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

(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.