August 6, 2002

     “AIDS? Hindi naman natin problema yan! Ang problema natin ay gutom, matinding kahirapan, kurakot, at krimen! Problema ng kano yan!”

     Or is it? Talaga, sigurado ka ba?

     It is true, a litany of plagues beset our nation today; and it is no surprise that due to misfortune, our own selfish ways or poor and corrupt governance we are still a poor and hungry nation. Pneumonia, tuberculosis and diarrheal illnesses still top the list of cause of mortality on our third world country. We have heard of this dreaded disease called AIDS (Acquired Immune Deficiency Syndrome), especially after a dramatic movie played by Gelli de Belen several years ago; but now it seems that the fire has died down. AIDS seems to be a problem of rich America and Europe, or ignorant Africa. It does not sound to be a big problem now, or is it? Has the epidemic ended?

     Let the facts answer for itself: there are currently 40 million people with HIV (Human Immunodeficiency Virus) infection, 17.6 million are women and 2.7 million are children. Each year, 4.2 million persons catch the virus, 3 million die and 14 million get orphaned. In Southeast Asia, there are 6 million afflicted. The numbers have not decreased since 1981. It shows no sign of decreasing. (Sources: www.cdc.gov/hiv/stats.htm, www.unicef.org/aids, www.usaid.gov/pop-health/aids)

     “Eh, sa ‘Pinas hindi naman marami”, ka mo. For now, perhaps. It is estimated that we now have 9,400 infected Pinoys locally (excluding immigrants). 2,500 of these are women, 10 are kids. As of June 2001, 720 have died and 4,100 orphans have been produced. It gets scary to know that only 1,515 cases are known or reported and only 225 deaths were recorded as due to AIDS. Most are still in Metro Manila, but it is proliferating and spreading. So far, there have been 408 OCW’s (Overseas Contract Workers) who picked it up from their travels, and when they come home; they bring the scourge to their families. (Sources: www.doh.gov.ph/aids, www.unaids.org/hivaidsinfo).

     “Paano naman nila nahawa ito?” Natural, habang may mga ibon na mababa ang lipad, at merong pumapatol sa bakla, o nagpapa-high sa bawal na droga, lalaki lang ang problema. In the Philippines, despite all the government campaigns, Sexually Transmitted Diseases (STD) and drug abuse is still rising. 40% of Filipino commercial sex workers have had STD and 52% of drug addicts still share needles. Locally, 75% of gay persons caught HIV by unprotected sex (mas masarap daw e) and of the non-gays, 34% was a gift from prostitutes (mababaw na kaligayahan) and 56% was heterosexually acquired (kung sino-sino kasi ang dine-date).

     If you have not seen AIDS in the Philippines, just wait and you will. As a Post Graduate Intern in Manila back in 1994, I had only seen 2 cases. I would not have known that they had AIDS until I was told. Neither will you unless you have a high index of suspicion because they usually present with secondary opportunistic infections. And of course, infections abound in the Philippines. They are more likely to die of pneumonia, tuberculosis, or diarrhea that as mentioned, are the erstwhile champions of death locally. Then if they do present with other weird stuff, you often have no tools to deal with them anyway, or they cannot afford to pay for the tests much less the medicines. When I was in Iloilo City last February, I found that not a single lab or hospital could routinely check CD4/T-cell counts, HIV-viral load, or Western Blot despite the abundance of my friends and fellow Infectious Disease specialists in the area.

     So what are we doing about it? Whether we like it or not, the AIDS epidemic will hit home sooner or later.

     Back in 1992, then president Fidel Ramos formed the Philippine National AIDS Council (PNAC), the “central advisory, planning and policy-making body for the comprehensive and integrated HIV/AIDS prevention and control program” of the country. Multiple other programs and campaigns have arisen since then. These included publications, the AIDS Registry, and hotlines. It seemed to have partly worked, considering that for 20 years, our prevalence rate is still <1 % despite the rise in STD, drug abuse and promiscuity.

     Then in 1998, Republic Act 8504 was promulgated (‘The Philippine AIDS Prevention and Control Act of 1998”). These laws covered issues concerning patient’s right of privacy, universal precautions, education and general guidelines. There is now a Guidebook, a National Plan, and the RA 8504 Handbook that can be very helpful sources for physicians. These can be found and acquired through the Department of Health (DOH) in Sta. Cruz, Manila, or in www.doh.gov.ph/aids/iroc.doc.

     If you need further information, suspect or know you have HIV, or suspect you have an HIV + patient, get in touch with a local Infectious Disease specialist. You can also access the DOH hotlines from this website: www.doh.gov.ph/doh_hotlines.htm or you can contact the PNAC at (632) 743-0512, (632) 743-8301 or email: naspcp@doh.gov.ph.

     It is time for those who know that they have risk factors (madalas maligo na walang kapote, tumitira, o bumebenta at bumibili ng kaligayahan) to “come out” and get tested so that the infirmity can be addressed and the scourge halted. Nahihiya o natatakot ka ba? Being shy or timid can cost you and others your life. This same and fear is partly due to the general concept that those who get HIV are evil, lewd persons. Some perhaps, but not all; some got it though their philandering husbands, with blood transfusion, by childbirth, or contamination. Even then, we physicians should be examples to stop ostracism, bigotry, and treating HIV+ persons as filthy pieces of trash. We all know that the virus is not spread except by exchange of bodily fluids, so there is no need to isolate the patient like a leper in Biblical times.

     Last July 7-12, the XIV International AIDS Conference was held in Barcelona, Spain. Apart from studies and new treatment related guidelines, it was concluded that most countries still have inadequate laws, resources, and even education related to controlling this epidemic. The yearly cost of proper HIV treatment is about $ 11,000/year (P 550,000). There is a need for us to join this fight, for just like the CD4 cells in AIDS, gradually our immunity will decline and we will find ourselves at the mercy of microbes that still rule the earth.

     How can you help at the very least? Quit sleeping around!

Comments regarding this week's column are welcome. Please fill up the fields below and click Send to Author.

     The author's e-mail address is at docdan1@pol.net.

     All views expressed on this column and any other by-lined articles on this site are the authors' own and do not necessarily reflect the views of the organization or its members. For comments, please e-mail the author.