UNDER THE MICROSCOPE
As US President Trump promised, its “America First.” One of the first Executive Orders he signed was to pause/cut foreign aid for 90 days while it’s being reviewed. Supposedly, there are exemptions for “core lifesaving medicine, medical services, food, shelter and subsistence assistance as well as reasonable administrative costs as necessary to deliver such assistance.”
But the Philippine Tropical Disease Foundation, which has been working with USAID-funded programs on HIV and TB control, has received no approved waiver from Washington, so funding for all these activities is now suspended pending the 90-day review period.
One of its suspended projects is the HIV control program, which provided diagnosed HIV patients with anti-retroviral therapy (ART) medications to reduce HIV viral load, and prevent progression to Acquired Immunodeficiency Syndrome (AIDS), as well as prevention efforts that supply Pre-Exposure Prophylaxis (PREP) drugs and condoms to persons at risk. Their HIV clinic caters to these patients on a continuing basis to support their treatment with consultations, refilling their medicines, counselling, and viral load testing (to check if the anti-HIV medications are working).
The ART drugs act to suppress the virus even down to undetectable limits but does not eliminate it. It remains in so-called “sanctuary cells” where they lurk without causing harm since they only affect helper T-cells specifically. It will be unethical to just abandon these patients abruptly, as discontinuation of anti-HIV drugs will cause resurgence of the disease and progression to AIDS. It will also give rise to ART-resistance, making HIV harder to control.
This development will greatly impact efforts to control the spread of HIV since testing for detection and case finding will also be stopped. Without the PREP drugs, those at risk will have higher chances of contracting the virus. Our steadily rising HIV incidence will probably surge as a result.
In 2020, USAID committed ₱875 million to support the Philippine government’s HIV/AIDS prevention and treatment efforts. It appears that is now paused as well since its current website cannot be accessed.
It remains to be seen if the DOH can bridge the gap left by the abrupt cessation of USAID funding, since it states it will rely largely on its own budget, PhilHealth reimbursements and funding from LGUs and the private sector. But there is still a funding gap of ₱22.4 billion out of the ₱45.6 billion for the 2024-2026 HIV co-financing plan, even with foreign aid.
As of 2023, there were 189,900 people living with HIV (PLHIV). 26,700 annual new cases, and 1,700 deaths due to AIDS in the Philippines. With a steadily rising incidence, these statistics will surely increase since even with foreign-funded programs, there were still gaps in implementation that will widen with the aid cuts.
The National HIV-AIDS program targets of 95-95-95 (95 percent of PLHIV are diagnosed, 95 percent diagnosed PLHIV enrolled and alive on ART, and 95 percent PLHIV enrolled to treatment are virally suppressed), will now be harder to achieve. The 2023 data shows only 62-63-44 achievements in these areas. The key issues are low testing coverage, low linkage to care and enrolment to treatment among diagnosed PLHIV, and low viral load testing, which were supported then by USAID. With the aid cuts, these issues will likely persist and increase in severity and we may see an explosion of HIV cases and deaths in the near future. The goal of ending AIDS-related deaths by 2030 will be harder, if not impossible to achieve.
This brings up the issue of mendicancy culture (the tendency to rely on handouts or the kindness of other people for help), which apparently affects the government as well. But with America looking inward and withdrawing aid to other countries, we have no choice but to help ourselves.
The HIV-AIDS epidemic is a worldwide issue but more concentrated in low-resource countries because of poor access to testing, treatment, and education aggravated by poor governance and corruption. It is time we face the issue head-on and devote more resources to fighting this scourge before it spills over to the general population. If that happens, our health system will be totally overwhelmed.
Where can we source the funds needed to combat HIV-AIDS? We can certainly afford to divert some of the 2025 national budget unprogrammed funds to HIV-AIDS control. It will pay big dividends in terms of less allocations for ART if we reduce new infections as well as expensive medical care for less AIDS cases.
This is definitely a case of an ounce of prevention is worth a pound of cure, since, sans a cure for HIV infection, treatment is for life. A person on ART can expect a normal lifespan. That will mean an extended treatment period with the consequent expense.
Let’s invest in HIV -AIDS prevention now, with a little bit of political will.