Addressing a public health paradox in the Philippines: Rising HIV infections among youth amid expanding PrEP uptake

The global HIV incidence and mortality have declined between 2010 and 2021 by 21.9% and 39.7%, respectively[1]. Nonetheless, recent studies highlighted the persistent challenges faced by people living with HIV in Africa, such as drug-resistant tuberculosis and kidney impairment[2,3]. Several Asian countries are also experiencing challenges related to increasing HIV infection rates, with reports highlighting that the Philippines has one of the fastest-growing HIV epidemics in the Western Pacific region[1,4,5]. In a June 2025 media briefing, the Philippine Department of Health (DOH) urged the national government to declare HIV a National Public Health Emergency, citing approximately 500% increase in HIV cases, especially among the youth aged 15 to 25 years. Nationally, from January to March 2025 alone, the country recorded a total of 57 new cases daily, a substantial increase from the nine cases reported daily in 2012, with the youngest patient being 12 years old[5,6]. This rising incidence is further exacerbated by recent United States Agency for International Development (USAID) funding cuts, which have led to local HIV organizations to downsizing their free sexual health clinics or shift to limited online models[7,8]. Likewise, stigma regarding HIV is prevalent, usually stemming from perspectives of religious immorality and the sexual orientation of men who have sex with men[9,10]. Therefore, it is urgent to strengthen and expand HIV services in the country. Encouragingly, HIV Pre-exposure Prophylaxis (PrEP) uptake have shown promise in the Philippines. Between 2021 and 2023, the number of PrEP clients in the country rose by 269%, from 4 263 to 15 719[11]. This expansion was made possible through the collaborative efforts of the government, stakeholders, and non-governmental organizations, with support from the USAID and the US President’s Emergency Plan for AIDS Relief (US- PEPFAR)[11,12]. These played a key role in PrEP implementation by enhancing the capacity of healthcare and community workers to deliver clinical services[11,12]. For example, starting in 2021 with donated medications from US-PEPFAR and the Global Fund, PrEP access expanded through tailored national advocacy[11]. To guide these efforts, the government established national and site- specific targets for PrEP initiation and retention in 2023, based on population estimates and service coverage[11]. These benchmarks informed the distribution of PrEP and HIV test-related supplies, as well as targeted promotional efforts[11]. These efforts were further bolstered when the government included PrEP in the national drug formulary in 2022, facilitating the possibility of government-funded procurement in 2024 and helping the country to target the enrollment of 150000 individuals using domestic resources[11,12]. Nonetheless, challenges remain, especially in the face of increasing HIV cases among the youth in the recent year. First, to respond more effectively, both the Philippine government and non-government sectors can enhance youth-focused HIV education by developing HIV prevention and education modules, as well as providing training in schools, universities, and community settings. These efforts should be institutionalized by integrating age and culturally appropriate HIV education and promotion into health curricula at both basic and higher education levels. Second, family involvement is equally important in the Filipino culture[13]. Therefore, health promotion and prevention activities should also extend to families and communities to foster supportive environments for HIV screening, prevention, and open dialogue about safer sex practices, including condom use. Third, sustained funding is a key concern, especially following the dissolution of USAID support, which had been one of the primary sources of implementation support[8,11]. Thus, given the funding cuts from such foreign donors[7,8], the Philippine government must significantly increase its funding in HIV programs while mobilizing support from private foundations and individuals. Doing so can help facilitate the national expansion of PrEP distribution beyond its initial implementation sites, which can be critical to reach underserved and rural communities. Fourth, to address the decline in physical clinics, expanding telemedicine services and medication delivery systems is essential for maintaining and broadening HIV-related healthcare services. Additionally, increasing access to HIV medications and prophylaxis by authorizing commercial pharmacies, aside from accredited HIV treatment hubs and facilities[5], to dispense them can decentralize care and enhance treatment reach and availability. Lastly, monitoring and evaluation must also be enhanced through strengthening research to ensure interventions are culturally appropriate and responsive to the needs of key populations. Therefore, ongoing collaboration among the government, researchers, non-government organizations, and stakeholders, and along with sustained funding, monitoring, and context-specific service delivery, can be crucial for expanding HIV prevention and increasing PrEP uptake. Overall, HIV cases are rapidly rising in the Philippines, especially among the youth, prompting calls for a national public health emergency. Therefore, a collaborative, well-funded, and inclusive national response is essential to prevent the HIV epidemic from worsening further, especially among the youth. Conflict of interest statement The author declares no competing interests. Funding The author received no extramural funding for the study. Publisher’s note The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Edited by Zhang Q, Lei Y, Pan Y