SEPTEMBER 2012
DEPARTMENT OF HEALTH NATIONAL EPIDEMIOLOGY CENTER
In September 2012, there were 316 new HIV Ab sero-positive individuals confirmed by the STD/AIDS Cooperative Central Laboratory (SACCL) and reported to the HIV and AIDS Registry (Table 1). This was 25% higher compared to the same period last year (n=253 in 2011) [Figure 1].
Table 1. Quick Facts
Most of the cases (96%) were males. The median age was 28 years (age range: 16-70 years). The 20-29 year (57%) age-group had the most number of cases. Fifty-four percent (170) of the reported cases were from the National Capital Region (NCR).
Demographic Data
Sept 2012
Jan-Sept 2012
Cumulative 1984—2012
316 306
2,466 2,340
10,830 9,722
Total Reported Cases Asymptomatic Cases AIDS Cases
10
126
1,108
Males
304
2,355
9,245*
Females
12
111
1,574*
Youth 15-24yo
91
688
2,605
Children <15yo Reported Deaths due to AIDS
0 0
4 11
62 353
*Note: No data available on sex for (11) cases.
Reported mode of transmission were sexual contact (312) and needle sharing among injecting drug users (4). [Table 2, page 3]. Males having sex with other males (82%) were the predominant type of sexual transmission [Figure 2]. Most (97%) of the cases were still asymptomatic at the time of reporting [Figure 3].
Figure 1. Number of New HIV Cases per Month (2010-2012) Number of New Cases
350
AIDS Cases Of the 316 HIV positive cases, ten were reported as AIDS cases, all were males. The median age is 24 years (age range: 16-49 years). All acquired the infection through sexual contact (6 homosexual, 1 heterosexual and 3 bisexual). There was no reported death for this month.
300 250 200 150 100 50 0 J an
Feb
M ar
A pr
M ay
J un
J ul
A ug
Sep
Oc t
Nov
Dec
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
316
Figure 2. Comparison of the Proportion of Types of Sexual Transmission in 2012, 2011 & Cumulative Data (1984-2012)
Overseas Filipino Workers (OFW) Heterosexual
100%
Forty-two of the 316 (13%) reported cases were OFWs [Figure 11, page 4]. There were 38 males and 4 females. The median age was 32 years (age range: 24-61 years). All acquired the infection through sexual contact (17 heterosexual, 13 homosexual and 12 bisexual).
Proportion of Cases
Philippine HIV and AIDS Registry
Newly Diagnosed HIV Cases in the Philippines
57
39
84
80
Bisexual Homosexual
3,204
75%
2,618
50%
171
25%
107
4,127
Sept 2011
Cumulative
0%
Sept 2012
Figure 3. Number of HIV/AIDS Cases Reported in the Philippines by Year, Jan 1984 to September 2012 (N=10,830) 2500 2250 2000 1750 1500 1250 1000 750 500 250 0
'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
T OT A L
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, 466
A sympt 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, 340
A I 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
126
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
*Nine initially asymptomatic cases reported in 2011, died due to AIDS that same year.
1
September 2012
Philippine HIV/AIDS Registry
AIDS Cases (1984-2012) Of the 2,466 HIV positive cases in 2012, one hundred twenty â&#x20AC;&#x201C;six were reported as AIDS cases. Of these, 120 were males and 6 were females. Ages ranged from 7-81 years (median 32 years). Ninety-eight percent (124) acquired the infection through sexual contact (69 homosexual, 34 bisexual and 21 heterosexual), and 2% (2) mother-to-child transmission.
Figure 4. Proportion of Modes of Transmission of AIDS Cases by Year, Jan 1984â&#x20AC;&#x201D;September 2012 100%
Proportion of Cases
75%
From 1984 to 2012, there were 1,108 AIDS cases reported. Seventy-six percent (842) were males. Median age is 34 years (age range: 1-81 years). Of the reported AIDS cases, 353 (32%) had already died at the time of reporting. Sexual contact was the most common mode of HIV transmission, accounting for 94% (1,042) of all reported AIDS cases. Almost half (495) of sexual transmission was through heterosexual contact, followed by homosexual contact (395) then bisexual contact (152). 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.
50%
25%
0% 1984-2008
2009
2010
2011
2012
Needl e P r i ck
2
0
0
0
0
B l ood T r ansf usi on
10
0
0
0
0
M T CT
16
1
0
1
2
I DU
4
0
0
2
0
B i sexual Cont act
64
8
7
39
34
Homosexual Cont act
246
16
19
45
69
Het er osexual Cont act
442
6
3
23
21
*Note: 28 did not report mode of transmission
Demographic Characteristics (1984-2012) Figure 5. Proportion of Sex & Age-Groups in Sept 2012 & Jan-Sept 2012 100%
Proportion of Cases
Ninety-six percent of the 2,466 cases were males (2,355). Ages ranged from 2 to 81 years old (median 28 years). The 20-29 year old age group had the most (58%) 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 10,830 HIV Ab sero-positive cases reported (Table 1), of which 9,722 (90%) were asymptomatic and 1,108 (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 (9,245) were males. Ages ranged from 1-81 years (median 29 years). The age groups with the most number of cases were: 20-24 years (22%), 25-29 (29%), and 30-34 years (19%) [Figure 6].
75%
50%
25%
0% Sept 2012 (M )
Sept 2012 (F)
2012 (M al e)
2012 (Femal e)
50 & ol der
13
2
51
10
35-49y o
46
3
395
33
25-34y o
158
3
1, 239
46
15-24y o
87
4
667
21
1-14y o
0
0
3
1
Figure 6. Comparison of the Distribution of Male and Female HIV Cases by Age-Group and Certain Highlighted Years 1984-2007
50 & o lder
2008
2009
2010
2011
2012
45-49yo 40-44yo 35-39yo 30-34yo 25-29yo 20-24yo 15-19yo
Number of Male Cases 2750
2500
2250
2000
1750
Number of Female Cases
<15yo 1500
1250
1000
750
500
250
0
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 & ol der
<15yo
15-19yo
20-24yo
25-29yo
30-34yo
35-39yo
40-44yo
45-49yo
50 & ol der
2012
3
63
604
792
447
210
114
71
51
2012
1
6
15
28
18
15
9
9
10
2011
1
76
589
739
378
193
117
51
49
2011
2
3
36
44
23
21
10
8
9
2010
1
50
405
455
256
128
81
42
48
2010
2
5
28
21
34
15
9
7
4
2009
1
22
179
227
124
90
41
18
29
2009
1
4
13
19
21
20
14
7
5
2008
2
11
92
140
90
59
36
23
20
2008
0
0
8
14
8
10
9
3
3
1984-2007
27
15
157
374
414
364
279
185
176
1984-2007
21
33
191
225
202
154
90
35
44
*Note: 74 did not report age, 11 did not report sex, 10 did not report age and sex
2
September 2012
Philippine HIV/AIDS Registry
Geographic Distribution I
2%
II
2%
III
5%
IVA
15%
IVB
1%
V
1%
VI
4%
VII
5%
VIII
2%
IX
1%
X
1%
XI
5%
Fig 8. Comparison of Proportion of HIV Cases by Region & Year
In September 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.
% of Cases
100%
75%
Proportion of Cases
Region
Figure 7. New HIV Cases by Region, September 2012 R eg 3 5%
R OT C 16 %
R eg 4 A 15%
50%
25%
0%
R eg 7 5% R eg 11 5%
2012
2007-2011
1984-2012
Reg1
2%
2%
2%
Reg3
6%
6%
9%
13%
12%
12%
XII
2%
CAR
<1%
Reg6
3%
3%
3%
1%
Reg7
10%
9%
9%
Reg11
6%
7%
6%
52%
54%
51%
8%
7%
8%
CARAGA ARMM
<1%
NCR
54%
Reg4A
NCR 54 %
NCR ROT C*
*ROTC: Rest of the Country
Modes of Transmission (1984-2012) In 2012, 93% (2,303) were infected through sexual contact, 6% (159) through needle sharing among injecting drug users, and <1% (4) through mother-to-child transmission (Table 2). There were 2,202 males and 101 females infected through sexual transmission. The age range of those infected through sexual transmission was 15-81 years old (median 28 years).
Table 2. Reported Mode of HIV Transmission Mode of Transmission Sexual Contact
Of the 10,830 HIV positive cases reported from 1984 to 2012, 92% (9,949) were infected through sexual contact, 4% (424) 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 3% (375) of the cases.
Jan-Sept 2012 n=2,466
Sept 2012 n=316
Cumulative N=10,830
312
2,303
9,949
Heterosexual contact
57(18%)
328(14%)
3,204(32%)
Homosexual contact
171(55%)
1,239(54%)
4,127(42%)
Bisexual contact
84(27%)
736(32%)
2,618(26%)
Blood/Blood Products
0
0
20
Injecting Drug Use
4
159
424
Needle Prick Injury
0
0
3
Mother-to-Child
0
4
59
No Data Available
0
0
375
Cumulative data shows 32% (3,204) were infected through heterosexual contact, 42% (4,127) through homosexual contact, and 26% (2,618) 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]. Figure 10. HIV Transmission by Age-Group, 2012 (n=2,466)
Figure 9. Proportion of Types of Sexual Transmission, Jan 1984â&#x20AC;&#x201D;September 2012
1350 1275
100%
1200 1125
90%
Number of Cases
1050
Proportion of Cases
80% 70% 60% 50%
975 900 825 750 675 600 525 450 375 300 225
40%
150 75 0
30% 20% 10% 0%
'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
Het er osexual
1
7
24
24
16
19
35
30
41
47
58
56
81
82
138 114 93
B i 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
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 10361239
128 129 129 123 131 193 139 160 216 274 388 328 127 252 467 806 736
<7yo
7-14yo
15-17yo
18-24yo
25-34yo
35-49yo
50&ol der
B l ood T r ansf usi on - Femal e
-
-
-
-
-
-
-
M at 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 - M al e
-
-
2
53
50
43
2
Het er osexual Cont act - Femal e
-
-
-
19
40
32
10
Het er osexual Cont act - M al e
-
-
-
23
121
65
18
B i sexual Cont act
-
-
2
200
410
115
9
Homosexual Cont act
-
-
4
383
658
172
22
3
September 2012
Philippine HIV/AIDS Registry
Overseas Filipino Workers (OFW) In 2012, there were 264 HIV positive OFWs, comprising 11% of cases reported for the year [Figure 11]. Of these, 229 (87%) were males and 35 (13%) were females. All were infected through sexual contact. There were 2,052 HIV positive OFWs since 1984, comprising 19% of all reported cases [Figure 11]. Seventy-eight percent (1,599) 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 (1,754) were asymptomatic while 15% (298) were AIDS cases. Table 3. Mode of HIV Transmission Among OFWs
Figure 11. Number of OFWs Compared to Non-OFWs by Year (1984-2012)
Sept 2012 n=42
Jan-Sept 2012 n=264
Cumulative N=2,052
2400
42
264
1,990
2000
Heterosexual contact
17(40%)
83(31%)
1,181(59%)
Homosexual contact
13(31%)
102(39%)
457(23%)
12(29%)
79(30%)
352(18%)
Blood/Blood Products
0
0
10
Injecting Drug Use
0
0
1
Sexual Transmission
Bisexual contact
Needle Prick Injury
0
0
3
No Data Available
0
0
48
2200
Number of Cases
Mode of Transmission
1800 1600 1400 1200 1000 800 600 400 200 0
'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
OFW
1
2
0
3
9
5
10
7
14
29
31
24
35
27
51
67
60
79
96
93
86
92
130
106
122
164
174
271
264
Non-OFW
1
8
29
35
23
34
56
78
58
73
87
92
119
90
138
91
63
95
88
100
113
118
179
236
406
671
1417 2078 2202
% of OFW
50%
20%
0%
8%
28%
13%
15%
8%
19%
28%
26%
21%
23%
23%
27%
42%
49%
45%
52%
48%
43%
44%
42%
31%
23%
20%
11%
Blood Units Confirmed for HIV As of September 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 unless they underwent voluntary counseling and testing as individuals.
2012
2011
January
17
11
February
18
15
March
National Epidemiology Center, Department of Health, Bldg. 19, San Lazaro Compound, Sta. Cruz, Manila 1003 Philippines Tel: +632 651-7800 local 2926, 2952 Fax: +632 495-0513 Email: HIVepicenter@gmail.com Website: http://www.doh.gov.ph
Table 5. Number of PLHIV on ART Month
2012
14
January
2,087 2,169
April
21
20
May
21
10
March
2,278
June
9
32
April
2,498
May
2,633
July
22
22
August
25
18
13
18
October
22
November
17
December
18
Total
National HIV/AIDS & STI Strategic Information and Surveillance Unit
34
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.
February
September
11%
PLHIV on Anti-Retroviral Therapy
Table 4. Number of Confirmed HIV Positive Blood Units Month
12%
180
217
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
June
2,761
July
Data not yet available Data not yet available Data not yet available
August September October November December
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
* 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 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 Laboratories (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 individualâ&#x20AC;&#x2122;s 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.
4