HIV knocks

What is your favorite Tom Hanks movie? Maybe most of you would be quick to say, “Forrest Gump.” But do you remember “Philadelphia”? For those who have a hazy recollection, unaware of its existence from having been too young to be allowed inside a theater, or haven’t been born yet, it was a film in the early 1990s about a successful lawyer who had filed a case against his law firm for being unjustly terminated on false grounds. His law partners had found out that he was gay and suffering from acquired immunodeficiency syndrome now more popularly known now as AIDS, an advanced form of HIV infection, and they had to find a way to ease him out. In the beginning, no one had wanted to be his legal counsel, not only because of the stigma attached to the disease but also because he was up against a powerhouse. Dec. 1 was World AIDS Day. According to the World Health Organization, as of July 2023, there are 39 million PLHIV (people living with HIV) the majority of which are adults at 37.5 million, with children less than 15 years of age accounting for the remaining 1.5 million.

How big of a problem do we face as a country? While incidence and HIV-related deaths have been on a downtrend in other parts of the world, the Philippines is going against the tide. From 2012 to 2023, in a paper by Gangcuangco et al., there has been an unbelievable 411-percent increase in daily incidence. Most cases unfortunately involve the younger population with male-to-male sex as the predominant mode of transmission. The top four areas with the highest number of newly diagnosed HIV cases as of May this year include the National Capital Region, followed by Region 4A (Calabarzon), Region 3 (Central Luzon), and Region 7 (Central Visayas). While various factors continue to serve as barriers to control, the steady decline in awareness in recent years has also contributed to the increase. The following is a brief overview to hopefully assist in dispelling some fallacies and lead to a better understanding of the disease.

HIV or the human immunodeficiency virus has two types, HIV-1 and HIV-2. HIV-1 is more common. From a clinician’s standpoint, the identification of HIV-2 can be a cause of concern because of its inherent resistance to some antiretrovirals. Only humans can serve as reservoirs of infection. Basically acquired through sexual contact, other routes include exposure of mucous membranes to contaminated body fluids (human milk, vaginal secretions, semen) or blood, needlestick injuries, transfusion of contaminated blood products, and mother-to-child transmission. Therefore, infection cannot be acquired from a toilet seat, interaction with monkeys of the four-legged variety, or touching, hugging, or shaking hands.

HIV infection is not a death sentence if recognized and given treatment early. While there is no cure, the advent of antiretrovirals has greatly improved life expectancy and it is now considered to be a chronic illness. Mortality is greatly associated with individuals with far-advanced diseases or those with co-infections. Management becomes more complicated in individuals afflicted with tuberculosis and/or hepatitis B. The Philippines unfortunately is endemic for both.

In general, there is no contraindication to age-appropriate immunization with inactivated vaccines save for those classified as live, namely measles, mumps, rubella, and varicella, wherein administration would be highly dependent on an individual’s degree of immunosuppression.

Despite the less-than-rosy picture, it would be unfair to believe that as a country, as health professionals and private citizens, we have been remiss in our efforts to stem the epidemic.

There have been measures taken. Republic Act No. 11166 or the Philippine HIV and AIDS Policy Act of 2018 was signed into law in December 2018 and took effect on Jan. 25, 2019. This has been instrumental in providing better access to both HIV testing and treatment. Not only did it encourage voluntary testing but there is a section that states that parental consent is no longer needed for those in the 15-17 years age group who wish to be screened. Quite a number of patient advocacy support groups are also in existence, and it was a welcome surprise to hear from an infectious disease colleague, that the Catholic Church has also been active in reaching out to schoolchildren through educational campaigns.

In an HIV summit last week, we were able to engage in healthy conversations with families and individuals affected by the disease. Listening to their experiences and their concerns, some of us couldn’t help but shed tears, for though the stigma has lessened, it remains, and there is that real fear that there might come a time when medications will no longer be available, as there have been unfortunate instances of a stock-out.

Remain vigilant as no one is exempt. Don’t let it in.

[email protected]