The Philippines is an inspiring, tenacious, resilient country and a proud nation. I was fortunate enough to have the opportunity to embark on a two-day virtual mission to the Philippines this month, meeting with representatives from the government, civil society and to meet people living with HIV. Despite the physical distance, I felt close to the Filippino community as they opened their hearts and shared their stories of courage and resilience.
Despite having a strong, community-led response to HIV, and active government engagement, the Philippines has one of the fastest-growing HIV epidemics in the world. New HIV infections have soared by 237% from 2010 to 2020, with almost 50% of new HIV infections occurring among young people. AIDS-related deaths have also rocketed by a staggering 450% in the last 10 years, despite life-saving treatment being available free of charge in more than 160 treatment facilities across the country. So, what is going wrong?
The spread of HIV in the Philippines is being fueled by inequalities. 47% of new HIV infections are among young, key populations, men who have sex with men, people who inject drugs, sex workers and prisoners. Stigma and discrimination are still pervasive in healthcare settings, in the workplace, at home and in society. Legal and policy barriers are also a determining factor. Sex work is criminalized as well as drug use, meaning that these key populations are unlikely to come forward to access HIV testing or treatment. In addition, under the Reproductive Health Law young people below 18 years old cannot access contraceptives including condoms without parental consent.
The impact of the colliding pandemics of COVID-19 and HIV has further intensified social and economic disparities, exacerbated the vulnerabilities of the country’s health system and disrupted HIV services. Compared to 2019, HIV testing dropped by 61% in 2020. Treatment enrolment also fell by 28% as people living with HIV met additional challenges in accessing treatment due to lockdowns and movement restrictions.
But there is good news. The government has confronted HIV with a bold action plan which sets the basis for high impact HIV prevention, testing and treatment strategies. A recent amendment to the Philippine National AIDS Law in 2018 reduced the age of consent to HIV testing from 18 to 15 years old, a decisive move to increase access to HIV testing by giving greater freedom to young people to take control of their sexual health and rights.
To advance the response further a number of steps need to be taken.
Firstly, ramp up community engagement. UNAIDS is already actively supporting this action in the Philippines because communities have the know-how and experience to reach the most vulnerable and ensure that no one is left behind. During the COVID-19 pandemic, communities delivered HIV treatment to people’s doorsteps, established hotlines to offer psychosocial support and mobilized partners to help people displaced by the pandemic. These approaches now need to be institutionalized and scaled up.
Secondly, efforts need to be redoubled to ensure that by 2025, less than 10% of people living with HIV and key populations experience stigma and discrimination. To achieve this, all legal and policy barriers that block access to HIV services need to be removed, and stigma and discrimination reduction interventions scaled-up.
Thirdly, young people should be at the centre. I had the privilege of meeting with some young people and hearing about their concerns and ideas firsthand. A wealth of ideas can be gained from them to identify what interventions work best for them. For example, they have pinpointed that one single HIV prevention approach alone cannot stop the epidemic. Meeting the ambitious 2025 targets requires focused combination packages that offer a mix of proven high-impact HIV prevention interventions, including PrEP and self-testing. Likewise, comprehensive sexuality education in and out of school and sexual and reproductive health services should be provided nationwide.
Lastly, as the world confronts the challenges of the difficult fiscal situation exacerbated by COVID-19, we see a growing recognition that investments in health are not unaffordable expenditures but vital investments for recovery and development. Together, we must find and allocate money to ensure we leave no one behind, not in rhetoric but in reality.
The Philippines has the means to turn around its HIV epidemic. My virtual mission came at an opportune time, just before the United Nations Member States, including the Philippines, will come together on 8-10 June 2021 for the United Nations High-level Meeting on HIV and AIDS.
World leaders must seize the opportunity offered by this new high-level meeting to maintain their focus and commitment to ending AIDS as a public health threat as part of the Sustainable Development Goals.
AIDS is unfinished business and must be ended for everyone everywhere. As the United Nations, we are not only by your side right now, but for the years ahead. We are with you as you work to tackle inequalities, to tackle HIV and to tackle COVID-19.
Together, in solidarity, we can do this.
by Winnie Byanyima, Executive Director of UNAIDS