DEPARTMENT OF HEALTH NATIONAL EPIDEMIOLOGY CENTER

APRIL 2013

Newly Diagnosed HIV Cases in the Philippines

In April 2013, there were 388 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 67% higher compared to the same period last year (n=233 in 2012) [Figure 1].
Table 2. Percentage of HIV Cases per Region (Apr 2013)
Region I II III IVA IVB V VI VII VIII IX X XI XII CAR CARAGA ARMM NCR % of Cases 2% 1% 5% 16% <1% 1% 4% 14% 1% 1% 1% 8% 2% 1% 1% 1% 43%

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
Apr 2013 Jan-Apr 2013 Cumulative 19842013

388 363 25 368 20 119 0 0

1,477 1,393 84 1,404 73 414 0 0

13,179 11,926 1,253 11,480* 1,688* 3,228 62 353

Philippine HIV and AIDS Registry

Most of the cases (95%) were males. The median age was 28 years (age range: 17-63 years). The 20-29 year (61%) age group had the most number of cases. Reported mode of transmission were sexual contact (356) and

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

Figure 1. Number of New HIV Cases per Month (2011-2013)

400

Number of New Cases

needle sharing among injecting drug users (32) [Table 3, page 2]. Males having sex with other males (81%) type were of the sexual predominant

350 300 250 200 150 100 50 0 J an 2011 2012 2013 152 212 380 Feb 159 274 339 M ar 172 313 370 A pr 171 233 388 M ay 184 273 J un 178 295 Jul 204 278 A ug 196 272 Sep 253 316 Oc t 200 295 Nov 212 284 Dec 268 293

transmission [Figure 2]. Most (94%) of the cases were still asymptomatic at the time of reporting [Figure 3]. In April 2013, bulk of the new HIV cases came from NCR, Region 4A, Region 7, Region 11, and Region 3 [Table 2]. The three highest reporting regions were NCR, 4A and 7.

Figure 2. Comparison of the Proportion of Types of Sexual Transmission in 2013, 2012 & Cumulative Data (1984-2013)
100%

Het erosexual

Proportion of Cases

69
75%

26 3,608 71 3,327

Bisexual Homosexual

111
50%

25%

176

113

5,305

0%

A p r 2 0 13

A p r 2 0 12

C umul at i ve

Figure 3. Number of HIV/AIDS Cases Reported in the Philippines by Year, Jan 1984 to April 2013 (N=13,179)
3500 3250 3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0
T OT A L A s y mpt 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 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 '12 '13 1, 477 1, 393 84 0

2, 349 3, 338 2, 239 3, 152 110 *19 186 11

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

Philippine HIV/AIDS Registry

April 2013

Demographic Characteristics (1984-2013)

Ninety-five percent of the 1,477 cases in 2013 were males (1,404). Ages ranged from 17 to 63 years old (median 28 years). The 20-29 year old age group had the most (59%) number of cases for 2013. For the male age group, the most number of cases were found among the 20-24 years old (25%), 25-29 years old (34%), and 30-34 years old (20%) [Figure 4]. From 1984 to 2013, there were 13,179 HIV Ab sero-positive cases reported (Table 1), of which 11,926 (90%) were asymptomatic and 1,253 (10%) were AIDS cases. As shown in Figure 4, there is a significant difference in the number of male and female cases reported. Eighty-seven percent (11,480) were males. Ages ranged from 1-81 years (median 29 years). The age groups with the most number of cases were: 20-24 years (22%), 25-29 (30%), and 30-34 years (19%) [Figure 4]. Figure 4. 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 5-1 9yo

1984-2008

2009

2010

2011

2012

2013

Number of Male Cases

3750 3500 3250 3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0

<1 5yo
0 250 500 750 1000 1250 1500 1750 2000

Number of Female Cases

2250 2500 2750 3000 3250 3500 3750

<15y o 2013 2012 2011 2010 2009 1984-2008 0 3 1 1 1 29

15-19y o 41 95 76 50 22 26

20-24yo 355 774 589 405 179 249

25-29y o 483 1, 090 739 455 227 514

30-34y o 274 622 378 256 124 504

35-39y o 110 289 193 128 90 423

40-44yo 68 153 117 81 41 315

45-49y o 37 89 51 42 18 208

50 & ol der 36 71 49 48 29 196

2013 2012 2011 2010 2009 1984-2008

<15y o 0 1 2 2 1 21

15-19y o 1 8 3 5 4 33

20-24y o 17 20 36 28 13 199

25-29y o 21 39 44 21 19 239

30-34y o 15 23 23 34 21 210

35-39y o 6 24 21 15 20 164

40-44y o 3 13 10 9 14 99

45-49y o 7 12 8 7 7 38

50 & ol der 3 12 9 4 5 47

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

Modes of Transmission (1984-2013)

In 2013, ninety-seven percent (1,435) were infected through sexual contact and 3% (42) through needle sharing among injecting drug users (Table 3). There were 1,363 males and 72 females infected through sexual transmission. The age range of those infected through sexual transmission was 17-63 years old (median 28 years). Of the 13,179 HIV positive cases reported from 1984 to 2013, 93% (12,240) were infected through sexual contact, 4% (482) 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 3]. No data is available for 3% (375) of the cases. Figure 5. Proportion of Types of Sexual Transmission, Jan 1984April 2013
100% 90%

Table 3. Reported Mode of HIV Transmission

Mode of Transmission Sexual Contact Apr 2013 n=388 356 Jan-Apr 2013 n=1,477 1,435 Cumulative N=13,179 12,240

Heterosexual contact Homosexual contact Bisexual contact

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

69(19%) 176(49%) 111(31%)

0 32 0 0 0

252(18%) 730(51%) 453(32%)

0 42 0 0 0

3,608(29%) 5, ,305(43%) 3,327(27%)

20 482 3 59 375

Figure 6. HIV Transmission by Age-Group, 2013 (n=1,477)

900 800 700

Number of Cases

80%

600 500 400 300 200 100 0 <7y o 7-14y o 15-17y o 1 2 18-24y o 6 18 30 118 239 25-34yo 9 36 87 266 395 35-49y o 1 21 15 52 60 82 50&ol der 4 3 11 9 12

Proportion of Cases

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

'84 1 0 0 '85 7 2 1 '86 24 0 4 '87 24 4 3 '88 16 2 4 '89 19 2 6 '90 35 4 8 '91 30 4 15 '92 41 5 5 '93 47 2 16 '94 58 3 20 '95 56 8 21 '96 81 7 30 '97 82 7 25 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13

B l ood T r ansf us i on - Femal e M at er nal t o Chi l d I nj ec t i ng Dr ug Use - Femal e I nj ec t i ng Dr ug Use - M al e Het er os exual Cont act - Femal e Het er os exual Cont act - M al e B i sex ual Cont ac t Homos exual Cont ac t

Het er os exual B i s exual Homos exual

138 114 93 9 36 10 30 8 17

128 129 129 123 131 193 139 160 216 274 388 480 252 5 32 8 46 14 40 12 27 14 47 26 81 74 127 252 467 806 992 453

107 215 336 680 10361, 68 730

Philippine HIV/AIDS Registry

April 2013
Figure 7. HIV Cases by Region, Jan 1984-April 2013
R OT C 13 % R eg 3 9% R eg 4 A 13 %

Geographic Distribution (1984-2013)

Since 1984 to present, there were 13,179 cases reported. More than half (6,164) came from the National Capital Region. [Figure 7]. Thirteen percent (1,530) came from region 4A, followed by 9% (1,021) from Region 3, 8% (1,015) from Region 7, 6% (701) from Region 11 and the rest of the country comprises 13% (1,612) of all the cases.

R eg 7 8% R eg 11 6%

*Note: 1,136 cases did not report data on address

NCR 51%

AIDS Cases (1984-2013)

Of the 1,477 HIV positive cases in 2013, eighty-four were reported as AIDS cases. Of these, 78 were males and 6 were females. Ages ranged from 17-59 years (median 30 years). Ninety-eight percent (82) acquired the infection through sexual contact (42 homosexual, 16 bisexual and 24 heterosexual) and 2% (2) through injecting drug use. From 1984 to 2013, there were 1,253 AIDS cases reported. Seventy-eight percent (979) were males. Median age is 34 years (age range: 1-81 years). Of the reported AIDS cases, 353 (29%) had already died at the time of reporting. Sexual contact was the most common mode of HIV transmission, accounting for 94% (1,184) of all reported AIDS cases. Almost half (532) of sexual transmission was through heterosexual contact, followed by homosexual contact (471) then bisexual contact (181). Other modes of transmission include: mother-to-child transmission (20), blood transfusion (10), injecting drug use (9), and needle prick injuries (2). Two percent (28) of the AIDS cases did not report mode of HIV transmission.

Overseas Filipino Workers (OFW)

In 2013, there were 168 HIV positive OFWs, comprising 11% of cases reported for the year [Figure 8]. Of these, 156 (93%) were males and 12 (7%) were females. Ninety-nine percent acquired the infection through sexual contact (48 heterosexual, 61 homosexual and 57 bisexual) and 1% through injecting drug use. There were 2,298 HIV positive OFWs since 1984, comprising 17% of all reported cases [Figure 8]. Eighty percent (1,827) were males. Ages ranged from 18 to 69 years (median 34 years). Sexual contact (97%) was the predominant mode of transmission (Table 4). Eighty-seven percent (1,991) were asymptomatic while 13% (307) were AIDS cases. Table 4. Mode of HIV Transmission Among OFWs
Mode of Transmission Apr 2013 n=40 2013 n=168 Cumulative N=2,298 2,234
3200 3000 2800 2600 2400 2200 2000 1800 1600 1400 1200 1000 800 600 400 200 0
OFW Non - OFW % of OFW

Figure 8. Number of OFWs Compared to Non-OFWs by Year (1984-2013)

Heterosexual contact Homosexual contact Bisexual contact

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

12(31%) 15(38%) 12(31%)

0 1 0 0

48(29%) 61(37%) 57(34%)

0 2 0 0

1,254(56%) 552(25%) 428(19%)

10 3 3 48

Number of Cases

Table Mode of HIV Transmission Sexual3. Transmission 39 Among OFWs 166

'8 4 1 1

'8 5 2 8

'8 6 0 29 0%

'8 7 3 35

'8 8 9 23

'8 9 5 34

'9 0 10 56

'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

'0 8 12 2

'0 9 16 4

'10 17 4

'11

'12

'13

2 7 1 3 4 2 16 8

2 3 6 4 0 6 6 7 1 14 17 2 0 7 8 2 9 9 3 13 0 9 3 1% 2 3 % 2 0 % 11% 12 % 10 % 11%

50% 20%

8 % 2 8 % 13 % 15 %

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 %

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.