sero-positive individuals confirmed by the STD/AIDS Cooperative Central Laboratory (SACCL) and reported to the HIV and AIDS Registry (Table 1). This was 39% higher compared to the same period last year (n=196 in 2011) [Figure 1]. Most of the cases (95%) were males. The median age was 28 years (age range: 18-60 years). The 20-29 year (59%) age-group had the most number of cases. Fifty-one percent (138) of the reported cases were from the National Capital Region (NCR). Reported mode of transmission were sexual contact (253) and needle sharing among injecting drug users (19). [Table 2, page 3]. Males having sex with other males (86%) were the predominant type of sexual transmission [Figure 2]. Most (93%) of the cases were still asymptomatic at the time of reporting [Figure 3]. AIDS Cases Of the 272 HIV positive cases, twenty were reported as AIDS cases, all were males. The median age is 30 years (age range: 21-46 years). All acquired the infection through sexual contact (11 homosexual, 4 heterosexual and 5 bisexual). Of the AIDS cases, there was one reported death for this month; a 41 year old male. Overseas Filipino Workers (OFW) Twenty-five of the 272 (9%) reported cases were OFWs [Figure 11, page 4]. There were 18 males and 7 females. The median age was 32 years (age range: 22-58 years). All acquired the infection through sexual contact (10 heterosexual , 10 homosexual and 5 bisexual). Figure 3. Number of HIV/AIDS Cases Reported in the Philippines by Year, Jan 1984 to August 2012 (N=10,514) *Note: No data available on sex for (11) cases.
Newly Diagnosed HIV Cases in the Philippines P h i l i p p i n e
H I V
a n d
A I D S
R e g i s t r y
DE P ART ME NT OF HE AL T H
NAT I ONAL E P I DE MI OL OG Y CE NT E R AUGUST 2012 Table 1. Quick Facts Demographic Data August 2012 Cumulative 19842012 Jan-Aug 2012 Total Reported Cases 272 10,514 2,150 Asymptomatic Cases 252 9,416 2,034 AIDS Cases 20 1,098 116 Males 258 8,941* 2,051 Females 14 1,562* 99 Youth 15-24yo 69 2,514 597 Children <15yo 0 62 4 Reported Deaths due to AIDS 1 353 11 148 79 69 67 2,534 36 41 3,147 3,956 0% 25% 50% 75% 100% August 2 0 12 August 2 0 11 Cumul at i ve P r o p o r t i o n
o f
C a s e s Het erosexual Bisexual Homosexual Figure 2. Comparison of the Proportion of Types of Sexual Transmission in 2012, 2011 & Cumulative Data (1984-2012) 0 50 100 150 200 250 300 350 N u m b e r
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N e w
C a s e s 2010 143 130 120 154 153 109 131 108 153 104 112 174 2011 152 159 172 171 184 178 204 196 253 200 212 268 2012 212 274 313 233 273 295 278 272 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Figure 1. Number of New HIV Cases per Month (2010-2012) 0 250 500 750 1000 1250 1500 1750 2000 2250 2500 TOTAL 2 10 29 38 32 39 66 85 72 102 118 116 154 117 189 158 123 174 184 193 199 210 309 342 528 835 1591 2, 349 2, 150 Asympt omat i c 0 6 18 25 21 29 48 68 51 64 61 65 104 94 144 80 83 117 140 139 160 171 273 311 505 804 1562 2, 239 2, 034 AI DS 2 4 11 13 11 10 18 17 21 38 57 51 50 23 45 78 40 57 44 54 39 39 36 31 23 31 29 110 116 Deat h 2 4 10 12 9 8 15 13 13 11 19 24 27 10 16 17 8 20 11 11 8 16 18 10 7 1 3 *19 11 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12
*Nine initially asymptomatic cases reported in 2011, died due to AIDS that same year. 2
0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 <15yo 15-19yo 20-24yo 25-29yo 30-34yo 35-39yo 40-44yo 45-49yo 50 & older Number of Male Cases 2012 3 51 529 691 389 177 105 67 39 2011 1 76 589 739 378 193 117 51 49 2010 1 50 405 455 256 128 81 42 48 2009 1 22 179 227 124 90 41 18 29 2008 2 11 92 140 90 59 36 23 20 1984-2007 27 15 157 374 414 364 279 185 176 <15yo 15-19yo 20-24yo 25-29yo 30-34yo 35-39yo 40-44yo 45-49yo 50 &ol der 0% 25% 50% 75% 100% P r o p o r t i o n
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C a s e s Needl e Pr i ck 2 0 0 0 0 Bl ood Tr ansf usi on 10 0 0 0 0 MTCT 16 1 0 1 2 I DU 4 0 0 2 0 Bi sexual Cont act 64 8 7 39 31 Homosexual Cont act 246 16 19 45 63 Het er osexual Cont act 442 6 3 23 20 1984-2008 2009 2010 2011 2012 AIDS Cases (1984-2012) *Note: 28 did not report mode of transmission Demographic Characteristics (1984-2012) August 2012 Philippine HIV/AIDS Registry Of the 2,150 HIV positive cases in 2012, one hundred sixteen were reported as AIDS cases. Of these, 110 were males and 6 were females. Ages ranged from 7-81 years (median 32 years). Ninety-eight percent (114) acquired the infection through sexual contact (63 homosexual, 31 bisexual and 20 heterosexual), and 2% (2) mother-to-child transmission. From 1984 to 2012, there were 1,098 AIDS cases reported. Seventy-six percent (832) were males. Median age is 35 years (age range: 1-81 years). Of the reported AIDS cases, 352 (32%) had already died at the time of reporting. Sexual contact was the most common mode of HIV transmission, accounting for 94% (1,032) of all reported AIDS cases. Almost half (494) of sexual transmission was through heterosexual contact, followed by homosexual contact (389) then bisexual contact (149). Other modes of transmission include: mother-to-child transmission (20), blood transfusion (10), injecting drug use (6), and needle prick injuries (2) [Figure 4]. Three 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 1984August 2012 Ninety-five percent of the 2,150 cases were males (2,051). Ages ranged from 2 to 81 years old (median 28 years). The 20-29 year old age group had the most (59%) number of cases for 2012. For the male age group, the most number of cases were found among the 20-24 years old (26%), 25-29 years old (34%), and 30-34 years old (19%) [Figure 6]. From 1984 to 2012, there were 10,514 HIV Ab sero-positive cases reported (Table 1), of which 9,416 (90%) were asymptomatic and 1,098 (10%) were AIDS cases. As shown in Figure 6, there is a significant difference in the number of male and female cases reported. Eighty-five percent (8,941) 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 (28%), and 30-34 years (19%) [Figure 6]. Figure 6. Comparison of the Distribution of Male and Female HIV Cases by Age-Group and Certain Highlighted Years 0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 Number of Female Cases 1984-2007 2008 2009 2010 2011 2012 2012 1 4 13 26 17 14 8 8 8 2011 2 3 36 44 23 21 10 8 9 2010 2 5 28 21 34 15 9 7 4 2009 1 4 13 19 21 20 14 7 5 2008 0 0 8 14 8 10 9 3 3 1984-2007 21 33 191 225 202 154 90 35 44 <15yo 15-19yo 20-24yo 25-29yo 30-34yo 35-39yo 40-44yo 45-49yo 50 &ol der *Note: 74 did not report age, 11 did not report sex, 10 did not report age and sex Figure 5. Proportion of Sex & Age-Groups in August 2012 & Jan-Aug 2012 0% 25% 50% 75% 100% P r o p o r t i o n
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C a s e s 50 &ol der 9 1 39 8 35-49yo 39 7 349 30 25-34yo 145 2 1, 080 43 15-24yo 65 4 580 17 1-14yo 0 0 3 1 August 2012 (M) August 2012 (F) 2012 (Mal e) 2012 (Femal e) 3
Reg 3 8 % Reg 4 A 12 % Reg 7 10 % Reg 11 6 % NCR 51% ROTC 13 % *ROTC: Rest of the Country August 2012 Philippine HIV/AIDS Registry 0 75 150 225 300 375 450 525 600 675 750 825 900 975 1050 1125 1200 N u m b e r
o f
C a s e s
Bl ood T r ansf usi on - Femal e - - - - - - - Mat er nal t o Chi l d 1 3 - - - - - I nj ect i ng Dr ug Use - Femal e - - - 2 6 1 - I nj ect i ng Dr ug Use - Mal e - - 2 51 48 43 2 Het er osexual Cont act - Femal e - - - 15 37 29 8 Het er osexual Cont act - Mal e - - - 19 96 55 12 Bi sexual Cont act - - 1 172 367 105 7 Homosexual Cont act - - 3 332 570 146 17 <7yo 7-14yo 15-17yo 18-24yo 25-34yo 35-49yo 50&ol der Modes of Transmission (1984-2012) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% P r o p o r t i o n
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C a s e s Het er osexual 1 7 24 24 16 19 35 30 41 47 58 56 81 82 138 114 93 128 129 129 123 131 193 139 160 216 274 388 271 Bi sexual 0 2 0 4 2 2 4 4 5 2 3 8 7 7 9 10 8 5 8 14 12 14 26 74 127 252 467 806 652 Homosexual 0 1 4 3 4 6 8 15 5 16 20 21 30 25 36 30 17 32 46 40 27 47 81 107 215 336 680 10361, 06 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 Figure 9. Proportion of Types of Sexual Transmission, Jan 1984August 2012 Figure 10. HIV Transmission by Age-Group, 2012 (n=2,150) In 2012, 93% (1,991) were infected through sexual contact, 7% (155) through needle sharing among injecting drug users, and <1% (4) through mother-to-child transmission (Table 2). There were 1,902 males and 89 females infected through sexual transmission. The age range of those infected through sexual transmission was 15-81 years old (median 28 years). Of the 10,514 HIV positive cases reported from 1984 to 2012, 92% (9,637) were infected through sexual contact, 4% (420) 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 4% (375) of the cases. Table 2. Reported Mode of HIV Transmission Mode of Transmission August 2012 n=272 Cumulative N=10,514 Jan-August 2012 n=2,150 Sexual Contact 253 9,637 1,991 Heterosexual contact 36(14%) 3,147(33%) 271(14%) Homosexual contact 148(58%) 3,956(41%) 1,068(54%) Bisexual contact 69(27%) 2,534(26%) 652(33%) Blood/Blood Products 0 20 0 Injecting Drug Use 19 420 155 Needle Prick Injury 0 3 0 Mother-to-Child 0 59 4 No Data Available 0 375 0 Figure 7. New HIV Cases by Region, August 2012 Geographic Distribution 0% 25% 50% 75% 100% P r o p o r t i o n
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C a s e s Reg1 2% 2% 2% Reg3 7% 6% 9% Reg4A 13% 12% 12% Reg6 3% 3% 3% Reg7 11% 9% 9% Reg11 6% 7% 6% NCR 51% 54% 51% ROT C* 7% 7% 8% 2012 2007-2011 1984-2012 In August 2012, bulk of the new HIV cases came from NCR, Region 4A, Region 7, Region 3, and Region 11 [Fig 7]. The three highest reporting regions were NCR, Region 4A, and Region 7. Cumulative data shows 33% (3,147) were infected through heterosexual contact, 41% (3,956) through homosexual contact, and 26% (2,534) 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]. Region % of Cases I 3% II <1% III 8% IVA 12% IVB 1% V <1% VI 3% VII 10% VIII 1% IX 2% X 1% XI 6% XII 1% CAR <1% CARAGA 1% ARMM 0% NCR 51% Fig 8. Comparison of Proportion of HIV Cases by Region & Year 4
As of June 2012, there are 2,761* People Living with HIV presently on Anti-Retroviral Therapy (ART). Data for July and August is not yet available. 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 Blood Units Confirmed for HIV Table 4. Number of Confirmed HIV Positive Blood Units Overseas Filipino Workers (OFW) August 2012 Philippine HIV/AIDS Registry In 2012, there were 222 HIV positive OFWs, comprising 10% of cases reported for the year [Figure 11]. Of these, 191 (86%) were males and 31 (14%) were females. All were infected through sexual contact. There were 2,010 HIV positive OFWs since 1984, comprising 19% of all reported cases [Figure 11]. Seventy-eight percent (1,561) were males. Ages ranged from 18 to 69 years (median 35 years). Sexual contact (97%) was the predominant mode of transmission (Table 3). Eighty-five percent (1,712) were asymptomatic while 15% (298) were AIDS cases. Mode of Transmission August 2012 n=25 Cumulative N=2,010 Jan-August 2012 n=222 Sexual Transmission 25 1,948 222 Heterosexual contact 10(40%) 1,164(60%) 66(30%) Homosexual contact 10(40%) 444(23%) 89(40%) Bisexual contact 5(20%) 340(17%) 67(30%) Blood/Blood Products 0 10 0 Injecting Drug Use 0 1 0 Needle Prick Injury 0 3 0 No Data Available 0 48 0 0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 N u m b e r
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C a s e s OFW 1 2 0 3 9 5 10 7 14 2 9 3 1 2 4 3 5 2 7 5 1 6 7 6 0 7 9 9 6 9 3 8 6 9 2 13 0 10 6 12 2 16 4 17 4 2 7 1 2 2 2 Non - OFW 1 8 2 9 3 5 2 3 3 4 5 6 7 8 5 8 7 3 8 7 9 2 119 9 0 13 8 9 1 6 3 9 5 8 8 10 0 113 118 17 9 2 3 6 4 0 6 6 7 1 14 17 2 0 7 8 19 2 8 % of OFW 5 0 % 2 0 % 0 % 8 % 2 8 % 13 % 15 % 8 % 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 % 11% 12 % 10 % '8 4 '8 5 '8 6 '8 7 '8 8 '8 9 '9 0 '9 1 '9 2 '9 3 '9 4 '9 5 '9 6 '9 7 '9 8 '9 9 '0 0 '0 1 '0 2 '0 3 '0 4 '0 5 '0 6 '0 7 '0 8 '0 9 '10 '11 '12 Figure 11. Number of OFWs Compared to Non-OFWs by Year (1984-2012) Month 2012 2011 January 17 11 February 18 15 March 34 14 April 21 20 May 21 10 June 9 32 July 22 22 August 25 18 September 18 October 22 November 17 December 18 Total 167 217 As of August 2012, 167 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 unl ess t hey under went vol untary counsel i ng and testing as individuals.
PLHIV on Anti-Retroviral Therapy Month 2012 January 2,087 February 2,169 March 2,278 April 2,498 May 2,633 June 2,761 July Data not yet available August Data not yet available September October November December Table 5. Number of PLHIV on ART Table 3. Mode of HIV Transmission Among OFWs * This is not a cumulative number. It does not include those who already have died, left the country, or decided to stop taking ART. 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 National HIV/AIDS & STI Strategic Information and Surveillance Unit
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 Labora- tories (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. National Epidemiology Center, Department of Health, Bldg. 19, San Lazaro Compound, Sta. Cruz, Manila 1003 Philippines
E. The Qualities and Responsibilities of A Good Health Care Provider To The Client, Society and Its Profession Basic Qualities of A Health Care Practitioner