Addressing the HIV crisis in the Philippines
Authors: Jez Lim Marston, Daniela Marín-Hernández, Douglas F Nixon
Journal: The Lancet Public Health (2019)

We read with interest the Correspondence from Louie Gangcuangco,1Gangcuangco LMA HIV crisis in the Philippines: urgent actions needed.Lancet Public Health. 2019; 4: e84Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar which paradoxically was published in The Lancet Public Health around the same time as the 2019 State of the Union address by President Donald Trump, in which he said, “Together, we will defeat AIDS in America. And beyond.”2The White HouseRemarks by President Trump in State of the Union address.https://www.whitehouse.gov/briefings-statements/remarks-president-trump-state-union-address-2/Date: Feb 5, 2019Date accessed: February 13, 2019Google Scholar The Philippines has a burgeoning epidemic of HIV infection, predominantly within populations of men who have sex with men and among those who inject drugs but, as observed in other countries, epidemics have no sexual or sociological boundaries.3Restar A Nguyen M Nguyen K et al.Trends and emerging directions in HIV risk and prevention research in the Philippines: a systematic review of the literature.PLoS ONE. 2018; 13: e0207663Crossref PubMed Scopus (26) Google Scholar The Philippines is therefore at a crucial so-called incidence-prevalence window of opportunity, at which interventions now will have maximal impact later. We agree that combination antiretroviral drug therapy should be updated to include integrase inhibitors, as has been provided for other countries through Mylan4MylanMylan is proud to support International AIDS 2018.http://www.mylan.com/en/news/feature-stories/mylan-sponsors-international-aids-2018Date: July 12, 2018Date accessed: February 13, 2019Google Scholar and the US President's Emergency Plan for AIDS Relief (PEPFAR).5The United States President's Emergency Plan for AIDS ReliefPartnering to achieve epidemic control in the Asia region.https://www.pepfar.gov/countries/asiaregion/index.htmDate accessed: February 13, 2019Google Scholar Perhaps the Government and the health department of the Philippines could negotiate with companies (such as Mylan) to provide tenofovir–lamivudine–dolutegravir instead of lamivudine–tenofovir–efavirenz. Widespread adoption of tenofovir–lamivudine–dolutegravir would help to reduce community viral loads to undetectable and untransmissible levels—this approach could reduce new infections. In southeast Asia, with the help of USAID and the PEPFAR-funded LINKAGES programme, antiretroviral drugs were provided for almost 16 000 people in 2016.5The United States President's Emergency Plan for AIDS ReliefPartnering to achieve epidemic control in the Asia region.https://www.pepfar.gov/countries/asiaregion/index.htmDate accessed: February 13, 2019Google Scholar The strategies laid out in the Correspondence from Gangcuangco should be implemented now, and PEPFAR programmes should expand to include the Philippines. We declare no competing interests. HIV crisis in the Philippines: urgent actions neededThe Philippines is facing the fastest growing HIV epidemic in the western Pacific, with a 174% increase in HIV incidence between 2010 and 2017. There were 1047 new cases in August, 2018, alone.1 Although national HIV prevalence remains below 0·1%, men having sex with men are disproportionately affected, accounting for 84% of all new infections. UNAIDS estimates that only 67% of people living with HIV know their status, 55% have CD4 count lower than 200 cells/μL at the time of diagnosis, 32% are on antiretroviral therapy (ART), and 82% remain on ART 12 months after treatment initiation. Full-Text PDF Open Access