On World AIDS Day, the World Health Organization (WHO) is calling for new action and stronger commitment from the global health community for the fight against HIV/AIDS.
With 22 new cases of HIV infection reported every day, the Philippines has one of the fastest growing HIV epidemics, an anomaly to the declining HIV prevalence trends observed across the world. The national HIV prevalence remains less than 0.1%, but is rapidly expanding among key populations such as men who have sex with men (MSM) and people who inject drugs (PWID). In 2015 the HIV prevalence among MSM reached as high as 14%, and one out of two people who inject drugs (PWID) are HIV positive. A large number of HIV negative MSM and PWID as well as their spouses and partners are at an increased risk for infection by sexual transmission of HIV.
To counter the high rates of infection, new and innovative prevention strategies are arguably needed. Oral pre-exposure prophylaxis (PrEP) has demonstrated efficacy in reducing HIV incidence among MSM, serodiscordant couples (where one partner is HIV negative and the other is HIV positive), women and PWID. Oral PrEP for HIV requires daily dosage of antiretroviral (ARV) drugs by an uninfected person before potential exposure to block the acquisition of HIV. When taken as directed, PrEP is estimated to be over 90% protective against HIV.
WHO recommends offering PrEP to all population groups at substantial risk such as serodiscordant couples, inconsistent use of condoms and sharing of needles among injecting drug users. High quality evidence shows the level of protection from PrEP to be strongly correlated with adherence in those at risk.
Managing the HIV burden – Treatment as Prevention
The Philippines Health Sector Plan for HIV and STI 2015-2020 set the goal to maintain HIV infection below 66 HIV cases per 100,000 populations by preventing HIV transmission. Recent rapid rises in HIV prevalence among key populations across the Philippines reveal that prevention strategies currently employed have been inadequate to control the epidemic.
WHO is supporting the HIV clinic of the Research Institute of Tropical Medicine (RITM) of the Department of Health (DOH) to implement a PrEP pilot project in a peer-driven HIV testing clinic in Manila. In November 2015, WHO conducted site assessments and meetings with relevant government and nongovernment stakeholders, including DOH, Philippines Food and Drug Administration, The Joint United Nations Programme on HIV and AIDS, Love Yourself Inc. Showing strong motivation and willingness to test new strategies for preventing HIV , all recognized the important role that ARV chemoprophylaxis could play in curbing the HIV epidemic in the Philippines, and reducing new infections among key populations.
The pilot project will assist the DOH in identifying drivers for PrEP supply and demand, evaluate efficient and effective delivery, estimate goals for scaling up services and support the development of WHO guidance for PrEP implementation. HIV testing is required before and throughout PrEP in order to minimize the likelihood of acquiring HIV drug resistance. Therefore it presents an opportunity to increase HIV testing uptake and testing frequency and link those diagnosed HIV positive to treatment and care. PrEP can indirectly reduce HIV drug resistance by decreasing the number of HIV infections, thereby removing the potential for drug resistance caused by patient non-adherence to treatment.
On World AIDS Day, WHO calls on the government, civil society organizations, affected communities, health care providers and international partners to join in advocating, implementing and rolling out this new strategy to prevent the further spread of this preventable disease.
WHO (2015) recommends that oral PrEP containing tenofovir disoproxil fumarate (TDF) should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches.