

128 129 129 123 131 193 139 160 216 274 388 430 5 32 8 46 14 40 12 27 14 47 26 81 74 127 252 467 806 891 107 215 336 680 10361550

Number of Cases

Philippine HIV/AIDS Registry

November 2012

Overseas Filipino Workers (OFW)

In 2012, there were 330 HIV positive OFWs, comprising 11% of cases reported for the year [Figure 11]. Of these, 290 (88%) were males and 40 (12%) were females. All were infected through sexual contact. There were 2,118 HIV positive OFWs since 1984, comprising 19% of all reported cases [Figure 11]. Seventy-eight percent (1,660) were males. Ages ranged from 18 to 69 years (median 34 years). Sexual contact (97%) was the predominant mode of transmission (Table 3). Eighty-six percent (1,819) were asymptomatic while 14% (299) were AIDS cases.
Table 3. Mode of HIV Transmission Among OFWs
Mode of Transmission Sexual Transmission Heterosexual contact Homosexual contact Bisexual contact Blood/Blood Products Injecting Drug Use Needle Prick Injury No Data Available Nov 2012 n=35 35 12(34%) 16(46%) 7(20%) 0 0 0 0 Jan-Nov 2012 n=330 330 102(31%) 133(40%) 95(29%) 0 0 0 0 Cumulative N=2,118 2,056 1,200(58%) 488(24%) 368(18%) 10 1 3 48
3000 2800 2600 2400 2200 2000 1800 1600 1400 1200 1000 800 600 400 200 0
'8 4 1 1 '8 5 2 8 '8 6 0 29 0% '8 7 3 35 8% '8 8 9 23 '8 9 5 34 '9 0 10 56 15 % '9 1 7 78 8% '9 2 14 58 '9 3 29 73 '9 4 31 87 '9 5 24 92 '9 6 35 119 '9 7 27 90 '9 8 51 13 8 '9 9 67 91 '0 0 60 63 '0 1 79 95 '0 2 96 88 '0 3 93 10 0 '0 4 86 113 '0 5 92 118 '0 6 13 0 17 9 '0 7 10 6 2 36 '0 8 12 2 '0 9 16 4 '10 17 4 '11 271 '12 3 30 OFW Non - OFW % of OFW

Figure 11. Number of OFWs Compared to Non-OFWs by Year (1984-2012)

Number of Cases

4 0 6 6 7 1 14 17 2 0 7 8 2 7 15 11% 12 % 11%

5 0% 20 %

2 8 % 13 %

19 % 2 8 % 2 6 % 2 1% 2 3 % 2 3 % 2 7 % 4 2 % 4 9 % 4 5 % 5 2 % 4 8 % 4 3 % 4 4 % 4 2 % 3 1% 2 3 % 2 0 %

Blood Units Confirmed for HIV

As of November 2012, 216 blood units were confirmed positive for HIV by RITM. 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 t hey underwent voluntary counseling and testing as individuals.
Table 4. Number of Confirmed HIV Positive Blood Units Month January February March April May June July August September October November December Total 216 2012 17 18 34 21 21 9 22 25 13 14 22 2011 11 15 14 20 10 32 22 18 18 22 17 18 217

PLHIV on Anti-Retroviral Therapy

As of September 2012, there are 3,115* People Living with HIV presently on Anti-Retroviral Therapy (ART). Data for July and August is not yet available.
Table 5. Number of PLHIV on ART Month January February March April May June July August September October November December 2012 2,087 2,169 2,278 2,498 2,633 2,761 2,914 3,026 3,115
Data not yet available Data not yet available * This is not a cumulative number. It does not include those who already have died, left the country, or decided to stop taking ART.
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

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

Philippine HIV & AIDS Registry Report Editorial Team:

Patricia Isabel T. Gayya, RN, MSPH HIV Surveillance Assistant, HIV Unit Krizelle Anne G. Ronquillo, RSW Asst. HIV Surveillance Officer, HIV Unit Noel S. Palaypayon, RN, MGM-ESP HIV Surveillance Officer, HIV Unit Genesis May J. Samonte, MD, PHSAE Epidemiologist, HIV Unit Agnes B. Segarra, MD, PHSAE Chief, SRAE, NEC Enrique A. Tayag, MD, PHSAE,FPSMID,CESO III Director IV, NEC

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.