Reflections on the Human Condition - Api-fellowships.org

noted for HBs antigen (HBsAg) among blood donors
in 1990 (Arguillas, M. O., E. O. Domingo, F. Tsuda,
M. Mayumi, and H. Suzuki. 1991), and anti-HCV was
reported to be 4.6% (23/502 tested) among inmates.
(Katayama, Y., N. G. Barzaga, A. Alipio, Soetjipto, H.
Doi, S. Ishido, and H. Hotta. 1996) The data of the
prevalence of blood-borne infections among injecting
drug users is scarcely recognized to date. The data
limitation currently makes it difficult to track the route
of blood-borne infections.
Figure 2: Factors contributing to HIV outbreak
from Asian past history.
% HIV prevalence
Injecting drug users
Guangxi, China
Jakarta, Indonesia
Hanoi, Viet Nam
Year (1994-2003)
Sex workers
Guangxi, China
Jakarta, Indonesia
Hanoi, Viet Nam
Sources: Adapted from MAP, 2004; National survillance reports from China, Indonesia and Viet Nam.
The Philippines as the Model Site for Monitoring
the HIV/AIDS Outbreak
The Philippines is one of the low prevalence countries
for HIV. Based on the HIV/AIDS registry of the
Department of Health in the Philippines, the total
number of HIV cases has increased but remained at low
level at a cumulative total of 2,333 as of August 2005.
Main mode of HIV transmission has been reported to be
sexual intercourse (92%, as of August 2005) since 1984.
Although HIV-positive cases have appeared sporadically
among sexually active populations, no outbreak has
occurred yet among them in this country, suggesting
that the sexually infected transmission may not trigger
the HIV/AIDS epidemic. Statistically overseas workers
(especially seafarers) have been the major population
among already reported cases in HIV/AIDS registry.
Thus, triggering phase has not yet happened at the
Philippines and only a few infected cases (via sexual
contact) at abroad have entered into this country and
secondary (domestic) infection has rarely observed in
the Philippines to date.
Regardless of the low prevalence, wide-range HIV
CHANGING LIFESTYLES AND HEALTH
179
strains have already been introduced into the country,
i.e.; five HIV-1 sub-types (A, B, C, D, and F), a
circulating recombinant form (CRF01_AE) (7, 15,
19), a recombinant strain (gag-A/env-B). (Espantaleon,
Kageyama, Bernardo, Nakano, Leano, Alban, Abrenica,
Morimatsu, Teraoka, and Agdamag, 2003) Even HIV-2
(Leano, Kageyama, Espantaleon, Maniar, Iwasaki, Saple,
Yoshihara, Kurimura, and Agdamag, 2003) have been
identified. Among these, HIV-1 subtype B was the most
predominant, followed by CRF01_AE. (Espantaleon,
Kageyama, Bernardo, Nakano, Leano, Alban, Abrenica,
Morimatsu, Teraoka, and Agdamag, 2003; Paladin,
Monzon, Tsuchie, Aplasca, Learn, and Kurimura, 998;
Santiago, Santiago, Hafalla, Manalo, Orantia, Cajimat,
Martin, Cuaresma, Dominguez, Borromeo, De Groot,
Flanigan, Carpenter, Mayer, and Ramirez,1998)
The low prevalence and the variety of HIV strains in
the Philippines indicate that HIV has mainly been
imported from abroad and the gateway of HIV into the
Philippines has been quite open. Overseas workers may
have brought those wide ranged strains into the county.
Therefore, the migration sites, migration population
and the subsequent circulation pathways of HIV have
become one of the most important concerns for the
prevention of an AIDS outbreak in the Philippines.
In this story, Metro Cebu of the Philippines was selected
as the study field for the analysis of the blood-borne
infections because the working teams here had a long
and productive history (experience) with the injecting
drug users to attain their harm reduction. The high
number of injecting drug users does not always indicate
the poor situation. This rather indicates the high activity
level of caregivers for the purpose of infection control as
well as the health care for the people at a poor setting.
It could be mentioned, “No activity, no injecting drug
users”.
Specific Goal of this Study and the Hypotheses
I hypothesized here in this study that blood-borne
infection might be the triggering pathway and HIV
epidemic may be superimposed on other blood-borne
pathogens. Therefore, I focused on the infections
caused by hepatitis B virus and hepatitis C virus as the
representative blood-born infections to monitor the
initial phase of HIV outbreak. In this study, a hepatitis
C virus-epidemic site was attempted to identify among
the injecting drug users in the Philippines and the genetic
links of the hepatitis C virus strains circulating among the
population was tried to analyze for the determination of
their possible migration site, circulation pathways and
the spreading speed. Such sequential examinations of
the prevalence and characterization of viruses, the entry
Ref lections on the Human Condition: Change, Conflict and Modernity
The Work of the 2004/2005 API Fellows