As the HIV epidemic explodes in the Philippines, a doctor’s call for artillery

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Dr. Edsel Maurice T. Salvaña at ID Week at the San Diego Conference Center

Standing next to his ID Week poster presentations –one on HIV opportunistic infections, one on flu monitoring — at the San Diego Conference Center last week, Dr. Edsel Maurice T. Salvaña cheerfully explained how he recently got chosen to be one of the Jaycee’s Ten Outstanding Young Persons of the World.

“I have a big mouth,” he said. But while his big mouth – or willingness to talk about things other people shied away from – factored into the most recent honor bestowed on Salvaña, that was only part of the story. The rest of his story involved changing the trajectory of his life to try to change the trajectory of an epidemic in his country.

If his life had gone as he planned, Salvaña, 37, would be spending his days with parasites now.

From one of Salvaña's poster displays, showing the steep ascent of new HIV diagnoses in his country. Click on image to enlarge

“I actually wrote on my application for Case Western ‘I love worms!’” Salvaña recalls now. He has a convivial, nearly perpetual smile, but he is wistful too. That was back around 2005, when Salvaña, already a physician when he came to the United States from the Philippines, had finished his internal medicine training in Wisconsin and was on the home stretch of his studies for what was to be his life’s work, in tropical medicine. In the course of his infectious diseases fellowship at Case Western, he was trained in treating HIV because that was part of the deal, but it didn’t seem relevant to his plan. His plan was to take his education back to the Philippines, where, when he left in 2002, the HIV epidemic had been so “low and slow,” as he described it later, to be an oddity.

Tropical medicine diploma in hand, he went home in 2008, just in time to see the number of people diagnosed with HIV double in a single year. Then it happened again. Where one case had turned up every three days, 10 cases began to turn up daily. The clinic where Salvaña worked went from fifty HIV patients to 500. By 2011, more than half of the country’s 7,000-plus HIV diagnoses since 1984 had been made in just the previous four years. And, he adds, only about 6 percent of the population have been tested. It is likely, he says, still just the beginning,

Returning home to the Philippines it turned out, was a lot like landing in San Francisco in the 1980s, he says now.

That resemblance extended not only to caseload but to the country’s state of preparedness to address a burgeoning epidemic. Salvaña was one of just five doctors in the country trained to treat HIV. A couple of visiting medical students from Australia were shocked to find the clinic where he worked had no equipment to measure immune cells counts – necessary to monitor HIV patients’ health. They offered to help raise funds, but asked one thing – that Salvaña make a parallel effort, say, by holding an awareness and fund-raising rock concert.

"One bright spot in the Philippines," Salvaña says, "is the family support has really been phenomenal." This poster targets university students, aiming to capitalize on young people's close family bonds.

“It was going to be a dinky concert in the back of a garage,” Salvaña says, and laughs, “It was a monster!”

Headlining major stars from the region the concert fulfilled its goal, and a CD4 count machine is on its way, he says. “It was an incredible experience,” he says. “I never want to do it again!”

A hundred radio spots, a hundred television spots followed.

“I actually tested a reporter on national TV,” Salvaña says, looking somewhat abashed, before laughing. “It’s a good thing he was negative!”

Each time, each media blitz, was followed by a brief five-fold increase in people getting tested, he says. So he kept it up.

Most doctors are media shy, he says. The AIDS epidemic, in a sexually conservative, highly Catholic country where only about 30 percent of the population would consider using condoms, was not the stuff of public discourse.

“I figured I had to do something, because all these kids are dying. All these 20 year-olds, in the prime of their lives dropping dead. I just get really, really upset when I have to tell a mom her kid is dying,” he says. “It’s the worst feeling in the world. It makes you feel like you didn’t do your job properly. Especially when it’s preventable.”

As critical as awareness campaigns are, with condom use low, and discouraged by the Church, his biggest hope for the Philippines  came with the result of the HPTN 052 trial showing that immediate treatment that suppresses patients’ viral loads acts as effective prevention of HIV transmission. The size of the population and the known prevalence of HIV in the country now, make the Philippines an ideal site for a test-and-treat strategy of addressing the epidemic, he says, and has written.

It is, perhaps, a hard sell, with the local response still mounting, and the Global Fund money running out in the Philippines this year.

So Salvaña, whose big mouth perhaps, but his research as well, also earned him recognition as an “Outstanding Young Scientist,” and an “Outstanding Young Men” award in the Philippines in 2010, keeps talking.

The alternative is too depressing, he says, “it’s kind of like watching glass break.”

 

 

 

 

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