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Mini review article, a critical survey on renewable energy applications in the philippines and china: present challenges and perspectives.

• Law School, Kunming University of Science and Technology, Kunming, China

China’s Belt and Road (B&R) initiative provides new ideas and opportunities for international cooperation. Renewable energy plays a crucial role not only in the national sustainable development framework of China and the Philippines but also in bilateral cooperation between them. However, some obstacles still need to be addressed because renewable energy cooperation between China and the Philippines has not been thoroughly and comprehensively studied to date. Based on an in-depth analysis of current renewable energy cooperation between China and the Philippines, this paper employs PESTEL analysis to fully investigate the cooperative advantages and disadvantages by considering politics (P), economy (E), society (S), technology (T), environment (E), and legislation (L) and proposes several constructive suggestions. The ultimate purpose was to design feasible schemes to ensure the sufficient utilization of renewable energy and the construction of integrated power grid systems to meet shortages of electricity supply especially in the isolated small islands in the Philippines through cooperation with China. In particular, it offers valuable advice concerning the U.S.-China trade war and COVID- 19 pandemic, outlining how cooperation in the exploitation of potential renewable energy is vital.

Introduction

In response to the advantages of renewable energy ( Gullberg et al., 2014 ), many countries and regional organizations have entered into cooperative targeted renewable energy initiatives ( Anand et al., 2021 ; Mohan, 2021 ; Sasmita and Sidhartha, 2021 ). Existing research on renewable cooperation ( Feng et al., 2020 ) is mainly focused on a comprehensive analysis of the renewable energy cooperative mechanism between two countries ( Suryanarayana and Saumendra, 2020 ), a country and regional organizations ( Mehdi and Mehdi, 2020 ), and regional organizations ( Indeo, 2019 ), by forecasting the potentiality of cooperation and undertaking analysis via a mathematical model ( Satish and Vinod, 2020 ). However, three existing gaps need to be overcome.

• Most previous studies fail to comprehensively analyze the advantages and disadvantages of renewable energy cooperation between specific countries under B & R.

• Specific suggestions based on the effective factors of cooperation such as politics, economy, society, technology, environment, and legislation have not been proposed.

• The latest factors, including the COVID-19 pandemic and the United States-China trade war, have not been addressed.

This paper focuses on the exploitation of renewable energy cooperation between China and the Philippines, proposing a new perspective in response to this new context and undertakes a comprehensive investigation of a cooperative scheme between two countries. Based on a systematic overview of renewable energy systems in China and the Philippines, including the current situation, existing problems, policies, and plans, the basis and challenges for further cooperation between the two countries are explored ( Renewable Energy Development in the Philippines and Renewable Energy Development Status in China Sections).

The background informing this topic and existing renewable energy cooperation projects between China and the Philippines are addressed, and a Political, Economic, Social, Technological, Environmental, and Legal (PESTEL) analysis is adopted to illustrate the advantages and disadvantages of those factors in cooperation ( The Philippines—China Renewable Energy Cooperation Under Political, Economic, Social, Technological, Environmental, and Legal Analysis Section);

Finally, some feasible and promising suggestions are proposed to deal with emerging problems and opportunities in renewable cooperation between China and the Philippines under B&R ( Political, Economic, Social, Technological, Environmental, and Legal Recommendations Section).

Renewable Energy Development in the Philippines

Current status.

The Philippines stores rich renewable energy which also plays an important role in the energy supply of the country. As Table 1 shows, although the proportion of renewable energy in the total amount of installed capacity is only about 30% and there has been a slight downward trend in the last 3 years, the quantity produced is still steadily growing.

TABLE 1 . The Philippine installed capacity mix (MW) ( The Department of Energy, 2019 ).

Geothermal Energy

The Philippines is located in a tropical low-latitude area at the junction of Asia, Europe, and the Pacific plate, which means the country has rich geothermal energy resources. After many years of development, the installed capacity of geothermal power reached 1,944 MW in 2018, accounting for 13% of the world’s total, and ranking third after the United States and Indonesia ( Ratio et al., 2020 ).

Hydropower Energy

The Philippines has 421 rivers, numerous mountains, rugged terrain, and a rainy climate, which create abundant hydropower resources that contribute the largest portion of installed capacity generated by renewable energy. Although the Philippines already has some large-scale hydropower plants and has made achievements in the development of hydropower infrastructure, there is still 13,097 MW of undeveloped hydropower generation capacity remaining, according to an assessment by the Philippine Department of Energy ( The Department of Energy, 2019 ).

Solar Energy

With solar radiation of 4.0–6.0 kWh/m2/day, the Philippines has abundant solar energy resources which evenly distribute across the country and vary between 10 and 20% every month ( Sharma and Kolhe, 2020 ). Due to the continuous improvement of technology and efficiency of solar photovoltaic (PV) modules, the solar energy industry has achieved scale development and significantly reduced the costs of solar power generation ( Sharma and Kolhe, 2020 ). More and more residents and industrial sectors in the Philippines have started to use small-scale solar PV production.

Problem and Causes

The continuous economic expansion of the Philippines has brought serious problems in the form of insufficient energy supply ( Mondal et al., 2018 ). The Philippines’ GDP in 2018 grew by 6.2%, exceeding 6% for the seventh consecutive year ( GPD, 2019 ). However, more than 11% of the population has no electricity, and a higher proportion suffers from unreliable electricity supply ( Bertheau et al., 2020 ).

Huge reserves and the potential of renewable energy resources have not achieved a satisfying development in the Philippines.

The main reasons for the insufficient utilization of renewable energy, include the fact that the development of renewable energy requires high prepayment and technology costs ( Zafar et al., 2019 ). Moreover, hydropower and geothermal energy, which generate the most electricity, have a very long development cycle ( Barroco and Herrera, 2019 ). Moreover, the Philippines is unable to form an integrated power grid system, which impacts the sufficient transmission of electricity generated by renewable energy. The Philippine power supply system is also divided into “on-grid” and “off-grid” areas. The on-grid is supplied by two separate main power grids which lack a connection with each other. The off-grid covers these areas but suffers from insufficient power or even no power supply at all ( Bertheau et al., 2020 ).

Policies and Plans

The Philippine government has realized the importance of developing renewable energy and has formulated several policies and plans based on the focuses: 1) ensuring energy security, 2) achieving optimal energy pricing, 3) diversifying fuel sources, and 4) developing sustainable energy systems ( The Department of Energy, 2017 ). The National Renewable Energy Program (2011–2030) anticipates that the generation capacity of renewable energy will triple by 2030 ( Wang et al., 2020 ) This has lead to the development of policies including carbon taxes, the improvement of energy efficiency in both generation and consumption, diversification of the energy supply-mix ( Cabalu et al., 2015 ). Those policies and plans not only ensure energy security and reduced reliance on fossil energy they are also milestones in building a greener Philippines.

Renewable Energy Development Status in China

As the second-largest economy in the world, China has abundant renewable energy storage. By the end of 2019, the installed capacity of renewable energy in China was as high as 794.88 GW and has increased by 8.7% since 2018 ( Si et al., 2021 ). The current power generation capacity of each renewable energy source is shown in Figure 1 , and the current situation of China’s renewable energy is shown in Table 2 ( China Renewable Energy Engineering Institute, 2019 ). In 2013, China proposed the B&R initiative, which covers 65 countries in Asia, Africa, and Europe ( Wang et al., 2020 ). More importantly, promoting the green and low-carbon transformation of the energy structure of countries along the B&R is a core content of green construction in the area and a significant measure in improving the ecological environment and supporting global sustainable development ( Yang et al., 2021 ). As a key country along the Maritime Silk Road, the Philippines has also joined the Asian Infrastructure Investment Bank initiated by the Chinese government.

FIGURE 1 . Various types of power generation (A) installed capacity, and (B) proportion.

TABLE 2 . Status of types of renewable energy in China.

After decades of efforts, China has developed innovative approaches to energy and shared these experiences with other countries through the green cooperation of B&R to eliminate dependence on high-carbon growth models.

The advantages of the Chinese approach stem from it being a strong financial power. China has promoted the vigorous development of renewable energy, and in 2018 China became the world’s largest investor in renewable energy for the seventh consecutive year, an investment that accounts for almost one-third of the world’s total, reaching US $91.2 billion ( Si et al., 2021 ). Moreover, China’s renewable energy technology, manufacturing level, and high-quality production capacity have significantly improved in recent years, and a complete industrial chain with international advanced levels has been constructed in the renewable energy sector. This huge renewable energy product market has also contributed to the development of renewable energy worldwide.

In 2005, China enacted the Renewable Energy Law, quickly followed by more than 100 policies, regulating grid subsidies and special fund management measures, including guidance on promoting renewable energy consumption and other aspects as shown in Figure 2 ( China Renewable Energy Engineering Institute, 2019 ). The most important renewable energy plan of China is the 14th Five-year Plan (2021–2025). The key tasks of which include giving priority to the development of renewable energy based on market forces and low costs, systematically evaluating the development conditions and goals of various renewable energy resources, promoting renewable energy technologies and equipment to develop a relative industrial system, etc., ( Liu, 2019 ). In addition to the macro level, specific plans for different types of renewable energy exist that are international and jointly promote the construction of clean energy ( Liu, 2019 ).

FIGURE 2 . Renewable energy policy roadmap in China ( China Renewable Energy Engineering Institute, 2019 ). Abbreviations: National People’s Congress (NPC); State Council (SC); Renewable Energy (RE); Ministry of Finance (MOF); National Development and Reform Commission (NDRC); National Energy Administration (NEA); Exchange rate: 100 (CNY) = 15.4400 (USD) (Date: January 22, 2021).

The Philippines—China Renewable Energy Cooperation Under Political, Economic, Social, Technological, Environmental, and Legal Analysis

Existing cooperation.

China and the Philippines have a history of extensive cooperation in renewable energy, including hydropower, PV, biomass energy, and wind energy, as shown in Table 3 . This includes both the supply of existing equipment and Engineering Procurement Construction (EPC). This has greatly improved the utilization of hydroelectric and PV in the Philippines, and has made up for power shortages in some areas.

TABLE 3 . The Philippines—China renewable energy corporation projects.

Hydropower cooperation is the focus of the China-Philippines renewable energy cooperation agreement. Cooperative projects are mainly large-scale hydropower plants with an installed capacity of over 10 MW. Solar energy has now become the fastest-growing type of renewable energy in the Philippines, which has attracted many Chinese enterprises.

As one of the listed companies affiliated with the State Grid of China, the NARI Group owns several EPC projects of PV power stations in the Philippines. The Hengshun Group, a private company in China, signed an EPC contract of wind power and PV integration with Energy Logics Philippines, Inc. in 2016: the largest PV integration project to date in the Philippines.

Political, Economic, Social, Technological, Environmental, and Legal Analysis of Renewable Energy Cooperation

Under the intensifying forces of globalization and competition, PESTEL has recently evolved from PEST analysis, to consider the environmental and legal factors, with increased potential impact on businesses ( Thakur, 2021 ). The PESTEL analysis model is an effective tool for macro-environmental analysis that can not only analyze the external environment but also identify all forces that have an impact on the organization. This analysis mode mainly analyzes the investment environment of enterprises.

China and the Philippines have established diplomatic relations for 45 years. A mutual friendship formed after the election of Roberto Duterte to President of the Philippines in 2016. Building upon this preexisting relationship, China’s focus on green energy cooperation among countries means that it actively seeks energy cooperation partners in different regions. The Philippines is currently pursuing a green energy development model, implementing a large number of fiscal incentives to attract foreign investment in the renewable energy sector ( Cabalu et al., 2015 ).

Disadvantage

The relevant disputes between China and the Philippines in the South China Sea once froze the bilateral relationship. The current highly friendly relationship benefits from Duterte’s policy towards China, but this might change when Duterte’s term in office ends in 2022. Besides, the Philippines has serious political corruption problems and bureaucracy that may also lead to the unfair treatment of Chinese companies.

The Philippines is one of the most dynamic economies in the East Asia Pacific region. As a beneficiary of the power industry reform of the Philippines, the State Grid Corporation of China holds 40% of the National Grid Corporation of the Philippines. Meanwhile, Chinese energy enterprises have excellent brands and performance advantages. For example, as an active partner cooperating with the Philippines, China Energy Engineering Group Company has experience in power engineering projects and formed a complete industrial chain in international cooperation ( Shang et al., 2020 ).

In 2020, COVID- 19 pandemic caused a recession in the world economy and hindered international cooperation. In addition, the United States-China trade war has seriously affected the world market and greatly increased the trade barriers between economies. These international economic factors are detrimental to the cooperation between the two countries.

The overall economic level of the Philippines is not high, and the per capita GDP ranks 123rd in the world ( International Monetary Fund Philippine GDP per capita, 2019 ). Moreover, the industrial development level of the Philippines is relatively low, and public facilities such as transportation, electricity, and hydropower lag behind other countries. An out-of-date economy and lesser developed technical facilities make cooperation between the Philippines and other countries difficult.

China and the Philippines belong to the East Asian cultural circle and have a long history of cultural exchange. A Cultural Exchange Forum and a series of public welfare activities between the two countries were also held recently ( Sina News, 2018 ). After the COVID- 19 pandemic, China has repeatedly donated medical materials to the Philippines to jointly fight the epidemic.

The Philippines has an abundant labor force and a very young population structure in which the working-age population aged between 15 and 65 has reached 63.6%. In addition, English is the official language of the Philippines, and the literacy rate of Philippines residents is 96.4%, ranking among the highest in Asia ( Ministry of Commerce of the People’s Republic of China, 2019 ).

The domestic security situation of the Philippines is not favorable. There were 8,826 murders and 16,100 robberies in 2017, with 8.40 per 100,000 people ( Ministry of Commerce of the People’s Republic of China, 2019 ). There are also several armed rebel terrors groups.

The price levels and costs in the Philippines are also extremely high. The prices of vegetables and fruits, electricity, and hotel accommodation and meals are 3–4 times, 2–3 times, and 1–2 times higher than that of China, respectively ( Ministry of Commerce of the People’s Republic of China, 2019 ).

Technological

China and the Philippines are technically complementary in terms of energy development and power construction. China’s power technology is in the front ranks of the world and could help power development in the Philippines. For example, the advanced UHVDC power transmission technology could realize a sufficient power supply in the offshore islands, which is highly conducive to the formation of the power grid system in the Philippines. Meanwhile, China’s infrastructure construction, including 5G, the internet of things, and the industrial internet are also very advanced ( Yang et al., 2021 ). The Philippines also attaches great importance to the development of science and technology through active cooperation with technology-developed countries in engineering and scientific projects via higher education.

Due to the limitations of technology and financial resources, the level of large-scale projects independently constructed by the Philippines is very limited. Hence, many projects have been completed with capital and technologies from other countries. Chinese enterprises may lack the most advanced technology and experience in geothermal energy cooperation due to the lack of domestic geothermal resources.

The risks affecting electricity technical standards of design and construction cannot be ignored. The Philippines mainly adopts American standards which are different from those of China and lead to the extension of design and approval time.

Environment

China is a maritime neighbor of the Philippines, and the local time of the Philippines is consistent with Beijing time, which is convenient for cooperation and communication.

Due to its fragile climate and frequent geological disasters, the Philippines is frequently affected by natural disasters resulting in a great loss of human life and property ( Bollettino et al., 2020 ). Besides, the construction of hydropower stations could adversely affect wildlife and plants and lead to geological disasters. Local people and environmental protection organizations are very opposed to the construction of hydropower stations and the development of geothermal energy, which may greatly impact energy cooperation.

China and the Philippines issued the “Renewable Energy Law” in 2005 and 2008, respectively, to vigorously develop renewable energy and ensure energy security and the optimization of the ecological environment. Foreign investment in biomass and garbage power generation projects had a restriction of 40% lifted in November of 2019 after an announcement by the Philippine government. It is anticipated that other renewable energy projects will be further opened to foreign investment in the future ( The Department of Energy Administrative Order, 2020 ).

According to Philippine law, foreign investors are prohibited from buying land ( The Department of Energy Administrative Order, 2020 ). In addition, the Philippines has strict controls over work visas for Chinese, which is not conducive to management and technical personnel traveling there from China. Furthermore, as the main form of contracted projects between Chinese enterprises and the Philippines, government projects can only be established after being approved by the Philippine National Economic Development Agency.

Political, Economic, Social, Technological, Environmental, and Legal Recommendations

First, the Philippines and China should make the most of the existing mutual friendly diplomatic relationship to actively develop cooperation. The B&R and the China-ASEAN Free Trade Area have brought more opportunities and favorable conditions for renewable energy cooperation between the two countries. In terms of disputes in the South China Sea, it is the consensus and commitment of China and the Philippines to settle through negotiation and properly manage their relevant dispute.

Secondly, the renewable energy development strategy could be deepened in the two countries respectively. China should consider renewable energy as a new orientation of developing export trade and investment outward, and actively guide and support overseas cooperation. The Philippines could absorb advanced foreign renewable energy technologies in grid construction while mobilizing domestic resources to develop renewable energy.

With the guidance of the B&R initiative and the help from the Asian Infrastructure Investment Bank, the Philippines could actively carry out infrastructure construction to improve the business environment. In terms of offshore islands, the construction of renewable energy power plants and grids would solve electricity shortages.

Hydropower and geothermal power generation are the main areas of international cooperation in the Philippines. The EPC mode could be an ideal choice in cooperation, which is relatively fixed, and the implementation period is not long. Chinese companies could integrate the upstream and downstream of the industrial chain systematically to achieve sufficient cooperation and expand the scale and benefits of collaboration.

The two countries could continue to carry out cultural exchange under the background of B&R and promote non-government exchange. In addition, China and the Philippines always adhere to the coexistence of diversified culture, mutual learning, and cooperation for shared benefits. Therefore, Chinese companies participating in cooperation should pay attention to local cultural differences, and respect the local customs, religions, and living habits of the Philippines. Besides, the Philippine government needs to increase public security management through the reduction of crime rate, strictly control the possession of guns, and standardize its application administrative procedures.

Firstly, China is an advantageous partner in assisting the Philippines to form a complete power grid that especially aims to increase the power supply of offshore islands. To reduce the technical risk, research and exploitation in major technology should be strengthened. Making good use of a contract to constraint risk, promoting project supervision and construction quality should be the focus of project management.

Secondly, great attention should also be paid to the integration of power standards with international standards. Due to the different situations in each country, integration should not aim to achieve the unity of technical standards but to learn from the international advanced technical standards and increase public knowledge of China’s working practices to continuously optimize and update standards.

Due to the frequent occurrence of natural disasters and tropical epidemic diseases in the Philippines, contractors should pay close attention to local news and take preventive measures to prevent personnel and property losses.

Actively fulfilling social responsibility and strengthening environmental awareness is of great significance, because they develop the local economy and improve local people’s livelihoods. Through appropriate publicity in a local area, the public could be told more about the cooperative project, and gain an understanding of the fact that they will directly experience an improvement in quality of life quality from these projects. This would improve the enterprise’s local popularity and form a positive corporate image.

On the governmental level, an agreement focused on the strategic cooperation of renewable energy and based on the national strategy and security of both two countries could be reached, which may include investment, technology cooperation, grid construction, and trade. Furthermore, governments of China and the Philippines could establish a unified and effective platform to share renewable cooperative information, corresponding policies, and administrative procedures to solve the difficulty of information collection and nontransparent policies faced by potential cooperators or contractors.

In terms of enterprises, Chinese organizations need to fully understand Philippine laws and regulations to ensure they operate legally, including visas, environmental protection, land, and localized employment regulations. Moreover, the restriction of the foreign investment ratio of renewable energy projects should be studied seriously to maximize the profit of the enterprises in accordance with the laws of the Philippines.

This paper is the first to undertake a systematic study of renewable energy cooperation between China and the Philippines under B&R, and draws the following crucial conclusions:

Firstly, the cooperation between China and the Philippines in renewable energy is a mthod of building a greener Philippines and protecting the environment. The coexistence of abundant but undeveloped renewable energy resources and the shortage of electricity supply, especially in the offshore islands, requires deep cooperation with China, as it has superior technological and extensive experience in grid construction. Among various renewable energy, hydropower and geothermal powers are major cooperative areas, in terms of the status of the Philippines. How to explore and utilize renewable energy more economically and efficiently, and realize a sufficient electricity supply are important factors in alleviating dependence on imported fossil fuel energy, a will form a top priority of any cooperative agreement. In addition, the two countries can use the opportunity of renewable energy cooperation to promote cooperation in other industries and achieve mutual benefit and win-win results between the two countries.

Secondly, renewable energy cooperation is the focus of energy cooperation in any B&R initiative. Moreover, a Regional Comprehensive Economic Partnership was established in 2020 and has eliminated trade barriers between Asia-Pacific countries and ASEAN countries. The combination of these initiatives and agreements presents an unprecedented opportunity for China and the Philippines to develop renewable energy cooperation. However, the outbreak of the United States-China trade war and the ongoing COVID- 19 pandemic have brought unprecedented challenges to such potential cooperation initiatives. In response to opportunities and challenges and to achieve a win-win situation, China and the Philippines need to strengthen political and economic cooperation and promote corresponding policies.

Thirdly, a cooperative agreement focused on strategic cooperation concerning renewable energy that is based on national strategy and the security of both two countries may include investment, technology cooperation, grid construction, and trade for renewable energy infrastructure. Furthermore, the Chinese and the Philippine governments could establish a unified and effective platform to share renewable cooperative information, corresponding policies, and administrative procedures to solve the difficulties of collecting information and nontransparent policies faced by potential cooperators or contractors.

Finally, although the disputes between China and the Philippines in the South China Sea once impacted this bilateral relationship seriously, the current friendly relationship has lasted 5 years, creating a positive and timely opportunity for cooperation between the two countries.

Author Contributions

XL: Conceptualization, Writing- Reviewing and Editing. HW: Writing- Original draft preparation, Investigation. YL: Writing- Reviewing and Editing. WL: Supervision, Resources.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors acknowledge the support of the Talents Training Program of Kunming University of Science and Technology (KKZ3201524007).

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Keywords: the belt and road, the Philippines-China cooperation, renewable energy, PESTEL analysis, renewable energy cooperation

Citation: Li X, Wang H, Lu Y and Li W (2021) A Critical Survey on Renewable Energy Applications in the Philippines and China: Present Challenges and Perspectives. Front. Energy Res. 9:724892. doi: 10.3389/fenrg.2021.724892

Received: 15 June 2021; Accepted: 19 July 2021; Published: 30 July 2021.

Reviewed by:

Copyright © 2021 Li, Wang, Lu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Wanlin Li, [email protected]

This article is part of the Research Topic

Advanced Optimization and Control for Smart Grids with High Penetration of Renewable Energy Systems

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• Historical Archives and Photographs: Cebuano Studies Center, Philippines
• Indonesian Illuminated Manuscripts
• Indonesian Television Archive
• Jawi Transliteration Project
• Laos Temple Murals
• Living Memory of the Khmer
• Living Memory Project
• Mandalay Marionettes Theater Puppet Show
• May Ebihara Collection: Ethnographic Research in Rural Community, 1959-1995
• On The Record: Indonesian Literary Figures
• Palm-Leaf Manuscripts at the National Library of Cambodia
• Palm-Leaf Manuscripts of Thailand
• Pa'o Religious and Literary Manuscripts
• Pesantren Sabilil Muttaqin (PSM) Manuscripts
• SEADL Undergraduate Paper Award
• Selections from the Donn V. Hart Southeast Asia Collection
• Then and Now: Historical Photographs of Cambodia
• UKM-NIU Digitization Project
• Victim-Former Khmer Rouge Dialogue
• Virtual Southeast Asia
• Call For Proposals

Philippines: Online Research Resources

Open access journals.

Asian-Pacific Law & Policy Journal, University of Hawaii This website provides online Journal articles about law and policy study in Asia-Pacific regions. Browse the journal or type a related topic in search after connecting to the link.

Journal of Asian Studies This is a website of the Journal of Asian Studies. It covers a range of research topics about Asia, and some articles are free for download.

Journal of Education, Management and Development Studies (JEMDS)

The Journal of Education, Management and Development Studies (JEMDS) publishes original research papers, reviews, and case studies related to broad areas of disciplines, including Education, Agriculture and Biological Sciences, Environment and Natural Resources, Health Sciences, Social and Behavioral Sciences, Public Management, Business Management and Entrepreneurship, Development Management, and Gender and Development. This also covers multidisciplinary and interdisciplinary studies on sustainable development in regional, national and global perspectives.

Journal of Health and Caring Sciences

The Journal of Health and Caring Sciences (JHCS) is an OPEN-ACCESS, international, peer-reviewed, interdisciplinary, official health and caring science publication of the San Beda University. It welcomes submission in various formats, including but not limited to original completed research studies, systematic reviews, case studies, book reviews, commentaries, letter to the editor and innovative research proposals which explores timely and emerging topics on human health, wellness and caring science.

Kyoto Review of Southeast Asia This website provides reviews of socio-political topics related to the Philippines and Southeast Asia. Type a related topic in search after connecting to the link.

Philippine E-Journals

Digital Collections

Center for Southeast Asian Studies, University of Hawaii This website contains a collection of 301 pictures of the Philippines, taken in 2000.

Digital Collection, the United States and Its Territories, the Age of Imperialism (1870-1925), the University of Michigan Library This is the University of Michigan Library’s Southeast Asia Collection of full text monographs and government documents published in the United States, Spain and the Philippines between 1870 and 1925.

Digital Collections, University of Washington Libraries This websites contains old photograph collection of the Philippines in the early 1900s and other countries in Southeast Asia. Type a related topic in search after connecting to the link.

Library of Congress Philippine Elections Web Archive The Philippine Elections web archive documents the Philippine general elections of 2010 and 2019.

Mangyan Bamboo Collection from Mindoro, Philippines, circa 1900-1939, at the Library of Congress The Asian Division's Southeast Asian Rare Book Collection counts among its most unique items a collection of 71 bamboo slats and 6 cylinders from the island of Mindoro in the Philippines. These items are etched with either verses or prose in the Mangyan script.

Philippines Maps, Perry-Castaneda Library, Map Collection, University of Texas Libraries This website holds a collection of old Philippines maps. It provides online version of a scanned-quality map produced by the U.S. Central Intelligence Agency.

SEAsite, Southeast Asia Picture Database (Northern Illinois University) This site provides a digital photograph collection of contemporary Philippines and Southeast Asia.

Southeast Asia Vision Collection (Cornell University Library) This site provides full download of old texts and rare book collections about Philippines and countries in Southeast Asia. Type a related topic in search after connecting to the link.

Southeast Asian Images and Texts, University of Wisconsin Digital Collection This website contains a digital photograph collection from the Philippines during the American colonial period and Laos in 1957, 1959 and 1969.

The Digital Library of the Commons, Indiana University This site provides full download of articles about the Philippines and countries in Southeast Asia. Type a related topic in search after connecting to the link.

The National Library of Australia This website provides a digital photograph collection of the early and contemporary Philippines and Southeast Asia. Type a related topic in search after connecting to the link.

The Spanish-American War in Motion Pictures Home Page This website contains information in the Philippines during the war.

Research Papers

Big Data for a Climate Disaster-Resilient Country, Philippines Ebinezer R. Florano

A Veto Players Analysis of Subnational Territorial Reform in Indonesia Michael A. Tumanut

The Politics of Municipal Merger in the Philippines Michael A. Tumanut

2018 AGPA Conference papers 

Management of Social Media for Disaster Risk Reduction and Mitigation in Philippine Local Government Units Erwin A. Alamapy, Maricris Delos Santos, and Xavier Venn Asuncion

An Assessment of the Impact of GAD Programs on the Retention Intentions of Female Uniformed Personnel of the Philippine Navy Michelle C. Castillo

Contextualizing Inclusive Business: Amelioration of ASEAN Economic Community Arman V. Cruz

The impact of mobile financial services in low- and lower middle-income countries Erwin A. Alampay, Goodiel Charles Moshi, Ishita Ghosh, Mina Lyn C. Peralta and Juliana Harshanti

How Cities Are Promoting Clean Energy and Dealing with Problems Along the Way Rizalino B. Cruz Impact Assessment Methods: Toward Institutional Impact Assessment Romeo B. Ocampo

Philippine Technocracy and Politico-administrative Realities During the Martial Law Period (1972–1986): Decentralization, Local governance and Autonomy Concerns of Prescient Technocrats Alex B. Brillantes, Jr. and Abigail Modino

Policy Reforms to Improve the Quality of Public Services in the Philippines Maria Fe Villamejor-Mendoza

Compliance with, and Effective Implementation of Multilateral Environmental Agreements: Looking Back at the Transboundary Haze Pollution Problem in the ASEAN Region Ebinezer R. Florano, Ph.D.

ASEAN, Food Security, and Land Rights: Enlarging a Democratic Space for Public Services in the ASEAN Maria Faina L. Diola, DPA

Public Finance in the ASEAN: Trend and Patterns Jocelyn C. Cuaresma, DPA

Private Sector Engagement in Climate Change Mitigation and Adaptation: Implications in Regional Governance Maria Fe Villamejor-Mendoza , Ph.D.

Philippine Response to Curb Human Trafficking of Migrant Workers Lizan Perante-Calina

Local Heritage Networking for ASEAN Connectivity Salvacion Manuel-Arlante

Financing Universal Healthcare and the ASEAN: Focus on the Philippine Sin Tax Law Abigail A. Modino

Decentralized Local Governance in Asian Region:Good Practices of Mandaluyong City, Philippines Rose Gay E. Gonzales- Castaneda

Disaster-Resilient Community Index: Measuring the Resiliency of Barangays in Tacloban, Iligan, Dagupan and Marikina Ebinezer R. Florano , Ph.D.

Towards Attaining the Vision “Pasig Green City”: Thinking Strategically, Acting Democratically Ebinezer R. Florano , Ph.D.

Community Governance for Disaster Recovery and Resilience: Four Case Studies in the Philippines  Ebinezer R. Florano , Ph.D.

Mainstreaming Integrated Climate Change Adaptation and Disaster Risk Reduction in Local development Plans in the Philippines Ebinezer R. Florano , Ph.D. 

Building Back a Better Nation: Disaster Rehabilitation and Recovery in the Philippines Ebinezer R. Florano , Ph.D.  and Joe-Mar S. Perez

The New Public Management Then and Now: Lessons from the Transition in Central and Eastern Europe Wolfgang Drechsler and Tiina Randma-Liiv

Optimizing ICT Budgets through eGovernment Projects Harmonization Erwin A. Alampay

ICT Sector Performance Review for Philippines Erwin A. Alampay

The Challenges to the Futures of Public Administration Education Maria Fe Villamejor-Mendoza

Enhancing Trust and Performance in the Philippine Public Enterprises: A Revisit of Recent Reforms and Transformations Maria Fe Villamejor-Mendoza

The Legal Framework for the Philippine Third Sector: Progressive or Regressive? Ma. Oliva Z. Domingo

Roles of Community and Communal Law in Disaster Management in the Philippines: The Case of Dagupan City Ebinezer R. Florano

Revisiting Meritocracy in Asian Settings: Dimensions of colonial Influences and Indigenous Traditions Danilo R. Reyes

The openness of the University of the Philippines Open University: Issues and Prospects Maria Fe Villamejor-Mendoza

Equity and Fairness in Public-Private Partnerships: The Case of Airport Infrastructure Development in the Philippines Maria Fe Villamejor- Mendoza

Restoring Trust and Building Integrity in Government: Issues and Concerns in the Philippines and Areas for Reform Alex B. Brillantes, Jr. and Maricel T. Fernandez

Competition in Electricity Markets: The Case of the Philippines  Maria Fe Villamejor-Mendoza

Economic Reforms for Philippine Competitiveness, UP Open University Maria Fe Villamejor-Mendoza and G.H. Ambat (Eds) 

Open Access to Educational Resources: The Wave of the Future? Maria Fe Villamejor-Mendoza

Climate Change Governance in the Philippines and Means of Implementation diagram Ebinezer R. Florano

Mobile 2.0: M-money for the BoP in the Philippines Erwin A. Alampay and Gemma Bala

When Social Networking Websites Meet Mobile Commerce Erwin A. Alampay 

Monitoring Employee Use of the Internet in Philippine Organizations Erwin A. Alampay 

Living the Information Society Erwin A. Alampay

Analysing Socio-Demographic Differences in the Access & Use of ICTs in the Philippines Using the Capability Approach, Electronic Journal of Information Systems in Developing Countries Erwin A. Alampay

Measuring Capabilities in the Information Society Erwin A. Alampay

Modes of Learning and Performance Among U.P. Open University Graduates, Electronic Journal of Information Systems in Developing Countries Victoria A. Bautista and Ma. Anna T. Quimbo

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Social Media Filipinos and Key National Issues in the Philippines

International Journal of Research and Innovation in Social Science (IJRISS) | Volume IV, Issue IV, April 2020 | ISSN 2454–6186

Social Media, Filipinos, and Key National Issues in the Philippines: A Macro Analysis

Prof. Mark Gabriel Wagan Aguilar, CTP, CNA, CMC School Director, Abe International Business College-Quezon City, Philippines

Abstract:  The Philippines as the top user of social media worldwide has witnessed Filipinos rely on information posted in social media for knowledge on key national issues. This research clearly explained the root cause why people of the Philippines has become ignorant towards issues but remained highly confident when it comes to giving comments on such through social networking websites. It has been found that Filipinos are likely to give comments and/or feedbacks to issues despite knowing nothing on it, and tend to rely on information posted in social media without checking its validity and the sources’ reliability due to the illusory truth effect caused by the continuous commenting, posting, and sharing of information verified or not.

The results also show that poverty is the reason why a person has limited access to reliable information that affects their perception towards key national issues, thus, regulating social media in countries where poverty rate is high is highly recommended.

Social Media, Filipinos, Social Issues, Poverty, Ignorance

I.INTRODUCTION

The Philippines as a country with a democratic form of government gives its people freedom of speech and expression. It’s more fun in the Philippines; the country’s slogan for Tourism could easily be a justification to what Philippine-Style Democracy is; colorful, occasionally chaotic, and arguably inspiring, Abad (2014). However, the country has yet to prove the real power of democracy, that resides in the possibility of a new collective salvation since it has been analyzed to concentrate on the few and the privileged, that is has been shared discriminately, and has been found incapable of tirelessly challenging frozen assumptions and prevailing worldviews, Untalan (2015).

Democracy in the Philippines is undoubtedly alive with 75-78% voter turnout on the 2019 election out of around 62,000,000 registered voters of the 108,116,615 nation’s population that time. It is further justified by Geronimo (2018) in his article where it was stated that 84% of Filipinos are satisfied with how democracy in the country works.

However, democracy was questioned by Socrates, an Athenian Philosopher stating that democracy should not be for everyone, thus, it is only for those people who are educated. In Book Six of The Republic, Plato, another Athenian Philosopher described Socrates falling into a conversation with a character named Adeimantus; Socrates compared

elections to choosing someone to be in charge of a sea vessel, just anyone or someone who is educated in the rules and demands of seafaring. He pointed that voting in an election is a skill and not a random intuition, and that letting someone to vote without an education is as irresponsible as putting them in charge of a trireme sailing. (Chapter 2, Work: Politics and Government, The Book of Life).

The Philippines on the other hand, has embraced democratic traditions of participation and freedom of choice and expression over the years, Abad (2014), and that democracy aside from the right to vote, is speech freedom having it heavily emphasized in the 1987 Constitution which is the current fundamental principle of the country; “No law shall be passed abridging the freedom of speech, of expression, or of the press, or the right of the people to peaceably to assemble and petition the government for redress of grievances”. (Article III, Section 4, Constitution of the Republic of the Philippines, 1987).

Facebook, a social networking website, with 2.2 billion facebook users worldwide which Filipinos are named as the top user with an average of 10 hours a day usage, technically has given another platform for people to exercise freedom of speech. According to Ohme (2018) in his article, facebook has now become a vital part of democracy where daily news is being shared and political discussions are conducted among others. This gives people an opportunity to also discuss other matters such as key national issues.

This study guided by the Think before you Speak (Is it True, Helpful, Inspiring, Necessary, and Kind) principle by Alan Redpath, with the author’s own interpretation; Know before your Click, Ipsos MORI’s The Perils of Perception 2017, and a number of published researches, macro analyzed the knowledge of Filipinos towards Key National Issues and details behind the confidence despite lack of awareness on issues, leading to a conclusion that the platform-social media where they are able to speak freely should be regulated once and for all.

II. METHODS

A qualitative research approach was used to analyze data gathered for this study. The results in Ipsos MORI’s The Perils of Perception 2017, relevant published researches, and news articles were used as sources of data. Data from these resources were collated and macro analyzed with heavy emphasis on the knowledge of Filipinos towards key national issues, and how and why they respond with full of confidence even they know nothing about it.

III. DISCUSSION

Ipsos Mori’s The Perils of Perception 2017 survey showed how wrong the online public across the globe is about their country’s key national issues, not limited to crimes and health. The Philippines ranked third as the most ignorant with South Africa and Brazil in the first and second spots respectively. The result of the study also showed that Filipinos despite being one of the most ignorant are still among the most confident with their answers, together with Indians and Peruvians. This clearly shows that Filipinos are likely to give comments and feedbacks on issues even they know nothing about it or they have not known the facts behind it.

The Philippines as the world knows is historically a third world country but now is a developing one. Based on World Population Review, an independent organization based in California, USA and source of the world’s demographic data, the Philippines’ Gross Domestic Product is low while the infant mortality rate is high, leaving many of its citizens very limited access to health care and higher education. The Philippines is in fact at rank 28 in the list of poorest countries published by Focus Economics, www.focus-economics.com.

According to Child Fund International, a non-profit organization based in Virginia, poverty and education is inextricably linked with each other. In the research conducted by DeNavas-Walt and Proctor (2014) on Income and Poverty in the United States of America. It was found out that people who had lower educational attainment particularly those who had no high school diploma comprise a greater share of the population in poverty. The root cause of poverty is lack of education, Hickman (2015), and like a tree, poverty has many roots, but among many causes of global poverty, one factor still stands out; Education, Geovetti (2019).

In the Philippines, most of those living in poverty have failed to obtain a diploma. While lack of education makes someone lacks confidence in showing up for work and apply by himself, it leaves him unemployed, Hickman (2015), making him incapable of acquiring means that will give him access to information, such as cellphone, tablet, internet, television, and radio among others. Though an android cellphone in the Philippines is quite affordable, access to information is still limited since people without internet can only access social media for free without the provision of all information particularly photos and link sources, thus, creating a wrong perception towards national issues posted, making them ignorant on what really is happening, but still with the freedom to comment, react, and share such post.

The Illusory truth effect that was first identified by Hasher, Goldstein, and Toppino on 1977 in their research on referential validity, is the tendency of people to believe false information to be correct after repeatedly exposed, is the current event in social media as Filipinos continuously copy, paste, and share information validated or not.

Sherman (2014) in his article published in Inc.com cited Dunning’s statement that in his several studies, it was confirmed that people who don’t know much about a given set of skills tend to grossly overestimate their prowess and performance. While the Philippines is a third world country with almost a quarter or about 18 million of the population living in poverty in 2018, who has no formal education and has only limited access to information, this perfectly reflects on the way Filipinos react on key national issues posted in social media; full of confidence.

Manstead (2018), identified the lower class to less likely define themselves in terms of their socioeconomic status and are more likely to have interdependent self-concepts, that they are also inclined to explain social events in situational terms, which as a result is having a lower sense of personal control; this in addition perfectly reflects the way Filipinos react on key national issues posted in social media; based on their feelings and not on facts, react positively on information that is pleasing to their eyes and react negatively on those that are not.

To give a concrete example; in a poll conducted by Pinoy Ekspres, a public page in facebook with around 5,100 followers. The administrators asked people to give grades to their Mayors based on their performance against Corona Virus 2019 Outbreak in the Philippines. Majority were not satisfied resulting to 40% of them giving their Mayor a score of 1, which is the lowest grade that can be given. Most messages to the Mayors were negative; some even asked their Mayors to step down due to his/her allegedly poor performance. However, in the question regarding their knowledge towards the current state of their city/ municipality amidst COVID19 Outbreak, 18% which is 3rd to the highest, said that they have no idea. This has technically proved that Filipinos are indeed more likely to speak and judge without having enough knowledge on an issue.

This data undeniably explain also the increase of cybercrime cases in the country, which according to the Philippine National Police Anti-Cybercrime Group, had increased by nearly 80% or to 4,103 on 2018 from the 2,284 cases reported on 2017.

IV. CONCLUSION

This matrix is hereby conceptualized based on the results of this study.

Figure 1: Matrix showing the relationship among poverty, social media, and perception of people; The Author’s own interpretation based on what has been analyzed in this study.

Figure 1 explains how the different situations affect the perception of people towards information posted in social media. In a third world country, people has limited access to education, which leads to people having low confidence and incompetence towards doing work or performing a job. and this will automatically put them in an unemployed status. Unemployment means no source of income which will definitely result to poverty.

People living in poverty do not have sufficient budget to purchase things that are not considered necessities, some of them do not have budget at all, and this will result to limited access to information which will eventually make people ignorant. However, having limited access to information would also make people base what is factual on whatever information they could access to, that they would share to others believing that the information they have gotten is legitimate. People who have received the information from others would also believe on it due to the illusory truth effect it has brought to their mind. These clearly explain why they are confident in giving comments, feedbacks, and reaction towards key national issues.

Moreover, Filipinos when they know nothing about a national issue will respond based on what they have only read and on what information is available within their access at a certain moment. Lower social classes won’t bother to do further researches to make sure that what they have read is sufficient since they have limited access to such means. Reason why sources of information should provide clear and sufficient information on their social media posts as much as possible.

In addition, Filipinos tend to believe on information posted in social media without having it checked for truthfulness and the sources for reliability due to the illusory truth effect. It is further concluded that aside from the Philippines, there is indeed a need to regulate the use of social media particularly facebook in other countries where the poverty rate is high. This will avoid the spread of fake news, and probably would contribute in changing the way people respond to issues (Social Media Filipinos and Key National Issues in the Philippines) affecting the economy.

[1]. Manstead, 2018: The Psychology of social class: How socioeconomic status impacts though, feelings, and behaviour. British Journal of Social Psychology/ Volume 57, Issue 2.

[2]. DeNavas-Walt & Proctor, 2014: Income and Poverty in the United States: 2014/ Current Population Reports, P60-252, Census Bureau

[3]. Hasher, Goldstein, &Toppino, 1977: Frequency and the Conference pf referential validity. Journal of Verbal Learning and Verbal Behavior, P107-112

[4]. Ipsos MORI, 2017: The Perils of Perceptions 2017

[5]. Abad, 2014: What the Philippines tells us about democracy. World Economic Forum on East Asia, March 21-23, 2014

[6]. Untalan, 2015: The Real Crisis of Philippine Democracy. Kyoto Review of Southeast Asia/ Issue 18. September 2015

[7]. Hickman, 2015: Lack of education is root cause of poverty.

Rochester Business Journal

[8]. Tupas, 2019: Cybercrimes up by 80% in 2018/ Philippine National Police Anti-Cybercrime Group/ The Philippine Star Global News

[9]. World Population Review: Third World Countries 2020/ United National Development Programme.

[10]. 1987, Article III, Section 4, Constitution of the Republic of the Philippines

[11]. Geronimo, 2018: Social Weather Stations Survey on September 2018; 84% of Filipinos satisfied with how democracy works

[12]. FocusEconomics S.L.U., 2018: The Poorest Countries in the World

[13]. Chapter 2. Works: Politics and Government, The Book of Life.

The School of Life

[14]. Ohme, 2018: Facebook is now a vital part of our democracy. The Conversation UK

[15]. ChildFund International.Org; Poverty and Education

[16]. Giovetti, 2019: How does education affect poverty? It can help it. / ConcernUSA.Org

[17]. Sherman, 2014: Finally: Science explains why we’re all more ignorant than we think. / Inc.com

JOURNAL ISSUES

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Author: Niño B. Galacgac, Maria Caridad H. Tarroja

A Narrative Analysis Of The Experiences Of Barangay Officials Involved In Community-Based Drug Rehab

The purpose of the study is to understand the phenomenon of community-based drug rehabilitation (CBDR) in the Philippine context from the perspective of barangay officials involved in CBDR. The research investigated the narratives of officials, both treatment facilitators... Read more

Author: Mark Angelo D. Allado, Norman Gabrielle M. Gumba, Kyla Jann Melo, Ma. Regina M. Hechanova

A Narrative Analysis Of The Experiences Of Barangay Ofcials Involved In Community-Based Drug Rehabil

The purpose of the study is to understand the phenomenon of community-based drug rehabilitation (CBDR) in the Philippine context from the perspective of barangay officials involved in CBDR. The research investigated the narratives of officials, both treatment facilitators and program overseers, reg... Read more

Career And Talent Development Self-Efficacy Of Filipino Students: The Role Of Self-Compassion And Ho

The recent reforms in the Philippine educational system aim to develop lifelong learners who are competent in their chosen career and capable of contributing to society. Career and talent development self-efficacy is an enabling resource that could facilitate the realization of these goals. The pres... Read more

Author: Ma. Jenina N. Nalipay, Maria Kristina S. Alfonso

Volume: 51 No. 1 | Publication: 2018-12-01

Life Satisfaction Predicts Positive Workplace Outcomes Among Filipino Guidance Counselors

The study tested the broaden-and-build theory of positive emotions (Fredrickson, 1998; 2003) in the field of counseling practice. The researchers hypothesized that counselors’ life satisfaction would predict outcomes relevant in practice: counseling self-efficacy, emotional awareness, and flow state... Read more

Author: Niño Jose Mateo Maria, Guadalupe Salanga

Sanctification Of Adolescence: A Qualitative Analysis Of Thriving Among Filipino Youth With Religiou

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Author: Jet U. Buenconsejo

Construct Validation Of Ryff’s Psychological Well-being Scale: Evidence From Filipino Teachers In Th

Research on psychological well-being has given attention to employees in various industries but research involving teachers particularly in non-Western contexts remains scarce. Using both within- and between-network validation approaches, this study attends to gaps in literature through the examinat... Read more

Author: Jonalyn B. Villarosa, Fraide A. Ganotice Jr.

Financial Stress And Well-being Of Filipino Students: The Moderating Role Of External Locus-of-hope

One of the core principles of positive psychology is that character strengths buffer the effects of adverse experiences on well-being. This study investigated whether external locus-of-hope (LOH) moderates the effects of financial stress on Filipino students’ well-being. Students from various unive... Read more

Author: Allan B. I. Bernardo, Katrina Fernando Resurreccion

Interdependent Happiness Is Associated With Higher Levels Of Behavioral And Emotional Engagement Amo

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Philippine Journal Of Psychology Volume 51

Content and cover. Read more

Volume: 51 No. 1 | Publication: 2018-06-01

PJP AIMS AND SCOPE

The Philippine Journal of Psychology (PJP) is an international, open access, and refereed journal published annually by the Psychological Association of the Philippines (PAP). It is the flagship journal of psychology in the Philippines, and its principal aim is to promote psychological studies in the Philippines and psychological studies of the Filipino people. PJP issues are archived in this site: https://www.pap.ph/pjp

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The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

Louie mar a. gangcuangco.

1 Hawaii Center for AIDS, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA

Patrick C. Eustaquio

2 Love Yourself, Inc., Mandaluyong 1552, Metro Manila, Philippines; hp.flesruoyevol@kcirtap

In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15–17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine–tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.

1. Introduction

In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region [ 1 ]. The first recorded cases of HIV in the Philippines were in 1985 among two then-labeled “ hospitality women ” from the cities of Angeles and Olongapo in Central Luzon [ 2 ]. Prior to 2010, the HIV epidemic was described to be “low and slow”, with about four newly diagnosed cases reported every month and a national prevalence of less than 0.1% [ 3 ]. Several factors implicated for the initial indolent rise in cases include the archipelagic geography of the Philippines, high rates of male circumcision, lower proportion of people who injecting drugs, and the culture of sexual conservatism [ 3 ].

While the overall trend of HIV incidence and AIDS-related deaths are declining globally [ 4 ], an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines (HARP) in the recent decade ( Figure 1 ). In 2012, there were only approximately nine new HIV cases every day. In 2023, however, there have been 46 cases reported daily [ 5 ], a stunning 411% increase in daily incidence in 10 years. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis [ 5 ].

Estimated annual new HIV infections among individuals 15 years old and above from 2000–2021 globally and in the Philippines, based on UNAIDS estimates.

As of January 2023, there were 110,736 HIV cases reported in the Philippines [ 5 ]. Although this number seems low considering that the country has over 109 million people [ 6 ], the pervasive stigma, sociopolitical conditions, and barriers to healthcare services are fueling the epidemic in marginalized populations. The number of people living with HIV (PLHIV) is projected to increase by 200% from 158,400 in 2022 to 364,000 by 2030 [ 7 ]. Despite these challenges, there were advances in the rollout of newer antiretroviral agents, access to pre-exposure prophylaxis, and healthcare legislations that positively impact HIV treatment and prevention. In this narrative review, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.

2. Populations Disproportionately Impacted by HIV

Populations disproportionately affected by HIV include key populations, comprising 92% of the new infections in 2022, and vulnerable populations [ 7 ]. Key populations include males having sex with males (MSM), transgender women, sex workers, trafficked women and girls, and people who inject drugs (PWID) [ 7 ]. Vulnerable populations include migrant workers, people with disabilities, people in enclosed spaces, and female partners of key populations [ 7 ].

2.1. Men Having Sex with Men

Sexual transmission remains to be the predominant mode of HIV acquisition in the Philippines, primarily among MSM [ 5 ]. One of the earliest HIV prevalence studies among MSM was conducted in 2010. HIV testing performed outside the entertainment areas/gay bars of Manila found that, among 406 MSM screened using rapid HIV antibody test kits, 48 tested positive (11.8% [95% confidence interval: 8.7% to 15.0%]). Forty participants consented to a Western blot confirmatory test, with 39 participants testing positive for HIV-1 and one patient testing positive for both HIV-1 and HIV-2 [ 8 ]. Data from the Philippine Department of Health (DOH) in January 2023 showed that approximately 70% of all HIV cases were among males who have sex with other males, and 17% were among males who have sex with both males and females [ 5 ].

2.2. Persons Who Inject Drugs

HIV transmission through the sharing of infected needles remains relatively low in the Philippines. It was reported to be highest in 2010, accounting for 9% of all new HIV cases that year [ 9 ]. In the same year, an outbreak of HIV and hepatitis C virus (HCV) occurred in Cebu City, where over 50% of PWID were found to have HIV, and 93% were infected with HCV [ 10 ]. HIV transmission through infected needles has decreased since 2011 and constitutes ~1% of all newly reported cases in the past few years [ 9 ]. However, due to the recent sociopolitical climate, particularly during former president Rodrigo Duterte’s “ war on drugs” [ 11 ], it is likely that data among PWID and among those who use illicit drugs remain underreported for fear of legal ramifications. The last biobehavioral surveillance data among PWID were reported in 2015.

Needle and syringe programs (NSPs) provide access to sterile needles and syringes and facilitate their safe disposal. NSPs have been shown to effectively reduce HIV transmission [ 12 ]. However, the implementation of NSPs remain difficult in the Philippines given that the Comprehensive Dangerous Drugs Act of 2002 (Republic Act [RA] 9165) considers any unauthorized possession of drug paraphernalia as prima facie evidence of self-administration of dangerous drugs [ 13 ]. Violation could lead to a maximum of 4 years imprisonment and a minimum monetary penalty of PHP 10,000 (~USD 182) [ 13 ], which is higher than the upper bound of the average monthly minimum wage in 2022 [ 14 ]. Political pressure and the Dangerous Drugs Act of 2022 continue to make NSPs inaccessible, deterring effective community-based comprehensive HIV prevention services among PWID. The Big Cities Project (BCP) in Cebu funded by the World Bank and the Asian Development Bank aimed to reduce HIV transmission by reducing risk behaviors among PWID. However, the sterile needle distribution aspect of this project was halted within 5 months of implementation due to political pressure [ 15 , 16 ]. Mental health and substance use disorders need to be addressed as part of a comprehensive response to the HIV epidemic in the Philippines.

2.3. Transgender Populations

In the HIV surveillance systems of the Philippines, transgender women were previously included under MSM until 2018 when the HARP and the Integrated HIV Behavioral and Serologic Surveillance (IHBSS) disaggregated data based on gender identity. Of the total reported new HIV cases in January 2023, 3% were transgender women [ 5 ]. Unique concerns among transgender populations in the Philippines include differences in HIV knowledge, need for safe sex communication, and disparate access to healthcare services [ 17 ]. One study among trans men and trans women ( N = 525) in Metro Manila showed that as many as 82% declined HIV testing and counseling services [ 18 ]. Amid the gaps in healthcare access, a community-led health service delivery model providing integrated HIV and gender-affirming care showed promise in providing essential health services to transgender people [ 19 ].

2.4. Other Vulnerable Groups

There are other populations in the Philippines vulnerable to HIV. These include migrant workers, people who exchange sex, people trafficked for sex, and people in enclosed spaces.

Despite efforts to abolish policies that discriminate against PLHIV, several countries continue to mandate HIV antibody testing prior to migration or employment [ 20 ]. Historically, overseas Filipino workers (OFWs) have comprised a significant proportion of HIV cases, likely because of increased case detection from the pre-departure HIV testing imposed by their prospective employers abroad. In a 2006 publication, it was reported that, of 2410 HIV seropositive cases in the Philippines, 821 (34%) were OFWs [ 21 ]. As HIV testing entry requirements are eased by countries globally and the epidemic affects other key populations, there has been a decline in the proportion of OFWs diagnosed to have HIV. In January 2023, OFWs comprised only 5% ( N = 76) of newly diagnosed cases in the Philippines [ 5 ]. In a serological study of over 69,000 OFWs screened for HIV antibody, only one (0.001%) tested positive [ 22 ]. OFWs remain vulnerable to HIV due to the intersectionality of sociocultural factors, stigma, working conditions abroad, and barriers to healthcare access [ 23 ].

Data from the Young Adult Fertility and Sexual Health (YAFSH) study showed that 1% of Filipino men and 0.03% of women aged 15 to 24 years paid for sex in 2021, while 1% of men and 0.1% of women received payment for sex [ 24 ]. High-risk behaviors were also reported in this survey, with only 13% of male youth using condoms every time they paid for sex in the past 12 months [ 24 ]. Vulnerable populations are more likely to engage in transactional sex. For instance, female sex workers previously constituted majority of the HIV cases during the early part of the epidemic [ 25 ]. Moreover, around 38% of MSM and transgender women surveyed in the IHBSS 2018 reported receiving payment in exchange for sex in the past year [ 26 ]. Additionally, sex work has been reported outside of urban areas, as demonstrated by the “ call boys ” in rural fish ports [ 27 ]. Although commercial sex work is illegal in the Philippines, transactional sex encompasses “nonmarital, noncommercial sexual relationships motivated by the implicit assumption that sex will be exchanged for material benefit or status” [ 28 ]. Alcohol, drugs, monetary gifts, and housing have also been implicated as drivers of transactional sex [ 29 ]. Young people who engage in transactional sex have increased risk of alcohol and substance use, as well as of HIV and sexually transmitted infections [ 28 , 29 ].

According to human rights groups, the Philippines is a major sex trafficking hub in Southeast Asia. Underage Filipinos as young as 14 years old have been reported to trade sex while working in entertainment bars, spas, or illegal brothels [ 30 ]. The minors, compared to the older workers, were more likely to have been told to have sex without a condom by their managers [ 30 ]. Some risk factors for sex trafficking that have been identified include a history of childhood abuse, gender inequality, and poverty [ 31 ].

Multiple social vulnerabilities prior to incarceration, the prison environment, and management practices in these facilities have magnified HIV vulnerability among prisoners in the Philippines [ 32 ]. This is a particularly urgent issue as the recent “war on drugs” was associated with the 511% congestion rate in prisons and jails in the Philippines, fueling the twin epidemic of HIV and HCV [ 33 , 34 ].

3. The “ABCs” of HIV Prevention

HIV prevention efforts have traditionally focused on the ABCs: abstinence, being faithful, and condom use [ 35 ]. Among MSM, several reasons for not using condoms were trust in one’s sexual partner, diminished pleasure, and unavailability of condoms [ 8 ]. Among heterosexuals, condoms were perceived primarily as a birth control measure rather than as protection against HIV and sexually transmitted infections [ 36 ]. Other barriers identified were the stigma associated with purchasing a condom, as it is associated with premarital sex or infidelity [ 36 ]. Behavioral and cultural challenges to these interventions call for more robust prevention strategies, including pharmacological interventions (pre-exposure prophylaxis, PrEP), increased HIV testing, and treatment as prevention. The seventh AIDS Medium Term Plan (2023–2028), serving as the country’s blueprint to address the HIV epidemic, aims to expand access to combination prevention services and to address social, gender inequities, and stigma [ 7 ].

Stigma is an attribute causing people to be perceived as less or shamed, and it can be (1) enacted through experiencing discrimination, (2) felt through vulnerability toward discrimination, or (3) internalized through self-validation of negative societal experiences [ 37 ]. Stigma is enacted through various forms of discrimination, including victimization, violence, and macro- and microaggressions, by different perpetrators, including by the general public, employers, healthcare workers, or even oneself, friends, and family [ 38 , 39 ]. Stigma and discrimination are associated with poor quality of life and poor physical and mental health outcomes [ 40 , 41 , 42 , 43 ], which affect engagement in HIV-related services [ 44 , 45 ]. In the Philippine PLHIV Stigma Index 2019, about one in five reported stigma and discrimination within the past year, mostly from being gossiped by friends and/or family [ 46 ]. There were reports of HIV status disclosure without consent, particularly among coworkers [ 46 ]. Around one in three reported that their HIV status negatively affected their self-efficacy, most commonly in losing desire to have children [ 46 ]. There were also reports of feelings of worthlessness, shame, guilt, and self-exclusion [ 46 ].

Populations disproportionately affected by HIV experience multiple sources of stigma, from their serostatus, race and/or ethnicity, sex assigned at birth, sexual orientation, gender identity and/or expression (SOGIE), drug-injecting behavior, sex work, religious beliefs, language, culture, and social class [ 37 , 39 , 47 ]. MSM living with HIV in Manila described perceptions of being immoral and fatalistic, which often perpetuate internalized shame and hopelessness [ 37 ].

Stigma may be present even within groups of sexual and gender minorities; in particular, transgender women in the Philippines report discomfort in accessing HIV services in facilities focused on MSM [ 48 ]. People who use drugs are often targets of stigma perpetuated by the current sociopolitical climate [ 42 ]. The burden of multiple sources of stigma and their deep underpinning in larger social, political, and cultural contexts of inequity and power warrant a lens of intersectionality on studying health disparities based on stigma [ 49 ]. Being mindful of the intersecting social determinants of health is crucial in tackling health issues, particularly among populations with overlapping behaviors that put them at higher risk of HIV, such as key populations engaging in sexualized drug use (e.g., “chemsex” among MSM) and key populations engaging in sex work or transactional sex.

5. HIV Counseling and Testing

The World Health Organization (WHO) recommends that, in countries with less than 5% HIV prevalence, HIV testing should be offered to (a) individuals who present in clinical settings with manifestations and conditions suggestive of HIV primary or coinfection, such as tuberculosis and sexually transmitted infections, (b) children and infants who are symptomatic or exposed to HIV, (c) key populations and their partners, and (d) all pregnant individuals [ 50 ]. In the Philippines, HIV testing remains focused among the aforementioned key populations. Barriers to HIV testing among Filipinos included HIV-related stigma, misconceptions about the virus, fear of testing HIV-positive, and financial instability [ 51 ]. Particularly among MSM, barriers to HIV screening included perception of not needing the test due to the absence of symptoms, feeling morally superior, belonging to a higher socioeconomic class, inaccessibility of the testing facility, uncertainty of treatment side-effects, and fear of HIV-related healthcare expenses [ 52 ].

Historically, the Philippine AIDS Prevention and Control Act of 1998 (RA 8504) required pre-test and post-test counseling by a certified HIV counselor, amid their limited number, and required parental consent for HIV testing among individuals less than 18 years old, despite their level of risk for HIV [ 53 ]. In 2018, RA 8504 was revised into the Philippine HIV and AIDS Policy Act of 2018 (RA 11166). This law expanded HIV testing to include provider-initiated counseling and testing, allowing licensed social workers and health service providers to provide HIV testing services [ 54 ]. Furthermore, RA 11166 allows HIV testing among individuals 15–17 years old without parental consent [ 54 ].

Community-based organizations (CBOs) have played a key role in improving access to HIV prevention services in the Philippines. CBOs were at the forefront of research, advocacy, and policy work that expanded HIV testing from the traditional facility-based screening to now include community-based screening and HIV self-testing [ 55 , 56 ]. Monumental to the introduction of HIV self-testing in the country were HIV self-testing demonstration projects held in the Western Visayas region and in Metro Manila [ 57 , 58 ]. In the former, multiple CBO project sites reached many first-time testers among MSM and trans women [ 57 ]. In the latter, participants reported high acceptability for HIV self-testing [ 58 ]. In both projects, about 8–9% tested positive for HIV antibody, and more than half were linked to further testing and treatment [ 57 , 58 ]. These projects were conducted successfully despite the stringent quarantine protocols during the COVID-19 pandemic. It was estimated that there was a 61% decrease in the number of HIV tests performed and a 37% decrease in HIV diagnosis in 2020 nationally, attributed largely to the quarantine restrictions imposed during the COVID-19 pandemic [ 59 ], further highlighting the importance of improving the accessibility of HIV testing services in the community.

Given the success of community-led HIV testing projects, HIV self-testing was included in the national HIV testing guidelines in 2022 [ 56 ]. However, challenges remain in the rollout of HIV self-testing. Most of the HIV self-testing kits in the Philippines are blood-based tests, despite the acceptability of oral-based tests [ 60 ]. Moreover, there are unauthorized online sellers of HIV test kits [ 61 ]. Regulations must be strengthened to ensure the quality of HIV test kits purchased online. Furthermore, support systems must be in place to facilitate linkage to care, making medical and psychosocial support accessible for persons who test positive at home.

In addition to HIV self-testing, social network and index testing (partner notification) were recently included as HIV testing approaches [ 56 ]. While benefits outweigh the risk, index testing is associated with experiences of intimate partner violence [ 62 , 63 ]. In the Philippines, where intimate partner violence among cisgender women is prevalent [ 64 ] and national legislative protections for sexual and gender minorities are lacking [ 65 ], it is imperative for the country to improve violence prevention and push forward legislations that will protect the rights and wellbeing of key and vulnerable populations regardless of HIV status.

In 2019, the Philippines started to transition from the use of the Western blot test for HIV confirmation to the rapid HIV diagnostic algorithm (rHIVda), which involves the use of three rapid diagnostic test kits to confirm HIV diagnosis ( Figure 2 ) [ 66 , 67 ]. This approach decentralized confirmation of HIV diagnosis from a couple of reference laboratories in Metro Manila to the 38 certified rHIVda confirmatory laboratories around the country as of September 2022 [ 68 ]. RHIVda significantly decreased waiting time for HIV confirmation and facilitated linkage to care from weeks to days [ 68 ]. As there are limited algorithms approved in the Philippines [ 69 ], stock issues in rapid diagnostic test kits present a potential challenge. Nonetheless, the continuous validation of kits and consideration of new technologies provide flexibility to this challenge [ 67 , 69 ].

Traditional versus rapid HIV diagnostic algorithm in the Philippines. Abbreviations: rHIVda: rapid HIV diagnostic algorithm; IA: immunoassay.

6. HIV Pre-Exposure Prophylaxis (PrEP)

PrEP is the use of combination antiretrovirals for HIV prevention indicated for people who are HIV-seronegative at substantial risk for HIV [ 50 , 70 ]. Depending on a person’s risk behavior, PrEP may be taken daily or “on demand”/event-driven. Event-driven PrEP, otherwise known as “2–1–1”, is currently recommended by the WHO to prevent sexual acquisition of HIV by cisgender men and trans and gender diverse people assigned male at birth who are not taking hormones that are estradiol-based [ 70 ]. In this regimen, a person takes two pills of emtricitabine/tenofovir 2–24 hours before potential exposure, one pill 24 hours after the first dose, and one pill 24 hours after the second dose [ 70 , 71 ].

A landmark pilot implementation project that paved the way to the approval of PrEP in the Philippines was the community-led program called Project PrEPPY. In this 2 year pilot implementation, there were no reported new HIV infections, no increase in condomless anal intercourse, and no significant increase in STI incidence from baseline among MSM and transgender women who used PrEP [ 72 ].

Emtricitabine–tenofovir disoproxil fumarate (TDF) was the first approved PrEP medication [ 73 ]. Chronic use of TDF has been associated with mild kidney-related adverse events [ 74 ] and decreased bone mineral density [ 75 ]. A newer prodrug of tenofovir (tenofovir alafenamide) was shown to have less impact on the kidney and bone mineral density [ 76 ], but was associated in some studies with weight gain and lipid disorders [ 77 , 78 ].

In 2021, the WHO recommended dapivirine vaginal rings (DPV-VR) as a new choice for HIV prevention for women at substantial risk of HIV infection [ 79 ]. DPV-VR is a bendable silicone ring inserted into the vagina that slowly releases the antiretroviral dapivirine, replaced every 28 days [ 79 ]. In 2022, long-acting cabotegravir, which is administered intramuscularly 4 weeks apart for the first two injections and then every 8 weeks thereafter, was recommended by the WHO as an additional prevention choice for people at substantial risk of HIV infection [ 80 ]. However, only oral emtricitabine–TDF is currently available in the Philippines and is not covered by the national health insurance. Donor-funded emtricitabine–TDF is limited, and the out-of-pocket cost is about USD 30–65 for a 30-tablet bottle. It must be noted that the minimum wage in the National Capital Region is about PHP 500 (~USD 9.20) per day (minimum wage is lower in other regions of the Philippines) [ 14 ], limiting the accessibility of PrEP, especially among people living in poverty.

7. HIV Post-Exposure Prophylaxis (PEP)

Persons without HIV who may have been recently exposed to HIV may take post-exposure prophylaxis (PEP) as soon as possible within 72 hours of high-risk exposure to prevent HIV acquisition [ 81 ]. PEP implementation in the Philippines remains limited to healthcare-related exposure, in both clinical and community-based settings [ 55 , 82 ]. The Philippine Health Sector HIV Strategic Plan 2020–2022 aimed to expand PEP to non-healthcare-related exposures [ 83 ].

8. HIV Treatment and Care Delivery

8.1. access to hiv services.

As of January 2023, there were about 180 treatment hubs and primary HIV care facilities in the Philippines [ 5 ]. ART is dispensed only through these designated facilities and is not available from commercial pharmacies, which may pose as a challenge for PLHIV living in rural areas trying to access ART [ 1 , 84 ]. While the national HIV program provides ART for free to PLHIV, other fees for medical care, such as consultation fees and laboratory tests, may be covered by the national health insurance, Philippine Health Insurance Corporation (PhilHealth), through their Outpatient HIV/AIDS Treatment (OHAT) Package. The OHAT package provides an annual reimbursement of PHP 30,000 (~USD 544), which is paid to the treatment facility where the PLHIV is enrolled [ 85 ]. In 2022, it was estimated that one in three PLHIV was not enrolled in OHAT [ 7 ].

The OHAT package provides financial support to PLHIV and covers the biomedical aspect of the HIV care cascade. However, other components essential to strengthen HIV management, such as peer support and counseling, psychosocial support, and ancillary services for shelter and violence response/prevention are mostly out of pocket, if not covered by external funding, particularly from donor organizations, or by the national program through domestic funding.

Although domestic funding comprises 94% of HIV spending from government sources, through the national HIV program and PhilHealth, with 6% coming from external sources, these only constitute 40% of the financial requirement to reach the 95–95–95 UNAIDS target (see Section 9 ), leaving a 60% funding gap [ 7 ]. The country’s transition toward universal healthcare (UHC), since the passage of the UHC Law (RA 11223) [ 86 ], goes hand in hand with RA 11166 in providing sustainable mechanisms to address these financial gaps. Moreover, the Mandanas Ruling by the Supreme Court would potentially increase the share of local government units from national taxes, which could also contribute to address these gaps if HIV and healthcare services are prioritized at the local level [ 7 ].

8.2. Antiretroviral Therapy (ART)

Although studies to cure HIV through various novel techniques are ongoing, such as bone marrow transplant and gene therapy [ 87 , 88 ], there remains no commercially available cure for PLHIV. Plasma HIV RNA suppression is achieved through regular ART. Early in the infection, HIV establishes latency in various cellular and tissue reservoir sites, including the central nervous system, gut lymphoid tissue, and resting memory CD4 T cells [ 89 ]. ART controls active viral replication in the plasma but does not completely eradicate viruses in these reservoir sites. Once ART is stopped, viral load rebounds [ 90 ].

For several years, the only available one pill once a day ART regimen in the Philippines has been lamivudine/TDF/efavirenz (LTE). Although efavirenz is a potent non-nucleoside reverse transcriptase inhibitor, it is known to cause neuropsychiatric symptoms, such as vivid dreams, severe depression, or suicidal ideation, which have been reported in up to 50% of patients [ 91 ]. In July 2019, the WHO issued a statement that the integrase strand transfer inhibitor (INSTI) dolutegravir is the preferred first-line and second-line treatment option for all populations [ 92 ]. This was based on multiple studies showing that dolutegravir is more effective in achieving virological suppression, is better tolerated, and is more cost-effective than alternative drugs [ 92 ]. Furthermore, dolutegravir displays potent in vitro activity and a lower barrier for genetic resistance development [ 93 ].

In 2020, the Philippines started prescribing TDF/lamivudine/dolutegravir (TLD) single-formulation tablets. The Philippine government prioritized the use of TLD among newly diagnosed PLHIV and among patients with severe side-effects from the current efavirenz-based regimen [ 94 ]. Significant progress has transpired with the inclusion of TLD in the Philippine National Formulary in 2021 [ 95 ], enabling government procurement. The Philippine HIV treatment guidelines were also revised in 2022 [ 96 ], officially recommending dolutegravir-based ART as the first-line regimen for PLHIV.

The long-acting injectable combination of cabotegravir/rilpivirine has been approved by the US FDA for use in adult PLHIV who are virologically suppressed on a stable ART regimen [ 97 ]. Cabotegravir/rilpivirine is administered by a healthcare provider as an intramuscular (gluteal) injection every 2 months [ 98 ] and replaces the need for daily oral ART. This medication is currently not available in the Philippines.

8.3. Tuberculosis and Hepatitis B Co-Infection

The treatment of PLHIV with tuberculosis (TB) co-infection remains a challenge in a country with one of the highest TB/HIV burdens in Asia [ 99 ]. Rifampicin, one of the key medications for long-term tuberculosis treatment, reduces dolutegravir exposure, requiring an additional dose of dolutegravir to be administered 12 hours after the standard daily dose [ 100 ]. However, the single-formulation dolutegravir 50 mg tablet remains difficult to access in the Philippines. This limits the use of TLD, particularly among the estimated 12,000 individuals with TB/HIV co-infection [ 101 ]. Moreover, PLHIV who have treatment failure with efavirenz are further disadvantaged, as they are likely taking protease inhibitors which have serious drug–drug interactions with rifampicin [ 102 ].

Another challenge in the ART management among PLHIV in the Philippines is the high burden of hepatitis B virus (HBV) in the country, with an estimated Hepatitis B surface antigen (HBsAg) seroprevalence of 16.7% in the general population [ 103 ]. Prevalence data on HBV/HIV co-infection in the Philippines remain limited, but one study reported that, among PLHIV ( N = 302), 13.3% ( n = 40) were co-infected with HBV [ 104 ]. The use of certain ART in the setting of HIV/HBV co-infection (such as TDF and lamivudine) requires careful monitoring, since chronic HBV may increase the risk of hepatotoxicity from ART and abrupt discontinuation of ART with anti-HBV activity may lead to HBV reactivation and fulminant hepatitis [ 105 , 106 ].

8.4. Treatment as Prevention

VL suppression is not only essential in decreasing morbidity and mortality among PLHIV, but also a key measure to prevent HIV transmission in the community. In recent years, the public health message “ undetectable = untransmittable (U=U)” has gained significant traction to fight stigma and promote ART adherence. PLHIV who achieve and maintain an undetectable viral load by regularly taking ART as prescribed will not sexually transmit HIV to others [ 107 ]. This concept of U=U is underpinned by “treatment as prevention”, where achieving viral load suppression through ART is used as a prevention strategy at the population level [ 108 ]. Communicating U=U was associated with improved overall sexual and mental health, medication adherence, and viral load suppression [ 109 ]. Moreover, it is a huge step in de-stigmatization, particularly among people who face multiple intersecting stigma [ 108 , 110 ].

8.5. Maternal–Child Transmission

A total of 724 women in the Philippines were diagnosed to have HIV during their pregnancy between January 2011 to January 2023 [ 5 ]. The DOH started to recommend triple screening among pregnant women for HIV, syphilis, and HBV in 2016 [ 111 ]. This is aligned with the global movement for the triple elimination of HIV, syphilis, and HBV. Only 15% of pregnant women are receiving ART for the prevention of mother-to-child transmission (MTCT) [ 112 ]. Although newer recommendations on antiretroviral prophylaxis among HIV-exposed infants were provided in the recently revised HIV treatment guidelines [ 96 ], the last DOH guidelines on prevention of MTCT was published in 2009 [ 113 ]. Updating these guidelines is crucial to ensure continuity of standard of care across all the components of the MTCT cascade.

9. Viral Load Monitoring, Genotyping, and Resistance Testing

The Joint United Nations Program on HIV/AIDS (UNAIDS) set a global target of 95–95–95 by 2030: 95% know their HIV status, 95% are on ART, and 95% have achieved viral load suppression [ 114 ]. As of September 2022, the Philippines has achieved 63–65–97 [ 7 ]. It should be noted, however, that the 97% viral suppression rate was based only among 20% of PLHIV on ART who were tested for plasma HIV RNA [ 7 ]. A study on the care cascade of 3137 MSM diagnosed to have HIV in a community-based clinic in Manila showed a 98% viral suppression rate among 84% of PLHIV on ART who were tested for viral load [ 115 ]. In another surveillance study, an HIV clinic in a tertiary hospital found 95% viral suppression among the 48.2% of PLHIV on ART who had viral load testing [ 116 ].

HIV RNA viral load testing is unfortunately not routinely performed in the country due to the associated costs and limited availability [ 116 ]. An administrative order was issued by the DOH in 2022 to facilitate the integration of HIV and TB services. This collaborative approach to the prevention and control of TB and HIV aims to increase the access to polymerase chain reaction (PCR) machines for HIV viral load and TB diagnosis [ 117 ].

Where resources are available, baseline HIV drug resistance testing is recommended to guide the selection of the initial ART regimen [ 118 ]. HIV genotype testing is also helpful to facilitate the switching of medications in the event of treatment failure. However, low- and middle-income countries face challenges in accessing HIV drug resistance testing. In 2013, deep sequencing analysis to assess drug-resistance mutations (DRMs) among PLHIV in the Philippines showed that only two from the 110 evaluable individuals with major HIV variants were highly resistant to non-nucleoside reverse transcriptase inhibitors (NNRTI: efavirenz and nevirapine). However, minority drug-resistant HIV variants were detected: highly resistant to nevirapine (89/110), rilpivirine (5/110), and efavirenz (49/110) [ 119 ]. A study published in 2017 among a relatively small sample of treatment-naïve PLHIV in the Philippines ( N = 95) showed transmitted drug resistance (TDR) in six patients (6.3%) [ 120 ]. In a more recent publication of PLHIV ( N = 513) on ART, 10.3% experienced treatment failure after 1 year [ 121 ]. Among those who failed treatment ( n = 53), 90.6% had DRMs. The study found unexpectedly high rates of NRTI, NNRTI, and K65R tenofovir resistance, as well as multiclass resistance [ 121 ]. These data emphasize the need for continued efforts to increase viral load and drug resistance testing in the Philippines.

10. Changing Molecular Epidemiology of HIV

The increase in HIV cases in the Philippines is multifactorial and cannot only be attributed to various healthcare, socioeconomic, and political factors. The changing molecular epidemiology of the virus may also be fueling transmission. During the early part of the epidemic, subtype B was the prevailing HIV-1 subtype in the country. However, multiple studies in the past decade have shown that CRF_01AE is now the predominant subtype, constituting over 70% of strains among newly diagnosed PLHIV [ 122 , 123 ]. CRF_01AE appears to be a more aggressive subtype, reported in various cohorts to cause more rapid CD4 T-cell decline and faster HIV/AIDS progression [ 121 , 124 , 125 ]. The poorer outcomes associated with this predominant HIV subtype circulating in the Philippines should be an impetus for various stakeholders to further ramp up HIV testing, treatment, and care delivery in the country.

11. Conclusions

There has been significant progress in HIV treatment and prevention in the Philippines. The Philippine HIV and AIDS Policy Act of 2018 expanded access to HIV services in the country [ 54 ]. HIV testing now includes community-based screening and self-testing [ 56 ] and allows for the screening of minors 15–17 years old without parental consent [ 54 ]. Newer antiretrovirals have been procured, and dolutegravir-based ART is now first line, consistent with the WHO recommendations [ 92 ]. PrEP has been rolled out [ 72 ]. The number of treatment hubs and primary HIV care facilities continues to increase. However, barriers including stigma, limited harm reduction services for PWID, and sociocultural and political deterrents remain. HIV RNA viral load testing and drug resistance testing are not routinely performed due to associated costs and limited resources. The high burden of TB and HBV co-infection complicates HIV management [ 102 , 104 ]. PrEP and PEP need to be expanded to further reach populations at risk. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders.

Funding Statement

This review article received no external funding.

Author Contributions

L.M.A.G. and P.C.E. contributed equally to this article. All authors have read and agreed to the published version of the manuscript.

Conflicts of Interest

The authors declare no conflict of interest. The views and opinions expressed in this article do not reflect the views and opinions of the authors’ affiliations.

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Volume 627 Issue 8005, 28 March 2024

Qubit quota.

The accumulation of errors hampers the use of quantum computers. Although there are ways to design circuits so they detect and correct errors, this typically requires a substantial number of additional qubits. In this week’s issue, researchers at IBM present a protocol for low-overhead error correction in quantum computers. The researchers use low-density parity-check codes, which correct errors by monitoring several symmetries each supported on only a small set of qubits. This code performed as well as established error-correction protocols but crucially needed only about one-tenth of the qubits. This could make error-corrected quantum computers substantially smaller machines than previously assumed. The cover image offers an artistic rendering of the qubit connectivity required for the new protocol in which each qubit needs to interact with six others. Qubits are linked as if they were placed onto the surface of a torus.

Cover image: IBM

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Escalating tensions in the South China Sea, President Ferdinand R. Marcos Jr. says, are not only a regional issue, but a global one.

By Sui-Lee Wee and Camille Elemia

With China aggressively asserting its claims on the South China Sea, President Ferdinand R. Marcos Jr. of the Philippines spent his first year on the job beefing up Manila’s alliance with its oldest ally, the United States. Now he is shoring up support from a wider and new network of partners.

Mr. Marcos is adding a new intensity to his muscular foreign policy at a critical moment in his country’s territorial dispute with Beijing. Maritime clashes between Chinese and Philippine vessels have become more frequent in recent months.

In January, Mr. Marcos and the leaders of Vietnam, another country fighting off Chinese claims to the crucial waterway, pledged closer cooperation between their coast guards. This month, Mr. Marcos clinched a maritime cooperation deal with Australia. And this past week, he took his pitch to Europe.

“It has to be recognized that the South China Sea handles 60 percent of the trade of the entire world. So, it’s not solely the interest of the Philippines, or of ASEAN, or of the Indo-Pacific region, but the entire world,” Mr. Marcos said on Tuesday in Berlin, apparently referring to global maritime trade and using shorthand for the Association of Southeast Asian Nations.

Standing alongside Chancellor Olaf Scholz of Germany, Mr. Marcos, the first Philippine president to visit Germany in a decade, added, “That is why it’s in all our interest to keep it as a safe passage for all international commerce that goes on in the South China Sea.”

This flurry of diplomacy, analysts said, might ultimately help to deter China. But they also acknowledged that Beijing was going to continue doubling down on its territorial claims, increasing the risks of a conflict that could ultimately draw in the United States, the Philippines’ oldest treaty ally. Washington has repeatedly condemned Beijing’s actions and has vowed to come to the aid of Manila in the event of an armed conflict.

The foreign policy strategy adopted by Mr. Marcos, who took office in June 2022, is almost the opposite of the approach of his predecessor, Rodrigo Duterte. While Mr. Duterte spurned the West and courted China, Mr. Marcos has revived and cemented ties with traditional security partners like the United States and Japan. He has also cultivated new relations with the likes of Sweden and France, and his government has pushed for arms deals and military drills.

Tensions flared again this month when Chinese boats blocked the Philippine vessels off the Second Thomas Shoal, a contested reef 120 miles off the coast of the western province of Palawan. The confrontation culminated in Chinese and Philippine coast guard vessels colliding.

Mr. Marcos told reporters then there was no reason yet to invoke the mutual defense treaty with the United States.

China claims 90 percent of the South China Sea, some of it hundreds of miles from the mainland and in waters surrounding Vietnam, Malaysia, Brunei, Indonesia and the Philippines. In the past decade or so, China has asserted ever greater control over these waters, using two island chains called the Paracels and the Spratlys to expand its military footprint by building and fortifying outposts and airstrips.

The militarization of the Spratly Islands allowed China to maintain a round-the-clock presence in waters more than 500 miles from the coast of China. At another formation, the Scarborough Shoal, Chinese boats have repeatedly harassed Filipino fishing boats in an area that an international tribunal in The Hague had ruled was a traditional fishing ground of the Philippines, Vietnam and other nations. The Chinese presence also prevented Manila from fully exploring oil and gas deposits in the surrounding water.

China has blamed the Philippines for the frequent clashes in the South China Sea.

Wang Yi, China’s foreign minister, in December admonished the Philippines for “changing its policy stance, reneging on its commitments and continuing to provoke and cause trouble at sea.”

Mr. Wang also issued a warning: “If the Philippines misjudges the situation, insists on going its own way, or even colludes with malicious external forces to continue causing trouble and chaos, China will definitely safeguard its rights in accordance with the law and respond resolutely.”

Two weeks later, the Philippines announced that it had signed agreements with Britain and Canada to increase defense cooperation. They were part of 10 security agreements that Mr. Marcos has signed with seven countries since last year, according to a tally of public statements.

“China is basically pushing us closer to the United States and to the other countries that have already indicated their support, as far as Germany and as far as the Czech Republic,” said Renato Cruz De Castro, a professor of international studies at De La Salle University in Manila.

On Thursday, Petr Pavel, the president of the Czech Republic, said he was willing to cooperate with the Philippines in defense and cybersecurity, adding that his country “fully” supports Manila in the South China Sea.

“To us, South China Sea may seem to be far, far away, but if you take into account the percentage of share of world or global trade that passes through this area, any disruption of these routes would have an adverse impact on Europe, not only in the form of shortage of goods but also soaring prices,” Mr. Pavel told reporters at a joint news conference with Mr. Marcos. “Which is why we have to pay attention to this topic.”

New allies, Mr. De Castro said, are welcome because the Philippines cannot rely on the United States alone, especially if former President Donald J. Trump returns to power next year.

“The U.S. is simply — even Americans would say — so unstable right now, the political system is so volatile, look at what’s happening with the U.S. military assistance to Ukraine,” he said. “And I’m not saying that Trump would win, but there’s always uncertainty because of how unstable American domestic politics is.”

Another important calculus for Mr. Marcos, analysts said, is securing investments for the Philippines.

“That means that we can really be assertive, we can really protect the South China Sea interests without thinking of the economic backlash that China might impose on us,” said Aries A. Arugay, the chairman of the political science department of the University of the Philippines Diliman.

Even India, which has been silent on the South China Sea dispute for years, announced last June that it would provide loans with preferential rates to the Philippines for its military modernization. In August, both countries signed agreements to cooperate in the coast guard sectors.

Last week, when he was in Australia, Mr. Marcos warned that the constant clashes between Filipino and Chinese vessels have increased the risks of miscalculation.

“The potential for outright conflict is much higher now than it was before,” he said. “We worry in the Philippines because it could come from not a strategic decision by anyone saying, ‘OK, we’re going to war,’ but just by some servicemen making a mistake, or some action that’s misunderstood.”

An earlier version of this article misstated one site where Chinese boats harassed Philippine fishermen. It is the Scarborough Shoal, not the Spratly Islands.

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Sui-Lee Wee is the Southeast Asia bureau chief for The Times, overseeing coverage of 11 countries in the region. More about Sui-Lee Wee

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FACT SHEET: President   Biden Issues Executive Order and Announces New Actions to Advance Women’s Health Research and   Innovation

In his State of the Union address, President Biden laid out his vision for transforming women’s health research and improving women’s lives all across America. The President called on Congress to make a bold, transformative investment of $12 billion in new funding for women’s health research. This investment would be used to create a Fund for Women’s Health Research at the National Institutes of Health (NIH) to advance a cutting-edge, interdisciplinary research agenda and to establish a new nationwide network of research centers of excellence and innovation in women’s health—which would serve as a national gold standard for women’s health research across the lifespan.

It is long past time to ensure women get the answers they need when it comes to their health—from cardiovascular disease to autoimmune diseases to menopause-related conditions. To pioneer the next generation of discoveries, the President and the First Lady launched the first-ever White House Initiative on Women’s Health Research , which aims to fundamentally change how we approach and fund women’s health research in the United States.

Today, President Biden is signing a new Executive Order that will direct the most comprehensive set of executive actions ever taken to expand and improve research on women’s health. These directives will ensure women’s health is integrated and prioritized across the federal research portfolio and budget, and will galvanize new research on a wide range of topics, including women’s midlife health.

The President and First Lady are also announcing more than twenty new actions and commitments by federal agencies, including through the U.S. Department of Health and Human Services (HHS), the Department of Defense (DoD), the Department of Veterans Affairs (VA), and the National Science Foundation (NSF). This includes the launch of a new NIH-wide effort that will direct key investments of $200 million in Fiscal Year 2025 to fund new, interdisciplinary women’s health research—a first step towards the transformative central Fund on Women’s Health that the President has called on Congress to invest in. These actions also build on the First Lady’s announcement last month of the Advanced Research Projects Agency for Health (ARPA-H) Sprint for Women’s Health , which committed $100 million towards transformative research and development in women’s health.

Today, the President is issuing an Executive Order that will:

• Integrate Women’s Health Across the Federal Research Portfolio . The Executive Order directs the Initiative’s constituent agencies to develop and strengthen research and data standards on women’s health across all relevant research and funding opportunities, with the goal of helping ensure that the Administration is better leveraging every dollar of federal funding for health research to improve women’s health. These actions will build on the NIH’s current policy to ensure that research it funds considers women’s health in the development of study design and in data collection and analysis. Agencies will take action to ensure women’s health is being considered at every step in the research process—from the applications that prospective grantees submit to the way that they report on grant implementation.
• Prioritize Investments in Women’s Health Research . The Executive Order directs the Initiative’s constituent agencies to prioritize funding for women’s health research and encourage innovation in women’s health, including through ARPA-H and multi-agency initiatives such as the Small Business Innovation Research Program and the Small Business Technology Transfer Program. These entities are dedicated to high-impact research and innovation, including through the support of early-stage small businesses and entrepreneurs engaged in research and innovation. The Executive Order further directs HHS and NSF to study ways to leverage artificial intelligence to advance women’s health research. These additional investments—across a wide range of agencies—will support innovation and open new doors to breakthroughs in women’s health.
• Galvanize New Research on Women’s Midlife Health .  To narrow research gaps on diseases and conditions associated with women’s midlife health or that are more likely to occur after menopause, such as rheumatoid arthritis, heart attack, and osteoporosis, the President is directing HHS to: expand data collection efforts related to women’s midlife health; launch a comprehensive research agenda that will guide future investments in menopause-related research; identify ways to improve management of menopause-related issues and the clinical care that women receive; and develop new resources to help women better understand their options for menopause-related symptoms prevention and treatment. The Executive Order also directs the DoD and VA to study and take steps to improve the treatment of, and research related to, menopause for Service women and women veterans.
• Assess Unmet Needs to Support Women’s Health Research . The Executive Order directs the Office of Management and Budget and the Gender Policy Council to lead a robust effort to assess gaps in federal funding for women’s health research and identify changes—whether statutory, regulatory, or budgetary—that are needed to maximally support the broad scope of women’s health research across the federal government. Agencies will also be required to report annually on their investments in women’s health research, as well as progress towards their efforts to improve women’s health.

Today, agencies are also announcing new actions they are taking to promote women’s health research , as part of their ongoing efforts through the White House Initiative on Women’s Health Research. Agencies are announcing actions to:

Prioritize and Increase Investments in Women’s Health Research

• Launch an NIH-Cross Cutting Effort to Transform Women’s Health Throughout the Lifespan. NIH is launching an NIH-wide effort to close gaps in women’s health research across the lifespan. This effort—which will initially be supported by $200 million from NIH beginning in FY 2025—will allow NIH to catalyze interdisciplinary research, particularly on issues that cut across the traditional mandates of the institutes and centers at NIH. It will also allow NIH to launch ambitious, multi-faceted research projects such as research on the impact of perimenopause and menopause on heart health, brain health and bone health. In addition, the President’s FY25 Budget Request would double current funding for the NIH Office of Research on Women’s Health to support new and existing initiatives that emphasize women’s health research.

This coordinated, NIH-wide effort will be co-chaired by the NIH Office of the Director, the Office of Research on Women’s Health, and the institute directors from the National Institute on Aging; the National Heart, Lung, and Blood Institute; the National Institute on Drug Abuse; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Institute on Arthritis, Musculoskeletal and Skin Diseases.

• Invest in Research on a Wide Range of Women’s Health Issues. The bipartisan Congressionally Directed Medical Research Program (CDMRP), led out of DoD, funds research on women’s health encompassing a range of diseases and conditions that affect women uniquely, disproportionately, or differently from men. While the programs and topic areas directed by Congress differ each year, CDMRP has consistently funded research to advance women’s health since its creation in 1993. In Fiscal Year 2022, DoD implemented nearly $490 million in CDMRP investments towards women’s health research projects ranging from breast and ovarian cancer to lupus to orthotics and prosthetics in women.  In Fiscal Year 2023, DoD anticipates implementing approximately $500 million in CDMRP funding for women’s health research, including in endometriosis, rheumatoid arthritis, and chronic fatigue.
• Call for New Proposals on Emerging Women’s Health Issues . Today, NSF is calling for new research and education proposals to advance discoveries and innovations related to women’s health. To promote multidisciplinary solutions to women’s health disparities, NSF invites applications that would improve women’s health through a wide range of disciplines—from computational research to engineering biomechanics. This is the first time that NSF has broadly called for novel and transformative research that is focused entirely on women’s health topics, and proposals will be considered on an ongoing basis.
• Increase Research on How Environmental Factors Affect Women’s Health. The Environmental Protection Agency (EPA) is updating its grant solicitations and contracts to ensure that applicants prioritize, as appropriate, the consideration of women’s exposures and health outcomes. These changes will help ensure that women’s health is better accounted for across EPA’s research portfolio and increase our knowledge of women’s environmental health—from endocrine disruption to toxic exposure.
• Create a Dedicated, One-Stop Shop for NIH Funding Opportunities on Women’s Health. Researchers are often unaware of existing opportunities to apply for federal funding. To help close this gap, NIH is issuing a new Notice of Special Interest that identifies current, open funding opportunities related to women’s health research across a wide range of health conditions and all Institutes, Centers, and Offices. The NIH Office of Research on Women’s Health will build on this new Notice by creating a dedicated one-stop shop on open funding opportunities related to women’s health research. This will make it easier for researchers and institutions to find and apply for funding—instead of having to search across each of NIH’s 27 institutes for funding opportunities.

Foster Innovation and Discovery in Women’s Health

• Accelerate Transformative Research and Development in Women’s Health. ARPA-H’s Sprint for Women’s Health launched in February 2024 commits $100 million to transformative research and development in women’s health. ARPA-H is soliciting ideas for novel groundbreaking research and development to address women’s health, as well as opportunities to accelerate and scale tools, products, and platforms with the potential for commercialization to improve women’s health outcomes.
• Support Private Sector Innovation Through Additional Federal Investments in Women’s Health Research. The NIH’s competitive Small Business Innovation Research Program and the Small Business Technology Transfer Program is committing to further increasing—by 50 percent—its investments in supporting innovators and early-stage small businesses engaged in research and development on women’s health. These programs will solicit new proposals on promising women’s health innovation and make evidence-based investments that bridge the gap between performance of basic science and commercialization of resulting innovations. This commitment for additional funds builds on the investments the Administration has already made to increase innovation in women’s health through small businesses, including by increasing investments by sevenfold between Fiscal Year 2021 and Fiscal Year 2023.
• Advance Initiatives to Protect and Promote the Health of Women. The Food and Drug Administration (FDA) seeks to advance efforts to help address gaps in research and availability of products for diseases and conditions that primarily impact women, or for which scientific considerations may be different for women, and is committed to research and regulatory initiatives that facilitate the development of safe and effective medical products for women. FDA also plans to issue guidance for industry that relates to the inclusion of women in clinical trials and conduct outreach to stakeholders to discuss opportunities to advance women’s health across the lifespan. And FDA’s Office of Women’s Health will update FDA’s framework for women’s health research and seek to fund research with an emphasis on bridging gaps in knowledge on important women’s health topics, including sex differences and conditions that uniquely or disproportionately impact women.
• Use Biomarkers to Improve the Health of Women Through Early Detection and Treatment of Conditions, such as Endometriosis. NIH will launch a new initiative dedicated to research on biomarker discovery and validation to help improve our ability to prevent, diagnose, and treat conditions that affect women uniquely, including endometriosis. This NIH initiative will accelerate our ability to identify new pathways for diagnosis and treatment by encouraging multi-sector collaboration and synergistic research that will speed the transfer of knowledge from bench to bedside.
• Leverage Engineering Research to Improve Women’s Health . The NSF Engineering Research Visioning Alliance (ERVA) is convening national experts to identify high-impact research opportunities in engineering that can improve women’s health. ERVA’s Transforming Women’s Health Outcomes Through Engineering visioning event will be held in June 2024, and will bring together experts from across engineering—including those in microfluidics, computational modeling, artificial intelligence/imaging, and diagnostic technologies and devices—to evaluate the landscape for new applications in women’s health. Following this event, ERVA will issue a report and roadmap on critical areas where engineering research can impact women’s health across the lifespan.
• Drive Engineering Innovations in Women’s Health Discovery . NSF awardees at Texas A&M University will hold a conference in summer 2024 to collectively identify challenges and opportunities in improving women’s health through engineering. Biomedical engineers and scientists will explore and identify how various types of engineering tools, including biomechanics and immuno-engineering, can be applied to women’s health and spark promising new research directions.

Expand and Leverage Data Collection and Analysis Related to Women’s Health

• Help Standardize Data to Support Research on Women’s Health. NIH is launching an effort to identify and develop new common data elements related to women’s health that will help researchers share and combine datasets, promote interoperability, and improve the accuracy of datasets when it comes to women’s health. NIH will initiate this process by convening data and scientific experts across the federal government to solicit feedback on the need to develop new NIH-endorsed common data elements—which are widely used in both research and clinical settings. By advancing new tools to capture more data about women’s health, NIH will give researchers and clinicians the tools they need to enable more meaningful data collection, analysis, and reporting and comprehensively improve our knowledge of women’s health.
• Reflect Women’s Health Needs in National Coverage Determinations. The Centers for Medicare & Medicaid Services (CMS) will strengthen its review process, including through Coverage with Evidence Development guidance, to ensure that new medical services and technologies work well in women, as applicable, before being covered nationally through the Medicare program. This will help ensure that Medicare funds are used for treatments with a sufficient evidence base to show that they actually work in women, who make up more than half of the Medicare population.
• Leverage Data and Quality Measures to Advance Women’s Health Research. The Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) are building on existing datasets to improve the collection, analysis, and reporting of information on women’s health. The CDC is expanding the collection of key quality measures across a woman’s lifespan, including to understand the link between pregnancy and post-partum hypertension and heart disease, and plans to release the Million Hearts Hypertension in Pregnancy Change Package. This resource will feature a menu of evidence-informed strategies by which clinicians can change care processes. Each strategy includes tested tools and resources to support related clinical quality improvement. HRSA is modernizing its Uniform Data System in ways that will improve the ability to assess how women are being served through HRSA-funded health centers. By improving the ability to analyze data on key clinical quality measures, CDC and HRSA can help close gaps in women’s health care access and identify new opportunities for high-impact research.  

Strengthen Coordination, Infrastructure, and Training to Support Women’s Health Research

• Launch New Joint Collaborative to Improve Women’s Health Research for Service Members and Veterans. DoD and VA are launching a new Women’s Health Research collaborative to explore opportunities that further promote joint efforts to advance women’s health research and improve evidence-based care for Service members and veterans. The collaborative will increase coordination with the goal of helping improve care across the lifespan for women in the military and women veterans. The Departments will further advance research on key women’s health issues and develop a roadmap to close pressing research gaps, including those specifically affecting Service women and women veterans.
• Coordinate Research to Advance the Health of Women in the Military. DoD will invest $10 million, contingent on available funds, in the Military Women’s Health Research Partnership. This Partnership is led by the Uniformed Services University and advances and coordinates women’s health research across the Department. The Partnership is supporting research in a wide range of health issues affecting women in the military, including cancers, mental and behavioral health, and the unique health care needs of Active Duty Service Women. In addition, the Uniformed Services University established a dedicated Director of Military Women’s Health Research Program, a role that is responsible for identifying research gaps, fostering collaboration, and coordinating and aligning a unified approach to address the evolving needs of Active Duty Service Women.
• Support EPA-Wide Research and Dissemination of Data on Women’s Health. EPA is establishing a Women’s Health Community of Practice to coordinate research and data dissemination. EPA also plans to direct the Board of Scientific Counselors to identify ways to advance EPA’s research with specific consideration of the intersection of environmental factors and women’s health, including maternal health.
• Expand Fellowship Training in Women’s Health Research. CDC, in collaboration with the CDC Foundation and American Board of Obstetrics and Gynecology, is expanding training in women’s health research and public health surveillance to OBGYNs, nurses and advanced practice nurses. Through fellowships and public health experiences with CDC, these clinicians will gain public health research skills to improve the health of women and children exposed to or affected by infectious diseases, mental health and substance use disorders. CDC will invite early career clinicians to train in public health and policy to become future leaders in women’s health research.

Improve Women’s Health Across the Lifespan

• Create a Comprehensive Research Agenda on Menopause. To help women get the answers they need about menopause, NIH will launch its first-ever Pathways to Prevention series on menopause and the treatment of menopausal symptoms. Pathways to Prevention is an independent, evidence-based process to synthesize the current state of the evidence, identify gaps in existing research, and develop a roadmap that can be used to help guide the field forward. The report, once completed, will help guide innovation and investments in menopause-related research and care across the federal government and research community.
• Improve Primary Care and Preventive Services for Women . The Agency for Healthcare Research and Quality (AHRQ) will issue a Notice of Intent to publish a funding opportunity announcement for research to advance the science of primary care, which will include a focus on women’s health. Through this funding opportunity, AHRQ will build evidence about key elements of primary care that influence patient outcomes and advance health equity—focusing on women of color—such as care coordination, continuity of care, comprehensiveness of care, person-centered care, and trust. The results from the funding opportunity will shed light on vital targets for improvements in the delivery of primary healthcare across a woman’s lifespan, including women’s health preventive services, prevention and management of multiple chronic diseases, perinatal care, transition from pediatric to adult care, sexual and reproductive health, and care of older adults.
• Promote the Health of American Indian and Alaska Native Women. The Indian Health Service is launching a series of engagements, including focus groups, to better understand tribal beliefs related to menopause in American Indian and Alaska Native Women. This series will inform new opportunities to expand culturally informed patient care and research as well as the development of new resources and educational materials.
• Connect Research to Real-World Outcomes to Improve Women’s Mental and Behavioral Health. The Substance Abuse and Mental Health Services Administration (SAMHSA) is supporting a range of health care providers to address the unique needs of women with or at risk for mental health and substance use disorders. Building on its current efforts to provide technical assistance through various initiatives , SAMHSA intends, contingent on available funds, to launch a new comprehensive Women’s Behavioral Health Technical Assistance Center. This center will identify and improve the implementation of best practices in women’s behavioral health across the life span; identify and fill critical gaps in knowledge of and resources for women’s behavioral health; and provide learning opportunities, training, and technical assistance for healthcare providers.
• Support Research on Maternal Health Outcomes. USDA will fund research to help recognize early warning signs of maternal morbidity and mortality in recipients of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and anticipates awarding up to $5 million in Fiscal Year 2023 to support maternal health research through WIC. In addition, research being conducted through the Agricultural Research Service’s Human Nutrition Research Centers is focusing on women’s health across the lifespan, including the nutritional needs of pregnant and breastfeeding women and older adults.

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