From a “slow but rising disease burden,” HIV/AIDS is now a full-blown epidemic in the Philippines, as the DOH requests a health emergency declaration to address the rapidly growing HIV epidemic in the country due to the alarming statistics.

In spite of two successive laws (RA8504 and RA11166 in 1998 and 2018 respectively) for HIV/AIDS control, there has been an increasing, and this year, an explosion in the number of diagnosed HIV-AIDS cases. This is an indication that past efforts have not been effective and we need alternative approaches to the problem.

The main issue is the failure/refusal to analyze why the policies and regulations have failed to stem the epidemic. I am speaking from the perspective of one who experienced firsthand the early 1980s AIDS epidemic in New York City. I saw how the testing was handled, being a Pathology resident at that time, and how government efforts controlled the epidemic in subsequent years.

On returning to the Philippines in 1987, I attended the initial discussions on HIV testing, which was just another serologic test, like Hepatitis B or syphilis. It was a rigid two-week regimen of training medical technologists in HIV testing, to which I objected since it was a routine test. They didn’t listen.

In addition, there was a requirement for pre- and post-test counseling, which was another way of stigmatizing people, knowing that the main risk factor for HIV/AIDS is unprotected sex.

No matter the strict confidentiality, the mere fact that the counselor has to ask for risky behaviors will definitely turn people off from being tested. In many hospital laboratories with HIV testing accreditation, the HIV testing trained technologist is often called to perform the counseling, in spite of the obvious conflict of interest that leaves both counseling and testing to the same person. Besides, it will take much more time for the patient to be in the testing facility to be counseled, aside from dealing with the unpleasantness of the counseling, both pre- and post-test. These factors alone discouraged many to have themselves tested.

In other countries, you can have yourself tested, no questions asked, not even your name if you don’t want to give it. It is simply anonymous and that’s what most people who need to be tested want.

The requirement for laboratories to have med techs trained for two weeks to be allowed/accredited to perform HIV testing in itself, limited the number of laboratories that were allowed to offer HIV testing, since the DOH can only accommodate a few trainees at a time. Most HIV testing accredited laboratories were initially in the major hospitals that can afford the stiff training fees, where the price is often high and there are many patients waiting to be tested for other reasons, another major discouragement. And this was for a test technique that med techs regularly do for other diseases.

It gets more complicated. If the test result was reactive/positive, it was sent to the Research Institute of Tropical Medicine for confirmation, meaning, there would be a delay in releasing the result to the patient. The confirmatory test at that time was a more specific test (Western Blot) that can also be done at other laboratories since the reagents were commercially available. I had been given samples of these reagents on my request since I was familiar with them during my training in the USA. So, we tested the samples in-house and sent them to RITM for official confirmation, which often took weeks, and could not release the results until “confirmation.” In the meantime, the patient could have infected another person with HIV.

This testing policy was replaced with rapid HIV diagnostic algorithm (rHIVda) in 2019, which requires retesting with two to three rapid HIV diagnostic tests. It also requires laboratories to be certified through the same training process. The pre- and post-test counseling policy remains.

My humble suggestions: 1. Stop “training” medical technologists for HIV testing. It’s so simple and is an insult to the medical technologist and pathologist. 2. Remove the pre-test counseling requirement and written informed consent. A person willing to be tested gives implied consent. It reduces stigma. 3. Allow self-testing. In many countries, people can test themselves with over-the-counter, cheap HIV rapid test kits. If they test positive, they can avail of official HIV testing, counseling and access anti-retroviral therapy (ART). 4. Deputize NGOs dealing with high-risk populations (MSM, transgenders, sex workers) to conduct free, informal testing and refer HIV-positive patients to HIV Treatment Hubs.

This is for just the testing part. More measures can be found in the AIDS Education and Prevention Journal published and edited by my classmate Dr. Francisco Sy (My Classmate, My Idol, April 15, 2025), which is on its 37th year.

It’s time for a reset if we are to contain the HIV/AIDS epidemic. ([email protected])