應對 COVID-19 大流行期間菲律賓的愛滋病毒危機
資料來源：www.thelancet.com/hiv/ 第 10 卷 / 2023 年 7 月
在COVID-19大流行之前，菲律賓頒布了一項新的愛滋病毒法，降低了未經父母同意進行愛滋病毒檢測的年齡，將愛滋病毒檢測納入產前照護，並將公共健康保險覆蓋範圍擴大到愛滋病毒治療。儘管2019年至2020年間菲律賓新發愛滋病毒感染人數有所下降，但官員們還記錄到，愛滋病毒檢測率、抗反轉錄病毒治療覆蓋率和愛滋病毒治療啟動率均較低，同期感染愛滋病毒的孕婦人數有所增加。這些變化可歸因於與大流行相關的限制、污名、獲得愛滋病毒服務的機會較少以及暴露前預防 (PrEP) 的獲得率較低。
當菲律賓取消 COVID-19 限制後，記錄的愛滋病毒感染人數有所增加。 2019年至2022年間，愛滋病毒感染總數增加了31·54%，從74,807人增加到109,282人。同期新增愛滋病毒感染人數增加了14·64%，從12,778人增加到14,970人。平均每天被診斷出愛滋病毒的人數從 35 人增加到 44 人。2022年，受影響最大的是男男性行為者、25 至 34 歲的成年人以及馬尼拉大都會地區的人們。因此，在菲律賓從 COVID-19 大流行中恢復過來的同時，必須緊急解決該國愛滋病毒流行問題。
首先，需要擴大愛滋病毒服務。菲律賓可以採用愛滋病毒新發感染率下降國家的創新成果。例如，受英國解決方案的啟發，可以在馬尼拉大都會和其他可以獲得線上服務的地區實施可以在線上購買並在家進行的愛滋病毒檢測試劑的規定。
其次，有針對性的預防活動可以降低受影響最嚴重的人群中愛滋病毒新發感染的情況。例如，英國開展的有針對性的活動提高了男男性行為者使用性健康服務的信心，增加了愛滋病毒檢測頻率，並改善了 PrEP 的獲取。菲律賓的類似活動可以提高男男性行為者的愛滋病毒檢測率和 PrEP 接受率。
第三，污名仍然是菲律賓人就愛滋病毒相關問題尋求幫助的障礙。因此，大流行期間線上信息傳播的改進（即網絡研討會）可用於傳播愛滋病毒預防信息。
第四，PrEP 主要在菲律賓的城市地區提供。可以透過培訓和支持初級保健醫生和農村醫生透過在線上和面對面的方式在社區中實施 PrEP 來擴大 PrEP 的可及性。總體而言，隨著菲律賓愛滋病毒危機重新出現，必須擴大愛滋病毒服務。
作者聲明沒有競爭利益。
*Rowalt Alibudbud rowalt.alibudbud@dlsu.edu.ph 德拉薩爾大學文學院社會學與行為科學系，馬尼拉市 1004，菲律賓 (RA)
Addressing the HIV crisis in the Philippines during the COVID-19 pandemic
www.thelancet.com/hiv/ Vol 10 / July 2023
Before the COVID-19 pandemic, the Philippines enacted a new HIV law that lowered the age of HIV testing without parental consent, incorporated HIV testing into prenatal care, and expanded public health insurance coverage to HIV treatment. Although the number of new HIV infections in the Philippines decreased between 2019 and 2020, officials also recorded lower rates of HIV testing, antiretroviral therapy coverage, and HIV treatment initiation, and an increase in the number of pregnant women with HIV in the same period.² These changes can be attributed to the pandemic-related restrictions, stigma, poor access to HIV services, and lower pre-exposure prophylaxis (PrEP) access.
When COVID-19 restrictions were lifted in the Philippines, the number of recorded HIV infections increased. The total number of HIV infections rose by 31·54%, from 74 807 to 109 282, between 2019 and 2022. The number of new HIV infections increased by 14·64%, from 12 778 to 14970, in the same period. The average number of people diagnosed with HIV per day increased from 35 to 44. In 2022, the most affected were men who have sex with men, adults aged 25–34 years, and people in the Metro Manila region. Therefore, the Philippines HIV epidemic must be addressed urgently while the country recovers from the COVID-19 pandemic.
First, the HIV services need to be expanded. Innovations from nations in which new HIV infection rates have decreased can be adopted in the Philippines. For example, inspired by a solution from the UK, provisions for HIV testing kits that can be purchased online and done at home could be implemented in Metro Manila and other areas with access to online services.
Second, targeted prevention campaigns could lower new HIV infections among most affected populations. For example, targeted campaigns in the UK have increased the confidence of men who have sex with men in using sexual health services, increased HIV testing frequency, and improved access to PrEP. Similar campaigns in the Philippines could improve HIV testing rates and PrEP uptake among men who have sex with men.
Third, stigma remains a barrier to seeking help with HIV-related concerns among Filipino people.2 Therefore, improvements in online information dissemination made during the pandemic (ie, webinars) could be used to distribute HIV prevention information.
Fourth, PrEP is available mainly in urban areas of the Philippines. PrEP accessibility could be expanded by training and supporting primary care and rural physicians to administer PrEP in their communities through online and face-to-face modalities. Overall, HIV services must be expanded as the Philippine HIV crisis re-emerges.
I declare no competing interests.
*Rowalt Alibudbud rowalt.alibudbud@dlsu.edu.ph Department of Sociology and Behavioral Sciences, College of Liberal Arts, De La Salle University, Manila City 1004, Philippines (RA)