The alarming increase in HIV cases of more than 500 percent among Filipino youth has led to a lot of angst and finger-pointing among different groups. Some religious organizations said that it was people’s bad choices that caused this unprecedented rise in cases. Some advocacy groups declared that the rise is not really all that concerning because it is a result of increased testing, and so it’s actually a good thing. There have been a lot of accusations and acrimonious statements made, especially on social media, and it is muddying the issue further. People are dying, and all this bickering is not going to help and may in fact, make it worse.

When an impasse is reached, it is helpful to find common ground. Both sides want to save the lives of Filipino youth from HIV. This is a good starting point. It is instructive to identify the facts and the misconceptions of each side’s argument and see what the scientific evidence says. As an infectious diseases physician who has been working on the HIV epidemic since 2008, I have had substantial experience with this subject. I’ve had young men and women die of AIDS in front of me, and I’ve had to console grieving families. I’ve also seen men and women who I thought were going to die respond well to treatment and go on to live fruitful and productive lives. HIV is a preventable and survivable illness. There is no reason why anyone should die of HIV in this day and age.

Myth: The increase in HIV is driven by an increase in testing.

Fact: This statement is only partially true. There are definitely more HIV tests being done now than 10 or 20 years ago, and this is a big win for the advocates. Testing is the first step in addressing any HIV epidemic, pushing for better testing results in more people with HIV (PWH) getting treatment as soon as possible. Treatment allows PWH to strengthen their immune systems and decreases their risk of dying. Treatment also suppresses viral replication and stops HIV from being transmitted. Unfortunately, the estimated percentage of PWH who have been tested and diagnosed in the Philippines has consistently hovered at only 60 percent over the last few years despite increased testing. Up to 40 percent of PWH in the Philippines remain undiagnosed and can potentially continue to transmit HIV to their partners. Going by the continued low median CD4 count (a measure of a PWH’s immune system) at diagnosis, people are getting tested quite late in their HIV course. Compared to 10 years ago, the CD4 count has increased a bit from below 200 to about 250 cells/mm3 (normal is 500 cells/mm3) and so there has been some progress. The tremendous rate of increase is being mostly driven by a large absolute number of cases, e.g., more people are getting infected, numbers that are increasing not just due to testing. Our estimates of the contribution of increased testing to the total cases are about 10 to 15 percent only. The remaining 85 to 90 percent of the increase in cases are new infections. While it is good and proper to celebrate the increased HIV testing as a result of the efforts of advocacy groups, there is so much more work to be done, and it is not a significant driver of the shocking rise in cases.

Myth: The increase in HIV is due to bad choices.

Fact: This is also only partially true. The predominant mode of HIV transmission in the Philippines is through sexual transmission (about 90 percent), and most of that is acquired through unsafe sex. Religious organizations state that if only people would wait until marriage to have sex, there would not be any HIV. Not having sex will result in no sexual transmission of HIV, but is this a scientifically realistic expectation? Studies have looked at the effect of “purity rings,” which ask the youth to pledge and commit to waiting before marriage to have sex. Upon following up on this group after five years, scientists found that 85 percent of those who pledged denied ever making the pledge. There was also no difference in unwanted pregnancies and sexually transmitted infections (STIs) between pledgers and non-pledgers, and pledgers were less likely to use protection against STIs and pregnancy. In other words, the pledges didn’t work, and it increased the risk of the pledgers for STIs and pregnancy. While it is good to applaud those pledgers who stuck to their pledges, sexual abstinence is not an effective public health policy. In the face of an increasing HIV epidemic, it is better to complement this with more effective interventions, such as the use of prophylactics and age-appropriate human sexuality education.

Rather than surmising that an infection with an STI is some punishment for bad behavior, a better approach would be to educate the youth regarding the dangers of early sexual activity and give them all the knowledge they need to protect themselves if they aren’t able to abstain from sex. An inclusive, compassionate approach will also increase the likelihood that if a young man or woman does get HIV or another STI, he or she will seek help for diagnosis and treatment early on and achieve the best possible outcomes. Finally, not all HIV infection is the result of bad personal choices. I have taken care of several married women, each of whom had only had sex with her husband, from whom she got HIV. Some of them were pregnant, and because there was a delay in getting diagnosed and starting treatment since they had no identifiable risk factors, their babies got HIV as well. Prenatal and perinatal treatment with antiretrovirals significantly decreases the risk of an infant acquiring HIV from an HIV-infected mother. These women and children did not make any kind of bad choices, and to lump them in with such an insensitive judgment on HIV is completely inappropriate.

Even though our cases of HIV are increasing, the chances of surviving from HIV in the Philippines in this day and age are higher than ever. Our government, in partnership with the HIV advocacy community and international partners, has made huge strides in setting up many HIV treatment hubs and ensuring the availability of lifesaving, free antiretroviral drugs. The earlier someone is diagnosed with HIV, the better his or her prospects of having a long and fruitful life. Once a person’s viral load is undetectable (in about three months, assuming no drug resistance and good adherence to treatment), he or she can no longer transmit HIV to anyone and can even have children the normal way. Despite our differences of opinion, I hope we can move forward together and help save our youth from this deadly disease. Every single HIV death is preventable, and we can achieve zero deaths from HIV and zero new HIV cases if we all work together.