MANILA, Philippines—The COVID-19 pandemic is disrupting services and treatments for other diseases, like the human immunodeficiency virus (HIV), which is projected to rise as a result, both directly and indirectly, of restrictions brought by the pandemic.
According to the World Health Organization (WHO), HIV is a virus that attacks the body’s immune system and “weakens people’s defense against many infections and some types of cancer that people with healthy immune systems can fight off.”
When left untreated, HIV could lead to AIDS (acquired immunodeficiency syndrome).
In the Philippines, Anakalusugan Rep. Michael Defensor has recently pointed out that the total HIV caseload in the country could go over the 100,000-mark by the first half of the year 2022.
In this article, INQUIRER.net will delve into how the COVID-19 pandemic—caused by the SARS-COV-2 virus—has impacted the government or the worldwide effort against HIV.
Increasing HIV cases
The disruptions in health services due to the COVID-19 pandemic, Defensor said, could cause the cumulative caseload of HIV to soar this year—which, based on data from the National HIV/AIDS Registry, was already at 94,337 confirmed cases as of 2021.
“A total of 12,341 new HIV infections were diagnosed in the country in 2021, up by 54 percent from the 8,036 new cases detected in 2020,” the lawmaker said in a statement.
Data from the national registry also showed that of the 12,341 new infections reported last year, 96 percent or 11,793 cases were male, while four percent or 548 cases were female.
Also included in the new infections were 746 Filipinos who had worked overseas in the last five years.
Unfortunately, 893 more Filipinos living with HIV died last year, bringing to 5,373 the cumulative deaths in the registry.
The United Nations Development Programme (UNDP) Philippines also stated that while the number of people living with HIV continued to increase in the country amid the pandemic, there might be tens of thousands of Filipinos who are left undiagnosed.
Cases of HIV around the world have also increased amid the pandemic, according to the Joint United Nations Programme on HIV and AIDS (UNAIDS).
In 2020, around 1.5 million or between 1 to 2 million people were newly infected with HIV.
This was, however, at least 52 percent less than the peak HIV cases recorded in 1997—which reached up to 3 million or between 2.1 to 4.2 million cases.
Data collected by the WHO showed that by the end of 2020, there were around 37.7 million or between 30.2 to 45.1 million people living with HIV.
The UNAIDS further detailed that at least 1.7 million, or between 1.2 to 2.2 million people, who had been found to have HIV as of 2020 were children between ages 0-14 years.
Around 53 percent of the 37.7 million HIV patients during the same year were women and girls.
At least 84 percent, or between 67 to 98 percent, of all people living with HIV were aware of their HIV status in 2020. About 6.1 million or between 4.9 to 7.3 million people, on the other hand, did not know that they were living with HIV in 2020.
The UNAIDS noted that the risk of acquiring HIV could be:
• 35 times higher among people who inject drugs
• 34 times higher for transgender women
• 26 times higher for sex workers
• 25 times higher among gay men and other men who have sex with men
To help address the impending blowup of HIV cases in the country amid the still ongoing COVID-19 pandemic, Defensor suggested that the next administration “may have to increase annual funding for HIV prevention and treatment to cope with the surge in new infections and the demand for treatment.”
Hampered treatment
The COVID-19 pandemic—with the series of lockdowns, quarantines, and restrictions due to safety concerns—might have “discouraged many Filipinos from seeking HIV testing, even if they suspect that they may be infected,” according to Defensor, who represents a health sector party-list group in Congress.
“If a person living with HIV is not diagnosed right away, then that individual could be unknowingly spreading the infection,” he added.
WHO explained that HIV can be transmitted through the exchange of body fluids from infected people, such as blood, breast milk, semen, and vaginal secretions.
The virus can also be transmitted from a mother to her child during pregnancy and delivery.
HIV still does not have any cure yet, but a combination of early diagnosis of three or more antiretroviral (ARV) drugs could help manage the disease.
“Current antiretroviral therapy (ART) does not cure HIV infection but highly suppresses viral replication within a person’s body and allows an individual’s immune system recovery to strengthen and regain the capacity to fight off opportunistic infections and some cancers,” WHO said.
In 2021, around 28.2 million people living with HIV across the globe were receiving ART. Still, the WHO noted that more efforts are needed to scale up treatment, particularly for children and adolescents.
Only 54 percent, or between 37 to 69 percent of children aged 0 to 14 years old, were receiving ART by end of 2020.
A total of 56,385 Filipinos living with HIV were undergoing daily lifelong ART as of December 2021, according to Defensor.
“We are worried that a significant number of Filipinos living with HIV may have fallen out of treatment, also due to complications related to the pandemic,” Defensor said.
“Right now, only 63 percent of the cases are receiving treatment, which is way below the 90 percent target,” he added.
The Philippines is just one of the 82 low-and middle-income countries reported to have adopted the WHO recommended policy to provide all people living with HIV—including children, adolescents, adults, and pregnant and breastfeeding women, regardless of clinical status or CD4 cell count—with lifelong ART.
Living with HIV amid pandemic
The UNDP Philippines, in a report released in July last year, has highlighted how the negative impact of the COVID-19 pandemic has disproportionately affected the lives of people living with HIV.
Limited mobility and job loss were found to impact and restrict the capacity of people living with HIV to have continued access to ARV drugs and other HIV care services across the country.
A certain “John” from Cebu has shared how the pandemic has hindered his ARV treatment, which started last year.
“I am currently unemployed. I still have personal savings from my previous job to pay for my treatment, but they are running low,” John said in the report published by the UNDP Philippines.
“My main problem is that my treatment hub where I get my ARV is from a different city and there is a strict border check. I do not want to divulge my condition to the authorities so that they would allow me to pass through,” John added.
A study published in 2020 in the Journal of Virus Eradication showed that aside from lockdowns, which has controlled the movement and has hindered access to care, physical distancing imposed to avoid COVID-19 has also affected people living with HIV amid the pandemic.
Physical distancing guidelines, according to the study, “can exacerbate the high levels of isolation that older individuals with HIV already face.”
The study also noted that the fear of contracting COVID-19 has also become one of the main reasons behind the decreased engagement with care among people living with HIV in several countries.
“The reasons for this are unsurprising. People who have faced stigma for decades due to their HIV status and live under the burden of a chronic virus are hesitant to engage in care when the prospect of being infected with another, more deadly virus is real,” the scientists stated.
“This fear has even led some to question the safety of going to pharmacies to collect ART,” they added.
TSB