An HIV epidemic is ready to emerge in the Philippines.
BACKGROUND
The state of the HIV epidemic in the Philippines has been described as "low and slow", which is in stark contrast to many other countries in the region. A review of the conditions for HIV spread in the Philippines is necessary.


METHODS
We evaluated the current epidemiology, trends in behaviour and public health response in the Philippines to identify factors that could account for the current HIV epidemic, as well as to review conditions that may be of concern for facilitating an emerging epidemic.


RESULTS
The past control of HIV in the Philippines cannot be attributed to any single factor, nor is it necessarily a result of the actions of the Filipino government or other stakeholders. Likely reasons for the epidemic's slow development include: the country's geography is complicated; injecting drug use is relatively uncommon; a culture of sexual conservatism exists; sex workers tend to have few clients; anal sex is relatively uncommon; and circumcision rates are relatively high.In contrast, there are numerous factors suggesting that HIV is increasing and ready to emerge at high rates, including: the lowest documented rates of condom use in Asia; increasing casual sexual activity; returning overseas Filipino workers from high-prevalence settings; widespread misconceptions about HIV/AIDS; and high needle-sharing rates among injecting drug users.There was a three-fold increase in the rate of HIV diagnoses in the Philippines between 2003 and 2008, and this has continued over the past year. HIV diagnoses rates have noticeably increased among men, particularly among bisexual and homosexual men (114% and 214% respective increases over 2003-2008). The average age of diagnosis has also significantly decreased, from approximately 36 to 29 years.


CONCLUSIONS
Young adults, men who have sex with men, commercial sex workers, injecting drug users, overseas Filipino workers, and the sexual partners of people in these groups are particularly vulnerable to HIV infection. There is no guarantee that a large HIV epidemic will be avoided in the near future. Indeed, an expanding HIV epidemic is likely to be only a matter of time as the components for such an epidemic are already present in the Philippines.
Farr
Anna C
AC
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia.
Wilson
David P
DP
D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D006801:Humans; D008297:Male; D010679:Philippines / Q000453:epidemiology; D012725:Sexual Behavior
AIDS. 1991;5 Suppl 2:S71-85
1845063
Am J Epidemiol. 1999 Aug 1;150(3):306-11
10430236
Sex Transm Dis. 2002 Jan;29(1):38-43
11773877
Am J Epidemiol. 2002 Jan 15;155(2):159-68
11790680
AIDS. 2009 Jan 14;23(2):243-52
19098494
PLoS Med. 2005 Nov;2(11):e298
16231970
Nat Rev Microbiol. 2004 Jan;2(1):33-42
15035007
AIDS. 2006 Apr 4;20(6):805-12
16549963
AIDS Wkly Plus. 1995 Dec 18;:22-4
12291189
AIDS. 1989 Jun;3(6):367-72
2502150
Lancet. 2007 Feb 24;369(9562):643-56
17321310
N Engl J Med. 1997 Apr 10;336(15):1072-8
9091805
JAMA. 2003 Mar 12;289(10):1265-73
12633188
Asia Pac Pop Policy. 1997 Jan;(40):1-4
12292304
Am J Public Health. 2003 Jun;93(6):943-8
12773360
Lancet. 2008 Nov 15;372(9651):1733-45
18817968
J Acquir Immune Defic Syndr. 2009 Jul 1;51(3):356-60
19582897
Lancet Infect Dis. 2003 Jun;3(6):320
12781490
Sex Health. 2009 Mar;6(1):19-33
19254488
J Clin Microbiol. 2003 Jan;41(1):516-8
12517912
Lancet. 2007 Feb 24;369(9562):657-66
17321311
Med J Aust. 1996 Nov 4;165(9):494-8
8937371
Lancet. 2009 Jan 3;373(9657):48-57
19038438
AIDS Educ Prev. 2004 Jun;16(3 Suppl A):43-52
15262564
Sex Transm Infect. 2008 Dec;84(7):554-5
18653565
J Clin Epidemiol. 1989;42(9):849-56
2789269
Am J Epidemiol. 2005 Nov 1;162(9):907-16
16177149
Lancet. 2008 Jul 26;372(9635):314-20
18657710
Sex Transm Infect. 1999 Feb;75(1):3-17
10448335