The Philippines, in the past two decades, has had one of the fastest-growing human immunodeficiency virus (HIV) epidemics in the world. While our total HIV case numbers remain lower than those of many countries in the Asia-Pacific, the percentage growth is faster than most and needs to be addressed urgently. Based on the latest statistics, the number of new cases continues to increase. The overall rate of increase, however, seems to be flattening out, and there have been more than a few hard-won steps in the right direction.

A lot has changed since HIV was first discovered in 1983. From an almost invariably fatal disease that caused the immune system to collapse, the discovery of antiretroviral treatment (ART) has transformed HIV infection into a manageable and survivable chronic illness. People with HIV (PWH) who are diagnosed early and started on ART can lead nearly normal lives. If their virus remains suppressed, they are unable to transmit HIV to other people. The Philippines mysteriously had very low numbers of PWH in the 1980s to the early 2000s, but the entry of a more virulent HIV subtype known as CRF01_AE fueled an unprecedented surge in cases, which has not yet abated. In recent years, DOH has partnered with civil society in ramping up interventions, including free ART, testing, and prevention services. The pandemic years presented a significant setback as services were interrupted and testing was disrupted. Since then, the health system has recovered, and treatment hubs are enrolling PWH into care at an unprecedented rate.

The recently released year-end fourth quarter report for 2025 from the Department of Health (DOH) highlighted these trends. The data is useful in gaining insights into what is working and what still needs a lot of work from both the government and the private sector.

The DOH HIV report starts with the HIV care cascade. This is a collection of five bar graphs that show key indicators in the fight against HIV, as well as the percentage progress in each domain. These graphs are: the estimated number of PWH, the number of diagnosed PWH, the number of PWH linked to care and on ART, the number of PWH who are tested for HIV viral load, and the number of PWH with suppressed or undetectable viral load. UNAIDS has set the so-called 95-95-95 targets to end HIV by 2030, and while we are still far from those goals, significant progress has been made. Specifically, these targets are that 95 percent of PWH know their status, 95 percent of those diagnosed are linked to care and started on treatment, and 95 percent of those on treatment should be virally suppressed (undetectable virus in the blood).

The estimated number of PWH is not an actual physical count but is based on a mathematical model that considers the diagnosed number of cases plus the number of undiagnosed cases. The undiagnosed cases are estimated using available data from surveillance programs, positivity rates, ad hoc sampling studies, and historical growth rates. Compared to 2024, our estimated cases grew from 215,400 to 252,800 in 2025, which translates to an increase of 27,400 new cases or 17.4 percent. This is higher than the 2023-2024 growth rate of 14 percent and reflects continued significant community transmission of HIV in our country.

The number of diagnosed PWH is at its highest ever, at 153,207, but this represents just 61 percent of the estimated PWH in the Philippines. This is significantly below the UNAIDS target. We have not made much progress in this area, as the numbers for 2023 and 2024 were both 63 percent. This means nearly 40 percent of HIV cases in the Philippines remain undiagnosed, and the rate of growth of new cases is matching the increase in testing. Improving this metric will entail more aggressive case finding and removing barriers to diagnosis. This includes addressing stigma from HIV and educating healthcare workers to routinely offer HIV testing to all their patients. In the US, the Centers for Disease Control and Prevention (CDC) recommends that anyone between the ages of 16 and 65 years old should have at least one HIV test in their lifetime due to the 10 percent of cases that remain undetected in the country. The 40 percent undetected cases in our country mean that we should be aiming for universal testing regardless of risk factors, and this can only be achieved if people agree to get tested routinely for HIV, just like with any other disease. The only way to do this is if stigma becomes a thing of the past.

The number of PWH on ART has reached 100,000 for the first time ever. This is a bright spot in the report and represents 66 percent of the diagnosed PWH. This has increased substantially from 90,000 last year and reflects continued support for free ART. ART can nearly restore life expectancy, and it also interrupts transmission, which is essential in controlling the epidemic. Provision of free ART is expected to continue, and there is a Philhealth package that provides additional services and diagnostics to optimize care.

Viral load monitoring has seen the biggest jump in recent years, where 59 percent of PWH on ART are being tested, compared to 42 percent in 2023 and 46 percent in 2024. Among those tested, viral suppression is at 97 percent, which is likely due to the switch to more potent dolutegravir-based regimens. In contrast, viral suppression was only at 88 percent in 2023 and in 2024. Viral load monitoring with cartridge-based molecular tests using the same Gene Xpert machines used for diagnosing tuberculosis has increased the availability of testing, but a significant scale-up needs to occur to reach the 95 percent threshold of viral load testing for everyone on ART.

Most new PWH cases are men (94 percent), and transmission is still predominantly through sex at 87 percent. Nearly one-third (32 percent) of newly diagnosed PWH are in the 15- to 24-year-old range, with 77 percent of total new cases being 34 years old or younger. Prevention programs, specifically pre-exposure prophylaxis (PrEP), which gives oral ART medication to prevent HIV acquisition in high-risk populations, continue to have low coverage, with only 18 percent of clients returning for a refill.

Based on the report, there is still a lot of work to do. One exciting development, as mentioned in a previous column, is the early rollout of lenacapavir in our country. This is being facilitated by the Global Fund and the US government after much lobbying from our government and local activists. Lenacapavir is a twice-a-year injectable that can prevent more than 96 percent of HIV infections, making it almost like a highly effective vaccine. The Philippines is being given preferential pricing as low as $40 per injection, which would make it cheaper than oral PrEP. If we play our cards right, proper utilization of this medication in the at-risk population, coupled with aggressive case finding, can help us achieve our HIV elimination targets and reverse our epidemic once and for all.