Behind the Worsening HIV Epidemic: A Retrospective Policy Analysis of the Philippine HIV/AIDS Response

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Guinaran, Neoman R. Roxas, Christian Joseph Ong, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7918370/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Apr, 2026 Read the published version in Discover Public Health → Version 1 posted 4 You are reading this latest preprint version Abstract (249 words) Background: While most of the world is steadily curbing HIV, the Philippines has become an outlier, with one of the fastest-growing epidemics in Asia. Despite progressive legal frameworks, new infections continue to surge exponentially, particularly among young men who have sex with men and transgender women. This study analyzes the evolution of the country’s HIV/AIDS response and examines systemic and policy-level barriers impeding progress. Methods: A retrospective policy analysis was conducted using the WHO health systems building blocks as an analytical framework. We gathered relevant and publicly available documents, including national laws, administrative issuances, and reports. Thematic synthesis was then performed to identify underlying systemic-level challenges. Results: A total of 21 key policy documents were analyzed. Findings revealed persistent weaknesses across all system domains. Governance was undermined by fragmented coordination, weak PNAC authority, and inconsistent local government implementation. Service delivery was hampered by centralized services and limited access to testing, prevention, and PrEP. Financing relied heavily on external donors, with insufficient domestic resources. Human resources were constrained by provider shortages and stigma among health workers. Information systems showed weak surveillance and fragmented data. Sociocultural barriers, including stigma, discrimination, and conservative opposition, further impeded prevention and care. Compared to neighbors like Thailand and Cambodia, the Philippines missed critical scale-up opportunities. Conclusion: The worsening epidemic reflects systemic governance failures, fragmented service delivery, and sociocultural resistance. Addressing this requires reinvigorating PNAC’s authority, embedding HIV services within universal health care, ensuring sustainable financing, modernizing surveillance, expanding community-based and rights-based programs, and dismantling stigma. HIV/AIDS human immunodeficiency virus epidemic vulnerable populations MSM youth health policy governance health financing population health Philippines I. Introduction The global HIV epidemic has undergone a remarkable transformation over the past four decades [ 1 ]. Since the first reported cases in the early 1980s, the disease has claimed more than 40 million lives worldwide, yet global progress has been palpable [ 1 ]. Significantly, the development of antiretroviral therapy (ART) has transformed HIV from a fatal illness into a manageable chronic condition, while widespread prevention strategies have driven substantial declines in new infections across many regions [ 1 , 2 ]. UNAIDS reported a 40% reduction in global HIV incidence from 2010 to 2024, a milestone attributed to aggressive prevention campaigns, improved testing, and rapid ART scale-up [ 3 ]. However, this global progress masks considerable heterogeneity, with certain regions and countries continuing to experience surges in incidence. The Philippines has emerged as a critical outlier in this global narrative. While neighbors like Thailand, Cambodia, and Vietnam have sustained successful interventions in reducing new cases, the Philippines has experienced an alarming surge of about 550% in new infections and over 600% in AIDS-related deaths over the past decade and a half [ 4 , 5 ]. According to the Department of Health (DOH) surveillance, what was once a single new infection reported per day in 2008 has escalated to more than 50 daily in early 2025 [ 5 ]. This rapidly escalating crisis underscores persistent gaps in prevention, service accessibility, and health system responsiveness for key populations. Moreover, the country’s situation is further compounded by the shortfall in meeting the UNAIDS 95–95–95 targets— an ambitious global commitment adopted in 2021 to end AIDS as a public health threat by 2030 [ 5 ]. In the Philippines, only 55% of the estimated people living with HIV have been diagnosed, of whom 66% are on ART; among those on treatment, fewer than half have received viral load testing, and only 40% have achieved viral suppression [ 5 ]. These gaps not only threaten the health of people living with HIV but also fuel continued transmission within communities. In strengthening health systems, government action and support have always been pivotal [ 6 , 7 , 8 ]. The Philippine government has passed progressive legislation in shaping the national HIV response, beginning with Republic Act 8504, the Philippine AIDS Prevention and Control Act of 1998 [ 9 , 10 ], and followed by Republic Act 11166, the Philippine HIV and AIDS Policy Act of 2018. These laws, alongside a series of AIDS Medium-Term Plans (AMTPs), were intended to provide a strong institutional foundation for prevention, treatment, and care. Yet despite this legal and policy infrastructure, the epidemic has continued to worsen in the country [ 11 , 12 , 13 ]. The paradox between progressive frameworks on paper and deteriorating epidemiological realities on the ground underscores the need for a deeper examination of where the response faltered, and why. This study offers a retrospective analysis of the Philippine government’s HIV policies and programs, tracing their evolution while interrogating the systemic barriers that have hindered progress. By examining governance, service delivery, financing, human resources, information systems, and sociocultural contexts, and situating these within broader regional and global comparisons, the analysis aims to shed light on the structural gaps that sustain the epidemic. Ultimately, the goal is to generate actionable insights that can inform reforms toward a more equitable, effective, and sustainable HIV response in the Philippines. II. Methods Study Design This study conducted a retrospective policy and systems analysis of the Philippine government’s responses to the HIV epidemic from 1998 to 2023. The approach systematically examined how legislative, administrative, and programmatic measures evolved over time and how their design and implementation affected national epidemic trajectories. The analysis drew on the World Health Organization (WHO) Health Systems Building Blocks Framework (WHO, 2007) as the primary analytical model, chosen for its capacity to dissect structural and systemic determinants of policy effectiveness while allowing integration of sociocultural dimensions as cross-cutting influences. This framework disaggregates health systems into six domains: leadership and governance, financing, service delivery, health workforce, information systems, and access to medicines and technologies. It provides a coherent lens through which to trace how policy intentions translated (or failed to translate) into outcomes across the health system. Data Sources and Scope Data were obtained through a systematic document review encompassing primary policy texts, government reports, and peer-reviewed and gray literature. Primary policy sources were retrieved from official repositories of the Department of Health (DOH), Philippine National AIDS Council (PNAC), and the Official Gazette, including key legislation such as Republic Act (RA) 8504 (Philippine AIDS Prevention and Control Act of 1998) and RA 11166(Philippine HIV and AIDS Policy Act of 2018), as well as successive AIDS Medium Term Plans (AMTPs). Government surveillance data were drawn from the HIV/AIDS and ART Registry of the Philippines (HARP). International and donor reports were included from UNAIDS, WHO, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Peer-reviewed literature was sourced from PubMed, Scopus, and Google Scholar to capture both empirical and policy analyses, while gray literature from civil society organizations (e.g., ACHIEVE, PAFPI) and media investigations provided ground-level perspectives on policy implementation gaps. The inclusion criteria comprised documents explicitly addressing HIV policy, health governance, program financing, and implementation outcomes in the Philippines. Materials were excluded if they did not engage with health system dimensions or policy processes. The review period covered 1998–2023, beginning with the institutionalization of the national HIV response through RA 8504 and extending to the latest AMTP VII and UHC integration efforts. Analytical Framework Documents were analyzed thematically using a deductive-inductive coding approach anchored in the WHO health systems framework. Deductive codes represented the six health system domains, while inductive coding captured emergent subthemes such as stigma, decentralization, and donor dependency. Coding and categorization were conducted manually and verified by an independent reviewer to ensure analytic consistency and inter-rater reliability. Discrepancies were resolved through iterative discussion until consensus was achieved. To enhance validity, data triangulation was applied across multiple document types (laws, reports, gray literature) and levels (national, subnational, and community). Patterns and contradictions were examined to identify systemic barriers, policy misalignments, and temporal shifts in program implementation. Surveillance data (e.g., annual incidence rates, ART coverage trends) were integrated descriptively to contextualize policy developments within epidemiological realities. A reflexive stance was maintained throughout the analysis, acknowledging potential biases arising from document selection and institutional perspectives embedded in official reports. A summary of the analytical framework is shown in Table 1 below. Table 1 WHO Health Systems Building Blocks as an Analytical Framework for Reviewing Barriers in the Philippine HIV Response Building Block Definition Application to HIV Policy and Response Leadership and Governance Ensuring strategic policy frameworks, oversight, accountability, and coalition building Effectiveness of PNAC, coordination between DOH and LGUs, enforcement of RA 8504 and RA 11166, policy fragmentation Financing Adequate funding to ensure access to needed services without financial hardship Reliance on donor support (e.g., Global Fund), domestic financing gaps, PhilHealth reimbursements, LGU resource disparities Service Delivery Provision of effective, safe, quality personal and non-personal health interventions when and where needed Availability and accessibility of HIV testing, ART hubs, PrEP services, integration into primary care, outreach to key populations Health Workforce Responsive, fair, and efficient workforce that achieves best health outcomes with available resources Adequacy of trained HIV counselors, clinicians, peer navigators; workforce distribution and stigma-sensitive training Access to Essential Medicines Equitable access to essential medical products, vaccines, and technologies of assured quality, safety, efficacy, and cost-effectiveness Consistent supply of ART, PrEP, condoms, test kits; procurement bottlenecks and distribution challenges Health Information Systems Production, analysis, dissemination, and use of reliable and timely information on health determinants and outcomes HIV/AIDS Registry, surveillance quality, disaggregation of data, timeliness of reporting for program decisions Source Adapted from WHO’s Framework for Action (2007) [ 14 ]. III. Results Overview of the Philippine HIV Response A total of 21 key policy documents were reviewed to trace the trajectory of the Philippine government’s HIV response, as outlined in Table 2 with sources ranging from official government issuances, surveillance bulletins, and donor evaluations to civil society reports. These documents can be broadly categorized into three clusters. The first cluster consists of “hard laws” such as Republic Act 8504 of 1998 and Republic Act 11166 of 2018, alongside the Universal Health Care Act of 2019, which created binding legal frameworks that redefined institutional responsibilities, established the Philippine National AIDS Council (PNAC), and expanded rights-based access to testing and treatment. The second cluster includes administrative issuances and financing mechanisms, such as the DOH Administrative Orders on ART decentralization (2014–2021) and the PhilHealth Outpatient HIV/AIDS Treatment Package (2010, updated 2015). These provided critical technical and financial guidance for service delivery but often left wide discretion for implementation at the local government level. The third cluster consists of programmatic reports and planning documents, including the successive AIDS Medium Term Plans (AMTPs), PNAC annual progress reports, DOH HIV/AIDS Registry bulletins, Global Fund performance reviews, and UNAIDS country reports. These documents primarily set strategic directions or provided monitoring data, but in many cases were limited to proposals and assessments without enforceable mechanisms for accountability. Taken together, these sources illustrate a policy landscape where laws provided the foundation, administrative issuances operationalized technical standards and financing, and programmatic reports monitored progress or proposed strategic priorities. However, the analysis revealed that while the documentary record is extensive, only a handful of documents included detailed provisions on how programs should be implemented and monitored. Many left execution to implementing agencies or devolved local government units, resulting in uneven adoption and persistent service delivery gaps. This imbalance between binding legal frameworks and largely aspirational plans contributed to the fragmentation observed across the country’s HIV response. Table 2 Summary of Philippine HIV Policy and Response Documents and Milestones Reviewed Period Document Description Source 1998 Republic Act 8504 (Philippine AIDS Prevention and Control Act) First comprehensive HIV/AIDS law institutionalizing prevention, care, and rights-based protections. Established PNAC as the national coordinating body. LawPhil [ 15 ] Early 2000s Introduction of Antiretroviral Therapy (ART) ART made available in treatment hubs, initially through Global Fund support, later increasingly funded by government. DOH & Global Fund Reports [ 16 ] 2003–2022 Global Fund Grant Performance Reports Evaluated donor-funded HIV prevention and treatment projects; critical in sustaining ART and prevention services before full domestic financing. Global Fund [ 17 ] 2005–2010 AIDS Medium Term Plan (AMTP IV) Focused on prevention and awareness campaigns; limited service coverage due to resource constraints and weak LGU capacity. PNAC Reports [ 18 ] 2005–2022 PNAC Annual Progress Reports Documented AMTP implementation, funding, and interagency coordination. PNAC [ 18 ] 2005–2022 Philippine HIV/AIDS Registry (HARP) Bulletins Monthly/quarterly surveillance of HIV incidence, treatment enrollment, and trends. DOH Epidemiology Bureau [ 19 ] 2008–2022 UNAIDS Country Reports on the Philippines Provided country-level progress on global HIV targets, financing, and epidemiological updates. UNAIDS [ 20 ] 2010, updated 2015 PhilHealth Outpatient HIV/AIDS Treatment Package Established financial coverage for outpatient HIV treatment, reducing out-of-pocket costs. PhilHealth Circulars [ 21 ] 2011–2016 AMTP V and VI Expanded scope to align with MDGs and later UNAIDS 90-90-90 targets; emphasized scaling up testing and treatment. PNAC (2012, 2015) [ 22 ] Mid-2010s Community-Based HIV Screening and Testing Pilots Rolled out rapid diagnostics and community-led testing for key populations in urban centers. DOH Administrative Orders [ 23 ] 2014–2021 DOH Administrative Orders on ART Expansion and Decentralization Set guidance on HIV testing protocols, ART initiation, and treatment hub accreditation to expand service coverage nationwide. DOH Bulletins [ 24 ] 2015–2021 Action for Health Initiatives (ACHIEVE) Policy Briefs Advocated rights-based HIV response, focusing on key populations and stigma reduction. ACHIEVE [ 25 ] 2017–2022 AMTP VI (extended) Comprehensive framework integrating prevention, treatment, stigma reduction, and multisectoral approaches. PNAC Reports [ 26 ] 2018 Republic Act 11166 (Philippine HIV and AIDS Policy Act) Replaced RA 8504 with progressive provisions, including lowering HIV testing age of consent to 15; strengthened LGU role; expanded treatment and prevention mandates. Official Gazette [ 27 ] 2019 Universal Health Care (UHC) Act Provided pathways for integrating HIV services into PhilHealth; implementation uneven under devolved governance. Official Gazette [ 28 ] 2020–present Expansion of ART and PrEP Wider ART availability supported by domestic financing; PrEP rollout initiated, though uptake limited by supply and awareness. DOH Bulletins; UNAIDS Country Reports [ 29 ] 2020s (ongoing) PNAC and DOH Strategic Shifts Emphasis on community-based, key-population-led service delivery; continued struggle with surveillance gaps, stigma, and donor dependency. DOH HARP; PNAC [ 30 ] 2010–2020 Positive Action Foundation Philippines Network (PAFPI) Reports Civil society reports documenting treatment access barriers, stigma, and community perspectives. PAFPI [ 31 ] 2023–present AMTP VII Most recent AIDS Medium Term Plan, aligning with SDG 2030 targets, prioritizing digital surveillance, equitable ART access, and PrEP expansion. PNAC (2023 AMTP VII Report) [ 32 ] Systemic Barriers by Health System Domains Table 3 synthesizes the key barriers mapped against WHO’s six domains, with sociocultural stigma embedded as an overarching determinant. The findings revealed that despite legislative progress and repeated planning cycles, the Philippine HIV response has been consistently undermined by systemic barriers that map onto the WHO health systems building blocks. These barriers interacted with each other, producing structural weaknesses that collectively constrained the effectiveness of the national response. The findings are summarized narratively below. Table 3 Barriers to the Philippine HIV Response by Health Systems Building Block Building Blocks Key Barriers Description Leadership & Governance Fragmented coordination; weak PNAC authority; decentralization challenges Limited LGU prioritization; inconsistent policy enforcement Financing Heavy donor dependence; insufficient domestic funds; weak absorptive capacity Delayed fund disbursement at LGUs; reliance on Global Fund until 2010s Service Delivery Centralized services; limited community-based testing; weak harm reduction ART clustered in urban hospitals; absence of needle/syringe programs Health Workforce Shortages of trained providers; stigma among health workers Lack of counselors in rural clinics; discriminatory attitudes Information Systems Weak surveillance; fragmented data collection; poor utilization Gaps in HARP disaggregation; delayed reporting Sociocultural Barriers Stigma, discrimination, and conservative opposition Resistance to sexuality education; barriers for MSM and transgender women Leadership and Governance Leadership of the HIV response in the Philippines has been fragmented. The Philippine National AIDS Council, mandated to coordinate the response, has often been criticized for its limited authority and bureaucratic inefficiency. Frequent changes in leadership within both PNAC and the Department of Health resulted in shifting priorities and inconsistent follow-through. The decentralization of health governance further diluted accountability, as local government units (LGUs) were tasked with implementing HIV programs but often lacked capacity, political will, or resources. Compared to Thailand’s strong central stewardship of its HIV program, the Philippines’ governance has been characterized by weak enforcement, insufficient multi-sectoral collaboration, and uneven political commitment at the national and subnational levels. Financing Historically, HIV financing in the Philippines has been donor-dependent. Until the mid-2010s, a significant portion of prevention and treatment programs, particularly those targeting key populations, was supported by the Global Fund and international development partners. Domestic financing only became more prominent after the enactment of RA 11166 and the rollout of the Universal Health Care (UHC) Law. However, budget allocations for HIV have remained insufficient, fragmented across agencies, and vulnerable to political shifts. Moreover, financial flows often stall at the LGU level, where absorptive capacity and prioritization are weak. In contrast, regional neighbors such as Vietnam and Cambodia successfully transitioned from donor to domestic financing through sustained government commitment and integration of HIV into national insurance schemes, a process that remains incomplete in the Philippines. Service Delivery Service delivery has lagged in both coverage and accessibility. HIV testing services were constrained for years by restrictive consent policies, with the age of consent for testing only lowered to 15 in 2018 under RA 11166. Access to testing and treatment has been concentrated in urban centers, leaving rural populations underserved. Community-based HIV screening and decentralized ART delivery have expanded in recent years, but scale-up remains inadequate. Harm reduction services for people who inject drugs are extremely limited due to punitive drug laws, while pre-exposure prophylaxis (PrEP) is still not widely available. By contrast, Thailand’s early and aggressive rollout of ART and differentiated service delivery models facilitated higher coverage and retention. Health Workforce The Philippine health workforce is overstretched and unevenly distributed. HIV services depend heavily on a small cadre of specialized physicians, nurses, and medical technologists concentrated in major cities. Local clinics often lack trained providers, and stigma among healthcare workers continues to deter key populations from accessing services. Community-based organizations have stepped in to bridge gaps, but they often face regulatory and funding constraints. The shortage of trained HIV counselors and case managers further hampers linkage-to-care and adherence support, limiting program effectiveness at scale. Information Systems Monitoring and evaluation systems remain fragmented and underutilized. The HIV/AIDS & ART Registry of the Philippines (HARP) provides basic surveillance data, but gaps in timeliness, disaggregation, and completeness limit its utility for policy and program planning. Coordination between DOH central offices, LGUs, and community organizations in reporting is inconsistent. Weak data systems hinder early detection of trends, such as rising HIV incidence among young MSM, and prevent rapid corrective action. Neighboring countries like Cambodia and Vietnam leveraged robust surveillance and cohort tracking to adapt their responses dynamically, an area where the Philippines has lagged. Sociocultural Barriers Underlying all system components is the persistence of stigma, discrimination, and moralistic attitudes toward sexuality, drug use, and gender diversity. HIV prevention campaigns have often been diluted by conservative cultural and political environments, with resistance to comprehensive sexuality education in schools and public discomfort with condom promotion. Key populations such as MSM, transgender women, sex workers, and PWID continue to face systemic exclusion, not only from health services but also from employment and education. These sociocultural barriers both reflect and reinforce weaknesses in governance, service delivery, and financing, creating a cycle of exclusion that fuels the epidemic. V. Discussion The persistence of structural, systemic, and sociocultural barriers explains in large part why the HIV epidemic in the Philippines has diverged from global trends [ 33 , 34 ]. While most countries in Southeast Asia have seen stabilization or decline in HIV incidence over the past decade [ 35 ], the Philippines has witnessed a steep increase, particularly among young men who have sex with men and transgender women [ 36 , 37 , 38 ]. The interplay of weak governance, limited service delivery capacity, inadequate financing, fragile health workforce, poor information systems, and entrenched stigma has created a perfect storm that allows transmission to continue largely unchecked [ 39 , 40 , 41 ]. These barriers do not operate in isolation but rather reinforce one another in ways that amplify their impact. For example, stigma that discourages individuals from testing is exacerbated by discriminatory health workers [ 42 ], which itself is a product of inadequate training and weak accountability systems [ 43 , 44 ]. From a governance perspective, the Philippines’ reliance on a devolved health system under the Local Government Code of 1991 has created both opportunities and vulnerabilities [ 45 ]. While devolution enables localized HIV programs in some progressive LGUs, it also produces wide variability in performance [ 46 , 47 ]. In a rapidly growing epidemic, this variability has been particularly damaging. Countries such as Thailand, which managed to bend the HIV curve earlier, illustrate the value of strong national coordination paired with empowered local implementation [ 48 ]. Thailand’s national AIDS program invested heavily in centralized monitoring and accountability, ensuring that provincial programs aligned with national targets. In contrast, the Philippine National AIDS Council (PNAC) has been underfunded and politically sidelined, leaving national strategies largely unenforceable at the local level. Strengthening PNAC’s authority and establishing clearer accountability frameworks between national and local governments is essential. Embedding HIV program performance within LGU scorecards tied to incentives and sanctions could enhance compliance, while improved inter-agency collaboration would ensure that HIV response is not siloed within health but integrated across education, labor, and social welfare sectors [ 49 ]. Service delivery challenges in the Philippines stand in sharp contrast with regional neighbors who have effectively scaled up innovations [ 50 ]. Cambodia, once considered an epicenter of the HIV epidemic [ 51 , 52 ], reduced its incidence by more than 80% through aggressive expansion of voluntary counseling and testing [ 53 , 54 ], broad access to ART [ 55 ], and integration of HIV services into primary health care [ 56 ]. The Philippines, in contrast, maintains ART coverage that is far from optimal [ 33 , 57 ], with treatment hubs clustered in urban areas and limited integration into primary facilities [ 58 ]. The delayed rollout of PrEP further highlights the country’s sluggish adoption of evidence-based interventions [ 59 , 60 , 61 ]. HIV services must be mainstreamed within the broader framework of universal health care, with ART, PrEP, and testing made widely available in primary care facilities [ 62 , 63 ]. Community-based and peer-led delivery models should be expanded to reach key populations more effectively [ 64 ], particularly in rural and peri-urban areas where formal health facilities are limited [ 65 ]. Overreliance on foreign donors, particularly the Global Fund, has created instability in the Philippine HIV response [ 66 ]. As donor contributions declined, domestic financing mechanisms proved insufficient [ 67 ]. In contrast, Vietnam deliberately transitioned HIV financing to domestic sources, embedding HIV within its national health insurance program [ 68 ]. Although the Philippines has taken steps through PhilHealth reimbursements and DOH allocations, the uneven fiscal capacity of LGUs continues to drive inequities. Prevention remains chronically underfunded relative to treatment, despite global evidence that prevention saves costs in the long term [ 69 ]. A financing strategy that prioritizes prevention while ensuring sustainability is crucial. This includes earmarking funds for prevention in the General Appropriations Act, expanding PhilHealth benefits for HIV-related services, and creating an HIV equity fund that redistributes resources from resource-rich to resource-poor LGUs. Strengthening financial management and ensuring timely disbursement of funds would further reduce service interruptions. A critical weakness lies in the underinvestment in prevention. In 2023, only 6% (₱211 million) of the country’s ₱3.6 billion HIV expenditure was allocated to prevention activities, despite the steep rise in new infections [ 70 , 71 ]. This shortfall has been exacerbated by the suspension of U.S. support, which disrupted the development and rollout of prevention programs and undermined community-led responses [ 72 ]. The consequences of these missed opportunities are wide-ranging. Beyond the human toll, the economic burden is considerable, encompassing the costs of lifelong HIV treatment, management of co-morbidities, and productivity losses. For affected households, the financial strain from medical expenses and loss of income is often severe. At a systemic level, the sustained increase in HIV cases is expected to further pressure an already stretched health system, particularly its workforce and service delivery capacity. The inadequacy of the health workforce is a significant bottleneck. Health workers are often unprepared to provide stigma-free services to key populations, reflecting gaps in training and deeply entrenched biases [ 73 ]. Countries like Thailand and Malaysia have mitigated this by integrating peer navigators and community-based organizations into service delivery. The Philippines has not systematically institutionalized such task-shifting models. HIV-specific training should be embedded in medical, nursing, and allied health curricula, complemented by continuous professional education on stigma reduction and rights-based care. Scaling up peer navigators and community health workers within the formal system could expand reach while fostering trust among marginalized populations [ 74 ]. Incentive structures to reduce staff turnover and protect health workers from discrimination themselves are also needed [ 75 ]. The deficiencies in surveillance and monitoring hinder timely and targeted interventions [ 12 , 76 ]. Unlike Thailand’s robust data systems, which enable rapid adjustments, the Philippines’ HIV/AIDS and ART Registry (HARP) is hampered by under-reporting, delayed updates, and limited disaggregation [ 12 ]. These weaknesses leave the response largely reactive. Modernizing HIV surveillance through real-time reporting, better integration with electronic medical records (EMRs), and disaggregated data collection is vital [ 77 , 78 ]. Investment in bio-behavioral surveys and predictive analytics could allow for anticipatory programming [ 79 ]. Linking surveillance data with LGU planning processes would ensure that local responses are evidence-driven [ 80 , 81 ] Sociocultural barriers remain among the most entrenched determinants of the epidemic. Stigma, discrimination, and moral opposition to preventive strategies have constrained both policy and service uptake. Comprehensive sexuality education, recognized globally as an effective prevention tool, continues to face resistance from conservative and religious sectors. In contrast, countries such as Thailand promoted pragmatic, rights-based approaches to sexual health education and condom promotion early in their epidemics [ 82 ]. Scaling up evidence-based sexuality education in schools and communities is crucial, alongside stronger enforcement of anti-discrimination laws. Partnerships with faith-based groups and civil society could help shift public narratives, while media campaigns tailored for youth and key populations can normalize testing, PrEP use, and treatment adherence. Addressing sociocultural constraints requires not only policy reform but also cultural change driven by sustained public engagement [ 83 ]. The Philippine HIV epidemic offers critical lessons for global health. It demonstrates that progressive laws and donor funding are insufficient without strong governance, sustainable financing, and a health system capable of delivering stigma-free services. It underscores the risks of decentralization without accountability, the dangers of neglecting prevention, and the profound influence of cultural conservatism on health outcomes. Moving forward, the Philippines must couple structural reforms with community engagement and rights-based approaches to align its epidemic trajectory with global goals. For the broader global health community, the Philippine experience reinforces that HIV is not only a biomedical challenge but also a political, economic, and cultural one, requiring integrated strategies that bridge these domains. VI. Conclusion The worsening trajectory of the Philippine HIV epidemic highlights the cost of delayed and fragmented responses. Despite progressive laws such as RA 8504 and RA 11166, their impact has been profoundly undermined by weak implementation. This retrospective analysis, framed through the WHO health systems building blocks, reveals systemic barriers in governance, financing, service delivery, workforce, data systems, and sociocultural contexts that have sustained rising infections despite global and regional progress. Weak leadership, devolved accountability, inadequate domestic investment, and entrenched stigma left the health system ill-equipped to address one of the world’s fastest-growing epidemics. In contrast, neighboring countries like Thailand, Cambodia, and Vietnam demonstrate how centralized coordination, rights-based approaches, and integrated service delivery can reverse trajectories. For the Philippines, urgent reforms include strengthening PNAC’s authority, embedding HIV services into universal health care, ensuring sustainable financing, modernizing surveillance, and addressing stigma through rights-based programming. Renewed commitment and systemic reform are imperative to transform the HIV response and protect vulnerable communities. Declarations Author contributions RCG conceptualized the manuscript; JBO, NRR, and CJNO wrote the initial draft and preparedthe figures and tables; JBO, CJNO, NRR, ERG, and DELP revised and edited the manuscript; DELP, ERG, and RCG supervised the manuscript. All authors reviewed and approved the manuscript. Competing interests The authors declare no competing interests. Funding This paper was supported by a grant from the AIDS Healthcare Foundation (AHF) Philippines. Ethical approval Not applicable. Consent to publish I hereby provide consent for the publication of this manuscript. Clinical trial number Not applicable. Acknowledgements We would like to extend our utmost gratitude to the AIDS Healthcare Foundation (AHF) Philippines and Global Health Focus (GHF). Their unwavering commitment to addressing the HIV crisis in the Philippines was instrumental in the completion of this work. References Ghosh AK. 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The global impact of scaling up HIV/AIDS prevention programs in low- and middle-income countries. Science. 2006;311:1474–6. 10.1126/science.1121176 . Cordero DA. Exploring the HIV epidemic in the Philippines: initiatives and challenges. J Int Assoc Provid AIDS Care. 2025;24:23259582241312294. 10.1177/23259582241312294 . World Health Organization (WHO). UNAIDS and WHO support DOH’s call for urgent action as the Philippines faces the fastest-growing HIV surge in the Asia-Pacific region. 2025 Jun 11. Available from: https://www.who.int/philippines/news/detail/11-06-2025-unaids--who-support-doh-s-call-for-urgent-action Calaguas NP, Kamami M, Schell E, Velasco RAF, Albright N. Nurses on the frontlines of collapse: advocacy, leadership, and HIV care in the wake of USAID’s withdrawal from Kenya, Malawi, and the Philippines. J Assoc Nurses AIDS Care. 2025;36(5):578–83. World Health Organization (WHO). WHO releases technical brief on reducing HIV-related stigma and discrimination in healthcare settings. 2024 Jul. Available from: https://www.who.int/news/item/22-07-2024-who-releases-technical-brief-on-reducing-hiv-related-stigma-and-discrimination-in-healthcare-settings Kennedy CE, Yeh PT, Verster A, Luhmann N, Nguyen VTT, de Mello MB, et al. Do peer navigators improve initiation and retention in HIV/VH/STI treatment programs for key populations? A systematic review. J Acquir Immune Defic Syndr. 2024;95(4):305–12. 10.1097/QAI.0000000000003364 . World Health Organization (WHO). WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. Geneva: WHO. 2021. Available from: https://www.who.int/publications/i/item/9789240024229 Mann SC, Barocas JA. Bolstering the HIV Surveillance System Through Innovative Methods, Technologic Advances, and Community-Driven Solutions to Inform Intervention Efforts and End the Epidemic. Curr HIV/AIDS Rep. 2024;22(1):11. 10.1007/s11904-024-00720-1 . Yingyong T, Aungkulanon S, Saithong W, et al. Development of automated HIV case reporting system using national electronic medical record in Thailand. BMJ Health Care Inf. 2022;29:e100601. 10.1136/bmhjci-2022-100601 . Srithanaviboonchai K, et al. Establishment, implementation, initial outcomes and lessons learned from nationwide recent HIV infection surveillance in Thailand. JMIR Public Health Surveill. 2024;10:e65124. 10.2196/65124 . Nethi AK, Karam AG, Alvarez KS, Luque AE, Nijhawan AE, Adhikari E, King HL. Using machine learning to identify patients at risk of acquiring HIV in an urban health system. J Acquir Immune Defic Syndr. 2024;97(1):40–7. 10.1097/QAI.0000000000003464 . Liwanag HJ, Wyss K. What conditions enable decentralization to improve the health system? qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines. PLoS ONE. 2018;13(11):e0206809. 10.1371/journal.pone.0206809 . Liwanag HJ, Wyss K. Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines. Health Res Policy Syst. 2019;17(1):4. 10.1186/s12961-018-0402-1 . Geoffroy A, Sirirungsi W, Jongpaijitsakul P, Chamjamrat W, Ruklao C, Kongka M, et al. Stigma and discrimination against adolescents living with perinatal HIV in Thailand: caregivers' perceptions. Front Public Health. 2025;13:1535004. 10.3389/fpubh.2025.1535004 . Apinundecha C, Laohasiriwong W, Cameron MP, Lim S. A community participation intervention to reduce HIV/AIDS stigma, Nakhon Ratchasima province, northeast Thailand. AIDS Care. 2007;19(9):1157–65. 10.1080/09540120701335204 . ‌. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7918370","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":533984934,"identity":"653d821e-e194-4e19-aa0b-920227dc8bff","order_by":0,"name":"Jerico Bautista Ogaya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYBACxgYGhgMwzsEPFUCSmbmBaC2MhyXOgLQw4teCDJgP8LbBjMGnrL334YEfFTZ2/TOSHxyQnFcbzd8O1PKjYhtuh/UcNzjYcyYtecaNNIMDhduO5844zNjA2HPmNm4tM9IYDjO2HU5muJFgcEBy27HcBqAWZsY2PFrmP4Nokb+R/uEA75xjufMJapnBBtZiZ3Ajx+AAb0NN7gaCWnrSGEB+STA886bgsMSxA7kbgVoO4vOLYfsx5g/AELOXO56++eOHmrrceecPH3zwowKPlgYIndggkACiD4N5B3CqBwJ5KG3PwA9WV4dP8SgYBaNgFIxQAADvZmc8Hcx22gAAAABJRU5ErkJggg==","orcid":"","institution":"Far Eastern University","correspondingAuthor":true,"prefix":"","firstName":"Jerico","middleName":"Bautista","lastName":"Ogaya","suffix":""},{"id":533984935,"identity":"957fdcdd-7ede-4fb1-ae04-b699cba00629","order_by":1,"name":"Ryan C. 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Introduction","content":"\u003cp\u003eThe global HIV epidemic has undergone a remarkable transformation over the past four decades [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Since the first reported cases in the early 1980s, the disease has claimed more than 40\u0026nbsp;million lives worldwide, yet global progress has been palpable [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Significantly, the development of antiretroviral therapy (ART) has transformed HIV from a fatal illness into a manageable chronic condition, while widespread prevention strategies have driven substantial declines in new infections across many regions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. UNAIDS reported a 40% reduction in global HIV incidence from 2010 to 2024, a milestone attributed to aggressive prevention campaigns, improved testing, and rapid ART scale-up [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, this global progress masks considerable heterogeneity, with certain regions and countries continuing to experience surges in incidence.\u003c/p\u003e\u003cp\u003eThe Philippines has emerged as a critical outlier in this global narrative. While neighbors like Thailand, Cambodia, and Vietnam have sustained successful interventions in reducing new cases, the Philippines has experienced an alarming surge of about 550% in new infections and over 600% in AIDS-related deaths over the past decade and a half [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to the Department of Health (DOH) surveillance, what was once a single new infection reported per day in 2008 has escalated to more than 50 daily in early 2025 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This rapidly escalating crisis underscores persistent gaps in prevention, service accessibility, and health system responsiveness for key populations. Moreover, the country\u0026rsquo;s situation is further compounded by the shortfall in meeting the UNAIDS 95\u0026ndash;95\u0026ndash;95 targets\u0026mdash; an ambitious global commitment adopted in 2021 to end AIDS as a public health threat by 2030 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the Philippines, only 55% of the estimated people living with HIV have been diagnosed, of whom 66% are on ART; among those on treatment, fewer than half have received viral load testing, and only 40% have achieved viral suppression [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These gaps not only threaten the health of people living with HIV but also fuel continued transmission within communities.\u003c/p\u003e\u003cp\u003eIn strengthening health systems, government action and support have always been pivotal [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The Philippine government has passed progressive legislation in shaping the national HIV response, beginning with Republic Act 8504, the Philippine AIDS Prevention and Control Act of 1998 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and followed by Republic Act 11166, the Philippine HIV and AIDS Policy Act of 2018. These laws, alongside a series of AIDS Medium-Term Plans (AMTPs), were intended to provide a strong institutional foundation for prevention, treatment, and care. Yet despite this legal and policy infrastructure, the epidemic has continued to worsen in the country [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The paradox between progressive frameworks on paper and deteriorating epidemiological realities on the ground underscores the need for a deeper examination of where the response faltered, and why.\u003c/p\u003e\u003cp\u003eThis study offers a retrospective analysis of the Philippine government\u0026rsquo;s HIV policies and programs, tracing their evolution while interrogating the systemic barriers that have hindered progress. By examining governance, service delivery, financing, human resources, information systems, and sociocultural contexts, and situating these within broader regional and global comparisons, the analysis aims to shed light on the structural gaps that sustain the epidemic. Ultimately, the goal is to generate actionable insights that can inform reforms toward a more equitable, effective, and sustainable HIV response in the Philippines.\u003c/p\u003e"},{"header":"II. Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study conducted a retrospective policy and systems analysis of the Philippine government\u0026rsquo;s responses to the HIV epidemic from 1998 to 2023. The approach systematically examined how legislative, administrative, and programmatic measures evolved over time and how their design and implementation affected national epidemic trajectories. The analysis drew on the World Health Organization (WHO) Health Systems Building Blocks Framework (WHO, 2007) as the primary analytical model, chosen for its capacity to dissect structural and systemic determinants of policy effectiveness while allowing integration of sociocultural dimensions as cross-cutting influences. This framework disaggregates health systems into six domains: leadership and governance, financing, service delivery, health workforce, information systems, and access to medicines and technologies. It provides a coherent lens through which to trace how policy intentions translated (or failed to translate) into outcomes across the health system.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Sources and Scope\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData were obtained through a systematic document review encompassing primary policy texts, government reports, and peer-reviewed and gray literature. Primary policy sources were retrieved from official repositories of the Department of Health (DOH), Philippine National AIDS Council (PNAC), and the Official Gazette, including key legislation such as Republic Act (RA) 8504 (Philippine AIDS Prevention and Control Act of 1998) and RA 11166(Philippine HIV and AIDS Policy Act of 2018), as well as successive AIDS Medium Term Plans (AMTPs). Government surveillance data were drawn from the HIV/AIDS and ART Registry of the Philippines (HARP). International and donor reports were included from UNAIDS, WHO, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Peer-reviewed literature was sourced from PubMed, Scopus, and Google Scholar to capture both empirical and policy analyses, while gray literature from civil society organizations (e.g., ACHIEVE, PAFPI) and media investigations provided ground-level perspectives on policy implementation gaps.\u003c/p\u003e\u003cp\u003eThe inclusion criteria comprised documents explicitly addressing HIV policy, health governance, program financing, and implementation outcomes in the Philippines. Materials were excluded if they did not engage with health system dimensions or policy processes. The review period covered 1998\u0026ndash;2023, beginning with the institutionalization of the national HIV response through RA 8504 and extending to the latest AMTP VII and UHC integration efforts.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalytical Framework\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDocuments were analyzed thematically using a deductive-inductive coding approach anchored in the WHO health systems framework. Deductive codes represented the six health system domains, while inductive coding captured emergent subthemes such as stigma, decentralization, and donor dependency. Coding and categorization were conducted manually and verified by an independent reviewer to ensure analytic consistency and inter-rater reliability. Discrepancies were resolved through iterative discussion until consensus was achieved.\u003c/p\u003e\u003cp\u003eTo enhance validity, data triangulation was applied across multiple document types (laws, reports, gray literature) and levels (national, subnational, and community). Patterns and contradictions were examined to identify systemic barriers, policy misalignments, and temporal shifts in program implementation. Surveillance data (e.g., annual incidence rates, ART coverage trends) were integrated descriptively to contextualize policy developments within epidemiological realities. A reflexive stance was maintained throughout the analysis, acknowledging potential biases arising from document selection and institutional perspectives embedded in official reports.\u003c/p\u003e\u003cp\u003eA summary of the analytical framework is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eWHO Health Systems Building Blocks as an Analytical Framework for Reviewing Barriers in the Philippine HIV Response\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBuilding Block\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDefinition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eApplication to HIV Policy and Response\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeadership and Governance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnsuring strategic policy frameworks, oversight, accountability, and coalition building\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEffectiveness of PNAC, coordination between DOH and LGUs, enforcement of RA 8504 and RA 11166, policy fragmentation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinancing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdequate funding to ensure access to needed services without financial hardship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReliance on donor support (e.g., Global Fund), domestic financing gaps, PhilHealth reimbursements, LGU resource disparities\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eService Delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProvision of effective, safe, quality personal and non-personal health interventions when and where needed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAvailability and accessibility of HIV testing, ART hubs, PrEP services, integration into primary care, outreach to key populations\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Workforce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResponsive, fair, and efficient workforce that achieves best health outcomes with available resources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAdequacy of trained HIV counselors, clinicians, peer navigators; workforce distribution and stigma-sensitive training\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to Essential Medicines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEquitable access to essential medical products, vaccines, and technologies of assured quality, safety, efficacy, and cost-effectiveness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConsistent supply of ART, PrEP, condoms, test kits; procurement bottlenecks and distribution challenges\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Information Systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProduction, analysis, dissemination, and use of reliable and timely information on health determinants and outcomes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHIV/AIDS Registry, surveillance quality, disaggregation of data, timeliness of reporting for program decisions\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003cp\u003eAdapted from WHO\u0026rsquo;s Framework for Action (2007) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e"},{"header":"III. Results","content":"\u003cp\u003e\u003cb\u003eOverview of the Philippine HIV Response\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 21 key policy documents were reviewed to trace the trajectory of the Philippine government\u0026rsquo;s HIV response, as outlined in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e with sources ranging from official government issuances, surveillance bulletins, and donor evaluations to civil society reports. These documents can be broadly categorized into three clusters. The first cluster consists of \u0026ldquo;hard laws\u0026rdquo; such as Republic Act 8504 of 1998 and Republic Act 11166 of 2018, alongside the Universal Health Care Act of 2019, which created binding legal frameworks that redefined institutional responsibilities, established the Philippine National AIDS Council (PNAC), and expanded rights-based access to testing and treatment. The second cluster includes administrative issuances and financing mechanisms, such as the DOH Administrative Orders on ART decentralization (2014\u0026ndash;2021) and the PhilHealth Outpatient HIV/AIDS Treatment Package (2010, updated 2015). These provided critical technical and financial guidance for service delivery but often left wide discretion for implementation at the local government level. The third cluster consists of programmatic reports and planning documents, including the successive AIDS Medium Term Plans (AMTPs), PNAC annual progress reports, DOH HIV/AIDS Registry bulletins, Global Fund performance reviews, and UNAIDS country reports. These documents primarily set strategic directions or provided monitoring data, but in many cases were limited to proposals and assessments without enforceable mechanisms for accountability.\u003c/p\u003e\u003cp\u003eTaken together, these sources illustrate a policy landscape where laws provided the foundation, administrative issuances operationalized technical standards and financing, and programmatic reports monitored progress or proposed strategic priorities. However, the analysis revealed that while the documentary record is extensive, only a handful of documents included detailed provisions on how programs should be implemented and monitored. Many left execution to implementing agencies or devolved local government units, resulting in uneven adoption and persistent service delivery gaps. This imbalance between binding legal frameworks and largely aspirational plans contributed to the fragmentation observed across the country\u0026rsquo;s HIV response.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Philippine HIV Policy and Response Documents and Milestones Reviewed\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeriod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDocument\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSource\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1998\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRepublic Act 8504 (Philippine AIDS Prevention and Control Act)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst comprehensive HIV/AIDS law institutionalizing prevention, care, and rights-based protections. Established PNAC as the national coordinating body.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLawPhil [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly 2000s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntroduction of Antiretroviral Therapy (ART)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eART made available in treatment hubs, initially through Global Fund support, later increasingly funded by government.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDOH \u0026amp; Global Fund Reports [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2003\u0026ndash;2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGlobal Fund Grant Performance Reports\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEvaluated donor-funded HIV prevention and treatment projects; critical in sustaining ART and prevention services before full domestic financing.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGlobal Fund [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2005\u0026ndash;2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAIDS Medium Term Plan (AMTP IV)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFocused on prevention and awareness campaigns; limited service coverage due to resource constraints and weak LGU capacity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePNAC Reports [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2005\u0026ndash;2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePNAC Annual Progress Reports\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDocumented AMTP implementation, funding, and interagency coordination.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePNAC [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2005\u0026ndash;2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhilippine HIV/AIDS Registry (HARP) Bulletins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonthly/quarterly surveillance of HIV incidence, treatment enrollment, and trends.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDOH Epidemiology Bureau [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2008\u0026ndash;2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUNAIDS Country Reports on the Philippines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProvided country-level progress on global HIV targets, financing, and epidemiological updates.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUNAIDS [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2010, updated 2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhilHealth Outpatient HIV/AIDS Treatment Package\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEstablished financial coverage for outpatient HIV treatment, reducing out-of-pocket costs.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePhilHealth Circulars [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2011\u0026ndash;2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAMTP V and VI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExpanded scope to align with MDGs and later UNAIDS 90-90-90 targets; emphasized scaling up testing and treatment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePNAC (2012, 2015) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMid-2010s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunity-Based HIV Screening and Testing Pilots\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRolled out rapid diagnostics and community-led testing for key populations in urban centers.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDOH Administrative Orders [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2014\u0026ndash;2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDOH Administrative Orders on ART Expansion and Decentralization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSet guidance on HIV testing protocols, ART initiation, and treatment hub accreditation to expand service coverage nationwide.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDOH Bulletins [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2015\u0026ndash;2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAction for Health Initiatives (ACHIEVE) Policy Briefs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAdvocated rights-based HIV response, focusing on key populations and stigma reduction.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eACHIEVE [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2017\u0026ndash;2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAMTP VI (extended)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eComprehensive framework integrating prevention, treatment, stigma reduction, and multisectoral approaches.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePNAC Reports [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRepublic Act 11166 (Philippine HIV and AIDS Policy Act)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReplaced RA 8504 with progressive provisions, including lowering HIV testing age of consent to 15; strengthened LGU role; expanded treatment and prevention mandates.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOfficial Gazette [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversal Health Care (UHC) Act\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProvided pathways for integrating HIV services into PhilHealth; implementation uneven under devolved governance.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOfficial Gazette [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u0026ndash;present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExpansion of ART and PrEP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWider ART availability supported by domestic financing; PrEP rollout initiated, though uptake limited by supply and awareness.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDOH Bulletins; UNAIDS Country Reports [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020s (ongoing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePNAC and DOH Strategic Shifts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEmphasis on community-based, key-population-led service delivery; continued struggle with surveillance gaps, stigma, and donor dependency.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDOH HARP; PNAC [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2010\u0026ndash;2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive Action Foundation Philippines Network (PAFPI) Reports\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCivil society reports documenting treatment access barriers, stigma, and community perspectives.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePAFPI [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2023\u0026ndash;present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAMTP VII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMost recent AIDS Medium Term Plan, aligning with SDG 2030 targets, prioritizing digital surveillance, equitable ART access, and PrEP expansion.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePNAC (2023 AMTP VII Report)\u003c/p\u003e\u003cp\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSystemic Barriers by Health System Domains\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e synthesizes the key barriers mapped against WHO\u0026rsquo;s six domains, with sociocultural stigma embedded as an overarching determinant. The findings revealed that despite legislative progress and repeated planning cycles, the Philippine HIV response has been consistently undermined by systemic barriers that map onto the WHO health systems building blocks. These barriers interacted with each other, producing structural weaknesses that collectively constrained the effectiveness of the national response. The findings are summarized narratively below.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBarriers to the Philippine HIV Response by Health Systems Building Block\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBuilding Blocks\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKey Barriers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeadership \u0026amp; Governance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFragmented coordination; weak PNAC authority; decentralization challenges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLimited LGU prioritization; inconsistent policy enforcement\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinancing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHeavy donor dependence; insufficient domestic funds; weak absorptive capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDelayed fund disbursement at LGUs; reliance on Global Fund until 2010s\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eService Delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCentralized services; limited community-based testing; weak harm reduction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eART clustered in urban hospitals; absence of needle/syringe programs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Workforce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShortages of trained providers; stigma among health workers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of counselors in rural clinics; discriminatory attitudes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInformation Systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeak surveillance; fragmented data collection; poor utilization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGaps in HARP disaggregation; delayed reporting\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSociocultural Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStigma, discrimination, and conservative opposition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eResistance to sexuality education; barriers for MSM and transgender women\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eLeadership and Governance\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLeadership of the HIV response in the Philippines has been fragmented. The Philippine National AIDS Council, mandated to coordinate the response, has often been criticized for its limited authority and bureaucratic inefficiency. Frequent changes in leadership within both PNAC and the Department of Health resulted in shifting priorities and inconsistent follow-through. The decentralization of health governance further diluted accountability, as local government units (LGUs) were tasked with implementing HIV programs but often lacked capacity, political will, or resources. Compared to Thailand\u0026rsquo;s strong central stewardship of its HIV program, the Philippines\u0026rsquo; governance has been characterized by weak enforcement, insufficient multi-sectoral collaboration, and uneven political commitment at the national and subnational levels.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFinancing\u003c/b\u003e\u003c/p\u003e\u003cp\u003eHistorically, HIV financing in the Philippines has been donor-dependent. Until the mid-2010s, a significant portion of prevention and treatment programs, particularly those targeting key populations, was supported by the Global Fund and international development partners. Domestic financing only became more prominent after the enactment of RA 11166 and the rollout of the Universal Health Care (UHC) Law. However, budget allocations for HIV have remained insufficient, fragmented across agencies, and vulnerable to political shifts. Moreover, financial flows often stall at the LGU level, where absorptive capacity and prioritization are weak. In contrast, regional neighbors such as Vietnam and Cambodia successfully transitioned from donor to domestic financing through sustained government commitment and integration of HIV into national insurance schemes, a process that remains incomplete in the Philippines.\u003c/p\u003e\u003cp\u003e\u003cb\u003eService Delivery\u003c/b\u003e\u003c/p\u003e\u003cp\u003eService delivery has lagged in both coverage and accessibility. HIV testing services were constrained for years by restrictive consent policies, with the age of consent for testing only lowered to 15 in 2018 under RA 11166. Access to testing and treatment has been concentrated in urban centers, leaving rural populations underserved. Community-based HIV screening and decentralized ART delivery have expanded in recent years, but scale-up remains inadequate. Harm reduction services for people who inject drugs are extremely limited due to punitive drug laws, while pre-exposure prophylaxis (PrEP) is still not widely available. By contrast, Thailand\u0026rsquo;s early and aggressive rollout of ART and differentiated service delivery models facilitated higher coverage and retention.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHealth Workforce\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Philippine health workforce is overstretched and unevenly distributed. HIV services depend heavily on a small cadre of specialized physicians, nurses, and medical technologists concentrated in major cities. Local clinics often lack trained providers, and stigma among healthcare workers continues to deter key populations from accessing services. Community-based organizations have stepped in to bridge gaps, but they often face regulatory and funding constraints. The shortage of trained HIV counselors and case managers further hampers linkage-to-care and adherence support, limiting program effectiveness at scale.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInformation Systems\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMonitoring and evaluation systems remain fragmented and underutilized. The HIV/AIDS \u0026amp; ART Registry of the Philippines (HARP) provides basic surveillance data, but gaps in timeliness, disaggregation, and completeness limit its utility for policy and program planning. Coordination between DOH central offices, LGUs, and community organizations in reporting is inconsistent. Weak data systems hinder early detection of trends, such as rising HIV incidence among young MSM, and prevent rapid corrective action. Neighboring countries like Cambodia and Vietnam leveraged robust surveillance and cohort tracking to adapt their responses dynamically, an area where the Philippines has lagged.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSociocultural Barriers\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUnderlying all system components is the persistence of stigma, discrimination, and moralistic attitudes toward sexuality, drug use, and gender diversity. HIV prevention campaigns have often been diluted by conservative cultural and political environments, with resistance to comprehensive sexuality education in schools and public discomfort with condom promotion. Key populations such as MSM, transgender women, sex workers, and PWID continue to face systemic exclusion, not only from health services but also from employment and education. These sociocultural barriers both reflect and reinforce weaknesses in governance, service delivery, and financing, creating a cycle of exclusion that fuels the epidemic.\u003c/p\u003e"},{"header":"V. Discussion","content":"\u003cp\u003eThe persistence of structural, systemic, and sociocultural barriers explains in large part why the HIV epidemic in the Philippines has diverged from global trends [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. While most countries in Southeast Asia have seen stabilization or decline in HIV incidence over the past decade [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], the Philippines has witnessed a steep increase, particularly among young men who have sex with men and transgender women [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The interplay of weak governance, limited service delivery capacity, inadequate financing, fragile health workforce, poor information systems, and entrenched stigma has created a perfect storm that allows transmission to continue largely unchecked [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. These barriers do not operate in isolation but rather reinforce one another in ways that amplify their impact. For example, stigma that discourages individuals from testing is exacerbated by discriminatory health workers [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], which itself is a product of inadequate training and weak accountability systems [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFrom a governance perspective, the Philippines\u0026rsquo; reliance on a devolved health system under the Local Government Code of 1991 has created both opportunities and vulnerabilities [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. While devolution enables localized HIV programs in some progressive LGUs, it also produces wide variability in performance [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. In a rapidly growing epidemic, this variability has been particularly damaging. Countries such as Thailand, which managed to bend the HIV curve earlier, illustrate the value of strong national coordination paired with empowered local implementation [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Thailand\u0026rsquo;s national AIDS program invested heavily in centralized monitoring and accountability, ensuring that provincial programs aligned with national targets. In contrast, the Philippine National AIDS Council (PNAC) has been underfunded and politically sidelined, leaving national strategies largely unenforceable at the local level. Strengthening PNAC\u0026rsquo;s authority and establishing clearer accountability frameworks between national and local governments is essential. Embedding HIV program performance within LGU scorecards tied to incentives and sanctions could enhance compliance, while improved inter-agency collaboration would ensure that HIV response is not siloed within health but integrated across education, labor, and social welfare sectors [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eService delivery challenges in the Philippines stand in sharp contrast with regional neighbors who have effectively scaled up innovations [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Cambodia, once considered an epicenter of the HIV epidemic [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], reduced its incidence by more than 80% through aggressive expansion of voluntary counseling and testing [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], broad access to ART [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], and integration of HIV services into primary health care [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. The Philippines, in contrast, maintains ART coverage that is far from optimal [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], with treatment hubs clustered in urban areas and limited integration into primary facilities [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. The delayed rollout of PrEP further highlights the country\u0026rsquo;s sluggish adoption of evidence-based interventions [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. HIV services must be mainstreamed within the broader framework of universal health care, with ART, PrEP, and testing made widely available in primary care facilities [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Community-based and peer-led delivery models should be expanded to reach key populations more effectively [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e], particularly in rural and peri-urban areas where formal health facilities are limited [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOverreliance on foreign donors, particularly the Global Fund, has created instability in the Philippine HIV response [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. As donor contributions declined, domestic financing mechanisms proved insufficient [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. In contrast, Vietnam deliberately transitioned HIV financing to domestic sources, embedding HIV within its national health insurance program [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. Although the Philippines has taken steps through PhilHealth reimbursements and DOH allocations, the uneven fiscal capacity of LGUs continues to drive inequities. Prevention remains chronically underfunded relative to treatment, despite global evidence that prevention saves costs in the long term [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. A financing strategy that prioritizes prevention while ensuring sustainability is crucial. This includes earmarking funds for prevention in the General Appropriations Act, expanding PhilHealth benefits for HIV-related services, and creating an HIV equity fund that redistributes resources from resource-rich to resource-poor LGUs. Strengthening financial management and ensuring timely disbursement of funds would further reduce service interruptions. A critical weakness lies in the underinvestment in prevention. In 2023, only 6% (₱211\u0026nbsp;million) of the country\u0026rsquo;s ₱3.6\u0026nbsp;billion HIV expenditure was allocated to prevention activities, despite the steep rise in new infections [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. This shortfall has been exacerbated by the suspension of U.S. support, which disrupted the development and rollout of prevention programs and undermined community-led responses [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. The consequences of these missed opportunities are wide-ranging. Beyond the human toll, the economic burden is considerable, encompassing the costs of lifelong HIV treatment, management of co-morbidities, and productivity losses. For affected households, the financial strain from medical expenses and loss of income is often severe. At a systemic level, the sustained increase in HIV cases is expected to further pressure an already stretched health system, particularly its workforce and service delivery capacity.\u003c/p\u003e\u003cp\u003eThe inadequacy of the health workforce is a significant bottleneck. Health workers are often unprepared to provide stigma-free services to key populations, reflecting gaps in training and deeply entrenched biases [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. Countries like Thailand and Malaysia have mitigated this by integrating peer navigators and community-based organizations into service delivery. The Philippines has not systematically institutionalized such task-shifting models. HIV-specific training should be embedded in medical, nursing, and allied health curricula, complemented by continuous professional education on stigma reduction and rights-based care. Scaling up peer navigators and community health workers within the formal system could expand reach while fostering trust among marginalized populations [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. Incentive structures to reduce staff turnover and protect health workers from discrimination themselves are also needed [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe deficiencies in surveillance and monitoring hinder timely and targeted interventions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. Unlike Thailand\u0026rsquo;s robust data systems, which enable rapid adjustments, the Philippines\u0026rsquo; HIV/AIDS and ART Registry (HARP) is hampered by under-reporting, delayed updates, and limited disaggregation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These weaknesses leave the response largely reactive. Modernizing HIV surveillance through real-time reporting, better integration with electronic medical records (EMRs), and disaggregated data collection is vital [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]. Investment in bio-behavioral surveys and predictive analytics could allow for anticipatory programming [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e]. Linking surveillance data with LGU planning processes would ensure that local responses are evidence-driven [\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eSociocultural barriers remain among the most entrenched determinants of the epidemic. Stigma, discrimination, and moral opposition to preventive strategies have constrained both policy and service uptake. Comprehensive sexuality education, recognized globally as an effective prevention tool, continues to face resistance from conservative and religious sectors. In contrast, countries such as Thailand promoted pragmatic, rights-based approaches to sexual health education and condom promotion early in their epidemics [\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e]. Scaling up evidence-based sexuality education in schools and communities is crucial, alongside stronger enforcement of anti-discrimination laws. Partnerships with faith-based groups and civil society could help shift public narratives, while media campaigns tailored for youth and key populations can normalize testing, PrEP use, and treatment adherence. Addressing sociocultural constraints requires not only policy reform but also cultural change driven by sustained public engagement [\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Philippine HIV epidemic offers critical lessons for global health. It demonstrates that progressive laws and donor funding are insufficient without strong governance, sustainable financing, and a health system capable of delivering stigma-free services. It underscores the risks of decentralization without accountability, the dangers of neglecting prevention, and the profound influence of cultural conservatism on health outcomes. Moving forward, the Philippines must couple structural reforms with community engagement and rights-based approaches to align its epidemic trajectory with global goals. For the broader global health community, the Philippine experience reinforces that HIV is not only a biomedical challenge but also a political, economic, and cultural one, requiring integrated strategies that bridge these domains.\u003c/p\u003e"},{"header":"VI. Conclusion","content":"\u003cp\u003eThe worsening trajectory of the Philippine HIV epidemic highlights the cost of delayed and fragmented responses. Despite progressive laws such as RA 8504 and RA 11166, their impact has been profoundly undermined by weak implementation. This retrospective analysis, framed through the WHO health systems building blocks, reveals systemic barriers in governance, financing, service delivery, workforce, data systems, and sociocultural contexts that have sustained rising infections despite global and regional progress. Weak leadership, devolved accountability, inadequate domestic investment, and entrenched stigma left the health system ill-equipped to address one of the world\u0026rsquo;s fastest-growing epidemics. In contrast, neighboring countries like Thailand, Cambodia, and Vietnam demonstrate how centralized coordination, rights-based approaches, and integrated service delivery can reverse trajectories. For the Philippines, urgent reforms include strengthening PNAC\u0026rsquo;s authority, embedding HIV services into universal health care, ensuring sustainable financing, modernizing surveillance, and addressing stigma through rights-based programming. Renewed commitment and systemic reform are imperative to transform the HIV response and protect vulnerable communities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRCG conceptualized the manuscript; JBO, NRR, and CJNO wrote the initial draft and preparedthe figures and tables; JBO, CJNO, NRR, ERG, and DELP revised and edited the manuscript; DELP, ERG, and RCG supervised the manuscript. All authors reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis paper was supported by a grant from the AIDS Healthcare Foundation (AHF) Philippines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI hereby provide consent for the publication of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to extend our utmost gratitude to the AIDS Healthcare Foundation (AHF) Philippines and Global Health Focus (GHF). 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AIDS Care. 2007;19(9):1157\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/09540120701335204\u003c/span\u003e\u003cspan address=\"10.1080/09540120701335204\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026amp;#8204.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV/AIDS, human immunodeficiency virus, epidemic, vulnerable populations, MSM youth, health policy, governance, health financing, population health, Philippines","lastPublishedDoi":"10.21203/rs.3.rs-7918370/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7918370/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"(249 words) Background: While most of the world is steadily curbing HIV, the Philippines has become an outlier, with one of the fastest-growing epidemics in Asia. Despite progressive legal frameworks, new infections continue to surge exponentially, particularly among young men who have sex with men and transgender women. This study analyzes the evolution of the country’s HIV/AIDS response and examines systemic and policy-level barriers impeding progress. Methods: A retrospective policy analysis was conducted using the WHO health systems building blocks as an analytical framework. We gathered relevant and publicly available documents, including national laws, administrative issuances, and reports. Thematic synthesis was then performed to identify underlying systemic-level challenges. Results: A total of 21 key policy documents were analyzed. Findings revealed persistent weaknesses across all system domains. Governance was undermined by fragmented coordination, weak PNAC authority, and inconsistent local government implementation. Service delivery was hampered by centralized services and limited access to testing, prevention, and PrEP. Financing relied heavily on external donors, with insufficient domestic resources. Human resources were constrained by provider shortages and stigma among health workers. Information systems showed weak surveillance and fragmented data. Sociocultural barriers, including stigma, discrimination, and conservative opposition, further impeded prevention and care. Compared to neighbors like Thailand and Cambodia, the Philippines missed critical scale-up opportunities. Conclusion: The worsening epidemic reflects systemic governance failures, fragmented service delivery, and sociocultural resistance. Addressing this requires reinvigorating PNAC’s authority, embedding HIV services within universal health care, ensuring sustainable financing, modernizing surveillance, expanding community-based and rights-based programs, and dismantling stigma.","manuscriptTitle":"Behind the Worsening HIV Epidemic: A Retrospective Policy Analysis of the Philippine HIV/AIDS Response","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-24 04:43:39","doi":"10.21203/rs.3.rs-7918370/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-24T17:25:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-24T04:38:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-24T04:37:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-10-21T17:39:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"021f5d68-1976-46fd-89f1-e2a54b871ddc","owner":[],"postedDate":"October 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:08:49+00:00","versionOfRecord":{"articleIdentity":"rs-7918370","link":"https://doi.org/10.1186/s12982-026-01654-2","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-04-02 15:58:58","publishedOnDateReadable":"April 2nd, 2026"},"versionCreatedAt":"2025-10-24 04:43:39","video":"","vorDoi":"10.1186/s12982-026-01654-2","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01654-2","workflowStages":[]},"version":"v1","identity":"rs-7918370","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7918370","identity":"rs-7918370","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}