The Philippines continues to face significant challenges with the human immunodeficiency virus (HIV), with new infections steadily occurring. To effectively curb this public health crisis, the country needs a strategic course correction to prioritize and improve access to essential interventions: pre-exposure prophylaxis (PrEP), antiretroviral therapy (ART), and self-testing.
While the country has made strides in HIV prevention and treatment, there are concerning gaps that need to be addressed. Here’s a closer look:
Limited awareness and access to PrEP: PrEP, a highly effective medication that can significantly reduce the risk of HIV infection, remains underutilized due to limited public awareness, stigma surrounding its use, and restricted access to healthcare facilities offering PrEP services. In the Philippines, doctors can prescribe PrEP to willing at-risk patients, but pharmacies do not readily sell and dispense these on a routine basis. As a result, prescription becomes a futile endeavor.
Excessive focus on HIV registration: The current system often prioritizes registration and tracking of individuals with HIV, potentially deterring people from seeking testing and treatment due to the fear of stigma and discrimination. This overemphasis on registration can hinder efforts to effectively address the epidemic.
Challenges with adherence to ART: Maintaining consistent medication adherence is crucial for the success of ART. However, social determinants of health, such as poverty and food insecurity, can significantly impact adherence. Like the situation regarding access to PrEP, doctors can prescribe ART on an outpatient basis with basic training, but private pharmacies are unable to sell and dispense these medications, forcing patients living with HIV (PLHIVs) to seek out a supply of ART in designated treatment hubs which are relatively sparse and can be an inconvenience to go to.
Late HIV diagnosis: Many Filipinos are diagnosed with HIV at a late stage, often when their immune systems are already compromised. Ironically, complications arising from this delay the initiation of ART, a combination of medications that effectively suppresses the virus and allows people with HIV to live long and healthy lives.
The Philippines can significantly reduce new HIV infections and improve the lives of PLHIVs.
Scaling up access to PrEP and ART: PrEP essentially prevents the transmission of HIV. It’s the closest option we have to a “vaccine.” By taking PrEP like one would do any maintenance drug (such as oral contraceptive pills), patients are able to protect themselves from HIV by dramatically minimizing the risk of infection despite exposure. Increasing the number of healthcare providers trained to prescribe and monitor PrEP is essential, but we also need to decentralize services by offering PrEP in community-based settings like clinics and private pharmacies.
It should also be similar with ART. Even ART can be prescribed after an exposure event (e.g. a needle prick or an unprotected sexual activity) — this is called post-exposure prophylaxis or PEP. This can effectively prevent HIV infection. Allow private clinics and pharmacies to prescribe and dispense these medicines. Price regulation of these drugs can also be considered in implementation. Health promotional activities should be conducted simultaneously, of course. Improving access to PrEP and ART will prevent HIV infection from taking hold and/or perhaps prevent the occurrence of advanced disease: life-saving stuff.
The role of self-testing in HIV prevention: HIV self-testing empowers individuals to take control of their health by enabling them to discreetly test themselves for HIV at home. Not everyone prefers to go to a facility to get tested. And let’s face it: not everyone is willing to be registered. In 2022, the DOH provided guidelines allowing for the utilization of HIV self-testing. However, over two years later, and as of writing, reliable self-testing kits have not made it into the local market.
Make self-tests more accessible: We need to increase the availability of reliable and accurate self-test kits through pharmacies and community-based organizations. This can be done by facilitating the evaluation and regulation of these self-test kits to ease availability in the formal market. Again, allow private clinics and pharmacies to prescribe and dispense these.
Developing robust support systems: Establishing clear guidelines on using self-tests will ensure that individuals who test positive have access to appropriate medical care and support. For example, some self-testing programs in other countries allow for patients to call a hotline so they can get guidance on the next steps should a positive result occur.
The Philippines has quite a bit of catching up to do with other countries in approaching the HIV epidemic. PrEP, ART, and self-testing are nothing new from a global perspective. Other countries have been able to provide these by easing access, and they have curbed their HIV rates — take for example Thailand and Cambodia. Self-test kits in these countries can be purchased from pharmacies and even online.
Making PrEP, ART, and self-testing free would certainly be a benefit for every citizen. But sustainability and cost will always be prohibitive, and public health resources are limited. Improving access by allowing the private sector to take part in this endeavor will most likely improve outcomes from an HIV standpoint. We ought to consider HIV registration as a requirement to gain access to free care and medicine, but for the unwilling, give them access to the free market. – Rappler.com
Carlo Emmanuel L. Yao, MD, MBA, is a researcher and team leader at EpiMetrics.
EpiMetrics is a public health research institution focused on the achievement of health equity through rigorous and creative conception, execution, translation, and communication of health systems and policy research.
