DEPARTMENT OF HEALTH NATIONAL EPIDEMIOLOGY CENTER

OCTOBER 2013

Newly Diagnosed HIV Cases in the Philippines

In October 2013, there were 491 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 is 66% higher
Table 1. Quick Facts
Demographic Data Total Reported Cases Asymptomatic Cases AIDS Cases Male Female Youth 15-24yo Children <15yo
October 2013 Jan-Oct 2013 Cumulative 19842013

491 453 38 461 30 151 1

4,072 3,800 272 3,874 198 1,146 3

15,774 14,333 1,441 13,950* 1,813* 3,960 65

Philippine HIV and AIDS Registry

compared to the same period last year (n=295 in 2012) [Figure 1] .

Table 2. Percentage of HIV Cases per Region (October 2013)
Region I II III IVA IVB V VI VII VIII IX X XI XII CAR CARAGA ARMM NCR % of Cases 2% 1% 7% 15% <1% 1% 4% 14% 1% 1% 1% 7% 2% 1% 1% <1% 41%

Most of the cases (94%) were male. The median age was 27 years (age range: 4-76 years). The 20-29 year (60%) age group had the most number of cases.

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

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

500

Number of New Cases

Reported mode of transmission were sexual contact (445), needle sharing among injecting drug users (45), and mother-to-child transmission (1) males (86%) type [Figure at the [Table 3, page were of 2]. the sexual Most of 2]. Males having sex with other predominant transmission asymptomatic

450 400 350 300 250 200 150 100 50 0 2011 2012 2013 Jan 152 212 380 Feb 159 274 339 Mar 172 313 370 Apr 171 233 388 May 184 273 415 Jun 178 295 431 Jul 204 278 449 Aug 196 272 382 Sep 253 316 427 Oct 200 295 491 Nov 212 284 Dec 268 293

(92%) of the cases were still time reporting [Figure 3]. In October 2013, bulk of the new HIV cases came from NCR, Region 3, Region 4A, the three Region 7, and reporting Region 11 [Table 2]. However, highest regions were NCR, 4A and 7.
Proportion of Cases

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

Heterosexual

63
75%

50 75

3,954

Bisexual Homosexual

170
50%

4,153

25%

212

161

6,541

0%

O c tobe r 2 0 13

O c tobe r 2 0 12

Cumula tive

Figure 3. Number of HIV/AIDS Cases Reported in the Philippines by Year, Jan 1984 to October 2013 (N=15,774)
4250 4000 3750 3500 3250 3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0
TOTAL Asympt omat ic AIDS

'84 2 0 2

'85 10 6 4

'86 29 18 11

'87 38 25 13

'88 32 21 11

'89 39 29 10

'90 66 48 18

'91 85 68 17

'92 72 51 21

'93 102 64 38

'94 118 61 57

'95 116 65 51

'96 154 104 50

'97 117 94 23

'98 189 144 45

'99 158 80 78

'00 123 83 40

'01 174 117 57

'02 184 140 44

'03 193 139 54

'04 199 160 39

'05 210 171 39

'06 309 273 36

'07 342 311 31

'08 528 505 23

'09 835 804 31

'10

'11

'12

'13

1591 2,349 3,338 4,072 1562 2,239 3,152 3,800 29 110 186 272

Philippine HIV/AIDS Registry

October 2013

Demographic Characteristics (1984-2013)

Ninety-five percent of the 4,072 cases in 2013 were male (3,874). Ages ranged from 4 to 79 years old (median 28 years). The 20-29 year old age group had the most (58%) 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 15,774 HIV Ab sero-positive cases reported (Table 1). Of these, 14,333 (91%) were asymptomatic and 1,441 (9%) were AIDS cases. As shown in Figure 4, there is a significant difference in the number of male and female cases reported. Eighty-eight percent (13,950) were male. Ages ranged from 1-81 years (median 28 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 & older 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

4500 4250 4000 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 2250 2500

Number of Female Cases

2750 3000 3250 3500 3750 4000 4250 4500

<15yo 2013 2012 2011 2010 2009 1984-2008 1 3 1 1 1 29

15-19yo 120 95 76 50 22 26

20-24yo 978 774 589 405 179 249

25-29yo 1,314 1,090 739 455 227 514

30-34yo 785 622 378 256 124 504

35-39yo 306 289 193 128 90 423

40-44yo 167 153 117 81 41 315

45-49yo 110 89 51 42 18 208

50 & older 93 71 49 48 29 196

2013 2012 2011 2010 2009 1984-2008

<15yo 2 1 2 2 1 21

15-19yo 10 8 3 5 4 33

20-24yo 38 20 36 28 13 199

25-29yo 48 39 44 21 19 239

30-34yo 38 23 23 34 21 210

35-39yo 28 24 21 15 20 164

40-44yo 14 13 10 9 14 99

45-49yo 50 & older 10 12 8 7 7 38 10 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-four percent (3,843) were infected through sexual contact, 6% (226) through needle sharing among injecting drug users and <1% (3) through mother to child transmission (Table 3). There were 3,661 male and 182 female infected through sexual transmission. The age range of those infected through sexual transmission was 15-79 years old (median 27 years). Of the 15,774 HIV positive cases reported from 1984 to 2013, 93% (14,648) were infected through sexual contact, 4% (666) through needle sharing among injecting drug users, <1% (62) through mother-to-child transmission, <1% (20) through blood transfusion and needle prick injury <1% (3) [Table 3]. No data is available for 2% (375) of the cases. Figure 5. Proportion of Types of Sexual Transmission, Jan 1984October 2013
100% 90% 80%

Table 3. Reported Mode of HIV Transmission

Mode of Transmission Sexual Contact October 2013 n=491 445 Jan-Oct 2013 n=4,072 3,843 Cumulative N=15,774 14,648

Heterosexual contact Homosexual contact Bisexual contact

Blood/Blood Products Injecting Drug Use Needle Prick Injury Mother-to-Child No Data Available
2400 2200 2000

63(14%) 212(48%) 170(38%)

0 45 0 1 0

598(16%) 1,966(51%) 1,279(33%)

0 226 0 3 0

3,954(27%) 6,541(45%) 4,153(28%)

20 666 3 62 375

Figure 6. HIV Transmission by Age-Group, 2013 (n=4,072)

Number of Cases

1800 1600 1400 1200 1000 800 600 400 200 0

Proportion of Cases

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

<7yo Blood Transfusion - Female Mother-to-Child Injecting Drug Use - Female Injecting Drug Use - Male
'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 93 8 17 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '12 '13

7-14yo -

15-17yo 3 2 1 1 9

18-24yo 2 45 44 71 369 599

25-34yo 6 77 80 223 728 1071

35-49yo 5 78 47 93 159 253

50&older 1 9 9 28 22 34

3 -

Heterosexual Contact - Female Heterosexual Contact - Male Bisexual Contact Homosexual Contact

Het er osexual B i sexual Homosexual

138 114 9 36 10 30

128 129 129 123 131 193 139 160 216 274 480 598 5 32 8 46 14 40 12 27 14 47 26 81 74 127 252 467 992 1279

107 215 336 680 1687 1966

Philippine HIV/AIDS Registry

October 2013
Figure 7. Percentage of HIV Cases by Region, Jan 1984- October 2013
R OT C 14% R eg 3 8% R eg 4A 13%

Geographic Distribution (1984-2013)

Since 1984 to present, there were 15,774 cases reported. Half (7,318) came from the National Capital Region. [Figure 7]. Thirteen percent (1,887) came from region 4A, followed by 9% (1,334) from Region 7, 8% (1,201) from Region 3, 6% (876) from Region 11 and the rest of the country comprises 14% (2,021) of all the cases.

R eg 7 9%

*Note: 1,137 cases had no reported data on their address at the time of diagnosis
R eg 11 6% NCR 50%

AIDS Cases (1984-2013)

Of the 4,072 HIV positive cases in 2013, two hundred seventy-two were reported as AIDS cases. Of these, 260 were male and 12 were female. Ages ranged from 17-59 years (median 30 years). Ninety-seven percent (265) acquired the infection through sexual contact (134 homosexual, 74 bisexual and 57 heterosexual) and 3% (7) through injecting drug use. From 1984 to 2013, there were 1,441 AIDS cases reported. Eighty-one percent (1,161) were male. Median age is 33 years (age range: 1-81 years). Sexual contact was the most common mode of HIV transmission, accounting for 95% (1,367) of all reported AIDS cases. Forty-one percent (565) of sexual transmission was through heterosexual contact, 41% was through homosexual contact (563), and 17% was through bisexual contact (239). Other modes of transmission include: mother-to-child transmission (20), injecting drug use (14), blood transfusion (10), 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 432 HIV positive OFWs, comprising 11% of cases reported for the year [Figure 8]. Of these, 385 (89%) were male and 47 (11%) were female. Ninety-nine percent (430) acquired the infection through sexual contact (122 heterosexual, 162 homosexual and 146 bisexual) and <1% (2) through injecting drug use. There were 2,562 HIV positive OFWs since 1984, comprising 16% of all reported cases [Figure 8]. Eighty percent (2,056) were male. Ages ranged from 18 to 76 years (median 34 years). Sexual contact (98%) was the predominant mode of transmission (Table 4). Eighty-eight percent (2,245) were asymptomatic while 12% (317) were AIDS cases.

Table 4. Mode of HIV Transmission Among OFWs

Mode of Transmission Sexual Transmission October 2013 n=37 37 Jan-Oct 2013 n=432 430 Cumulative N=2,562
Number of Cases

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

4000 3800 3600 3400 3200 3000 2800 2600 2400 2200 2000 1800 1600 1400 1200 1000 800 600 400 200 0
OFW Non-OFW % of OFW

2,498

Heterosexual contact Homosexual contact Bisexual contact

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

10(27%) 15(41%) 12(32%)

0 0 0 0

122(28%) 162(38%) 146(34%)

0 2 0 0

1,328(53%) 653(26%) 517(21%)

10 3 3 48

'84 1 1

'85 2 8

'86 0 29 0%

'87 3 35 8%

'88 9 23

'89 5 34

'90 10 56

'91 7 78 8%

'92 14 58 19%

'93 29 73

'94 31 87

'95 24 92

'96 35 119

'97 27 90

'98 51 138

'99 67 91

'00 60 63

'01 79 95

'02 96 88

'03 93 100

'04 86 113

'05 92 118

'06 130 179

'07 106 236

'08 122 406

'09 164 671

'10 174

'11 271

'12 342

'13 432

1417 2078 2993 3640 12% 10% 11%

50% 20%

28% 13% 15%

28% 26% 21% 23% 23% 27%

42% 49% 45% 52% 48% 43%

44% 42% 31% 23% 20% 11%

Philippine HIV/AIDS Registry

Report on Deaths, PLHIV on ART, & Blood Units

Table 5. Demographic data of reported deaths among People with HIV
Demographic Data Oct 2013 5 5 0 0 0 Jan-Oct 2013 148 141 7 14 1 Jan-Dec 2012 177 159 18 27 3 Cumulative* (1984-2013) 856 669 187 90 15

Deaths among People with HIV

From January 1984 to October 2013, there were 856 reported deaths among people with HIV [Table 5]. Seventy-eight percent (669) were male. In total, there has been 90 deaths among youth (15-24 years old) and 15 deaths among children (<15 years old). The annual number of deaths from 1984-2010 ranges from 2 to 36 cases with an average of 14 deaths per year. Beginning 2011, there has been an increase in the number of recorded deaths. There were 69 in 2011, and 177 in 2012. The DOH-NEC established an official reporting form in 2012. Based on submitted reports, there were a total of 148 deaths from January to October 2013. Ninety-five percent (141) were male while 5% (7) were female [Table 5]. The highest number of deaths occurred in the 25-29 (30%) age group [Figure 9]. This was followed by the 30-34 (28%) and the 35-39 (11%) age groups. For the month of October 2013, there were 5 deaths [Table 5]. Among the reported deaths in 2013, sexual contact (96%) was the most common mode of HIV transmission (78 homosexual, 41 bisexual, 23 heterosexual). There were five cases who got infected through injecting drug use (3%) and one case from maternal to child transmission (1%) [Figure 9].

Total Reported Deaths Male Female Youth 15-24yo Children <15yo

*Note: No year of death reported for 44 cases

Figure 9. HIV Transmission by Age-Group of Reported Deaths* among People with HIV, Jan-October 2013 (n=148)

*Note: No age reported for 2 cases.

Number of Cases

PLHIV on Anti-Retroviral Therapy (ART)

As of October 2013, are 5,141* People with HIV Anti-Retroviral there Living on
Treatment Hubs in the Philippines 1. Ilocos Training and Regional Medical Center 2. Cagayan Valley Medical Center 3. Baguio General Hospital and Medical Center 4. Jose B. Lingad Medical Center 5. James L. Gordon Memorial Hospital 6. Makati Medical Center 7. Philippine General Hospital 8. Research Institute for Tropical Medicine 9. San Lazaro Hospital 10. The Medical City 11. Bicol Regional Training and Teaching Hospital 12. Corazon Locsin Montelibano Memorial Regional Hospital 13. Western Visayas Medical Center 14. Gov. Celestino Gallares Memorial Hospital 15. Vicente Sotto Memorial Medical Center 16. Zamboanga City Medical Center 17. Southern Philippines Medical Center

Blood Units Confirmed for HIV

As of October 2013, 245 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 they underwent voluntary counseling and testing as individuals.

Table 6. Number of Confirmed HIV Positive Blood Units Month January February March April May June July August October October November December Total 245 2013 22 21 28 30 22 23 28 17 29 25

presently

Therapy.

These are the combined n u m b e r s o f a du l t a n d pediatric patients currently enrolled and accessing Anti-Retroviral drugs in the 17 treatment hubs listed on the right.

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

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:

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.