Why the Philippines’ ‘fast and furious’ HIV epidemic is moving in the wrong direction
The Catholic school was unequivocal: condoms were absolutely, indisputably off limits.
Darwin Tenoria, an HIV counsellor in the Philippines, had just arrived to deliver an information session to teenagers. But his heart sank as soon as he spoke to the teachers.
“The first thing we were told was, ‘please don’t discuss condoms’,” he told The Telegraph. “They said, ‘if you will be discussing prevention, please highlight conscience and abstinence’.
It wasn’t the first time Mr Tenoria had butted up against traditionalist values, and such conversations aren’t unique to the Philippines. But he is among those increasingly concerned that stigma and stereotypes are hampering conversations about HIV at a time when the country’s epidemic is spiralling.
“As a healthcare provider it’s difficult for us, frustrating for us – [condoms] are a healthcare intervention that we can easily provide,” he said.
“Students are open to unprotected behaviour because they really don’t know how to protect themselves,” he said. “They never talk about it inside their homes or schools, so where do they get the correct information?
“That’s one of the biggest problems – that’s the reason why we’re projecting that probably, we’ll be the number one in [terms of new] cases around the world.”
The Philippines already has the fastest growing epidemic in the Asia Pacific region: according to data published by UNAIDS on Monday, annual new infections skyrocketed by 540 per cent since 2010, from 4,400 to 28,000 in 2023.
The only other country with a significant epidemic that deteriorated more quickly was Egypt, where new cases jumped by 610 per cent to 7,800.
These countries are still some way off having the world’s largest epidemics – with 190,000 HIV positive cases in total, the Philippines ranks an unremarkable 60th.
Yet in many regions, transmission has slowed or fallen, and 2023 was the first time in history that more people were diagnosed outside sub-Saharan Africa than inside it, UNAIDS said.
Instead, Filipino experts project that, without a major shift in approach, there could be more than 400,000 people living with HIV across the vast archipelago by 2030.
“The optimistic side of me wants to say that it will get better as the years go by, but that’s not really the realistic one,” Louie Ocampo, the UNAIDS country director in the Philippines, told the Telegraph. “I think it will get worse before it gets better.”
As UN data shows, the epidemic here is predominantly spreading in younger cohorts: a whopping 88 per cent of new detections last year were among 15 to 35 year olds, mainly among gay and bisexual men and transgender women rather than among drug users. Almost half of cases came from those under 24.
“Ours is a relatively young epidemic,” said Dr Loyd Norella, the HIV programme manager at the Pilipinas Shell Foundation. “We used to call it hidden and growing, but now we’re saying it’s fast and furious.”
‘My family doesn’t know’
On a quiet street in Quezon City, the metropolis neighbouring the capital Manila, CJ passes a parked jeepney painted with the slogan ‘God is Love’ as he enters Klinika Project 7. He’s come to the health facility, described as a ‘social hygiene clinic’ to avoid unnecessary judgement from passers by, to collect his latest batch of antiretroviral drugs.
It is now four years since CJ was diagnosed with HIV. Then aged 35, the call centre worker was regularly hooking up with people from dating apps, but rarely used condoms. Now, daily treatment means his status is undetectable (the viral load is so low that he can’t pass the virus to anyone else).
But he still hasn’t told his parents.
“My family doesn’t know about my situation,” CJ said, asking to be referred to by his initials alone. “I wonder if they suspect it, but they don’t want to talk about it and I don’t want to either… There’s definitely still discrimination in the Philippines about being gay or bisexual, and being HIV positive.”
In fact, a bill outlawing discrimination related to sexual orientation or gender identity is yet to be enacted into law – even though it was first introduced in Congress more than two decades ago.
Still, CJ is proud of who he is: a bisexual Roman Catholic man living with HIV. The problem isn’t religion – he thanks God every day for his recovery – but people, he says.
“My faith is very strong… I go to church every week, but I don’t talk about HIV there. No one does. No priest, or anyone else [in the congregation] has ever talked about it,” he said.
This sense of taboo – inside schools and friendship groups, churches and families, even among doctors – has contributed to the knowledge gaps that enable HIV’s spread.
In a 2022 survey of the most affected groups (men who have sex with men and transgender women) just 31 per cent knew of a nearby HIV clinic, while 42 per cent were not aware that treatments for the virus exist, and 59 per cent had never been tested. Only 13 per cent were aware of HIV-blocking pre-exposure prophylaxis drugs, known as Prep.
But with “about 95 per cent” of cases here sexually transmitted, it is another stat that most concerns Dr Norella: the “condom lag”.
“The first time condoms are used usually would be five to six years after the onset of sex. So that really explains why we have a lot of transmission, especially in our young key populations – at least half of our new infections, 50 per day, are in [people aged] 24 years old and below,” he said. “It’s knowledge versus hormones.”
Zoe Black, a programme officer for Love Yourself, added that some shifts in cultural norms, increasing financial independence (allowing young people to move out of their family homes) and a boom in online dating has also enabled a rise in hook ups.
“My personal take is because sex has been very accessible, with just a tap of a finger to swipe right, hooking up has become so prevalent, especially in the LGBT community,” the 29-year-old transgender woman told the Telegraph. “It’s become very liberating for the youth, it’s this empowering thing and you are in control of your body.”
Ms Black was diagnosed with HIV five years ago, and struggled so much with the antiviral side effects that she temporarily halted treatment. Now she’s part of Love Yourself, a network to offer services and boost awareness of HIV/Aids, everywhere from Manila’s Pride marches to university campuses.
But as well as increasing hook ups, she thinks that some people are blasé about the risks.
“HIV is less scary because [people] know that there’s treatment available and it’s free now… while a few years back it was a death sentence,” she said. “But of course we want to boost the use of Prep and condoms, or whatever works for them.”
Health officials are starting from a low base. Overall, just 22 per cent of people use condoms, according to UNAIDS. There are two problems at play: attitudes and access.
“The Philippines is still relatively – well, very – conservative… there’s a feeling that giving out condoms and lubes encourages sexual promiscuity,” Dr Norella said, noting that around 80 per cent of people here are Catholic. “And although sex is discussed in schools, probably it’s not discussed enough.”
UNAIDS’ Dr Ocampo added: “Religion has been playing a big role… [contraception], it’s still a taboo topic. It is mandated by law for academic institutions to implement comprehensive sexuality education, but I think the question there is about the quality of that education.”
The Catholic Church has urged people not to turn their back on HIV patients, and groups the Philippines’ Catholic Aids Network are working to combat the epidemic. But many disagree with “artificial contraception”, including condoms – and these voices are loud and powerful.
After years of gruelling debates, negotiations and lobbying, the government finally passed the Reproductive Health law in 2012, only for full implementation to be blocked by legal challenges from the Church.
Two years later, the Supreme Court did rule that government health centres could distribute contraceptive pills and condoms for free – but even now, parental consent is required to give them to anyone under 15.
While teenagers can still buy condoms at shops, many don’t have the means or confidence.
“I think just now most people, especially the youngest ones, are not using condoms,” said CJ. “Maybe they’re too shy to go and buy in a store, especially when you’re young. I’m 39 and it can still feel intimidating.”
Across town in a shopping centre’s multi-storey car park, a discrete new project to sidestep some of this embarrassment has just opened: Klinika Eastwood, Quezon City’s first drive through testing clinic.
“This area is surrounded by call centres, where lots of young people work,” Dr Norella said, as he showed journalists around the small, glistening white facility – a stark contrast to the dim, concrete structure of the car park’s fourth floor.
“We chose this location because it’s discreet – people think others are just coming by to pick up their car or go to the shopping centre.”
The facility is part of a growing network of health centres across the city as NGOs and the government push to improve testing and treatment rates: only 59 per cent of people living with HIV have been diagnosed, while just 43 per cent are receiving treatment.
Like Klinika Project 7, it will also offer Prep. This is a relatively new intervention in the Philippines but since its launch in March 2021, almost 30,000 people here have used the HIV-blocking drugs. Health officials are aiming to boost uptake to 50,000 next year, and 100,000 in 2026.
It’s initiatives like this that keep some kernels of optimism alive inside Dr Ocampo, despite all the barriers the county has to overcome.
“The accessibility of services in the Philippines, it’s not easy. We’re living on 7,000 plus islands, and delivering services across them is an issue – for instance getting commodities from the central warehouse to more remote facilities,” he said.
“But there is a good side. I think we are at the stage where we are at a crossroad, where we can make the best scenario happen. The government seems to have a better understanding now of the HIV context and we’re started working with local government units – not all, but I think it’s a good start.
“The results may take a while, but I think we are in a perfect place right now to seize opportunities.”
The Global Fund, which finances HIV projects in the Philippines, contributed to travel costs for this reporting trip.
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