Is PrEP the key to ending our HIV epidemic?

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"PrEP is like a raincoat for your immune system," says Love Yourself program manager Danvic Rosadiño. "If you take a pill, the components of the drug will protect the immune system na kailangan ni HIV para mag-replicate.” Illustration by JL JAVIER

Manila (CNN Philippines Life) — The Philippines has the fastest growing HIV epidemic in the world.

According to the United Nations Program on HIV and AIDS (UNAIDS), it recorded about 13,384 new HIV cases in the country in 2018 alone. This, despite efforts by the government and civil service organizations to give out free counseling, testing, and even medication.

Meanwhile, in New York, it was announced that in 2018, the state recorded the lowest number of new HIV diagnoses in history. Only 2,481 people residing in New York contracted the virus that year. There is one factor that is believed to be the reason for the steep drop in new cases: PrEP, or pre-exposure prophylaxis, a drug that can reduce a person’s risk of contracting HIV by 97 percent. CNN reports that about 32,000 New York residents took PrEP in 2018.

PrEP has repeatedly been called the “miracle drug” and the “wonder pill” that could finally end the spread of HIV. But can it work in the Philippines?

Prevention is better than cure

PrEP has been available in the Philippines for three years now through a partnership between Love Yourself (a community-led non-profit that provides free HIV testing and counseling), the World Health Organization, the Department of Health, and the American Foundation for AIDS Research (amfAR).

Their first-ever demonstration project, called Project PrePPY, enrolled 250 people, who were given the drug for free and closely monitored from July 2016 to March 2019.

“What we found out in the study is that in the 250 people that we enrolled, none of them got HIV,” says Danvic Rosadiño, program manager for Project PrEPPY. “So basically it's proven that it is effective against HIV infection.”

How does it work? Rosadiño likens it to a raincoat for your immune system. “What PrEP does is, if you take a pill, the components of the drug will protect the immune system na kailangan ni HIV para mag-replicate. It basically gives you that raincoat. And if you’re not taking it everyday, nag-fe-fade ‘yung raincoat na ‘yun and you become vulnerable again.”

Rosadiño says there are two ways to take the drug: take one pill everyday, or take it on demand via the 2+1+1 regimen. “That’s two pills taken two to 24 hours before sexual activity, plus one pill 24 hours after taking the first two, plus another pill 24 hours after,” he says. “[But with the latter,] there is a lot of planning involved. If they cannot schedule their sexual activities or if they are forgetful, then the most convenient way is daily use.”

For the two trial enrollees we spoke to, the decision to join the demo came easy. Franco and Josh*, both 27, had learned about PrEP from pop culture and LGBT-centered news online.

“I knew it would alleviate any anxiety I had when it came to HIV protection. Even if I was a consistent condom user, there were times when I would second-guess myself and worry that I had put myself at greater risk by accident,” says Franco. “After starting [the trial], I would walk away from sexual encounters knowing that I was protected. I wouldn't mull over the details of the encounter the following day like I would usually do.”

Josh shares the same sentiments, but admits that having that sense of safety has its downsides too.

“I'm more confident now when it comes to sex. I know I'm protected from HIV regardless if the condom breaks,” says Josh. “Though it has made me a bit more reckless as well. I usually carry condoms in my wallet always, and always refill when I get home. But lately I don't refill as always na [because it feels like] regardless, at least I know I'm protected from the worst of the worst.”

Rosadiño warns that PrEP only protects you from contracting HIV, not other types of STIs, which is why it is still imperative to use condoms when engaging in sexual activity.

This sense of complacency that PrEP gives to some users is often cited as one of the reasons why the drug hasn’t taken off in other countries. PrEP has been met with opposition from many HIV activists and AIDS organizations for this reason.

Access and stigma

In the Philippines, though there doesn’t seem to be a vehement pushback against the drug, it still has several obstacles in its way before it can become ubiquitous.

Firstly, there is currently only one FDA-approved brand in the country, and it comes at a hefty price of ₱1,500 for a bottle lasting 30 days. With the funded trial over, Love Yourself continues to provide a PrEP program for anyone willing to pay a ₱2,000 fee inclusive of a month’s worth of pills, consultations, and diagnostic tests. Currently, there are about 500 people enrolled in the program, but demand for the drug is high (about 3,000 people signed up for the free trial).

Josh recognizes that not all Filipinos can afford PrEP. “Parang ‘di pa [siya accessible to most],” he says. “Medyo matagal at malayong laban pa ‘to.”

Additionally, there is only a handful of Love Yourself clinics scattered around Manila. Josh says that a friend of his chose to have his PrEP shipped from overseas (at a cost of ₱3,000) because the Love Yourself clinic was too far. And although there are dozens of DOH HIV testing and treatment centers across the country, none of these currently provide PrEP. (They do, however, provide condoms and lubricants, medication, and counseling for free. PhilHealth also offers a package to PLHIVs that covers diagnostic tests and other services.)

Rosadiño says that there are plans to make PrEP more accessible and more affordable for all Filipinos, but those plans are still in the pipeline. He also believes that we cannot solely rely on the government to combat HIV, but instead have more stakeholders get involved.

However, the stigma attached to HIV is still one of the biggest problems with overcoming the epidemic. A recent U.S. survey found that 28 percent of young adults say that they would avoid hugging and talking to PLHIVs. It should be noted that HIV cannot be transmitted by such means.

“HIV, first and foremost, is too stigmatized,” he says. “The fact that sex is taboo here in the Philippines, we don't discuss sex, that translates into our behavior of not discussing all the issues that are attached to it, including HIV, STIs, and teenage pregnancy. With the culture that we have ... awareness should be shared to each and every one. Regardless of who they are, they need to know what HIV is, how they can take care of themselves.”

Rosadiño says that there are three things that must be done for the epidemic to stop:

1.) Everyone must have access to and undergo HIV testing. “If you’re negative, you can take care of yourself [and arm yourself with prevention initiatives], like condoms, lubricants, PrEP,” he says.

2.) For those who test positive, treatment must be taken immediately. “Early access to treatment is important because, kapag maaga mong na-access ang treatment, your viral load will go to undetectable levels,” he says. “This means you will not be able to transmit it to other people. Undetectable equals untransmittable.”

3.) PrEP’s roll out (and use) must be widespread. For those with multiple sexual partners, PrEP is a preventative measure that’s proven to be more effective than condoms at curbing HIV infection.

When asked how more people can be convinced to take preventative measures against HIV, Rosadiño pauses before answering. “We cannot convince people to take medication … That’s not how it works. Your management of your sexual health and wellness will still always depend on you.”

He adds, “If you want to take care of yourself, and you want to have sexual activities with no worries, or if you have a partner who has HIV, and yes kahit nag-gagamot na siya, and you still want an added layer of protection, then PrEP may be for you.”


*Last names have been withheld at the request of the interviewees.