Key Findings


Average self reported baseline CD4  count was 280.2 cells/mm3

Only 7.4% of respondents received a viral load test 

The average duration between HIV diagnosis and first CD4 test was 10.8 months (median: 3.6 months, range: 0-228 months)

16.2% of those taking ART had experienced some delay in treatment initiation.

27.5% respondents reported having been sick in the 6 months prior to the interview and 47.9% of them required hospitalisation 

Average cost of treatment was 33, 037 PHP (754 USD) which is almost a double of an monthly income of respondents. 

Only 48.1% of participants reported being able to get condoms whenever they needed.

10% of participants reported having had their HIV status disclosed by a health care professional without their consent. 

Among 1000 MSMs interviewed, 68.5% had no steady partner but 47.7% of those without a steady partner were sexually active and only 44.6% always used condoms.  

Among MSMs with steady partners, only 31% ( of those partners ) were known to be HIV positive. Only 42% always used condoms.

6% of respondents or their spouse were pregnant since their HIV diagnosis and 71.4% of these were unintended.

24% were advised not to have children.2.9% reported being coerced to terminate pregnancy due to HIV status of mother

9% of respondents were still on a stavudine

 

Study Outline


 Since 2001, the Asia and the pacific region, has seen a 20% drop in the new HIV infections. In that same time the number of people living with HIV/AIDS who have access to ART has tripled. Despite this progress, access to ART, remains very low, with over 60% of PLHIV not having access to treatment. Overall, the East, South and South East, Asian region has some of the lowest levels of access in the world. For many years PLHIV groups were raising voice against a lack of rigorous research and information on the barriers and enablers to access to treatment, care and support. Historically studies in the region have been ad-hoc, and not representative of the needs and experiences of those affected by the disease.

Study Objectives 


 The overall objective is to monitor and document the issues related to PLHIV’s access to HIV treatment, care and support services in Asia and the Pacific region. The specific objectives of this study is to assess the HIV treatment-related issues such as access to pre-ART care, ART, ART adherence, treatment literacy, high risk behaviours, mental health status, health seeking behaviours, etc. and, to monitor changes in key issues in community access to treatment, care and support services.

Country Context 


Screen Shot 2014-07-18 at 7.51.58 PMIn the Philippines, efforts were made towards preventing the spread of HIV as early as 1984 when the first AIDS case was reported in the country. HIV/AIDS was classified as a notifiable disease by the Philippine Department of Health (DOH) in 1986 and in the following year the HIV/AIDS Registry, a passive form of surveillance, was institutionalized in the DOH. By 2011, the country was recording seven new infections a day, making it one of the only seven countries worldwide where HIV infection has risen by greater than 25% between 2001 and 2009. Since 1984, the Philippines HIV and AIDS registry documented a cumulative total of 8,364 cases for the period ending December 2011. Of the 8,364 cumulative cases, 28% (2,349) were reported in 2011 alone, highlighting the alarming increase in the rate of infection. The vast majority of people living with HIV are reported from three highly urbanized areas: Metro Manila, Metro Cebu and Davao City. But 72 of the 80 provinces in the country already have HIV cases recorded int the AIDS Registry. The Stigma Index Report noted that 16% of PLHIV surveyed in the Philippines had experienced direct pressure to disclose their HIV status and 38% had decided to withdraw from work as a result of their diagnosis. 

 

Methods  


Sample size was determined using proportionate sampling method with error allowance of 0.002 and a target of 1320 people living with HIV was set for the Philippines. The sample size was then distributed based on geographical caseload reported by National AIDS Program. Risk-group and gender specific seeds (initial respondents) were recruited, using convenience sampling.Thereafter, a snow-ball sampling technique was used to enrol study participants with seeds recommending their peers to the study. 

Respondents were recruited from 5 sitesin the Philippines, Luzon (931), Bacolod(50) , Iloilo (59), Cebu (140) and Davao (140) . A structured questionnaire was used to collect data. There were 14 sections and an interview in an average took 57 minutes to complete. A total of 14 data collectors were used. Ethical clearance was obtained from DOH Ethics Committee (DREC). All participants were provided standard information on the study and a written consent was obtained. Data collection was carried out between 6th November 2012 and 7th May 2013.

Soco-Demographics


Screen Shot 2014-07-18 at 7.54.28 PMThe mean age of respondents was 30.94 years. 55% fell between 25-35 years. 285/1320 (24%) of respondents were of age group 18-25.

87.6% of participants were male and 11 % female and 1.4% TG. 

8.6% live in a rural area, 26 % live in a small town and 65.4 % in a large town or city. 

13.8% of participants had a partner or spouse and were living with that person, 74.5% were single, divorced or widowed.

65% of respondents earned some form of income, on averaged 14,231 PHP (326.4 USD)  per month. 

The average household size for all respondents was 5 people. 

73% reported to have had college level education and less than 1% were either illiterate or could only read and write. 

The most common self-identified risk groups was MSM (76%). 13.3% identified as themselves international migrant workers.

31.2% of all participants reported being members of NGO or CBO and 10% did work in a HIV program. 

 

HIV Diagnosis and Pre-ART Care


Screen Shot 2014-07-18 at 7.56.17 PMThe most common reasons given for going for a HIV test was being referred by a doctor due to HIV-related symptoms (25.4%)

The most common place for getting a HIV test was in a government hospital (30.2%). 

85.9% of participants reported having had a CD4 test done, and only 7.4% had had a viral load test done. 

The average baseline CD4 was 280.2 cells/mm3

Majority (79.9%) of the study participants sought government hospitals or government clinics for HIV consultation while 14% went to private hospital/clinic

The average duration of time that the test was done after HIV diagnosis was 10.8 months (median: 3.6 months, range: 0-228 months)

Health Seeking behaviour and associated costs


Less than half (40%) visited their doctors, nurses or health workers once a month while 8.2%  visited only when they are sick. 

27.5% respondents reported of being sick within 6 months prior to the interview and 47.9% of them required hospitalisation and average cost of treatment was 33, 038 PHP (755 USD).

Only 22% of those who were sick and hospitalised mentioned that they received some sort of subsidy to pay for their treatment and 58.7% reported that they paid out of their pocket for their treatment.

Stigma and Discrimination


65.2% of participants had disclosed their HIV status to someone other than their spouse, close family member or health care worker. 

8.3 % of participants who disclosed their status had been forced to change their residence or were unable to rent accommodation because of their HIV status.

6.7% of participants reported having been denied health services due to their HIV status. 

10.1% of participants reported having had their HIV status disclosed by a health care professional without their consent. 

76.7% of participants were confident that their medical records were being kept completely confidential.

 

Relationship with Health Care Provider


10.8% of participants on ART agreed or strongly agreed that they were sometimes insulted when talking to their HCP.

79.5% of participants on ART agreed or strongly agreed that their HCP made them feel comfortable when discussing any issues. 

79.5% of participants on ART agreed or strongly agreed that their HCP made them feel comfortable when discussing any issues. 

92.2 % of participants on ART agreed or strongly agreed that their HCP had told them of the changes to expect in their health when taking ARVs.

 

HIV Risk Behaviours


19 respondents reported to be current injecting drug users.

57.9% of PWID reported that they were able to get access to clean syringes whenever they needed them. 21.1% reported only being able to get them sometimes.

67.5% of respondents with a spouse or partner reported that the HIV status of their partner was negative or unknown.

48.1% of respondents reported being able to get condoms whenever they needed them. 15.6% were never able to get condoms.

Among 1000 MSMs interviewed for the study 68.5% had no steady partner. 48 % of those without a steady partner were sexually active and only 44% always used condoms.  Among those with steady partners, only 31% were known to be HIV positive and only 42% always used condoms.

 

Reproductive Health


17.1% of respondents have children, of whom 11.9% are known to be HIV positive. 

23.9% of  respondents with a spouse/steady partner had received counselling on child baring since being diagnosed with HIV. 

11% of respondents who had a desire to have children reported being coerced into being sterilised. 

6.1% of respondents in a relationship, or their spouses, had become pregnant since being diagnosed.

The majority of those pregnancies were intended (71.4%)

Treatment of Co-Infections (TB and HCV)


26% were diagnosed with TB after being diagnosed with HIV. 

96.5% of those received treatment and 87.9% of those had completed treatment. 

42.6% of respondents were provided with information on Hep C. 

39.2% of whom were offered treatment. 

3% (14) of those tested were found positive for Hep C.

2 respondents had received treatment for Hep C.

3% (14) of those tested were found positive for Hep C.

2 respondents had received treatment for Hep C.

 

Treatment Literacy


 

Screen Shot 2014-07-18 at 8.08.20 PMHIV Treatment literacy was measured by respondents answers to 25 questions. The higher score represents a higher knowledge of HIV prevention and treatment. 

The mean score for HIV treatment literacy was 19.46. Only 3.5% of the total respondents had low treatment literacy, scoring below 5. 

73.6% of respondents had used the internet to search for HIV related information.

ART Initiation


66.1% of participants were on ART and those who are not in ART were not yet eligible at the time of the interview.

One percent of the study participants were not aware of what ART is. Of the 872 study participants who were taking ART, 20% were taking ART for three years and above.

16.2% of those taking ART delayed their initiation of ART treatment despite their eligibility.

AART Regimen and Self-reported Adherence


Screen Shot 2014-07-18 at 8.10.48 PM

The majority of those on ART were taking Ziudovudine + Lamuvudin + Efavirenz (46.6%). 

Among the current ARV users, 88% (770) reported taking 95-100% of their ARV drugs while 12% (103) reported taking less than 95% of their drugs

9% of respondents were still on stavudine.

83.7% of participants on ART reported to have never missed a dose of their ARVs. 10% have reported to miss an appointment with HCP within 3 months prior to interview. 

77% of those who missed an appointment cited being busy as the reason.

Long Term Side Effects (self-reported)


66% of participants on ART experienced at least one of the listed long-term side effects.

50% were told by a clinician that their body fat has changed due to side-effects of ARV

34% reported to have felt numbness in the limbs

45% reported to have had problems with the liver

Pinoy Plus


Pinoy Plus Association Inc. is the only association of its kind in the Philippines with 100% of its members people living with HIV and/or AIDS. The organization offers services such as counseling, referrals and care and support programs, skill building for PPAI members and/or similarity-minded groups.

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