HIV Epidemic Among Adolescents in the Philippines 2015 PDF

The Growing HIV Epidemic among Adolescents in the Philippines New infections doubled from 2011 to 2015 among adolescents...

The Growing HIV Epidemic among Adolescents in the Philippines New infections doubled from 2011 to 2015 among adolescents Figure 3. Start of high-risk behaviors, 2015 IHBSS Evidence from both the HIV/AIDS & ART Registry of the 16 y/o 17 y/o 18 y/o M/TSM Philippines (HARP) and the 2015 Integrated HIV Behavioral and first first first Serologic Surveillance (IHBSS) indicate an escalating HIV sex anal condom problem among Filipino adolescents. sex use From 2011 to 2015, newly diagnosed HIV cases among young 17 y/o 20 y/o key affected populations (YKAP) increased by 230% (Figure 1); FSW of which, male to male sex and males who have sex with both first first paid sex males and females were the two predominant modes of sex first condom use transmission (58% and 26%, respectively).1 There were also 9% who were infected from sex between males and females. Notably, 16 y/o 17 y/o 20 y/o 7% of these new infections were transmitted through sharing of PWID first first first drug injection infected needles. drug sex first condom use use Figure 1. Number of newly diagnosed HIV cases among adolescents by mode of transmission, 2011-2015 HIV/AIDS & ART Registry of the Philippines (HARP) Gateway behaviors that place YKAP at a higher risk include 300 drinking alcoholic beverages and taking recreational drugs. A significant proportion of YKAP reported getting drunk in the past No. of Cases 200 year (Figure 4). More importantly, a sizeable percentage (45% of M/TSM, 52% of FSWs, and 35% of male PWID) experienced 100 having sex while drunk. 0 Figure 4. Sexual practices of those who drank alcoholic 2011 2012 2013 2014 2015 beverages in the past 12 months, 2015 IHBSS Male-Male Sex Sex with Both Males & Females Adolescent M/TSM Adolescent FSW Adolescent Male PWID Heterosexual Contact Sharing of Infected Needles 100% 22% 15% Percentage 80% 57% This alarming increase in new HIV cases is consistent with the 60% doubling HIV prevalence particularly among adolescent males/ 40% 78% 85% 20% 45% 52% 43% 35% transgenders who have sex with males (M/TSM) in the past five 0% years (Figure 2). Got drunk Had sex Got drunk Had sex Got drunk Had sex while drunk while drunk while drunk Figure 2. HIV prevalence among M/TSM who have anal sex, 2015 IHBSS Got drunk Did not get drunk Had sex while drunk Did not have sex while drunk 10% 8.9% 8% Furthermore, among PWID, age of first drug use and first drug Percentage 6.2% 6.2% injection is 16 and 20 years old, respectively (Figure 3). Drug use 6% 4.0% was also found among other YKAP with 10% of M/TSM and 26% 4% 3.5% 3.6% 2.8% of FSW reporting said behavior in the past 12 months. Among 1.3% 2% 1.4% them, 3% of M/TSM and 15% of FSW had sex while under the 1.1% 0.6% 0% 0.9% influence of drugs (Figure 5). 2009 2011 2013 2015 15-19 yo 20-24 yo 25+ yo Figure 5. Sexual practices of those who used drugs in the past 12 months, 2015 IHBSS Adolescent M/TSM Adolescent FSW 100% Percentage 80% High risk behaviors start at an early age 74% 60% 90% 40% Findings from the 2015 IHBSS also showed that most M/TSM, 20% 10% 3% 26% 15% 0% female sex workers (FSWs) and people who inject drugs (PWID) Got high on drugs Had sex while high Got high on drugs Had sex while high start engaging in high-risk behaviors during their adolescent years on drugs on drugs (Figure 3). Used drugs Did not use drugs Had sex while high on drugs Did not have sex while high on drugs However, initiation into protective behaviors such as condom use, start two to three years later on the average. Apart from possible exposure to HIV during this condom lag (i.e. the gap between first sex and first condom use), further analysis indicates that the likelihood of eventual condom use decreases as the gap grows wider.  Yet among adolescent M/TSM who had anal sex, only 35% YKAP can be found in schools, social media, and reported having used a condom the last time they had sex (Figure 7). Further, only 11% of those who had anal sex reported cruising sites consistent use of condom with their three most recent partners. The IHBSS showed that some YKAP may be found in schools. Common reasons for not using a condom among M/TSM include: More than half (57%) of M/TSM were students while among FSW unavailability of condoms (61%), not liking condoms (17%), and male PWID, 39% and 13% were students. partner objection (7%), and thinking that condoms are not necessary (7%). A number of YKAP also reported having social networking accounts to look for partners. More than half of adolescent M/TSM Figure 7. Condom use at last sex, 2015 IHBSS (84%) and FSW (57%) have at least one social networking account used to look for partners. 65% 64% 74% Percentage 80 Further, the IHBSS also showed that among adolescent M/TSM, 60 39% 45% 40 29% 65% still go to cruising sites to find male partners. Among 17% 15% 19% 20 adolescent FSW, 51% go to bars and clubs, and 40% go to streets 0 and parks to find paying partners. M/TSM: Condom use at last FSW: Condom use last sex Male PWID: Condom use anal sex in the past 12 mos with male paying client in the last sex with male or female past 30 days non-paying partner in the past 12 mos YKAP have varied sex partners 15-17 yo 18-19 yo 20+ yo Condom use rate was highest among FSWs (65%) compared YKAP reported having sex with different types of partners (Table with other key populations. Among PWID, around 15% to 17% of 1). Though a smaller proportion of M/TSM engaged in 15 to 19 year old reported using condoms with male or female transactional sex, it was evident that majority (79%) had sex with non-paying partner in the past 12 months (Figure 7). multiple non-paying male partners in the past 12 months which included boyfriends, fuck buddies, or one-night stands. Gateway behaviors mentioned earlier pose additional challenges in ensuring safe sexual encounters as alcohol intake and use of FSW had more one-time male clients than returning male clients drugs further decreased rate of condom use across the different in the past month. Among the 68% of male PWID who had sex YKAP. Among M/TSM who had sex with a male or female partner with non-paying female partners in the past 12 months, most had while drunk or high on drugs, condom use was at 19% and 15% one partner only which included wives or girlfriends. A very small respectively. Among FSW who had sex with a male partner while percentage of male PWID reported M/TSM behavior by having drunk or high on drugs, condom use was at 51% and 57%. Lastly multiple non-paying male partners. among PWID, 24% reported use of a condom the last time they Table 1. Type of partner and median number of sex partners, had sex with a male or female partner while drunk. 2015 IHBSS % who reported Median Type of partner having sex with number of Knowledge about HIV and perception of risk is low the specific sex partners* type of partner Partners of M/TSM in the past 12 months Generally, low knowledge on HIV and self-perceived risk among Non-paying male partner 79% 3 YKAP further compound the risk of the said populations. Indeed, Paying male client 40% 2 relative to older age groups, knowledge on HIV prevention and Paid male partner 10% 2 transmission was lowest among 15 to 17 year old M/TSM and Anal sex partner met online 10% 2 Partners of FSW in the past month FSW at 32% and 14%, respectively (Figure 8). First-time male client 74% 3 Returning male client 45% 1 Figure 8. Comprehensive knowledge about HIV, Male client met online 4% 2 2015 IHBSS Non-paying male partner 50% 1 80 Percentage Partners of Male PWID in the past 12 months 60 44% 38% 32% 35% Non-paying female partner 68% 1 32% 37% 37% 40 22% Non-paying male partner 6% 3 14% 20 Paid female or male partner 5% DNA** 0 *Number of sex partners among those who reported having sex with the specific type of partner **Data not available M/TSM FSW Male PWID 15-17 yo 18-19 yo 20+ yo Almost half of adolescent M/TSM are having anal sex and Meanwhile, self-perceived risk of having HIV infection was condom use is way below target particularly salient among YKAP. Among 46% of M/TSM and 58% of FSW who felt they are at risk of having HIV, majority said it was During the last time adolescent M/TSM had sex with a male because they had multiple sex partners and did not always use partner in the past 12 months, 41% engaged in both oral and anal condom during sex. Less than a third (29%) of PWID said that sex, 5% had anal sex only, while 54% had oral sex only. (Figure they feel at risk of having HIV, of whom 52% said it was due to 6). sharing of infected needles. Figure 6. Type of sex during last sex with male partner among M/TSM, 2015 IHBSS YKAP have the lowest access to prevention commodities Oral sex only Had oral sex only and services 48% Had anal sex or Analoral inserter Both and anal sex On top of the risks discussed above, YKAP have inadequate 54% 46% ----------------------------- 33% Analinserter Anal receiver access to HIV services. Among male PWID, only 19% received 19% Anal receiver Both anal receiver and inserter free needles and syringes from social hygiene clinics (SHCs), peer educators (PEs), or drop-in centers (DICs). Meanwhile, M/TSM are particularly at a disadvantage when it comes to access to condoms and lubricants. Though condoms and lubricants are free and available at SHCs, less than half of adolescent M/TSM believed that condoms (37%) or lubricants (27%) are easy to get in the community.  Among FSW, though 77% reported that condoms are easily available, only 29% reported that lubricants are easy to get in the Only 25% of adolescents with HIV are linked to care community. and accessing treatment Moreover, compared to the older M/TSM cohort, fewer young Data from the HARP as of December 2015 is consistent with M/TSM reported access to condoms. Only 15% received free testing data from the 2015 IHBSS. Of the estimated 9,559 PLHIV condoms from SHCs or PEs, 9% received free condoms from aged 15 to 19 years old2, only 936 (10%) have ever been friends, 2% received free condoms from other sources, 12% diagnosed.3 bought condoms, and 8% bought and also received free condoms Among those diagnosed, 318 (34%) have been linked to care and (Figure 9). 238 (25%) are currently alive and accessing free antiretroviral Figure 9. Access to condoms among M/TSM, treatment from treatment hubs in the country (Figure 12). 2015 IHBSS Figure 12. HIV care cascade among adolescents 9% 2% 7%1% DidDon't buy or not buy or receive receivefree freecondoms condoms (15-19 yo), December 2015 HARP Bought and receives receivedfree free condoms from any 19 33% 15% Buys and condoms 9,559 10% 15-19 source (SHC/PE, friends, others) % 20+ 10000 Buys condoms only Frequency Bought condoms only yo 54% Received Receivesfree freecondoms condoms only fromSHC/PE only from SHC/PE yo 7500 34% 12% Received free condoms only from friends 25% Receives free condoms only from friends Received free condoms only from other sources 22% 18 5000 8% Receives free condoms only from other sources % 936 2500 318 287 238 0 Estimated PLHIV Actual number Linked to care Ever on ART Currently alive & Aggregating provision of HIV information and commodities as a (by Dec 2015) of cases on ART prevention package, the proportion of YKAP who received the diagnosed complete prevention package from SHC, PE, or DICs further decreased (Figure 10). Adolescents need to have access to interventions to Figure 10. Received HIV information and prevention commodities halt the growing HIV epidemic from SHC, PE, or DIC in the past 12 months, 2015 IHBSS High-risk behavior occurring among YKAP coupled with low 80 Adolescent M/TSM Adolescent FSW Adolescent Male PWID knowledge and limited access to HIV services are the primary 67% reasons for the escalating HIV epidemic among adolescents in 60 54% 46% the Philippines. Percentage 40% 47% 35% 40 31% 32% 33% 29% 27% 23% 22% 19% Strategies to increase access of adolescents to 18% 19% 20 14% 12% HIV services should be prioritized. 0 M/TSM reached M/TSM who FSW reached by FSW who Male PWID Male PWID who  Increase knowledge of YKAP on HIV and access to an HIV by SHC/PE received free SHC/PE received free reached by received free prevention package through a participatory, targeted, and condoms from condoms from SHC/PE/DIC needles and SHC/PE SHC/PE syringes from multi-platform approach. Activities need to be cognizant that 15-17 yo 18-19 yo 20+ yo SHC/PE/DIC face-to-face interventions are equally important as online strategies. These include scaling-up coverage of SHC and PE These findings contextualize the low levels of knowledge on HIV services, intensifying HIV in school curricula as mandated by and low condom use among M/TSM and the low proportion of RA 8504, and utilizing social media networks to reach more male PWID (45%) who did not use sterile injecting equipment at adolescents. last injection.  Improve HIV testing uptake of YKAP by promoting availability of free HIV testing in SHCs and treatment hubs and ensuring youth-responsiveness of these services. Less than 15% of YKAP know their HIV status  Establish satellite treatment hubs or community-based testing facilities to increase linkage to care among HIV-positive Overall, testing rate was low among key populations but adolescents. significantly lower among 15 to 17 years old (Figure 11). Note: FSW data refer to the 2013 IHBSS. M/TSM and PWID data from the 2015 IHBSS have Figure 11. Tested in the past 12 months and been adjusted using Time Location Sampling (TLS) and Respondent Driven Sampling (RDS) know HIV status, 2015 IHBSS weights. Data may not reflect national figures, but represent locations included in sample. 80 Percentage 60 References 1 HIV and ART Registry of the Philippines (HARP). Department of Health – Epidemiology 40 26% 26% 16% Bureau, Manila, Philippines. December 2015. 4% 5% 12% 11% 13% 13% 2 20 EPP Spectrum by December 2015. 3 0 2015 Integrated HIV Behavioral and Serologic Surveillance (IHBSS). Department of Health 15-17 yo 18-19 yo 20+ yo – Epidemiology Bureau, Manila, Philippines. February 2016. M/TSM FSW Male PWID Barriers to testing mentioned by YKAP respondents include: being afraid to get tested, not recognizing the need to get tested, National HIV/AIDS & STI Surveillance and and not knowing about HIV testing facilities. Notably, awareness Strategic Information Unit of HIV testing facilities is low particularly among adolescent FSWs Epidemiology Bureau, Department of Health 2nd Floor, Bldg. 19, San Lazaro Compound at 36%. Among M/TSM and male PWID, 70% and 82% knew Sta. Cruz, Manila, 1003, Philippines about available HIV testing facilities. Moreover, legal barriers to Tel: +632 651-7800 local 2952 testing minors for HIV without parental consent hamper scale-up Email: [email protected]  Website: www.doh.gov.ph of HIV testing among YKAP. Facebook: HIVepicenter  Twitter: HIVepicenter  Instagram: HIVepicenter