The aging community of HIV positive in the Philippines
(The author, a fashion designer by profession, is the corporate secretary of Positive Elders Philippines, Inc., a Department of Health HIV counselor; a mental health case management trainer, and a volunteer of AIDS Society of the Philippines).
The HIV situation in the Philippines has become a major health concern since 2010 as cases continue to rise.
Currently, HIV response programs of the government and civil society organizations (CSO) focus on the mixed population of persons living with HIV (PLHIVs) – children, youth, adults, men who have sex with men (MSM), heterosexual men and women, people who inject or use drugs, and gays, bisexuals, and transgender – of varying age groups.
Despite the hard work and dedication of stakeholders to include key affected population, community-based organizations and CSO, Philippine National AIDS Council, other government agencies, international health organizations and the Department of Health among others, HIV cases continue to rise.
As of February 2023, an average of 47 persons per day is diagnosed with HIV infection. Of the 1,292 cases for February, 337 have advanced HIV and 44 deaths were recorded. There are 112,028 HIV cases since January 1984.
From the February ca-ses, 645 were 25 to 34 years old at the time of their diagnosis, 373 were 15 to 24 years old, 236 were 35 to 49 years old, 35 were 50 years and older, two were less than 15 years old, and one had no reported age.
On the same month, there were 1,176 people with HIV who were enrolled for treatment. There were 1,172 who were on first line regimen and four were on other line of regimen. Among the newly enrolled clients, 604 were 25 to 34 years old, 334 were 15 to 24 years old, 209 were 35 to 49 years old, 27 were 50 years old, and two were less than 15 years old.
People detected with HIV undergo different regimens of anti-retroviral treatment (ART). Depending on the condition of the PLHIV, treatment regimens include taking a combination of at least three different drugs from at least two drug classes.
A total of 65,236 people living with HIV are presently on AR`T as of February, of which 63,116 are on the first line regimen; 1,441 are on the second line; and 679 are on the third line of regimen. A total of 44 deaths were recorded on the same month due to any cause among people diagnosed with HIV. One was less than 15 years old, eight were 15 to 24 years old, 26 were 25 to 34 years old, six were 35 to 49 years old, and three were 50 years old and above.
From January 1984 to February 2023, there were 6,425 reported deaths. Of that number, 41 were less than 15 years old at the time of death; 1,377 were 15 to 24 years old; 3,104 were 25 to 34 years old; 1,582 were 35 to 49 years old; and 317 were 50 years old and above.
Four of the reported deaths had no reported age at the time of death.
ART begins immediately after diagnosis regardless of how long they have the virus, a PLHIV’s viral load, and if a PLHIV is “healthy” upon diagnosis.
ART stops HIV from progressing by preventing the virus from multiplying and helping keep the immune system strong to fight infections, especially opportunistic infections or diseases that occur more often on people with a compromised immune system.
These infections and diseases include candidiasis, invasive cervical cancer, fungal infections that tend to attack the lungs and cause pneumonia, chronic diarrhea, HIV-related encelopathy, herpes simplex virus, tuberculosis, lymphoma, progressive multifocal leukoencephalopathy, and wasting, among others.
Delaying ART will result in continuing harm to a PLHIV’s immune system and increases the risk of transmitting the virus to a PLHIV’s partner, and the HIV progressing into AIDS.
There are stages of ART regimen depending a PLHIV’s CD4 (white blood cells) count, underlying conditions when diagnosed.
Initially, ART consists of intake of two drugs in combination with a third active drug or “booster” that essentially helps slow down the progression of HIV and prevents the virus from replicating itself, which, results in a lower viral load.
But taking in the medications has side effects such as fatigue, difficulty in breathing, skin rashes, muscle pain, nausea and vomiting, having unhealthy levels of fat in the blood, insulin resistance, and development of cardiovascular diseases, among others.
But constant adherence to the ART and intake of maintenance medication for other diseases has significantly improved the quality of life PLHIV.
Getting old and with HIV
“Equalize” is the theme of the UNAIDS for 2022. In the Philippines, there are many programs and campaigns on prevention and awareness, testing, and link to care. Key affected population for youth, MSM, women and children, sex workers, transgender, and PWID/PWUD are often in the system.
The aging PLHIV community, however, is overlooked in the HIV program in the Philippines.
Elder PLHIVs in the country who are 50 years old and above have expressed the need for a support and advocacy organization that will cater to them who have specific needs and concerns, mostly health issues that have to be addressed. This is why Positive Elders Philippines (PELP) was formed.
Aging PLHIVs are more susceptible to HIV-associated non-AIDS conditions. It occurs frequently in older persons with HIV or with comorbidities such as cardiovascular diseases, diabetes, renal disease, and cancer.
The HIV/AIDS and ART Registry of the Philippines (HARP) for November 2022 shows there are 2,542 people with HIV who are aged 50 years old and above.
The organization envisions itself as a partner in universal health care including HIV care and services for the elderly, their families, and significant others, and improving their quality of life to maintain self-dignity, self-respect, and respect for other persons living with HIV.
PELP is a support and advocacy organization that aims to assist and empower PLHIV who are 50 years and older through suitable and relevant projects and activities and advocate for government policies and programs to adequately meet the needs and address the concerns of elderly PLHIVs.
Some members have been under ART since 1995.
It was in the early ‘90s that the U.S. started clinical trials of ART in the Philippines through importations by private entities and organizations.
Even though they were diagnosed as early as 1989, they only started ART after five years. Thanks to the efforts of the private sector in accessing the ART because it was only 1998 that the Philippine government was able to create the Philippine HIV Law and the government health sector began importing ART in 2004.
Imagine the plight that these elders have encountered during the first trial periods. Their generation paved way for the goal of U=U (Undetectable and untransmittable).
U=U means people with HIV who achieve and maintain an undetectable amount of HIV in the blood by taking ART daily as prescribed cannot sexually transmit the virus to others.
They have undergone clinical experiments and served as respondents during the trial period of ART and other opportunistic infection medicines including comorbidities drugs. They have also experienced a lot of stigma and discrimination to the point that even their families disowned them. Needless to say, they survived because of their determination to live, advocate, and help others.
Living a normal life is what the UNAIDS wants the community to know; and that HIV-AIDS is no longer a death sentence. We can now call them a wise and experienced generation.
But reaching a “normal” life doesn’t mean that issues related to other health conditions have also become stable. The baggage that HIV caused them elevated as they aged.
In a needs assessment conducted by the PELP, the needs, concerns, and issues faced by elder PLHIVs are:
A. Personal/cultural – comorbidities such as high cholesterol, increased risk of acquiring the human pappiloma virus, erectile dysfunction, mental health problems, cancer, lack of opportunity for work and travel, relationship problems, isolation, stigma, and discrimination against elders and
B. Economic and health systems – maintenance medications, financial aid for elders, burial assistance, and access to mental health services.
These needs of elders in the Philippines have raised concerns over the universal health care. We need to reach, identify, and locate PLHIV elders in the country.
Recruitment of elder PLHIVs from various parts of the country to become part of PELP started in mid-July. A chat group of 65 elder PLHIVs was created for communication and coordination purposes.
The PELP’s core values are integrity, unity, compassion, and knowledge. It is our mission to undertake the well-being of elders as categorized into informational knowledge, policy development, meaningful involvement and development, and safe aging care.
PELP shall pursue and implement programs and services to the elderly PLHIVs based on their experiences as persons living long-term with HIV and address the needs of aging persons with HIV. With the advancement of medical technology, other than the needs assessments previously mentioned, an integ-rease inhibitor that became accessible early 2021 has been into transition and has lesser side effects compared to other regimen in the first line and second line drugs which include combination of nucleoside reverse transcriptease, non-nucleoside transcriptease, and protease inhibitor.
The introduction of integrease inhibitor; Dolutegravir, in combination with two nucleoside reverse trancriptease; is initally given to newly diagnosed PLHIV and to those who are not diagnosed and not under medications of tuberculosis then transitioned to those who are taking Zidovudine and Neviripine clients in all age-based key population. However, the integrease inhibitor, though has less side effects to most key affected population, has adverse effects with the elders with other comorbidities like those who have renal issues, respiratory conditions, cancer, other auto-immune conditions, and mental health medications, among others.
DOH officials have reported a special community of those who are not adoptible with the Dolutegravir combination will use their current regimen. It will be dependent with client-practitioners relationship as the doctors know the correct dosage and drug that they prescribe.
Recent achievements of the organization
In its effort to advance the concerns of PLHIV, PELP has participated in forums such as:
1. The seventh AIDS Medium Term Plan 2023-2028 which adopts the life cycle approach where HIV prevention is the rudimentary and staple feature in every Filipino’s fetal, neonatal, childhood, and up to adulthood stages of his/her life.
In the life cycle approach, the population further disaggregates to the key and vulnerable groups that are targeted for focused behavior change communication within the continuum of HIV care.
2. Joint program review of the DOH tuberculosis, HIV, malaria integration to the Global Fund, which recognizes key affected sectors including the elder population.
3. Network plus summit of 2022, which is for the inclusion of elders in the network association of PLHIV organizations.
4. Philippine country coordination mechanism, which aims for the inclusion of PELP in the key affected forum.
5. Dialogue on HIV, human rights, and the law with the legal community.
6. Mental health forums for elders and geriatric care and quality of life commitment of DOH in the inclusion of PELP in the Philippine National AIDS Council.
PELP also has projects and seminars to include member and baseline research agenda, family development workshop, and referral of needs for elders. The PELP aims to attain all facets in the HIV program and continuum care. Elders should not be overlooked or neglected. It is important to look for a holistic approach to identify the appropriate needs of elders. – With reports from Roberto Ruiz and Gem Cabreros