Addressing HIV With Compassion: Insights on Empowering Women,Children,and Communities in the Philippines

The Philippines has one of the fastest-growing human immunodeficiency virus (HIV) epidemics in the Western Pacific region. The country is experiencing an alarming rise in HIV cases, with an average of 55 new diagnoses reported each day. ¹ Between 2012 and 2023, daily new HIV cases increased from nine to 46, representing a 411% increase in daily incidence (see Gangcuangco and Eustaquio for a more comprehensive discussion). ² Despite this, only 15% of pregnant women receive antiretroviral therapy (ART) to prevent mother-to-child transmission. ² In response, the government has expanded HIV services through several initiatives under the Philippine HIV and AIDS Policy Act of 2018. These include the establishment of more community-based treatment centers, lowering the age for HIV testing, and improving access to antiretroviral treatment, rapid diagnostic tools, and pre-exposure prophylaxis (PrEP). ²

Despite government efforts, significant challenges persist. ¹ Stigma, low condom use, risky behaviors linked to dating apps, limited PrEP access in rural areas, and resistance to sexual education, influenced by traditional religious norms, can hinder progress.^1,2 Therefore, it was recommended that cultural, educational, and systemic barriers be addressed to help mitigate the local HIV epidemic and improve outcomes for people infected with HIV. This includes combating discrimination against individuals with HIV, increasing public knowledge about the disease, and improving access to treatment in rural areas.^1,2 Achieving these goals can require collaboration among the government, private sector, schools, religious organizations, and families.^1,2 These recommendations align with the global strategy to #EndAIDS, which aims to address inequalities and ensure equitable access to HIV related services while prioritizing populations with limited access to HIV services. ³

In addition to addressing these barriers, it is equally essential to improve maternal and child health to achieve the global #EndAIDS strategy, particularly in the Asia-Pacific region, including the Philippines. ⁴ Key measures include ensuring access to HIV treatment for pregnant women and providing prophylaxis to their newborns to reduce vertical transmission. ⁴ These measures are especially critical in the Philippines, a country grappling with one of the fastest-growing HIV epidemics in Asia and persistently high rates of vertical transmission.

Beyond HIV treatment and prophylaxis, providing mental health and psychosocial support services to pregnant women and their children infected with HIV is equally essential. This need is evident in the Philippines, where caregivers of children infected with HIV can face significant mental distress, such as the challenges of disclosure and helping their children understand their HIV status. ⁵ These difficulties are compounded by discrimination. ⁵ For instance, a mother during a study shared that she and her child were discriminated against by their relatives, claiming that they might spread their HIV infection to their nieces and nephews, which prompted her to think of ending her life. ⁵ Left unaddressed, such mental health challenges, including depressive symptoms, can undermine antiretroviral treatment adherence, negatively impacting health outcomes. ⁶ Therefore, these services are essential not only to alleviate psychological distress emanating from discrimination and disclosure ⁵ but also to promote adherence to HIV treatment among pregnant women and their children. However, like other developing countries in the Asia Pacific, the Philippines faces significant barriers, including limited access to mental health services and a shortage of mental health professionals. ⁷ Addressing these gaps requires empowering communities with social support and healthcare services tailored to their needs.

As a start, community-based workers, such as Barangay Health Workers and primary care physicians in the Philippines, can be trained to deliver psychological first aid to distressed pregnant women and children infected with HIV.^8,9 For instance, a recent study has utilized psychological first aid in addressing anxiety and depression among people infected with HIV during the COVID-19 pandemic in Canada. ¹⁰ Second, referral systems can be established to ensure seamless transitions between community-based healthcare and specialized mental health services. ¹¹ Third, age- and culturally appropriate educational materials and programs on HIV can be developed to support caregivers and children in understanding HIV treatment and prognosis. Fourth, HIV-related anti-discrimination programs can be extended to schools and peer groups to reduce stigma and discrimination against children infected with HIV. These are supported by a study in the United Kingdom highlighting that reducing stigma and improving social support can enhance the quality of life of people infected with HIV. ¹² Lastly, social welfare services in communities can be strengthened to provide socio-economic support to caregivers and children facing economic hardships due to HIV treatment costs. Evidence emphasized that social intervention strategies, such as cultural activities, community involvement, and peer-group support, can reduce social stigma, loneliness, marginalization, depression, and anxiety, as well as increase self-esteem, self-efficacy, and coping skills among people infected with HIV. ¹³

Overall, pregnant women and children infected with HIV can face mental health challenges. Providing comprehensive mental health and psychosocial support is necessary to address their distress, reduce stigma, and improve adherence to HIV treatment, ultimately contributing to ending AIDS globally.