Doc Alan
17th December 2016, 22:46
The Asia-Pacific region (http://www.thelancet.com/pdfs/journals/langas/PIIS2468-1253(16)30031-0.pdf) has the largest share of infections with hepatitis B virus ( HBV ) and C virus ( HCV ) in the world. Over 7 million Filipinos may be chronically infected with HBV, and a smaller number with HCV ( no reliable data ). Both HBV and HBC are strongly associated with development of liver cirrhosis and cancer. Most people with HBV and HBC infection don’t have symptoms. There’s a lack of awareness, and - while treatment is possible - it’s expensive, therefore both infections are undertreated. An HBV vaccination programme for infants in the Philippines is " free " ( a " donation box " is prominently displayed in clinic ), but many ( ~3/5 ) don’t receive the full three recommended doses. No HCV vaccine is yet available.
HIV infection (http://www.nytimes.com/aponline/2016/12/08/world/asia/ap-as-philippines-hiv-epidemic.html?ref=news&_r=0) has increased alarmingly in the country - possibly 55,000 cases by the end of this year ; with a trend from male-female sex to male-male sex transmission ( ~9/10 cases ). Although this is ~ half the cases in the UK, it’s likely the true number of infections is more. HIV infection is now a manageable chronic condition, which can also either be prevented with drugs or - better still - avoided by behaviour including use of condoms ( still not always available in the Philippines ).
TB (http://www.who.int/mediacentre/factsheets/fs104/en/) is far commoner in the Philippines (https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=PH&LAN=EN&outtype=html) than the UK (https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=GB&LAN=EN&outtype=html) ( ~320/100,000 compared to ~10/100,000 ). This is why visa applicants are screened for TB before migrating to the UK. It can also be treated, but over many months ( multidrug resistance is an increasing problem ) - around a third of people living with HIV also have TB infection.
Worldwide, a disproportionate burden of hepatitis, HIV, and TB are present in current and former prisoners (http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30466-4.pdf). Prisoners are often held in overcrowded, unsanitary, stressful and violent conditions (http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30663-8.pdf) - ripe for the spread of communicable diseases. Philippine prisons may exceed capacity fourfold (http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)32468-0.pdf).
Many Asian countries enforce extended incarceration or capital punishment for drug offences. Killing suspected drug users is one solution favoured by the new President and supported by many Filipinos. Each prison inmate may contribute to the increase in serious infections, apart from the cost ( perhaps US$ 1500 annually ). Singapore permits lengthy imprisonment and the death penalty for drug offenders, although rehabilitation is available for first- and second-time offenders. Singapore has the lowest drug use and crime in Southeast Asia.
( Previous Forum links here for hepatitis (http://filipinaroses.com/showthread.php/50504-ABC-of-hepatitis), HIV (http://filipinaroses.com/showthread.php/58973-HIV-AIDS-update?highlight=HIV+%2F+AIDS), and TB (http://filipinaroses.com/showthread.php/31919-TB-curable-but-a-long-way-to-go).)
HIV infection (http://www.nytimes.com/aponline/2016/12/08/world/asia/ap-as-philippines-hiv-epidemic.html?ref=news&_r=0) has increased alarmingly in the country - possibly 55,000 cases by the end of this year ; with a trend from male-female sex to male-male sex transmission ( ~9/10 cases ). Although this is ~ half the cases in the UK, it’s likely the true number of infections is more. HIV infection is now a manageable chronic condition, which can also either be prevented with drugs or - better still - avoided by behaviour including use of condoms ( still not always available in the Philippines ).
TB (http://www.who.int/mediacentre/factsheets/fs104/en/) is far commoner in the Philippines (https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=PH&LAN=EN&outtype=html) than the UK (https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=GB&LAN=EN&outtype=html) ( ~320/100,000 compared to ~10/100,000 ). This is why visa applicants are screened for TB before migrating to the UK. It can also be treated, but over many months ( multidrug resistance is an increasing problem ) - around a third of people living with HIV also have TB infection.
Worldwide, a disproportionate burden of hepatitis, HIV, and TB are present in current and former prisoners (http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30466-4.pdf). Prisoners are often held in overcrowded, unsanitary, stressful and violent conditions (http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30663-8.pdf) - ripe for the spread of communicable diseases. Philippine prisons may exceed capacity fourfold (http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)32468-0.pdf).
Many Asian countries enforce extended incarceration or capital punishment for drug offences. Killing suspected drug users is one solution favoured by the new President and supported by many Filipinos. Each prison inmate may contribute to the increase in serious infections, apart from the cost ( perhaps US$ 1500 annually ). Singapore permits lengthy imprisonment and the death penalty for drug offenders, although rehabilitation is available for first- and second-time offenders. Singapore has the lowest drug use and crime in Southeast Asia.
( Previous Forum links here for hepatitis (http://filipinaroses.com/showthread.php/50504-ABC-of-hepatitis), HIV (http://filipinaroses.com/showthread.php/58973-HIV-AIDS-update?highlight=HIV+%2F+AIDS), and TB (http://filipinaroses.com/showthread.php/31919-TB-curable-but-a-long-way-to-go).)