2 significant factors that make MSMs more at risk

for HIV - Epidemiology Bureau

Chrisha Ane Magtubo. MIMS. August 15, 2017. Retrieved from https://today.mims.com/topic/2-
significant-factors-that-make-msms-more-at-risk-for-hiv---epidemiology-
bureau?country=philippines&elq_mid=18525&elq_cid=24271

As more new HIV cases are reported, the emerging trend is that majority of these
infections result from male-to-male sexual contact.

Why are MSMs (males having sex with males) more prone to being infected with the
human immunodeficiency virus? The Epidemiology Bureau (EB) under the Department
of Health explains the disturbing situation.

The HIV/AIDS and ART Registry of the Philippines (HARP), which is under the EB,
noted in its May report on HIV/AIDS that 86 percent of new infections from January
2012 to May 2017, or 19,154, were through sexual contact among males.

Further, the report stated that beginning 2010, the trend shifted to MSM contact as the
dominant mode of transmission, whereas between 1984 and 2009, this was
predominantly spread through male-female contact.

The May report is significant in that it was the first time that HIV cases reported
breached the thousand mark at 1,098, and 95 percent of those infected were males.

Making matters worse are the UNAIDS global report on HIV epidemics stating that the
number of new infections in the Philippines more than doubled in the past six years
(from 4,300 in 2010 to 10,500 in 2016); and the fact that the country became the
fastest growing in Asia-Pacific in the number of new infections.

There is a bit of good news, however: in spite being the fastest growing, the numbers
reported in the Philippines is still not as high as in several countries in the region,
which is said to record tens of thousands of new cases annually.

Early sexual initiation

So, why are males - specifically those who have sexual contact with other males - at
high risk for HIV infection?

One important factor is they start risky sexual behaviour early.

Dr Genesis May Samonte, manager of the HIV Unit under the EB, first clarified that
MSM does not only refer to those who are openly homosexual. What we are saying is
that any male who has sex with another male - for whatever reason - is at risk for
getting HIV, she said during a press conference at the DOH Central Office.

She goes on to explain that the first sexual contact typically happens at 16 years old,
although risky behaviour starts to increase between 13 and 16, and 16 is the peak age,
then is followed by the first anal sexual contact at 17. But condom use [just] starts 2
years after, Dr Samonte noted.

Based on information gathering among patients, they commonly resort to using

protection during sexual contact two years after they start becoming sexually active.

Meanwhile, these young patients only get tested for HIV at 22, about six years from
their first sexual contact. A 6-year time lag means warrior cells are quickly being
depleted unless treatment is started immediately. Still, the timeline for progression of
HIV to AIDS ranges from 5 to 10 years, depending on the strain.

The window for prevention is very small. We have to reach this age group if we want to
prevent this infection, Dr Samonte stressed.

In May 2017 alone, 30 percent of the cases or 325 patients, belonged to the 15-24 age-
group and 95 percent of them were males.

All cases were infected through sexual contact - 36 involved male-female contact, 192
male-male contact, and 97 cases for both male and female contact.

Since January 1984, more than a fourth of all reported infections belonged to the 15-24
age group, accounting for 12,065 patients, or 27 percent of total cases.

Lacking in information
The second factor that makes young men vulnerable to HIV infection is their lack of
proper knowledge about the virus, and its end stage AIDS.

Very few young MSM have correct knowledge about HIV and available services, Dr
Samonte siad, , putting emphasis on correct knowledge.

Only 35 percent of MSMs in the Philippines are armed with proper information about
what HIV is, how it can infect people and access to screening and treatment. And the
number is even more dismal (6 percent) when it comes to knowing where they can get
antiretroviral therapy.

Dr Samonte underscored that the goal is not just to get tested, but to undergo treatment
with antiretroviral therapy (ART). This amounts to treatment as prevention.

[But] the treatment as prevention is a challenge at the moment because few MSMs are
aware of their HIV status, she said. Those submitting to HIV screening are rising, but
the tests among high-risk group are not increasing at the rate they want to.

The rate of testing among MSMs has gone from 5 percent to 9 percent and to 16
percent, but the data was from 2015. We hope to see improved numbers next year,
she said.

Presently, there are 50 treatment hubs and satellites scattered in the countrys 17
regions. There are 11 centers in NCR including San Lazaro Hospital, Philippine General
Hospital, The Medical City/ i-REACT Clinic, Makati Medical Center and St. Lukes
Medical Center (Global City), among others.

There are three other facilities in Region 4A and 11 others in NCR including social
hygiene clinics.

Four-pronged reduction strategy

In the battle to curb HIV infection, health authorities are looking at a number of
strategies. The first is to increase the publics knowledge regarding HIV transmission,
prevention and services by 90 percent. Second is to prevent new infections in the 15 to
42 age group, and third is to test and treat 90 percent of people living with HIV (PLHIV).

The fourth objective is to eliminate mother-to-child transmission.

Our problem with HIV [is that] it will not go away. We will reach 142,000 PLHIV by the
end of 2022 Dr Samonte warned.

Last year alone saw 56,000 cases, an additional 86,000 is expected in only 5 years
time. More alarming is that two out of three new infections will come from the 15-24 age
group of MSMs.

Essentially, the Health department hopes to strengthen both prevention and treatment,
and for those already infected, protect them from unnecessary death through treatment.
At the same time, health authorities are pushing to encourage more people to abstain
from early sexual contact, but for those already having sex to protect themselves, at
least through consistent condom use..

On antiretroviral therapy
HIV tests in not the end goal, [but] only a bridge to life saving treatment. The issue that
we are facing right now is that many people are getting tested but not accessing the
treatment, Dr Samonte reminded.
According to the World Health Organization (WHO), majority of people infected with HIV
will develop signs of related illness within a span of 5 to 10 years. AIDS diagnosis could
come within the next five years, sometimes longer.

The ART slows the disease progression by preventing replication, which decreases the
viral load.

Among PLHIV who are aged 30 and above, 70 percent of them are on ART. On the
other hand, only 3 percent of those under the 15 -19 age group are on treatment, while
the 20 to 24 age group, only has 11 percent on ART, she said.

If under ART, the [an infected] person will have a normal life, according to Dr
Samonte. MIMS

Read more:

May 2017 HIV cases highest recorded since 1984

HIV epidemic in PH has fastest growth rate in Asia-Pacific
WHO: Drug resistance against HIV increasing