STI Module 1:

HIV/STI Epidemiology
Objectives
• Discuss worldwide and local statistics of HIV
and other STIs.
• Give overview of HIV AIDS Registry
• Show importance of active and passive
surveillance

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 The Dangerous Synergy

HIV = STD
Infections Infections
*STI patients not mandated to undergo HIV testing.

3
Sexually Transmitted Infections
The Realities:
• Changing prevalence of HIV/STD.
• Common pathogens remain common.
• Vast majority of therapy is empiric.
• Altered antimicrobial susceptibility pattern
• STD as an emerging infection.

WHO/UNAIDS Intl Congress in HIV AIDS Asia Pacific

Kobe Japan 2005

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STD and HIV:
The Dangerous Synergy
• STDs (ulcer and non ulcer) increases in genital
secretions of HIV infected individuals
• STD increases susceptibility to infection when
sexually exposed to an HIV infected partner
• Detection and treatment of STDs will help reduce
spread of HIV
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DOH-EB Surveillance System
HIV/AIDS and ART Registry of the Philippines (HARP)
HIV Anti- Viral TB,
Diagnosi retroviral Suppressi Pregnanc Mortality
HIV & STI
HIV & s Therapy on & ADR y & OIs
Prevention STI
Activities
Testing FORM
FORM BC FORM D
A

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Status

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 Increasing NEW Infections
Philippines
Sri Lanka
Afghanistan
Pakistan
Papau New Guinea
Bangladesh
Australia

Source: UNAIDS 2017

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 The number of people living with HIV
will triple in the next 10 years
350,000
Region %
NCR 41%
300,000 265,900 4A 15%
7 9%
250,000
3 9%
11 6%
6 4%
200,000 12 2%
142,400 1 2%
10 2%
150,000
5 1%
108,400
9 1%
100,000
8 1%
79,700
67,100 2 1%
4B 1%
50,000 CARAGA 1%
CAR 1%
ARMM <1%
0
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Sources:
1 HIV/AIDS & ART Registry of the Philippines (HARP), December 2017
2 Spectrum-AIDS Epidemic Model (AEM) as of May 2017
Sources:
1 HIV/AIDS & ART Registry of the Philippines (HARP), March 2018
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 Common Sexually Transmitted Infections
in the Philippines (January to December 2017)
30.0% Male Female

25.0% 24.0%

20.0%

15.0%

10.0%

5.0% 4.2% 3.1%

2.0%
0.8% 0.9%
0.0%
Gonorrhea Positivity Rate Hep B Reactivity Rate Syphilis Reactivity Rate

Top 3 Top 3 Top 3

CARAGA 14% Region 9 5% Region 12 5%
Region 10 12% Region 12 5% Region 4A 2%
Region 12 12% Region 4B 5% Region 9 1%

Sources: HIV & STI Laboratory and Blood Bank Surveillance (LaBBS), December 2017 11
Aggregated numbers were generated from reporting public and private laboratories
 HIV & Hepatitis C prevalence remain high
among People Who Inject Drugs (PWID)
in Cebu City
100% 95.0% 93.3% 94.4%
88.2%
HIV Prevalence 82.6%
80%

60% 53.5% 53.2% 52.3%

45.9%
Percentage

40%

20%
0.80% 0.40% 0.6%
0%
2005 2007 2009 2010 2011 2013 2015
(n=250) (n=250) (n=341) (n=449) (n=301) (n=457) (n=436)
* Data Source: IHBSS Year & Sample Size
 HepB at birth Coverage by Region, Year 2014-2016
View1

Yr. 2014 Yr. 2015 Yr. 2016

N=1,228,744(46%) N=1,412,688(51%) N=1,536,837(55%)
2014.shp
Legend:
No Data
1<-60%
59
60 - 79
60-79%
80 - 89
80-89%
90 - 100
≥ 90%
HIV Transmission

Source: HARP, March 2019

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 HIV prevalence among MSM who have
anal sex
7.0%
5.8% Cities with HIV Prevalence >5%
6.0% among MSM**:

5.0% 4.4% Cebu – 14.0%

4.0% CDO – 9.3%
Percentage*

2.5% P. Princesa – 7.7%

3.0%
Mandaue – 6.5%
2.0%
1.0% Davao – 5.5%
1.0% QC – 7.4%
0.0% Paranaque – 5.9%
2009 2011 2013 2015 Makati – 5.2%
(n=719) (n=2,327) (n=1,975) (n=2,271)
**HIV prevalence is weighted.
*HIV prevalence is unweighted. These are the highest prevalence cities
Data is an aggregate of sentinel sites only, not all IHBSS sites. The sentinel sites include Angeles, among the 36 cities that participated in
Baguio, Cebu, CDO, Davao, Gen San, Zamboanga, Pasay, and Quezon City. the 2015 IHBSS (n=9,498).
6th AIDS Medium Term Targets

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HIV knowledge is lowest among 15-17 yrs old

Source: IHBSS, 2015

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Condom use is below national budget

Source: IHBSS, 2015

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40% of MSM do not buy or get free condoms

Source: IHBSS, 2015

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Priority Areas for HIV Intervention
Antipolo x Bacolod xBacoorx Baguio x
Batangas x Biñanx Bogo x Butuan x
Cabanatuan x Cabuyao xCagayan de
Oro x Calamba x Caloocan x Carcar x
Cavite x Cebu x Danao x Dasmariñas x
Davao x General Santos x General Trias
x Iligan xIloilo xImus xKoronodal x
Lapu -Lapu x Las Piñas x Lipa x Lucena
x Mabalacatx Makati x Malabon x
Malolosx Mandaluyong x Mandaue x
Manila x Marikina x Meycauayan x
Muntinlupa x Naga x Olongapo x
Parañaque x Pasay x Pasig x P.
Princesa x Quezon x San Fernando x
SJDM x San Pablo x San Pedro x Santa
Rosa x Tacloban x Taguig x Tagum x
Talisay xTarlac x Toledo x Valenzuela x
Zamboanga
 Percent of estimated PLHIV on ART has
been steadily increasing by 5% each year
90,000

79,700
80,000
79,600
70,000 67,100

60,000 56,200 ARV

adherence =
50,000 46,600
37% right ARVs =
40,000 38,000
32% right dosage =
30,600 right time
30,000 27%
22%
20,000 24,754
18%
17,940
10,000 12,533
8,482
5,567
0
2013 2014 2015 2016 2017 2018

Estimated in need of ART on ART Estimated PLHIV

Sources:
1 Spectrum-AIDS Epidemic Model (AEM) as of May 2017
2 HIV/AIDS & ART Registry of the Philippines (HARP), December 2018
Note: ART Coverage used is based number of on ART as of December 2017 among estimated PLHIV for the year
 Number of diagnosed PLHIV on ART
INCREASED in 2017 across key populations
Key Population 2016 2017 % Difference

Males who have sex

49% 54% 5%
with Males

Women Living
22% 27% 5%
with HIV

Overseas Filipino
Workers with HIV
39% 45% 6%

Persons who
share Drugs 10% 13% 3%

Children (0-14 y/o) 56% 57% 1%

with HIV
Sources:
1 HIV/AIDS & ART Registry of the Philippines (HARP), December 2017
 PLHIV who are lost to follow up after
12 months of ART initiation is INCREASING
100% 4% 1% 3% 3%
90% 11% 13%
15% 16%
80%

70%

60%

50%

40% 85% 86% 82% 81%

30%

20%

10%

0%
2013 2014 2015 2016
Year of ART Initiation

Alive on ART Lost to follow up Dead

Sources:
1 HIV/AIDS & ART Registry of the Philippines (HARP), December 2017
2013 enrollees (n=2,724); 2014 enrollees (n=3,443); 2015 enrollees (n=4,826); 2016 (n=6,944)
 Treatment outcomes of 2016 ART enrollees
after 12 months of initiation (N=6,944)

1%
81% Alive on ARV
More than 9 months

7th to 9th month 19%

Lost to 4th to 6th month 24%

16% follow up
3rd month or less 27%

Did not return after ART

enrollment
29%

3% Dead 0% 5% 10% 15% 20% 25% 30%

*Length of time before being lost to follow up (n=1,152)

Sources:
1 HIV/AIDS & ART Registry of the Philippines (HARP), December 2017
2016 ART enrollees (n=6,944)
* Among those observed at 12 months from ART initiation (2016 enrollees) [n=1,152]
 Review Questions:
1. Why is HIV and STI infections interrelated?
2. Why is the younger generation being infected?
3. What is the difference between active and passive
surveillance?

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