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  • Published: 24 November 2021

A study of awareness on HIV/AIDS among adolescents: A Longitudinal Study on UDAYA data

  • Shobhit Srivastava   ORCID: orcid.org/0000-0002-7138-4916 1 ,
  • Shekhar Chauhan   ORCID: orcid.org/0000-0002-6926-7649 2 ,
  • Ratna Patel   ORCID: orcid.org/0000-0002-5371-7369 3 &
  • Pradeep Kumar   ORCID: orcid.org/0000-0003-4259-820X 1  

Scientific Reports volume  11 , Article number:  22841 ( 2021 ) Cite this article

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Acquired Immunodeficiency Syndrome caused by Human Immunodeficiency Virus (HIV) poses a severe challenge to healthcare and is a significant public health issue worldwide. This study intends to examine the change in the awareness level of HIV among adolescents. Furthermore, this study examined the factors associated with the change in awareness level on HIV-related information among adolescents over the period. Data used for this study were drawn from Understanding the lives of adolescents and young adults, a longitudinal survey on adolescents aged 10–19 in Bihar and Uttar Pradesh. The present study utilized a sample of 4421 and 7587 unmarried adolescent boys and girls, respectively aged 10–19 years in wave-1 and wave-2. Descriptive analysis and t-test and proportion test were done to observe changes in certain selected variables from wave-1 (2015–2016) to wave-2 (2018–2019). Moreover, random effect regression analysis was used to estimate the association of change in HIV awareness among unmarried adolescents with household and individual factors. The percentage of adolescent boys who had awareness regarding HIV increased from 38.6% in wave-1 to 59.9% in wave-2. Among adolescent girls, the percentage increased from 30.2 to 39.1% between wave-1 & wave-2. With the increase in age and years of schooling, the HIV awareness increased among adolescent boys ([Coef: 0.05; p  < 0.01] and [Coef: 0.04; p  < 0.01]) and girls ([Coef: 0.03; p  < 0.01] and [Coef: 0.04; p  < 0.01]), respectively. The adolescent boys [Coef: 0.06; p  < 0.05] and girls [Coef: 0.03; p  < 0.05] who had any mass media exposure were more likely to have an awareness of HIV. Adolescent boys' paid work status was inversely associated with HIV awareness [Coef: − 0.01; p  < 0.10]. Use of internet among adolescent boys [Coef: 0.18; p  < 0.01] and girls [Coef: 0.14; p  < 0.01] was positively associated with HIV awareness with reference to their counterparts. There is a need to intensify efforts in ensuring that information regarding HIV should reach vulnerable sub-groups, as outlined in this study. It is important to mobilize the available resources to target the less educated and poor adolescents, focusing on rural adolescents.

Introduction

Acquired Immunodeficiency Syndrome (AIDS) caused by Human Immunodeficiency Virus (HIV) poses a severe challenge to healthcare and is a significant public health issue worldwide. So far, HIV has claimed almost 33 million lives; however, off lately, increasing access to HIV prevention, diagnosis, treatment, and care has enabled people living with HIV to lead a long and healthy life 1 . By the end of 2019, an estimated 38 million people were living with HIV 1 . More so, new infections fell by 39 percent, and HIV-related deaths fell by almost 51 percent between 2000 and 2019 1 . Despite all the positive news related to HIV, the success story is not the same everywhere; HIV varies between region, country, and population, where not everyone is able to access HIV testing and treatment and care 1 . HIV/AIDS holds back economic growth by destroying human capital by predominantly affecting adolescents and young adults 2 .

There are nearly 1.2 billion adolescents (10–19 years) worldwide, which constitute 18 percent of the world’s population, and in some countries, adolescents make up as much as one-fourth of the population 3 . In India, adolescents comprise more than one-fifth (21.8%) of the total population 4 . Despite a decline projection for the adolescent population in India 5 , there is a critical need to hold adolescents as adolescence is characterized as a period when peer victimization/pressure on psychosocial development is noteworthy 6 . Peer victimization/pressure is further linked to risky sexual behaviours among adolescents 7 , 8 . A higher proportion of low literacy in the Indian population leads to a low level of awareness of HIV/AIDS 9 . Furthermore, the awareness of HIV among adolescents is quite alarming 10 , 11 , 12 .

Unfortunately, there is a shortage of evidence on what predicts awareness of HIV among adolescents. Almost all the research in India is based on beliefs, attitudes, and awareness of HIV among adolescents 2 , 12 . However, few other studies worldwide have examined mass media as a strong predictor of HIV awareness among adolescents 13 . Mass media is an effective channel to increase an individuals’ knowledge about sexual health and improve understanding of facilities related to HIV prevention 14 , 15 . Various studies have outlined other factors associated with the increasing awareness of HIV among adolescents, including; age 16 , 17 , 18 , occupation 18 , education 16 , 17 , 18 , 19 , sex 16 , place of residence 16 , marital status 16 , and household wealth index 16 .

Several community-based studies have examined awareness of HIV among Indian adolescents 2 , 10 , 12 , 20 , 21 , 22 . However, studies investigating awareness of HIV among adolescents in a larger sample size remained elusive to date, courtesy of the unavailability of relevant data. Furthermore, no study in India had ever examined awareness of HIV among adolescents utilizing information on longitudinal data. To the author’s best knowledge, this is the first study in the Indian context with a large sample size that examines awareness of HIV among adolescents and combines information from a longitudinal survey. Therefore, this study intends to examine the change in the awareness level of HIV among adolescents. Furthermore, this study examined the factors associated with a change in awareness level on HIV-related information among adolescents over the period.

Data and methods

Data used for this study were drawn from Understanding the lives of adolescents and young adults (UDAYA), a longitudinal survey on adolescents aged 10–19 in Bihar and Uttar Pradesh 23 . The first wave was conducted in 2015–2016, and the follow-up survey was conducted after three years in 2018–2019 23 . The survey provides the estimates for state and the sample of unmarried boys and girls aged 10–19 and married girls aged 15–19. The study adopted a systematic, multi-stage stratified sampling design to draw sample areas independently for rural and urban areas. 150 primary sampling units (PSUs)—villages in rural areas and census wards in urban areas—were selected in each state, using the 2011 census list of villages and wards as the sampling frame. In each primary sampling unit (PSU), households to be interviewed were selected by systematic sampling. More details about the study design and sampling procedure have been published elsewhere 23 . Written consent was obtained from the respondents in both waves. In wave 1 (2015–2016), 20,594 adolescents were interviewed using the structured questionnaire with a response rate of 92%.

Moreover, in wave 2 (2018–2019), the study interviewed the participants who were successfully interviewed in 2015–2016 and who consented to be re-interviewed 23 . Of the 20,594 eligible for the re-interview, the survey re-interviewed 4567 boys and 12,251 girls (married and unmarried). After excluding the respondents who gave an inconsistent response to age and education at the follow-up survey (3%), the final follow-up sample covered 4428 boys and 11,864 girls with the follow-up rate of 74% for boys and 81% for girls. The effective sample size for the present study was 4421 unmarried adolescent boys aged 10–19 years in wave-1 and wave-2. Additionally, 7587 unmarried adolescent girls aged 10–19 years were interviewed in wave-1 and wave-2 23 . The cases whose follow-up was lost were excluded from the sample to strongly balance the dataset and set it for longitudinal analysis using xtset command in STATA 15. The survey questionnaire is available at https://dataverse.harvard.edu/file.xhtml?fileId=4163718&version=2.0 & https://dataverse.harvard.edu/file.xhtml?fileId=4163720&version=2.0 .

Outcome variable

HIV awareness was the outcome variable for this study, which is dichotomous. The question was asked to the adolescents ‘Have you heard of HIV/AIDS?’ The response was recorded as yes and no.

Exposure variables

The predictors for this study were selected based on previous literature. These were age (10–19 years at wave 1, continuous variable), schooling (continuous), any mass media exposure (no and yes), paid work in the last 12 months (no and yes), internet use (no and yes), wealth index (poorest, poorer, middle, richer, and richest), religion (Hindu and Non-Hindu), caste (Scheduled Caste/Scheduled Tribe, Other Backward Class, and others), place of residence (urban and rural), and states (Uttar Pradesh and Bihar).

Exposure to mass media (how often they read newspapers, listened to the radio, and watched television; responses on the frequencies were: almost every day, at least once a week, at least once a month, rarely or not at all; adolescents were considered to have any exposure to mass media if they had exposure to any of these sources and as having no exposure if they responded with ‘not at all’ for all three sources of media) 24 . Household wealth index based on ownership of selected durable goods and amenities with possible scores ranging from 0 to 57; households were then divided into quintiles, with the first quintile representing households of the poorest wealth status and the fifth quintile representing households with the wealthiest status 25 .

Statistical analysis

Descriptive analysis was done to observe the characteristics of unmarried adolescent boys and girls at wave-1 (2015–2016). In addition, the changes in certain selected variables were observed from wave-1 (2015–2016) to wave-2 (2018–2019), and the significance was tested using t-test and proportion test 26 , 27 . Moreover, random effect regression analysis 28 , 29 was used to estimate the association of change in HIV awareness among unmarried adolescents with household factors and individual factors. The random effect model has a specific benefit for the present paper's analysis: its ability to estimate the effect of any variable that does not vary within clusters, which holds for household variables, e.g., wealth status, which is assumed to be constant for wave-1 and wave-2 30 .

Table 1 represents the socio-economic profile of adolescent boys and girls. The estimates are from the baseline dataset, and it was assumed that none of the household characteristics changed over time among adolescent boys and girls.

Figure  1 represents the change in HIV awareness among adolescent boys and girls. The percentage of adolescent boys who had awareness regarding HIV increased from 38.6% in wave-1 to 59.9% in wave-2. Among adolescent girls, the percentage increased from 30.2% in wave-1 to 39.1% in wave-2.

figure 1

The percenate of HIV awareness among adolescent boys and girls, wave-1 (2015–2016) and wave-2 (2018–2019).

Table 2 represents the summary statistics for explanatory variables used in the analysis of UDAYA wave-1 and wave-2. The exposure to mass media is almost universal for adolescent boys, while for adolescent girls, it increases to 93% in wave-2 from 89.8% in wave-1. About 35.3% of adolescent boys were engaged in paid work during wave-1, whereas in wave-II, the share dropped to 33.5%, while in the case of adolescent girls, the estimates are almost unchanged. In wave-1, about 27.8% of adolescent boys were using the internet, while in wave-2, there is a steep increase of nearly 46.2%. Similarly, in adolescent girls, the use of the internet increased from 7.6% in wave-1 to 39.3% in wave-2.

Table 3 represents the estimates from random effects for awareness of HIV among adolescent boys and girls. It was found that with the increases in age and years of schooling the HIV awareness increased among adolescent boys ([Coef: 0.05; p  < 0.01] and [Coef: 0.04; p  < 0.01]) and girls ([Coef: 0.03; p  < 0.01] and [Coef: 0.04; p  < 0.01]), respectively. The adolescent boys [Coef: 0.06; p  < 0.05] and girls [Coef: 0.03; p  < 0.05] who had any mass media exposure were more likely to have an awareness of HIV in comparison to those who had no exposure to mass media. Adolescent boys' paid work status was inversely associated with HIV awareness about adolescent boys who did not do paid work [Coef: − 0.01; p  < 0.10]. Use of the internet among adolescent boys [Coef: 0.18; p  < 0.01] and girls [Coef: 0.14; p  < 0.01] was positively associated with HIV awareness in reference to their counterparts.

The awareness regarding HIV increases with the increase in household wealth index among both adolescent boys and girls. The adolescent girls from the non-Hindu household had a lower likelihood to be aware of HIV in reference to adolescent girls from Hindu households [Coef: − 0.09; p  < 0.01]. Adolescent girls from non-SC/ST households had a higher likelihood of being aware of HIV in reference to adolescent girls from other caste households [Coef: 0.04; p  < 0.01]. Adolescent boys [Coef: − 0.03; p  < 0.01] and girls [Coef: − 0.09; p  < 0.01] from a rural place of residence had a lower likelihood to be aware about HIV in reference to those from the urban place of residence. Adolescent boys [Coef: 0.04; p  < 0.01] and girls [Coef: 0.02; p  < 0.01] from Bihar had a higher likelihood to be aware about HIV in reference to those from Uttar Pradesh.

This is the first study of its kind to address awareness of HIV among adolescents utilizing longitudinal data in two indian states. Our study demonstrated that the awareness of HIV has increased over the period; however, it was more prominent among adolescent boys than in adolescent girls. Overall, the knowledge on HIV was relatively low, even during wave-II. Almost three-fifths (59.9%) of the boys and two-fifths (39.1%) of the girls were aware of HIV. The prevalence of awareness on HIV among adolescents in this study was lower than almost all of the community-based studies conducted in India 10 , 11 , 22 . A study conducted in slums in Delhi has found almost similar prevalence (40% compared to 39.1% during wave-II in this study) of awareness of HIV among adolescent girls 31 . The difference in prevalence could be attributed to the difference in methodology, study population, and study area.

The study found that the awareness of HIV among adolescent boys has increased from 38.6 percent in wave-I to 59.9 percent in wave-II; similarly, only 30.2 percent of the girls had an awareness of HIV during wave-I, which had increased to 39.1 percent. Several previous studies corroborated the finding and noticed a higher prevalence of awareness on HIV among adolescent boys than in adolescent girls 16 , 32 , 33 , 34 . However, a study conducted in a different setting noticed a higher awareness among girls than in boys 35 . Also, a study in the Indian context failed to notice any statistical differences in HIV knowledge between boys and girls 18 . Gender seems to be one of the significant determinants of comprehensive knowledge of HIV among adolescents. There is a wide gap in educational attainment among male and female adolescents, which could be attributed to lower awareness of HIV among girls in this study. Higher peer victimization among adolescent boys could be another reason for higher awareness of HIV among them 36 . Also, cultural double standards placed on males and females that encourage males to discuss HIV/AIDS and related sexual matters more openly and discourage or even restrict females from discussing sexual-related issues could be another pertinent factor of higher awareness among male adolescents 33 . Behavioural interventions among girls could be an effective way to improving knowledge HIV related information, as seen in previous study 37 . Furthermore, strengthening school-community accountability for girls' education would augment school retention among girls and deliver HIV awareness to girls 38 .

Similar to other studies 2 , 10 , 17 , 18 , 39 , 40 , 41 , age was another significant determinant observed in this study. Increasing age could be attributed to higher education which could explain better awareness with increasing age. As in other studies 18 , 39 , 41 , 42 , 43 , 44 , 45 , 46 , education was noted as a significant driver of awareness of HIV among adolescents in this study. Higher education might be associated with increased probability of mass media and internet exposure leading to higher awareness of HIV among adolescents. A study noted that school is one of the important factors in raising the awareness of HIV among adolescents, which could be linked to higher awareness among those with higher education 47 , 48 . Also, schooling provides adolescents an opportunity to improve their social capital, leading to increased awareness of HIV.

Following previous studies 18 , 40 , 46 , the current study also outlines a higher awareness among urban adolescents than their rural counterparts. One plausible reason for lower awareness among adolescents in rural areas could be limited access to HIV prevention information 16 . Moreover, rural–urban differences in awareness of HIV could also be due to differences in schooling, exposure to mass media, and wealth 44 , 45 . The household's wealth status was also noted as a significant predictor of awareness of HIV among adolescents. Corroborating with previous findings 16 , 33 , 42 , 49 , this study reported a higher awareness among adolescents from richer households than their counterparts from poor households. This could be because wealthier families can afford mass-media items like televisions and radios for their children, which, in turn, improves awareness of HIV among adolescents 33 .

Exposure to mass media and internet access were also significant predictors of higher awareness of HIV among adolescents. This finding agrees with several previous research, and almost all the research found a positive relationship between mass-media exposure and awareness of HIV among adolescents 10 . Mass media addresses such topics more openly and in a way that could attract adolescents’ attention is the plausible reason for higher awareness of HIV among those having access to mass media and the internet 33 . Improving mass media and internet usage, specifically among rural and uneducated masses, would bring required changes. Integrating sexual education into school curricula would be an important means of imparting awareness on HIV among adolescents; however, this is debatable as to which standard to include the required sexual education in the Indian schooling system. Glick (2009) thinks that the syllabus on sexual education might be included during secondary schooling 44 . Another study in the Indian context confirms the need for sex education for adolescents 50 , 51 .

Limitations and strengths of the study

The study has several limitations. At first, the awareness of HIV was measured with one question only. Given that no study has examined awareness of HIV among adolescents using longitudinal data, this limitation is not a concern. Second, the study findings cannot be generalized to the whole Indian population as the study was conducted in only two states of India. However, the two states selected in this study (Uttar Pradesh and Bihar) constitute almost one-fourth of India’s total population. Thirdly, the estimates were provided separately for boys and girls and could not be presented combined. However, the data is designed to provide estimates separately for girls and boys. The data had information on unmarried boys and girls and married girls; however, data did not collect information on married boys. Fourthly, the study estimates might have been affected by the recall bias. Since HIV is a sensitive topic, the possibility of respondents modifying their responses could not be ruled out. Hawthorne effect, respondents, modifying aspect of their behaviour in response, has a role to play in HIV related study 52 . Despite several limitations, the study has specific strengths too. This is the first study examining awareness of HIV among adolescent boys and girls utilizing longitudinal data. The study was conducted with a large sample size as several previous studies were conducted in a community setting with a minimal sample size 10 , 12 , 18 , 20 , 53 .

The study noted a higher awareness among adolescent boys than in adolescent girls. Specific predictors of high awareness were also noted in the study, including; higher age, higher education, exposure to mass media, internet use, household wealth, and urban residence. Based on the study findings, this study has specific suggestions to improve awareness of HIV among adolescents. There is a need to intensify efforts in ensuring that information regarding HIV should reach vulnerable sub-groups as outlined in this study. It is important to mobilize the available resources to target the less educated and poor adolescents, focusing on rural adolescents. Investment in education will help, but it would be a long-term solution; therefore, public information campaigns could be more useful in the short term.

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This paper was written using data collected as part of Population Council’s UDAYA study, which is funded by the Bill and Melinda Gates Foundation and the David and Lucile Packard Foundation. No additional funds were received for the preparation of the paper.

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Conception and design of the study: S.S. and P.K.; analysis and/or interpretation of data: P.K. and S.S.; drafting the manuscript: S.C., and R.P.; reading and approving the manuscript: S.S., P.K., S.C. and R.P.

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Srivastava, S., Chauhan, S., Patel, R. et al. A study of awareness on HIV/AIDS among adolescents: A Longitudinal Study on UDAYA data. Sci Rep 11 , 22841 (2021). https://doi.org/10.1038/s41598-021-02090-9

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hiv awareness research paper in the philippines

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

Affiliations.

  • 1 Hawaii Center for AIDS, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA.
  • 2 Love Yourself, Inc., Mandaluyong 1552, Metro Manila, Philippines.
  • PMID: 37235306
  • PMCID: PMC10224495
  • DOI: 10.3390/tropicalmed8050258

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.

Keywords: AIDS; HIV; Philippines; human immunodeficiency virus; public health.

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  • Open access
  • Published: 16 December 2022

Association of anticipated HIV testing stigma and provider mistrust on preference for HIV self-testing among cisgender men who have sex with men in the Philippines

  • Olivia T. Sison 1 , 2 , 3 , 4 ,
  • Emmanuel S. Baja 3 , 4 ,
  • Amiel Nazer C. Bermudez 1 , 2 , 5 ,
  • Ma. Irene N. Quilantang 2 , 6 , 7 ,
  • Godofreda V. Dalmacion 4 ,
  • Ernest Genesis Guevara 3 ,
  • Rhoda Myra Garces-Bacsal 8 ,
  • Charlotte Hemingway 9 ,
  • Miriam Taegtmeyer 9 , 10 ,
  • Don Operario 2 , 11 &
  • Katie B. Biello 1 , 6  

BMC Public Health volume  22 , Article number:  2362 ( 2022 ) Cite this article

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Metrics details

New HIV infections in the Philippines are increasing at an alarming rate. However, over three quarters of men who have sex with men (MSM) have never been tested for HIV. HIV self-testing (HIVST) may increase overall testing rates by removing barriers, particularly fear of stigmatization and mistrust of providers. This study aimed to determine if these factors are associated with preference for HIVST among Filipino cisgender MSM (cis-MSM), and whether there is an interaction between anticipated HIV testing stigma and provider mistrust on preference for HIVST.

We conducted secondary analysis of a one-time survey of 803 cis-MSM who were recruited using purposive sampling from online MSM dating sites and MSM-themed bar locations in Metro Manila, Philippines. Summary statistics were computed to describe participant characteristics. Multivariable modified Poisson regression analyses were conducted to determine if anticipated HIV testing stigma and provider mistrust were associated with preference for HIVST among cis-MSM. Other variables such as age, education, monthly income, relationship status, HIV serostatus, and knowing where to get HIV testing were the minimal sufficient adjustment set in the analyses.

Average age of participants was 28.6 years (SD = 8.0); most had received college degrees (73%) and were employed (80%). Most respondents (81%) preferred facility-based testing, while 19% preferred HIVST. A high percentage of participants reported anticipated HIV testing stigma (66%) and provider mistrust (44%). Anticipated HIV testing stigma (aPR = 1.51; 95% CI = 1.01–2.25, p  = 0.046) and provider mistrust (aPR = 1.49; 95% CI = 1.07–2.09, p  = 0.020) were independently associated with a preference for HIVST. There was a positive, additive interaction between provider mistrust and anticipated HIV testing stigma on preference for HIVST (RERI = 1.13, 95% CI: 0.20–2.06; p  = 0.017), indicating that the association between anticipated HIV testing stigma and preference for HIVST is greater among those with provider mistrust compared to those without provider mistrust.

Conclusions

HIVST should be offered as a supplement to traditional facility-based HIV testing services in the Philippines to expand testing and reach individuals who may not undergo testing due to anticipated HIV testing stigma and provider mistrust.

Peer Review reports

The rate of increase in new HIV infections in the Philippines is alarming [ 1 ]. On average, 42 new HIV cases per day were diagnosed in 2022 compared to 25 cases per day in 2016 and nine cases per day in 2012 [ 2 , 3 , 4 ]. Eighty-five percent of all diagnosed HIV cases in the Philippines from 2017 to 2022 were among men who have sex with men (MSM), the majority of whom were adolescents (30%) and young adults (50%) [ 3 ].

The HIV prevention continuum highlights the importance of HIV testing as an essential first step in both prevention and treatment cascades [ 5 ]. However, studies in Europe, the United States (US), South Africa, and the Philippines reported that low HIV testing uptake is associated with: sociodemographic factors such as younger age, lower education level, and higher socioeconomic status; lack of accessibility to services; lack of awareness of HIV testing and counseling; number of sexual partners; health care provider factors (e.g. onward referral due to avoidance of the issue of HIV testing); unfriendly testing environments; and psychosocial factors such as fear of rejection and disclosure, and HIV-related stigma and discrimination [ 6 , 7 , 8 , 9 , 10 , 11 ].

Voluntary facility-based testing is the primary model of HIV testing in the Philippines [ 12 , 13 , 14 ]. The most common facilities providing HIV testing services in the Philippines include hospitals, health clinics, or community-based organizations [ 12 , 13 , 14 ]. According to the Philippine Department of Health (DOH) Integrated HIV Behavioral and Serologic Surveillance data, HIV testing uptake among key populations (e.g., sex workers, MSM, people who inject drugs, transgender people) in the Philippines is low. Only 22 to 28% of MSM in the Philippines have received HIV testing between 2015 to 2019 [ 15 , 16 ]. During the first year of the COVID-19 pandemic, HIV testing in the Philippines decreased by 61% due to community restrictions that disrupted access to facility-based HIV testing services [ 14 , 17 ].

To achieve the United Nations 90–90-90 global HIV targets, with the goal of diagnosing 90% of all people living with HIV (PLHIV), providing antiretroviral therapy (ART) to 90% of those diagnosed with HIV, and achieving viral suppression for 90% of those receiving ART by 2020, the World Health Organization (WHO) launched a set of consolidated guidelines in 2016 for HIV testing services [ 5 ]. The guidelines emphasize the promise of HIV self-testing (HIVST) as an additional approach to increase HIV testing coverage, especially among MSM and other key populations [ 18 ]. Given the significant progress in addressing HIV globally, the United Nations updated the global HIV targets in 2020 and increased them to 95–95-95 [ 19 ]. This reflects the intention to diagnose 95% of all PLHIV by 2025. In response, the Philippine DOH issued an Administrative Order (AO No. 2022–0035) in August 2022 to include HIVST as one of the HIV testing options available at the primary care level in the country [ 20 ].

Previous studies in Australia, the US, Africa, and Hong Kong have shown that HIVST was generally acceptable among MSM, and that it increased HIV testing coverage because of its convenience while ensuring confidentiality and privacy [ 21 , 22 ]. Convenience, privacy, and confidentiality are motivating factors for HIVST in the Philippines [ 23 ]. A qualitative study in 2017 of key informants and stakeholders from the MSM and transgender women (TGW) communities in the Philippines found HIVST was acceptable as an additional approach to HIV testing services [ 12 ]. Due to limited access to facility-based testing services during the COVID-19 pandemic, demonstration studies were conducted in Metro Manila and Western Visayas in the Philippines and showed that HIVST was acceptable and feasible among MSM and TGW, and reactivity rate was 8–10% [ 23 , 24 , 25 ]. In these demonstration studies, HIVST was made available using courier delivery methods and via in-clinic appointments.

The acceptability and feasibility from these demonstration studies showed the promise of HIVST as a strategy to increase HIV testing coverage among key populations in the Philippines. However, factors contributing to HIVST uptake in the country must be further studied as there still remain some concerns regarding accessing the service, particularly the lack of privacy and maintenance of confidentiality during delivery of HIVST kits [ 23 ]. Studies on preference for HIVST, including identifying motivating factors as well as barriers to use, can guide HIVST roll out in the country.

Studies in the US found that experiencing stigma and medical-related mistrust have each been associated with lower engagement in care or underutilization of health services [ 11 , 26 , 27 , 28 , 29 , 30 ]. In particular, anticipated stigma was found to be a significant predictor of HIV testing behavior [ 31 , 32 ]. Anticipated stigma refers to an individual’s expectation to experience prejudice and discrimination from others in the future [ 33 ]. In a scoping review of health-related stigma outcomes in low- and middle-income countries, anticipated stigma was associated with decreased voluntary HIV testing [ 34 ]. Our study explored two specific areas of medical-related mistrust: mistrust in health care providers and mistrust in the health care facility [ 35 ]. Higher levels of provider mistrust among people living with HIV have previously been associated with suboptimal engagement with health care [ 11 ]. Provider mistrust and stigma are important determinants for poorer health outcomes because these potentially modifiable factors might influence health care utilization and thus affect the overall health among the high-risk groups. The additive effects of experiencing both anticipated stigma and provider mistrust have received limited research attention and deserve attention. A systematic review of research conducted in multiple global contexts found that HIVST is particularly promising among MSM who often encounter structural barriers, such as stigma and discrimination, that deter them from accessing HIV-related services [ 36 , 37 ].

To date, there is a paucity of data in the Philippines on preferences for HIVST among MSM and correlates of HIVST preferences in this population. This study aimed to (i) determine the percentage of cis-MSM in the Philippines who prefer HIVST rather than the traditional facility-based HIV testing services, (ii) determine if anticipated HIV testing stigma and provider mistrust were associated with preference for HIVST among Filipino cis-MSM, and (iii) examine whether there is an interaction between anticipated HIV testing stigma and provider mistrust on preference for HIVST.

Study design and setting

This study analyzed data from the HIV Gaming, Engaging, and Testing (HIV GET) Project, which had an overarching aim to develop and evaluate a mobile game application to address identified barriers to HIV services [ 38 ]. Targeted messaging was used to recruit HIV GET study participants via posting of study flyers and in-person outreach at venues where MSM frequent, and advertisements on MSM dating sites (e.g., Grindr, Planet Romeo, and GROWLr) and MSM-themed bar locations in Quezon City, Philippines. Participants were eligible if they were at least 18 years old, assigned male sex at birth, self-identified as MSM, and were able to give informed consent. Given the overarching project aims, HIV status was not a criterion for enrollment. Using purposive sampling, a total of 899 participants completed the survey between October and November 2016. We excluded in the analytic sample participants who did not identify as cis-MSM and those who self-reported to be HIV positive. A total of 803 cis-MSM was included in this secondary analysis. More than a quarter of these participants resided outside Metro Manila.

Screening questions were used to identify eligible participants, and those who were eligible were redirected to the main survey questionnaire page. Participants recruited from bar locations completed a survey administered via mobile tablet. Participants recruited via social media platforms responded to study informational messages posted on targeted websites. Those who clicked the advertisement on these sites were redirected to the informed consent page for the online survey. Survey questions were in English and Tagalog (local language). The survey questions were developed based on findings from an unpublished qualitative study among MSM, TGW, and HIV service providers [ 38 ]. Survey participants were not compensated in this study.

Dependent variable

Preferred HIV testing method. Participants selected their preferred HIV testing method from the following options: (1) hospital-based testing, (2) clinic-based testing (social hygiene clinics) , (3) home-based testing with a health worker, (4) community-based testing with a health worker, and (5) self-testing. This was coded as a binary variable (HIV self-testing vs. any other preferred option).

Independent variables

We assessed anticipated HIV testing stigma and provider mistrust as exposures of interest . As noted, items for both constructs were based on preliminary findings from a qualitative study of HIV testing preferences among key populations in the Philippines [ 38 ]. Anticipated HIV testing stigma was measured based on respondents’ level of agreement with the following statements: (1) I feel like I would be stigmatized going to an HIV/AIDS testing facility, (2) I worry about being recognized at the HIV/AIDS testing facility, (3) I feel like the staff would disrespect me (Cronbach α = 0.80) . Provider mistrust was assessed based on respondents’ level of agreement with the following statements: (1) I don’t think there will be anyone in the HIV/AIDS testing facility that I can trust to talk to , (2) I don’t trust the counselors at the HIV/AIDS testing facility , (3) I don’t trust the people that take your blood at the HIV/AIDS testing facility , (4) I don’t trust the results you get at the HIV/AIDS testing facility (Cronbach α = 0.89). The level of agreement for the statements was measured using a 7-point Likert scale (strongly disagree to strongly agree), and responses were dichotomized. If respondents agreed or strongly agreed to at least one of the statements indicative of anticipated HIV testing stigma and provider mistrust, they were coded as experiencing anticipated HIV testing stigma and provider mistrust, respectively.

Sociodemographic and other participant characteristics

The respondent’s age in years was categorized as 18–24, 25–34, ≥35. Educational attainment was coded as a binary variable (graduated from college or higher vs. some college and below). Monthly income was categorized based on a defined poverty threshold as 10,000 pesos and below (≤USD 207) or more than 10,000 pesos (>USD 207) [ 39 ]. Participants’ relationship status was classified as follows: single, not looking for a relationship; single, looking only for serious relationship; single, looking only for casual relationships; in a relationship, exclusive; and in a relationship, open. Participants’ recent HIV testing experience was probed (never been tested, past 12 months, more than a year ago), and their self- reported awareness of HIV status was categorized as HIV negative, HIV positive, unsure, did not want to answer. Those who self-reported to be HIV positive were excluded in the analytic sample. They were also asked if they knew where to get HIV testing (yes vs. no). Survey respondents were asked about their sexual orientation with the following response options: (1) heterosexual, (2) gay/homosexual, (3) bisexual, (4) discreet (do not openly disclose sexual activities), (5) not in any category.

Data analysis

Frequencies and percentages were calculated for categorical variables. Means, standard deviations, and ranges were calculated for continuous variables. To determine the internal consistency of our scale variables, we computed for Cronbach’s alpha. Separate bivariable modified Poisson regressions were performed to estimate the prevalence ratios for the association between preference for HIVST and the following covariates: age, relationship status, level of education, employment status, monthly income, knowing where to get HIV testing, recent HIV test, awareness of HIV status, anticipated HIV testing stigma, and provider mistrust. Modified Poisson regression was used to estimate prevalence ratios rather than odds ratios because the dependent variable was not rare [ 40 , 41 ]. Directed acyclic graphs (DAG) were constructed to determine the minimum set of covariates to adjust for in the analysis of the association between anticipated HIV testing stigma and preference for HIVST, and provider mistrust and preference for HIVST using Causal Fusion (See Additional file  1 ) [ 42 ]. All variables included in the DAG, as well as their interrelationships were determined a priori through expert knowledge and literature review. Using the DAGs constructed for this study, the association of the exposure variables with preference for HIVST was considered unbiased given a set of covariates S if, after conditioning on S , the open paths between the exposure variables and preference for HIVST were exactly the directed paths from the exposure variables to preference for HIVST. A variable was considered a component of S if conditioning on it blocks biasing backdoor paths [ 43 ]. For our study, the minimal sufficient adjustment set includes age [ 8 , 31 , 44 , 45 , 46 ], level of education [ 8 , 45 , 46 , 47 ], monthly income [ 10 , 46 ], relationship status [ 8 , 48 ], awareness of HIV status [ 6 , 49 ], and knowing where to get HIV testing [ 7 , 8 , 9 , 10 ]. Multivariable modified Poisson regression analyses were performed to estimate prevalence ratios for the association of exposure variables and preference for HIVST, adjusting for the covariates described previously. Separate generalized linear models with Poisson distribution and log link were constructed with anticipated HIV testing stigma and provider mistrust as independent variables in the two models (Models 1 and 2). A third model was constructed to explore the interaction between anticipated HIV testing stigma and provider mistrust on preference for HIVST (Model 3). The statistical interaction on the additive scale between anticipated HIV testing stigma and provider mistrust was determined by estimating the relative excess risk due to interaction (RERI) and its 95% confidence interval (CI), following the method outlined by VanderWeele [ 50 ]. A RERI of greater than zero denotes a positive interaction on the additive scale between anticipated HIV testing stigma and provider mistrust on preference for HIVST. Positive interaction in this study would denote a stronger association between anticipated HIV testing stigma and preference for HIVST among those who have provider mistrust compared to those who do not have provider mistrust. Estimating interaction on the additive scale is considered more relevant in evaluating the public health impact, as it suggests which exposure group to target for an intervention [ 50 ]. The ratio of prevalence ratios was also reported as the measure of multiplicative interaction, where a ratio of one means no interaction and a ratio bigger than one indicates positive interaction on the multiplicative scale. Adjusted prevalence ratios (aPR) and their 95% CIs relating the independent variables and preference for HIVST are presented [ 51 ]. Data management and statistical analyses were performed using Stata version 16 [ 52 ].

Table  1 summarizes the overall sample characteristics of the participants. In brief, survey participants were between 18 and 61 years old with an average age of 28.6 years (SD = 8.0), mostly with college degrees (73%) and employed (80%). The majority of the sample identified as gay/homosexual, more than a quarter identified as bisexual, while 17% did not openly disclose their sexual orientation. More than half (57%) reported to be HIV negative and one-third were unsure of their HIV status. Almost half (45%) of the respondents had undergone HIV testing in the past 12 months. However, 37% ( N  = 293) had never been tested for HIV, although 70% of all participants knew where to get HIV testing. Almost two out of ten (19%) preferred HIV self-testing over in-person, facility-based HIV testing methods.

Table  2 presents participants’ level of agreement with items assessing for anticipated HIV testing stigma and provider mistrust. Overall, 66% ( N  = 519) agreed to at least one statement pertaining to anticipated HIV testing stigma, while 44% ( N  = 338) reported mistrust of health care providers in the testing facilities.

Table  3 presents (i) bivariable associations between all covariates and preference for HIVST, and (ii) adjusted associations of anticipated HIV testing stigma and provider mistrust with preference for HIVST. Participants who preferred HIVST tended to be older, unsure of their HIV status, did not know where to get HIV testing, and had never been tested for HIV nor was currently engaged in routine testing. Both anticipated HIV testing stigma and provider mistrust were associated with participants’ preference for HIVST over the other HIV testing methods. In adjusted analyses, anticipated HIV testing stigma was associated with a 51% increase in the prevalence of HIVST preference (aPR = 1.51; 95% CI = 1.01–2.25, p  = 0.046), and provider mistrust was associated with a 49% increase in the prevalence of HIVST preference (aPR = 1.49; 95% CI = 1.07–2.09, p  = 0.020).

There was a significant positive, additive interaction between provider mistrust and anticipated HIV testing stigma on preference for HIVST (RERI = 1.13, 95% CI: 0.20–2.06; p  = 0.017), indicating the association between anticipated HIV testing stigma and preference for HIVST is greater among those with provider mistrust compared to those without provider mistrust. On the multiplicative scale, there was a positive interaction trend between provider mistrust and anticipated HIV testing stigma on preference for HIVST, but this fell short of statistical significance ( p = 0.168 ). Table  4 summarizes the stratified results. After adjusting for all covariates, provider mistrust was positively and significantly associated with preference for HIVST (aPR = 1.54; 95% CI = 1.00–2.36, p  = 0.050) among those with anticipated HIV testing stigma, and anticipated HIV testing stigma was also positively but non-significantly associated with preference for HIVST among respondents who reported to have provider mistrust (aPR = 3.71; 95% CI = 0.67–20.39, p  = 0.132).

Our study is the first known quantitative assessment of preference for HIVST among cis-MSM in the Philippines, who comprise more than 80% of all diagnosed HIV cases in the country [ 4 ]. Over 60% of survey participants had ever been tested for HIV with 45% having been tested in the past 12 months. This percentage was higher than the reported estimate that only 22% of Filipino MSM had ever been tested for HIV [ 15 ]. It is possible that because survey respondents were recruited in social venues where HIV prevention and testing messages exist, members of this study sample were more likely to have been tested for HIV.

Almost one fifth of the survey participants (155/803) preferred HIVST. This subgroup tended to be older, unsure of their HIV status, did not know where to get HIV testing, and had never been tested for HIV nor was currently engaged in routine testing. Compared to previous studies in other parts of the world which found that HIVST was highly acceptable to target users including MSM [ 12 , 44 , 53 , 54 , 55 , 56 ], the percentage of MSM in our sample who preferred HIVST was lower than expected. One possible reason for the lower preference for HIVST in this group is the moderate level of awareness about HIVST in the study sample. At the time of this report, only 56% of MSM in the Philippines had heard about HIVST [ 57 ]. Moreover, at the time of data collection for this study, HIVST was also not yet included in the national HIV testing policies and guidelines in the Philippines and WHO-approved self-test kits are unavailable. These may have contributed to lower than expected levels of preference for HIVST observed here.

More than half of the participants in the sample preferred facility-based HIV testing. Similar studies in the United Kingdom (UK) and Ireland conducted after the timing of our survey also found MSM still prefer facility-based HIV testing [ 58 , 59 ]. Some possible reasons for choosing facility-based HIV testing include the opportunity for engagement with a live, in-person counselor and access to ancillary services (e.g., referrals to mental health or social service programs; linkage to HIV care for those testing HIV positive) provided in the testing facility [ 21 ]. Preference for HIVST in this population is likely to increase as awareness of and trust in this testing modality grow in the Philippines. This was evident during the COVID-19 pandemic when community quarantines were enforced and access to in-clinic testing were limited [ 17 , 25 ]. HIV-focused community-based organizations (CBO) reported that delivery of HIV-related services, including HIVST, and conduct of HIVST with assistance by an HIV counselor via online platforms ensured that HIV testing services were continuously accessible to key populations and even first time users during the pandemic [ 17 , 25 , 60 ]. Given the confidentiality, privacy, and independence that HIVST provides, as well as the convenience of accessing it, if accessed via courier services facilitated by CBOs or HIV treatment facilities, HIVST proves to be a promising HIV-related service in the Philippines [ 17 , 23 , 25 , 60 ]. Thus, HIVST can be considered as supplementary to facility-based testing rather than needing to replace traditional HIV testing services [ 61 ]. Traditional HIV testing and HIVST may co-exist in the HIV testing services framework [ 62 ]. In fact, a meta-analysis conducted in 2017 showed that providing HIVST in addition to traditional testing modality significantly increased HIV testing uptake [ 22 , 63 ].

Provider mistrust and stigma are salient barriers to healthcare utilization and affect the overall health among vulnerable high-risk groups such as MSM [ 11 , 26 , 27 , 28 , 30 , 31 , 32 , 64 ]. A global systematic review including 18 studies reported that preferences for HIVST was due to increased convenience and confidentiality, especially among stigmatized populations and decreased test-associated stigma [ 65 ]. A significant percentage of our study participants reported anticipated HIV testing stigma and mistrust of health care providers in the testing facilities. Both anticipated HIV testing stigma and provider mistrust were associated with preference for HIVST. These findings are consistent with previous studies reporting that stigma and physician mistrust were associated with HIV testing behavior and utilization of health services among MSM [ 11 , 27 , 28 , 30 , 31 , 32 ]. Our findings suggest an opportunity to increase HIV testing in the Philippines by offering HIVST as an option for individuals concerned about stigma and provider mistrust. Moreover, efforts to rebuild trust in health care providers and address sources of stigma among Filipino MSM and other key populations are also needed to improve HIV testing uptake and engage members of these groups in necessary healthcare services. Indeed, as an early effort to address this concern, a “sundown clinic” (i.e., one that operates beyond traditional “daylight” working hours) was established in Quezon City, Philippines in 2012 and was considered non-stigmatizing and a safe space for MSM and transgender people for receiving HIV testing and counseling services [ 66 ]. However, future efforts to scale-up this initiative to different areas in the country are much needed.

There are several limitations of the study. First, participants were recruited via MSM social venues and mobile dating apps, and most of the participants were between 18 to 34 years old and were highly educated and employed. Thus, this study sample population may not reflect the Philippines’ general MSM population. Second, sexual behaviors were not measured, and HIV status was assessed via self-report. Therefore, the risk for HIV infection/transmission in our sample population is unclear. Third, social desirability may have led to overreporting of recent HIV testing and underreporting of HIV serostatus. Fourth, residual confounding may have been introduced due to possible unmeasured confounders, such as health service delivery and health provider factors that were not assessed in our study. We recommend future research studies investigate these multilevel determinants, and possibly examine contextual effects. Future research studies should look into other forms of stigma, the differences in experiences in health care stigma, and the difference in attitudes towards HIVST based on gender identity and sexuality. Fifth, exposure misclassification may have been introduced due to the limitations inherent to the secondary analysis of an existing dataset; however, we assume that these exposure misclassifications are likely to be non-differential with respect to the outcome, given that exposure definitions were developed post-data collection stage. A total of 223 (28%) of the observations were excluded in the adjusted analysis due to missing information mostly on income and some other covariates. There was no evidence of an association between missingness and our primary outcome, and that the complete case analysis estimates of exposure associations can be asymptotically unbiased [ 67 ]. Finally, due to the cross-sectional nature of the study, findings are descriptive and preclude temporal or causal inferences.

This study conducted among cis-MSM in the Philippines suggests that one out of five cis-MSM preferred HIVST over the traditional HIV testing strategies. An upsurge in preference for HIVST among cis-MSM in the Philippines may increase with expanded campaigns to raise awareness, understanding, and access to HIVST methods in the future. Moreover, Philippines national HIVST guidelines and access to WHO-approved HIVST materials are likely to increase levels of awareness, acceptability, and uptake of HIVST. Therefore, our findings reported here offer a baseline description of preference for HIVST prior to the implementation of structural programs to promote HIVST. In addition, anticipated HIV testing stigma and mistrust of health care providers in the testing facilities were reported, and both factors were associated with a higher prevalence of HIVST preference. HIVST represents a compelling complementary option to traditional HIV testing services in the Philippines, which can expand testing among cis-MSM who do not undergo testing due to anticipated HIV testing stigma and provider mistrust and provide differentiated HIV testing service delivery options to specific subgroups among key populations.

Availability of data and materials

The datasets generated and/or analyzed during the current study are available in the Harvard Dataverse repository, https://doi.org/10.7910/DVN/PFUMZM .

Abbreviations

Acquired immunodeficiency syndrome

Confidence Interval

Directed acyclic graph

Department of Health

Human immunodeficiency virus

HIV Gaming, Engaging, and Testing

  • HIV self-testing

Men who have sex with men

People Living with HIV

Prevalence Ratio

Relative Excess Risk due to Interaction

Standard Deviation

Transgender women

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Acknowledgements

We would like to acknowledge the participants of this study, the HIV Gaming, Engaging, and Testing (HIV GET) project research team from the University of the Philippines-Manila, Klinika Bernardo, Love Yourself Anglo, and the Liverpool School of Tropical Medicine, and the Philippine-UK Newton-Agham Program of the Medical Research Council, United Kingdom and the Philippine Council for Health Research and Development, Department of Science and Technology, Philippines.

This work was supported by the National Institutes of Health-Fogarty International Centre under Grant D43TW010565–02. Ms. Sison was a Graduate Fellow under the grant of Brown University and University of the Philippines Training Program for the Prevention of HIV in Vulnerable Populations. Dr. Baja’s effort was supported by the Newton Agham Grant through the UK Medical Research Council and Philippines Council for Health Research and Development, Department of Science and Technology (FP160001). The views and opinions expressed in this article are solely those of the authors and do not necessarily represent the official views of the sponsor. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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OS, EB, AB, MIQ, GD, EG, CH, MT, DO and KB were involved in the conceptualization of this paper. EB, GD, EG, RB, CH, and MT collected the data. OS, DO, and KB designed the analysis for this paper. OS conducted the data analysis and wrote the paper. OS, EB, MIQ, and DO revised the manuscript. All authors read and approved the final manuscript.

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OS: Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA; The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island, USA; Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Philippines.

EB: Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Philippines.

AB: Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA; The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island, USA; Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Philippines.

MIQ: Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA; The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island, USA; Department of Behavioral Sciences, College of Arts and Sciences, University of the Philippines Manila, Philippines.

GD: Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Philippines.

EG: Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Philippines.

RB: Department of Special Education, College of Education, United Arab Emirates University, P.O. Box 15551, Al Ain, UAE.

CH: Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Palace Liverpool, Liverpool L3 5QA, UK.

MT: Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Palace Liverpool, Liverpool L3 5QA, UK; Tropical Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.

DO: The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, Rhode Island, USA; Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

KB: Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA.

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Sison, O.T., Baja, E.S., Bermudez, A.N.C. et al. Association of anticipated HIV testing stigma and provider mistrust on preference for HIV self-testing among cisgender men who have sex with men in the Philippines. BMC Public Health 22 , 2362 (2022). https://doi.org/10.1186/s12889-022-14834-x

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Determinants of HIV testing among Filipino women: Results from the 2013 Philippine National Demographic and Health Survey

Roles Conceptualization, Formal analysis, Methodology, Writing – original draft

* E-mail: [email protected]

Affiliations Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom, Center for Research and Innovation, School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines

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Roles Conceptualization, Methodology, Supervision, Writing – review & editing

Affiliations Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

  • Veincent Christian F. Pepito, 

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  • Published: May 12, 2020
  • https://doi.org/10.1371/journal.pone.0232620
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26 Jan 2021: Pepito VCF, Newton S (2021) Correction: Determinants of HIV testing among Filipino women: Results from the 2013 Philippine National Demographic and Health Survey. PLOS ONE 16(1): e0246013. https://doi.org/10.1371/journal.pone.0246013 View correction

Table 1

The prevalence of having ever tested for HIV in the Philippines is very low and is far from the 90% target of the Philippine Department of Health (DOH) and UNAIDS, thus the need to identify the factors associated with ever testing for HIV among Filipino women.

We analysed the 2013 Philippine National Demographic and Health Survey (NDHS). The NDHS is a nationally representative survey which utilized a two-stage stratified design to sample Filipino women aged 15–49. We considered the following exposures in our study: socio-demographic characteristics of respondent and her partner (i.e., age of respondent, age of partner, wealth index, etc.), sexual practices and contraception (i.e., age at first intercourse, condom use, etc.), media access, tobacco use, HIV knowledge, tolerance to domestic violence, and women’s empowerment. The outcome variable is HIV testing. We used logistic regression for survey data to study the said associations.

Out of 16,155 respondents, only 372 (2.4%) have ever tested for HIV. After adjusting for confounders, having tertiary education (adjusted odds ratio (aOR) = 2.15; 95% Confidence Interval (CI): 1.15–4.04), living with partner (aOR = 1.72; 95% CI: 1.19–2.48), tobacco use (aOR = 1.87; 95% CI: 1.13–3.11); belonging to the middle class (aOR = 2.72; 95% CI: 1.30–5.67), richer (aOR = 3.00; 95% CI: 1.37–5.68), and richest (aOR = 4.14; 95% CI: 1.80–5.91) populations, having weekly television access (aOR = 1.75; 95% CI: 1.04–2.94) or internet access (aOR = 2.01; 95% CI: 1.35–3.00), living in a rural area (aOR = 1.87; 95% CI: 1.34–2.61); and being a Muslim (aOR = 2.30; 95% CI: 1.15–4.57) were associated with ever testing for HIV.

Conclusions

The low percentage of respondents who test for HIV is a call to further strengthen efforts to promote HIV testing among Filipino women. Information on its determinants can be used to guide the crafting and implementation of interventions to promote HIV testing to meet DOH and UNAIDS targets.

Citation: Pepito VCF, Newton S (2020) Determinants of HIV testing among Filipino women: Results from the 2013 Philippine National Demographic and Health Survey. PLoS ONE 15(5): e0232620. https://doi.org/10.1371/journal.pone.0232620

Editor: Joel Msafiri Francis, University of the Witwatersrand, SOUTH AFRICA

Received: January 31, 2020; Accepted: April 17, 2020; Published: May 12, 2020

Copyright: © 2020 Pepito, Newton. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data for the 2013 Philippine National Demographic and Health Survey Individual Recode are available from the Demographic and Health Surveys Program Website ( https://www.dhsprogram.com/data/available-datasets.cfm )

Funding: The authors have not received specific funding to conduct the analysis; however, they have received financial support from the Ateneo de Manila University School of Medicine and Public Health and the PLOS Publication Fee Assistance Office for the publication fee of the manuscript. These funding agencies did not have a role in the analysis, writing of the manuscript, as well as decision to publish.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Despite the worldwide decrease in the incidence of Human Immunodeficiency Virus (HIV) infections [ 1 , 2 ], the Philippines is currently experiencing a rapid increase in the number of HIV cases [ 2 – 5 ]. For the first seven months of 2019, around 35 new cases of HIV are diagnosed in the country every day. From 1984 to July 2019, there have been 69,512 HIV cases that have been diagnosed in the Philippines; 4,339 (6.7%) of whom are women [ 6 ]. However, HIV statistics in the Philippines are perceived to be underestimates due to Filipinos’ low knowledge and/or stigma associated with HIV testing [ 3 – 5 , 7 , 8 ]. It is estimated that around one-third of all Filipinos who have HIV do not know their true HIV status, despite HIV testing being free in many facilities throughout the country [ 3 ]. From the 2013 Philippine National Demographic and Health Survey (NDHS), only 2.3% of all the female respondents have reported that they have ever tested for HIV [ 9 ].

HIV testing is considered to be among the cornerstones of most HIV prevention and control strategies [ 10 – 12 ]. At the individual level, HIV testing, together with counselling, is an avenue where people can be educated about risky behaviors associated with the disease [ 13 ]. For those who have the disease, HIV testing is the first step into the continuum of care where they can be managed accordingly which will hopefully stop disease progression and transmission [ 12 , 14 ]. From a public health perspective, the greater the number of individuals who will undergo HIV testing, the more accurate the statistics will be for the disease. This will lead to better allocation of resources for public health interventions that will help curb the HIV epidemic [ 3 , 12 ]. For women, HIV testing has an added benefit of possibly preventing mother-to-child transmission of HIV. It is for this reason, together with the increasing numbers of pregnant women diagnosed with HIV and children born with HIV from 2011–16, that the Philippine Department of Health (DOH) has strongly encouraged pregnant women in the Philippines to undergo HIV testing. In relation to this, the DOH has decreed that by 2022, the proportion of people living with HIV (PLWH) who knows their status should be 90% [ 3 ]. This is in-line with the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, which stipulates that by 2020, “90% of all PLWH will know their true status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression” [ 15 ].

Given the importance of HIV testing among women, studies identifying its determinants have been carried out before. These determinants can be classified into socio-demographic determinants (e.g., age, educational attainment, address, religion, marital status, socio-economic status, employment, media exposure, and number of children) or HIV-related determinants (e.g., sexual behaviors, knowledge on HIV, perceptions on HIV testing, consumption of intoxicants, and having talked to mother or female guardian about HIV) [ 16 – 21 ]. Other determinants of HIV testing include having a dysfunctional relationship with their spouse/partner, tolerance of domestic violence, experiencing stigma, media exposure, number of lifetime sexual partners, having talked to mother/female guardian regarding HIV testing, ever pregnant, and exposure to public health interventions regarding HIV [ 16 , 17 , 22 ]. Two reviews emphasized that there are a host of social, institutional- and policy-level factors, often not considered in most observational studies, which may also act as barriers or enablers of HIV testing [ 23 , 24 ]. However, despite the numerous studies cited on HIV testing among women worldwide, and despite the HIV epidemic in the Philippines, there were no studies focusing on HIV testing among Filipino women in published literature. This is ostensibly due to the low proportion of cases of women with HIV in the country [ 6 ]. This implies that women could have been left behind in the response to the HIV epidemic in the country.

In order to address this gap and in order to craft interventions to encourage Filipino women to undergo testing, this analysis aims to identify the determinants of HIV testing among Filipino women. The results of this study could serve as the first step in the implementation of interventions to promote HIV testing among Filipino women to help meet DOH and UNAIDS targets.

Study design, setting, and participants

This study is a secondary analysis of the 2013 Philippine NDHS women’s individual recode data. The survey used a stratified two-stage sampling design with the 2010 Philippine Census of Population and Housing as sampling frame. The first stage sampling involved a systematic selection of 800 sample enumeration areas all over the country, distributed by urban/rural regions, to ensure representativeness. In the second stage, 20 housing units were randomly selected from each enumeration area using systematic sampling. All households in the sampled units were interviewed. From each household, women aged 15–49 were interviewed. The interviews were carried out all throughout the Philippines from August to October 2013. Other details of the sampling method for the 2013 Philippine NDHS can be found in its report [ 9 ].

Data collection and study variables

The 2013 Philippine NDHS utilized a paper-based, pre-tested interview schedule to collect data on a wide range of socio-demographic, economic, knowledge on some health issues, health practices, fertility and childbirth, immunization of children, health insurance, domestic violence, women’s empowerment, and other variables from a nationally-representative sample. A copy of the interview schedule can be seen on the final report of the 2013 Philippine NDHS [ 9 ].

Despite the multitude of variables collected in the study, only variables that are deemed to influence HIV testing were included in the analysis. The exposure variables for this study were: Age; educational attainment; civil status; condom use; consistent condom use; condom access; use of any traditional contraception method; tobacco consumption; age of husband/partner; educational attainment of partner; HIV knowledge, wealth index; address; tolerance to domestic-based gender violence; women’s empowerment score; number of children; religion, reading newspapers; weekly access to television, radio, newspapers, and internet; age of first sexual intercourse, and knowledge of condom source. The outcome variable for this study is HIV testing. A description of how the variables were operationally defined, as well as how they were coded are described in an Appendix ( S1 Appendix ).

To minimize observer bias, data collectors for the 2013 Philippine NDHS underwent a two-week training in administering the data collection tool. Furthermore, systematic random sampling was used to ensure representativeness. Moreover, data collectors visited the respondents at home repeatedly to ensure that the randomly selected respondents were interviewed, instead of replacing them with whoever is convenient, thus minimizing selection bias. To minimize encoding errors, encoders underwent training in using the data entry program created specifically for this NDHS [ 9 ].

Data management

Once permission was obtained from the NDHS data curators, the Individual Recode dataset of the 2013 Philippine NDHS was downloaded from the DHS website [ 25 ]. After this, the dataset was cleaned. In cleaning the dataset, new variables were generated from each variable that were included in the analysis. These new variables were cleaned and analysed to preserve the original data as much as possible. Inconsistent responses were considered as “no data” as the original responses of the respondents could no longer be obtained.

Some variables (e.g., employment status, marital status, etc.) were recoded to ensure that there were sufficient observations for each strata. Other variables (e.g., tobacco consumption) were recoded to ensure that the baseline stratum would have more observations, thus ensuring more stable estimates than if the current coding was used. Quantitative age variables were transformed into age brackets [e.g., 15–19, 20–24 years old, etc.] so that the effect of having similar ages on the outcome could be studied. The midpoint was assigned as the ‘score’ for each age group [e.g., the score ‘17’ were assigned to those who were aged 15–19; the score ‘22’ were assigned to those who were aged 20–24, etc.]. Condom use variables were recoded such that the baseline would be those who have never had sexual intercourse. Those who have used condoms consistently would also be noted with this variable. Similarly, variables on employment status or educational attainment of partner were recoded such that the baseline would be those who do not have partners at present.

Score variables (e.g., HIV knowledge score, women’s empowerment, tolerance to domestic violence) were aggregated from many questions. HIV knowledge score were derived from the following questions: [ 1 ] Ever heard of AIDS; [ 2 ] Reduce risk of getting HIV: Always use condoms during sex; [ 3 ] Reduce risk of getting HIV: have one sex partner only, who has no other partners; [ 4 ] Can get HIV from mosquito bites; [ 5 ] Can get HIV by sharing food with person who has AIDS; [ 6 ] A healthy looking person can have HIV; and [ 7 ] Can get AIDS by shaking hands. Tolerance to domestic violence score was aggregated from the following questions: [ 1 ] Beating justified if wife goes out without telling husband; [ 2 ] Beating justified if wife neglects the children; [ 3 ] Beating justified if wife argues with husband; [ 4 ] Beating justified if wife refuses to have sex with husband; [ 5 ] Beating justified if wife burns the food. Women’s empowerment score was derived from the following questions: [ 1 ] Who decides on your healthcare; [ 2 ] Who decides on large household purchases; [ 3 ] Who decides on daily household purchases; [ 4 ] Who decides on visits to family or relatives; and [ 5 ] Who decides what to do with money husband earns. For the HIV knowledge score questions, one point will be given for each correct answer, while no points will be given for incorrect or ‘don’t know’ answers. For tolerance to domestic violence questions, one point will be given for each ‘no’ answer while no points will be given for ‘don’t know’ answers. For each women empowerment questions, two points were given for each ‘respondent only’ answer, one point were given for each ‘respondent and partner’ answer and no points were given for each ‘other answers’. The points from each question were added to come up with the HIV knowledge score, women’s empowerment score, and tolerance to domestic violence score. A respondent with missing data in any of the questions that make up a score will not have an aggregate score. The aggregated score was left as a continuous variable so that the effect of a one-point increase in these variables on HIV testing can be quantified.

All data management and analyses were carried out in Stata/IC 14.0 [ 26 ].

Data analysis

After preliminary cleaning, the dataset was declared as survey data and the sampling weights and strata (i.e., urban and rural, regions) were defined. All subsequent analyses, if applicable, were weighted. The distributions of each variable were determined by noting the respective histograms and measures of central tendency for continuous variables, and frequencies and proportions for categorical variables. For the descriptive analyses, weighted means and proportions will be shown; however, counts, medians, and modes will not be weighted.

The association of the exposures with HIV testing were examined using Pearson’s χ 2 test (for categorical exposure variables), adjusted Wald test (for normally-distributed continuous exposure variables), or the Wilcoxon rank-sum test (for skewed continuous exposure variables). The Pearson’s χ 2 test and the adjusted Wald test will be weighted; however, the Wilcoxon rank-sum test is not weighted because of the lack of applicable non-parametric statistical tests for weighted data. Those with missing data were not included in computing for the p-values for these tests. Crude odds ratios (OR) for each of the associations between exposure and the outcome were estimated using logistic regression for survey data.

Once the crude OR for this association were obtained, variables that might be in the causal pathway of other variables were excluded from the analyses. The remaining variables were then classified into whether they are proximal or distal risk factors. Proximal risk factors (PRFs) can be defined as factors that are thought to be closer to the outcome in a causal diagram, while distal risk factors (DRFs) were factors that were farther from the outcome and may indirectly contribute to causing it [ 27 ]. After this, a variable was generated to indicate respondents who do not have missing data for any of the remaining variables. Multivariate analyses were only carried out for respondents who have complete data for all of the variables of interest. To determine the order in which variables will be introduced into the final model, logistic regression for survey data was used to assess the effect of each PRF, adjusting for the DRFs with a p≤0.20 in the bivariate analyses. Adjusted OR of each PRF, as well as corresponding p-values were noted.

Logistic regression for survey data was used in the analyses of these associations. In building the final model for the determinants of HIV testing, DRFs were added into the model with the variable having the smallest p-value added first, then the second smallest p-value added second, and so on, until all DRFs with p≤0.20 from the bivariate analysis are in the model. After this, PRFs were added to the model starting with those with the smallest p-values in the analysis adjusting for DRFs until all the PRFs with p≤0.20 in the analyses adjusting for DRFs were added, or the maximum number of parameters was reached. While p-value cutoffs are not to be blindly followed in studying causal relationships in epidemiology, they may aid in variable selection to prevent models from being too overly-parameterized [ 28 , 29 ]. The maximum number of parameters for the final model are contingent on the effective sample size for the multivariate analysis, taking into consideration the ‘rule of 10’ events per parameter estimated [ 30 ].

At any point in the building of the final model, test for departure from the linearity assumption was carried out by observing the stratum-specific ORs, and running the contrast command in Stata once a quantitative ordinal variable (e.g., age group, wealth index, etc.) was added to the model. Since the midpoint of each age group was used as the ‘score’, parameters of a common linear trend would not only estimate the common linear effect of the age groups on the outcome, but also the common change in effect on the outcome per unit change in age [ 31 ]. In addition, model estimates were also observed for signs of multicollinearity or separation every time a variable is added. Variables with problematic estimates may be excluded from the analysis.

Considering that assessing effect measure modification (EMM) was not among the objectives, and that Mantel-Haenszel methods cannot be used in the analysis of survey data [ 32 ], no assessment of EMM for any of the variables was carried out. Furthermore, no observations were deleted from the analyses to ensure that standard errors can be computed correctly [ 33 ]. Missing data were handled by presenting them in the univariate analyses and excluding respondents who have missing data in any of the variables of interest in the multivariate analyses.

Despite making several hypothesis tests, the level of significance was not adjusted. Instead, it was maintained at 0.05 all throughout the analysis as it is safer not to make adjustments for multiple comparisons in the analysis of empirical data to minimize errors in interpretation [ 34 ].

The 2013 Philippine NDHS has received ethical approval from ICF Macro Institutional Review Board (Project No.: 31561.00.000.00) dated July 1, 2010. This analysis has received ethical approval from the London School of Hygiene and Tropical Medicine MSc Ethics Committee (Reference No.: 15014).

The 2013 Philippine NDHS collected data from 16,437 Filipino women aged 15–49 years old. Interviews were completed for 16,155 individuals, with a 98.3% response rate. Except for counts, ranges, and non-parametric results, subsequent statistics shown are all weighted.

Only 372 (2.4%) respondents have ever tested for HIV. Most of the respondents finished secondary education, are married, do not use condom, do not use traditional contraception, are Roman Catholic, and have weekly television access. However, a substantial proportion of respondents have no data on condom access, age group of partner, and educational attainment of partner. This is predominantly because they have not had any sexual partners yet and/or have not had a partner at present. Among the categorical exposure variables and without adjusting for confounding, age of respondent, educational attainment of respondent, employment status of respondent, civil status, age at first intercourse, condom use, condom access, knowledge of condom source, usage of traditional contraception, tobacco use, educational attainment of partner, socio-economic status, and newspaper, television, and internet access were found to be associated with having ever tested for HIV ( Table 1 ). All of these factors are positively associated with having ever tested for HIV, except for condom access and condom source. The negative association of these latter two variables with HIV testing denote that not having condom access and not knowing a condom source is a determinant of never testing for HIV.

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https://doi.org/10.1371/journal.pone.0232620.t001

Around 38% of the respondents have never had sexual intercourse, and majority do not have more than one sexual partner throughout their lifetime. Imputed age at first intercourse ranged from 7 to 47 years old. There are 5,891 (37.0) respondents who do not have children, and around 4,480 (28.3%) having only one or two children. Most of the respondents have a high (≥5/7) HIV knowledge score, have a high women empowerment score (≥6/10), and a low tolerance to domestic violence. The distributions of the number of lifetime sexual partners and HIV knowledge score were found to differ between those who were tested for HIV and those who were never tested for HIV. Despite these, none of the quantitative exposure variables had shown a strong evidence of association with HIV testing ( Table 2 ).

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https://doi.org/10.1371/journal.pone.0232620.t002

For the multivariate analysis, distal risk factors that have a p≤0.20 in the cross-tabulations are age of respondent, highest educational attainment of respondent, employment status, civil status, tobacco use, highest educational attainment of partner, socio-economic status, domicile, religion, newspaper access, television access, and internet access. Proximal risk factors that have a p≤0.20 in the cross-tabulations are age at first intercourse, condom use, condom access, knowledge of condom source, traditional contraception, number of children, number of lifetime sexual partners and HIV knowledge score. However, because there is collinearity between knowledge of condom source and condom access, and because the latter has a lot of missing data, it will not be among the variables that will be considered in the analysis. Only 8,578 (53.2%) respondents have complete data for the variables that are considered in the multivariate analysis. Out of these, 243 (2.8%) have underwent HIV testing ( Table 3 ).

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https://doi.org/10.1371/journal.pone.0232620.t003

In building the final model, tests for linear trend were run for age of respondent, age at first sexual intercourse, and socio-economic status. Age of respondent (p = 0.27) and age at first sexual intercourse (p = 0.92) did not show evidence of deviation from a linear trend, but there is an evidence for deviation of a linear trend for socio-economic status (p<0.01), which meant that stratum-specific ORs were shown for socio-economic status instead of common ORs.

After adjusting for other variables, having tertiary education (adjusted odds ratio (aOR) = 2.15; 95% Confidence Interval (CI): 1.15–4.04), being unmarried but living together with partner (aOR = 1.72; 95% CI: 1.19–2.48), tobacco use (aOR = 1.87; 95% CI: 1.13–3.11); belonging to the middle class (aOR = 2.72; 95% CI: 1.30–5.67), richer (aOR = 3.00; 95% CI: 1.37–5.68), and richest (aOR = 4.14; 95% CI: 1.80–5.91) populations, having weekly television access (aOR = 1.75; 95% CI: 1.04–2.94) or internet access (aOR = 2.01; 95% CI: 1.35–3.00), living in a rural area (aOR = 1.87; 95% CI: 1.34–2.61); and being a Muslim (aOR = 2.30; 95% CI: 1.15–4.57) were associated with higher odds of HIV testing among Filipino women aged 15–49.

Only around 2% of Filipino women have had HIV testing throughout their lifetimes, implying that there is still substantial work to be done in promoting HIV testing to Filipino women to meet DOH and UNAIDS targets. Women’s educational attainment, civil status, tobacco use, socio-economic status, television and internet access, domicile, and religion showed strong evidence of association with HIV testing. This information could be used to guide the development of interventions to promote HIV testing among Filipino women.

These associations were similar to the findings of other studies. Specifically, there seems to be an increasing propensity for HIV testing among more educated or wealthier respondents, regardless of gender [ 7 , 16 ]. A study conducted in the United States also found that smoking was found to be strongly associated with HIV testing. Accordingly, the said study explains that smokers might be more likely to undergo HIV testing because being a smoker is associated with risky sexual behaviors and/or drug use, the latter two are known independent risk factors for HIV [ 35 ]. Due to certain religious taboos, HIV testing remains very low among some religious groups in the country. However, the odds of HIV testing are highest among Muslims. While there are no studies explaining this phenomenon in the Philippines, a study conducted in Malaysia explains that in their country, Muslim religious leaders were supportive of HIV testing because it provides a protective mechanism in line with Islamic teachings [ 36 ]. The specifics of the association between media exposure and HIV testing was examined in detail in this study and was found to be similar to those that are found in other settings [ 16 , 17 ]. Frequent exposure to television and Internet also increases the probability of exposure to HIV information, education, and communication (IEC) campaigns promoting HIV testing disseminated through these forms of media, thus promoting HIV testing.

There were also differences in the findings of this study with what has been published in literature. In this analysis, older individuals were found to be more likely to have undergone HIV testing than younger respondents, but this trend is the exact opposite of what was found in Burkina Faso, where older women were found to be less likely to test than younger ones. The same study in Burkina Faso found that living in a rural area inhibits HIV testing [ 16 ], while this analysis found that those from rural areas are more likely to have undergone HIV testing as compared to those from urban areas. Without adjusting for confounders, we found several factors to be associated with HIV testing in this analysis, but a secondary analysis of data collected on 2003 from Filipino males show that only HIV knowledge is strongly associated with getting HIV test result [ 7 ].

While consistency of results across populations or circumstances strengthen evidence for causation [ 37 ], its absence does not necessarily mean that results are no longer valid nor useful. A possible reason explaining the differences in the effect of age on HIV testing is the difference in how age was handled in the analyses. This study grouped respondents on five-year age groups, while other studies grouped respondents on 10-year groups [ 16 , 22 ]. Another possible reason for the differences between the findings of this study and others is that the populations and contexts on the studies being compared might be inherently different. Differences in social, economic and political context underpinning HIV epidemiology and response should not be ignored in comparing findings from different settings [ 38 – 41 ]. Findings from the older study involving Filipino males may differ from the current study due to gender differences. Secular changes may also explain why results differed between the previous study and this analysis [ 7 ].

The study presents several salient points of concern. First, the prevalence of HIV testing remains to be very low. Second, the association of socio-economic status and highest educational attainment with HIV testing highlights inequities in access and utilization of HIV testing services, despite it being offered for free in government facilities. This is ostensibly explained by low awareness of HIV testing, and an even lower awareness that it is offered for free [ 3 ]. Third, the Philippine DOH has made significant strides to encourage HIV testing among pregnant women [ 3 ], but as the results show, number of children was not found to be associated with HIV testing which highlight the need to do more in promoting HIV testing among pregnant women. Fourth, the lower odds of testing among those who are from urban areas are worrying because urban centers in the Philippines are where HIV cases are rapidly rising.

Despite these worrying conclusions, the study is best interpreted with its limitations in mind. The exclusion of almost half of the respondents in the multivariate analysis due to missing data underlines the possibility of selection bias. The respondents who were excluded were mostly those who do not have partners, or have never had sexual intercourse, because these respondents did not have data for educational attainment of partner. The exclusion of these respondents also meant that the baseline for the condom use variable are no longer those that have never had intercourse, as in the univariate analysis, but those who did not use condom in their last intercourse. This also meant that the baseline for the civil status variable are now those who are married, instead of those who were never in union as in the univariate analysis. A separate model was considered for those who do not have partners or those who never had sexual intercourse, but the very low proportion of respondents who tested for HIV for these populations meant that such a model might have low statistical power. Not to mention, those who never had sexual intercourse is deemed to have low risk in developing HIV as HIV is mostly transmitted sexually here in the Philippines. Given this, it should be kept in mind that the findings of this analysis may only be generalized to those who have already had sexual partners.

Alternative variable selection strategies emphasize that all known confounders should be controlled for in the model [ 42 ]. From this line of reasoning, there would still be residual confounding as we have not controlled for variables either because they were not collected in the original dataset (i.e., social support, drug use, etc. and other factors working beyond the individual level), or were excluded due to the specified p-value cutoff in the Methodology. However, controlling for all known confounders might lead to overly parameterized models, especially that our proportion of HIV testers is very low. It is for this reason that p-value cut-offs were used to select variables to include in the model. Even the multivariate model itself fails to meet the ‘rule-of-10’, having estimated 29 parameters on 243 events (i.e., people who tested for HIV), giving us 8.4 events per parameter. However, simulation studies have shown that the ‘rule-of-10’ can be relaxed to up to five events per parameter without expecting issues in chances of type-I error, problematic confidence intervals, and high relative bias [ 30 ].

Cross-sectional studies such as this analysis are especially susceptible to reverse causality, especially for data that may vary with time. This is often a problem for this study design as both exposure and outcome data are collected simultaneously. This prevents ascertainment of the temporal direction of the associations found in the study [ 43 ].

Another issue that usually affect HIV studies using self-report data, including this analysis, is response bias [ 44 ]. This was apparent for age at first sexual intercourse, which necessitated the use of imputed data. This also implies that sexual behavior (e.g., condom use, etc.) and other health data collected from the respondents should be interpreted cautiously due to the possibility of Hawthorne effect [ 45 ]. Ultimately, this implies that conclusions drawn from this analysis is only as good as the quality of data provided by the respondents.

Most importantly, there have been developments in HIV testing in the Philippines since the data was collected on 2013. On 2016, the country has piloted rapid diagnostic screening tests among high-burden cities in the country to increase uptake of HIV testing. These rapid diagnostic tests have the advantage of being cheaper and having a faster turn-around time as compared to current Western blot-based confirmatory tests [ 3 , 46 , 47 ]. However, despite the rollout of these initiatives, HIV testing remains very low and falls short of the 90-90-90 target set by the DOH and UNAIDS [ 3 ]. On 2019, the country has started the implementation of the new Philippine HIV and AIDS Policy Act. Among the provisions of this new law is allowing persons aged 15–18 to undergo HIV testing without parental consent and allowing pregnant and other adolescents younger than 15 years old and engaging in high-risk behavior to undergo testing without parental consent [ 48 ]. Owing to its recent implementation, however, we are yet to measure how this new law affects uptake and utilization of HIV testing, especially among Filipino women.

Despite these weaknesses and the policy changes since the data was collected, these findings should still be considered in formulating public health interventions to promote HIV testing, considering the dearth of evidence exploring this phenomenon and the urgency of the HIV situation in the Philippines. Further research should be undertaken to elucidate the relationships of some exposures with HIV testing to improve on the weaknesses of this study as well as assess the effect of new policy developments on uptake and utilization of HIV testing among Filipino women.

The low proportion of Filipino women who have ever tested for HIV is a call to strengthen efforts to promote HIV testing. Information on its determinants can help in the formulation and implementation of interventions and which segments of the population should be targeted by these interventions. Information, education, and communication campaigns to promote HIV testing and to dispel myths surrounding it should be disseminated via television or Internet. Such campaigns should target those who have lower socio-economic status, those who have low educational attainments, and those who live in urban areas. Further research to identify determinants of HIV testing, especially among populations that were not studied yet, should be done to identify segments of the population that should be reached by interventions to promote HIV testing. Further research to assess the impact of recent policies on HIV testing should likewise be conducted. Studies and implementation research focusing on availability, accessibility, and acceptability of HIV testing, including novel and alternative approaches, such as self-testing [ 46 , 49 ] and use of technology [ 50 ] should likewise be conducted. Only through the promotion of HIV testing, and its subsequent uptake by the population, will the DOH and UNAIDS reach their targets for the Philippines.

Supporting information

S1 appendix. definition of variables and coding manual..

https://doi.org/10.1371/journal.pone.0232620.s001

Acknowledgments

We thank the DHS Program for lending us the 2013 Philippine National Demographic and Health Survey dataset. We are also grateful for the comments of Ms. Arianna Maever L. Amit and anonymous reviewer/s from the London School of Hygiene and Tropical Medicine for improving this manuscript.

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HIV/AIDS risk in the Philippines : focus on adolescents and young adults

This paper focuses on HIV/AIDS risk in the Philippines, especially adolescents and young adults.

University of the Philippines

Population institute, you are here.

  • Posted on: 12 October 2022

Youth awareness of HIV/AIDS drops to all-time low

Amid a growing epidemic of human immunodeficiency virus (HIV) and/or acquired immuno-deficiency syndrome (AIDS) in the Philippines, the percentage of Filipino youth who are aware of HIV and/or AIDS has declined to its lowest level since 1994.

Based on the 2021 Young Adult Fertility and Sexuality Study (YAFS5), 76% of young Filipinos aged 15-24 have heard of HIV and/or AIDS, a 19-percentage point drop from 1994 when awareness stood at 95%. This sustains the decrease observed in 2013, when the share of youth who have heard of HIV and/or AIDS declined to 83% from 95% in 2002 (Figure 1).

Among those who have heard of HIV and/or AIDS, the YAFS5 also examined the percentage of those with comprehensive knowledge of HIV, based on five standardized statements consisting of a mix of correct information and misconceptions about the virus. In all, only 19% or one in five youth has comprehensive knowledge of HIV. The percentage significantly changed among women, from 16% in 2013 to 19% in 2021, but not among men, which only slightly changed from 18% in 2013 to 19% in 2021.

More than half or 52% of youth incorrectly believed that a person can get HIV by sharing food with someone who is infected. About two in five, on the other hand, did not believe that a healthy-looking person can have HIV.

Some 35% of young people also did not believe that a person can reduce the risk of getting HIV infection by using a condom during sex, contrary to multiple evidence that consistent condom use is very effective against HIV transmission. YAFS5 data show a low level of condom use during high-risk sexual activities, such as transactional and casual sex, among male youth (Figure 2).

Information gaps can stall efforts to arrest the number of HIV infections in the Philippines, which has the fastest-growing HIV epidemic in the Asia-Pacific region. According to the Department of Health, there were a total of 115,100 people living with HIV in the country in 2020, and 90% of the new infections were recorded among young males who have sex with males. Should the trend persist, the number of HIV cases is estimated to reach over 330,000 by 2030.

Among the global targets of Sustainable Development Goals is to eradicate AIDS by 2030. This year’s World AIDS Day commemoration carries the theme “Equalize,” drawing attention the need to “address the inequalities which are holding back progress in ending AIDS.”

Note: An earlier version of this article was posted on the UPPI website and was updated in time for World AIDS Day, 1 December 2022.

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Knowledge, Attitudes, and Practices on HIV/AIDS among College Students in Pampanga, Philippines

  • Batholomew Chibuike James Public Health Program, Graduate School, Angeles University Foundation, Angeles City, Pampanga, Philippines
  • Razel Kawano Public Health Program, Graduate School, Angeles University Foundation, Angeles City, Pampanga, Philippines
  • Ede Stephen Sunday 2Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Nsukka, Nigeria
  • Kanokwan Chullapant Endocrinology and Metabolism Unit, Prince of Songkla University HatYai, Songkhla, Thailand

Introduction. Young adults are more susceptible to HIV infection due to a lack of reliable and timely information about HIV/AIDS prevention and transmission. This study examined the KAPS of college students in Pampanga, Philippines due to high cases of HIV in the region. KAPs is vital in developing effective strategies for HIV intervention. Objective. The study evaluated the knowledge, attitudes, and practices on prevention and transmission HIV/AIDS among college students in Pampanga, Philippines. Method. This cross-sectional, descriptive study used a self-administered questionnaire to assess HIV/AIDS knowledge, attitudes, and practices among 565 college students aged 18–24 from three Pampanga higher educational institutions Philippines. A questionnaire was used to gather data on KAPs regarding HIV/AIDS transmission and prevention. The data were analyzed using SPSS version 20.0. Results. Among 565 participants, 239 persons (42%) showed low knowledge of transmission and prevention of HIV/AIDS, 203 (36%) had moderate level of knowledge, and 121 (21%) had high level. Common misconceptions about HIV transmission included washing genitals could prevent transmission and that transmission was possible through mosquito bites, respiratory fluids, sweat, or urine. Television was the most frequent source of HIV/AIDS-related knowledge among respondents. More than half (63.1%) of those surveyed had a good attitude toward HIV-positive people. Those who answered questions related to the sexual practices said that their last three encounters were with the same person (18.1%). Those who used piercing objects claimed to sterilize them before utilizing them on their bodies (18.6 %). And many participants refused to question related to practices. Conclusion. Participants had a low knowledge of HIV/AIDS, which explains why there were many misconceptions about HIV/AIDS transmission and prevention. More than half of the respondents had a good attitude toward HIVpositive people. Those who answered the practice-related questions engaged in risky behaviour. Providers should implement an intervention program to increase HIV/AIDS knowledge, attitudes, and behaviors in the region.

Author Biographies

Faculty Member Public Health Department 

Member Department of Medical Rehabilitation

Endocrinology and metabolism unit, Prince Songkhla University Hat-Yai Songkhla Province 90110, Thailand.

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hiv awareness research paper in the philippines

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As AIDS, HIV awareness among PH youth declines, cases, deaths rise

hiv awareness research paper in the philippines

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MANILA, Philippines—The HIV and AIDS epidemic in the Philippines is worsening, but the percentage of young Filipinos who are aware of the disease had fallen to its lowest since 1994.

This was revealed in the 2021 Young Adult Fertility and Sexuality Study (YAFS5) conducted by the University of the Philippines Population Institute (UPPI), which said that last year, only 76 percent of 15 to 24 year olds have heard of HIV and AIDS.

It was a 19-percentage point drop from 95 percent in 1994. HIV and AIDS awareness was still 95 percent in 2002, but a decrease was seen in 2013, when the share of youth who have heard of the virus and the disease fell to 83 percent.

UPPI said this was concerning since a low level of awareness and insufficient knowledge of HIV and AIDS can stall efforts to arrest the increasing number of infections in the Philippines.

As mentioned by the Department of Health (DOH), the Philippines has the fastest-growing HIV epidemic in the Asia-Pacific region, with a 237 percent increase in annual new infections from 2010 to 2020.

READ: HIV spread fastest in PH – study

HIV—human immunodeficiency virus—is a virus that attacks the body’s immune system, the US Centers for Disease Control and Prevention said. If HIV is not treated, it can lead to AIDS—acquired immunodeficiency syndrome.

hiv awareness research paper in the philippines

GRAPHIC: Ed Lustan

AIDS is the most severe stage of HIV, next to acute HIV infection (first stage) and chronic HIV infection (second stage). People with AIDS can have a high viral load and may easily transmit the virus. Without treatment, AIDS can lead to death.

Based on DOH data, AIDS-related deaths in the Philippines have increased by 315 percent—from 200 in 2010 to 820 in 2020. In 10 years, 4,890 in the Philippines had died of the disease.

Lack in deep knowledge of HIV, AIDS

According to Karger, a Switzerland-based publishing company that focuses on health and science, increasing knowledge and awareness about HIV and AIDS is one of the most crucial strategies in the prevention of infections and the disease.

This was the reason that UPPI said the low level of awareness and insufficient knowledge of HIV and AIDS could become a hindrance in preventing the spread of infections.

Out of those who have heard of HIV and AIDS, the UPPI also examined the percentage of those with comprehensive knowledge of the virus, based on five standardized statements consisting of a mix of right and wrong knowledge about HIV.

UPPI revealed that based on the results of the YAFS5, only one in five youth has comprehensive knowledge of the virus. The percentage significantly changed in women—from 16 percent in 2013 to 19 percent in 2021.

hiv awareness research paper in the philippines

While there was a slight change in the percentage of men who have comprehensive knowledge of HIV, UPPI stressed that it was not statistically significant—from 18 percent in 2013 to 19 percent in 2021.

YAFS5 found that 52 percent of young Filipinos incorrectly believed that a person can get HIV by sharing food with someone who is infected. About two in five did not believe that a healthy-looking person can have the virus.

Some 35 percent also did not believe that a person can reduce the risk of getting infected with HIV by using a condom every time they have sex. YAFS5 data revealed that among youth who have ever had sex, only a fifth have ever used a condom.

Likewise, 27 percent did not believe that the risk of transmission can be lessened by having sex with only one partner who is not infected and who has no other sexual partners, while 24 percent incorrectly believed that a person can get HIV from mosquito bites.

Not enough awareness in BARMM

YAFS5 found that awareness of HIV and AIDS is highest in Central Visayas at 87.4 percent, but lowest in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), where knowledge of the virus and the disease stood at only 38.8 percent.

According to the University Research Co., a company dedicated to improving the quality of health care, social services, and health education all over the world, the armed conflict in BARMM contributed to its present socio-economic condition.

“The region suffers from a lack of equitable access to health care and weaknesses in the quality of health care. Inequitable gender norms have also undermined health outcomes,” it said.

hiv awareness research paper in the philippines

Soccsksargen’s 46.5 percent is next to BARMM as the region with the lowest level of awareness of HIV and AIDS. The next lowest was Zamboanga Peninsula at 63.3 percent and Ilocos Region at 64.7 percent.

The regions next to Central Visayas in terms of awareness were Northern Mindanao (87.1 percent), Caraga Region (85.8 percent), Cordillera Administrative Region, or CAR (85.2 percent), Mimaropa (84.7 percent) and Metro Manila (84.5 percent).

Calabarzon has 82.6 percent level of awareness, while Davao Region has 81.9 percent. Western Visayas has 79.3 percent, Bicol Region has 76.6 percent, Cagayan Valley has 72.1 percent, Central Luzon has 70.8 percent, and Eastern Visayas has 69.3 percent.

Rise in cases, deaths concerning

The DOH had said while the total HIV prevalence in the Philippines is less than one percent, the total estimated number of people living with HIV (PLHIV) in 2020 hit the 115,100 mark, an increase from 99,600 in 2019.

According to data from the department, there were 5,000 new infections in 2010, 5,100 in 2011, 5,900 in 2012, 7,200 in 2013, 8,700 in 2014, 9,800 in 2015, 10,700 in 2016, 12,300 in 2017, 13,900 in 2018, 15,200 in 2019, and 16,700 in 2020.

hiv awareness research paper in the philippines

It stressed that if the rapid increase in new infections will persist, the estimated number of persons with HIV was expected to reach 331,500 by 2030. Back in 2019, out of the 99,600, 73 percent knew their status but only 44 percent were receiving antiretroviral treatment.

The DOH in 2020 had categorized a total of 118 local government units as “high burden areas” which have a median HIV case-infected population ratio of 10.5 for every 10,000 individuals.

RELATED STORY: Advocate: HIV still ‘silent epidemic’ amid COVID-19 threat

Out of the 115,100 persons with HIV in 2020, 38,700 were from Metro Manila, 19,300 were from Calabarzon, 11,900 were from Central Luzon, 11,400 were from Central Visayas, and 6,900 were from Davao Region.

hiv awareness research paper in the philippines

The regions with the least number of infected persons were BARMM (300), CAR (1,300), Caraga Region (1,300), Mimaropa (1,600), Cagayan Valley (1,700), Eastern Visayas (1,700), and Zamboanga Peninsula (1,700).

Intervention important

As stressed by the DOH in its “A Briefer on the Philippine HIV Estimates,” a total of 152,300 HIV infections were averted by the Philippines because of interventions established in HIV response since 2005.

“If no interventions were put in place between 2005 and 2020, the total cumulative HIV infections for 2020 would have reached 274,800, double the amount projected for the current estimates which is at 122,500,” it said.

The DOH stressed that with continued improvement in the country’s HIV response, more HIV infections could be averted and more lives saved from the virus and the disease.

But as of 2020, the Philippines is still far from accomplishing the 95-95-95 targets, which aims to diagnose 95 percent of cases, provide antiretroviral treatment for 95 percent of those diagnosed and achieve viral suppression for 95 percent of those treated by 2030.

hiv awareness research paper in the philippines

Based on DOH data as of December 2020, a total of 78,291 persons out of 115,100 have been diagnosed based on HARP data, indicating that the diagnosis coverage for the Philippines that year was 68 percent.

READ: How is PH faring in HIV treatment?

Out of the 78,291 at least 59,933 were enrolled in treatment and 47,977 are presently on antiretroviral treatment. From the first pillar to the last, a total of 67,123 persons with HIV were lost along the cascade of care, and were therefore not given access to life-saving treatment.

Breaking barriers

With antiretroviral treatment, HIV is no longer a death sentence, however, the stigma, which is stirred by misconceptions about the virus, persists.

READ: No longer a death sentence

It was in 2018 when then President Rodrigo Duterte signed Republic Act No. 11166, or the Philippine HIV and AIDS Policy Act.

The World Health Organization welcomed the new law, saying that it will help elevate attention to HIV and AIDS and address some of the critical bottlenecks in the HIV program in the Philippines.

hiv awareness research paper in the philippines

This, as HIV continues to be a serious health threat in the country with a record high of 32 reported infections per day.

The law, it said, will help in expanding access to evidence-based HIV prevention strategies. Access to means to prevent sexual transmission of HIV and transmission associated with drug use—such as condoms and other commodities—remains a critical need for curbing the rising epidemic.

Likewise, the new law will facilitate easier access to learning about one’s HIV status, in particular for young people aged 15 years old and above who can now undergo an HIV test without parental or guardian consent.

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“This is critical to intensify the response among the youth, who represent 62 percent of new HIV infections in the country. HIV testing is now also a routine procedure of prenatal care to prevent HIV infection from mother to child during pregnancy, labor and breastfeeding,” it said.

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News and updates, hiv cases rising at ‘fast and furious’ rate, group says.

hiv awareness research paper in the philippines

A decade ago, a new case of Human Immunodeficiency Virus (HIV) was reported every three days in the Philippines. Today, new HIV case is diagnosed every one and half hours, according to the Philippine National AIDS Council.

A total of 449 new cases of HIV were recorded in July alone this year, according to Department of Health (DOH). This is 62% higher compared to the same period last year (n=278 in 2012) and the highest number of cases reported in a month.

As spread of HIV decreased in many parts of the world, the Philippines is one of the seven countries struggling to combat the increase of HIV epidemic wherein most of the reported cases were predominantly caused by sexual contact among men-having-sex-with-men (MSM).

Men’s participation in unsafe sex and drug injections were primary responsible for the transmission of HIV. According to DOH serologic surveillance, MSM were identified as one of the sub-population with the highest risk of acquiring HIV. This was further supported by a study published in The Lancet Infectious Diseases Journal, identifying young sexually active MSM as core transmitter of HIV epidemic in the country.

The alarming increase of HIV in MSM poses an imminent threat and may impede the efforts of the nation to combat the disease.

As response to the rapidly increasing cases of HIV, legislators passed the “The Revised Philippine HIV and AIDS Policy and Program Act of 2012. The revised law amends the previous law that overlooks the “protection of and promotion of human rights as cornerstones of an effective response to the HIV epidemic.”

According to Dr. Edsel Maurice Salvaña of University of the Philippines Manila, Section of Infectious Diseases, in his article  The Philippine HIV/AIDS epidemic: A call to arms,  prevention and awareness campaigns remain by far potentially the most effective means of controlling HIV/AIDS in the Philippines.

With the knowledge, awareness, and medication such as retroviral treatment being offered for free in many public hospitals, the country has the capacity to potentially arrest and reverse the epidemic,” Dr. Salvaña stressed.

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An HIV epidemic is ready to emerge in the Philippines

Anna c farr.

1 National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia

David P Wilson

The state of the HIV epidemic in the Philippines has been described as "low and slow", which is in stark contrast to many other countries in the region. A review of the conditions for HIV spread in the Philippines is necessary.

We evaluated the current epidemiology, trends in behaviour and public health response in the Philippines to identify factors that could account for the current HIV epidemic, as well as to review conditions that may be of concern for facilitating an emerging epidemic.

The past control of HIV in the Philippines cannot be attributed to any single factor, nor is it necessarily a result of the actions of the Filipino government or other stakeholders. Likely reasons for the epidemic's slow development include: the country's geography is complicated; injecting drug use is relatively uncommon; a culture of sexual conservatism exists; sex workers tend to have few clients; anal sex is relatively uncommon; and circumcision rates are relatively high.

In contrast, there are numerous factors suggesting that HIV is increasing and ready to emerge at high rates, including: the lowest documented rates of condom use in Asia; increasing casual sexual activity; returning overseas Filipino workers from high-prevalence settings; widespread misconceptions about HIV/AIDS; and high needle-sharing rates among injecting drug users.

There was a three-fold increase in the rate of HIV diagnoses in the Philippines between 2003 and 2008, and this has continued over the past year. HIV diagnoses rates have noticeably increased among men, particularly among bisexual and homosexual men (114% and 214% respective increases over 2003-2008). The average age of diagnosis has also significantly decreased, from approximately 36 to 29 years.

Conclusions

Young adults, men who have sex with men, commercial sex workers, injecting drug users, overseas Filipino workers, and the sexual partners of people in these groups are particularly vulnerable to HIV infection. There is no guarantee that a large HIV epidemic will be avoided in the near future. Indeed, an expanding HIV epidemic is likely to be only a matter of time as the components for such an epidemic are already present in the Philippines.

Southeast Asia is experiencing numerous and diverse HIV epidemics that are evolving at varying rates, in different population groups, and in different geographical areas. Approximately 5 to 10 million people are living with HIV in Asia, with prevalence estimates of well over 1% among adults in numerous countries [ 1 ]. Yet there are some settings in which HIV prevalence has remained relatively very low.

The Philippines is one of the exceptional countries that has not faced a large HIV epidemic. It is important to understand the reasons for the disparate nature of HIV in this country in order to ascertain whether lessons can be learnt for effective control in other settings and to ensure that a large HIV epidemic does not emerge in the Philippines. The first recorded case of HIV infection in the Philippines was in 1984 [ 2 - 10 ]. Since then, the country has maintained an HIV prevalence of less than 0.1%, even among populations at high risk [ 3 , 5 , 7 , 9 ], with a cumulative total number of HIV diagnoses of just over 3300 [ 11 ]. In this paper, we attempt to evaluate the current epidemiology and public health response to identify factors which could account for the "low and slow" development of the HIV epidemic in the Philippines, as well as to review behavioural and epidemiological conditions that may be of concern for facilitating an emerging epidemic.

The geography of the Philippines may be one of the first reasons for the slow spread of HIV. The Philippines is an archipelago of more than 7000 islands and islets; its complicated geography and separateness from mainland Asia could aid in shielding it from the larger regional epidemic [ 5 , 9 , 12 , 13 ].

Additionally, the initial core group of people usually affected with HIV in Asian epidemics is not present to a large extent in the Philippines. Most HIV epidemics in southeast Asian settings initially establish among injecting drug users (IDUs) [ 14 ]. However, there are very low numbers of IDUs in the Philippines compared with most other southeast Asian countries [ 5 , 9 , 13 , 15 ]. At present, there are only an estimated 10,000 IDUs in the Philippines [ 13 ] (out of its population of ~90 million people; that is, 0.01%). In comparison, neighbouring Thailand, China and Indonesia have estimated IDU populations sizes (and population proportions) of 160,000 (0.38%), 1,800,000 (0.25%) and 219,000 (0.14%), respectively [ 16 ].

There also exists a culture of relative sexual conservatism in the Philippines [ 9 , 17 ]. There are limited data available on sexual partner acquisition in the Philippines, and detailed behavioural sentinel surveillance data are not widely released [ 18 ]. The only reference to sexual partner rates of which we are aware is from a previous Philippines National AIDS Council Report, which indicates that the majority of the male population has only one sexual partner at any time and relatively low partnership breakup rates [ 19 ]. Although the validity of this statement should be questioned until solid data have been evaluated, this suggests that sexual conservatism exists in the Philippines relative to neighbouring countries.

The limited reporting available from behavioural surveillance conducted a number of years ago suggests that Filipinos tend to have fewer sexual partners than their counterparts in countries with higher HIV/AIDS rates [ 20 ]. For example, sex workers in the Philippines tend to have fewer clients, an average of between two and four per week compared with ~15 in many other settings [ 5 , 13 , 15 , 21 , 22 ]. Although this does not indicate levels of sexual activity in the general population, it is indicative of less sexual mixing outside regular partnerships.

However, fewer sexual partners is not necessarily a clear indicator of a smaller epidemic as reflected in China's expanding HIV epidemic despite reported sexual partner acquisition rates being similarly low [ 23 ]. One could expect different sexual behaviour across different social strata and thus an HIV epidemic sustained at low levels may not necessarily be a reflection of low average rates of partner change across a population.

There has also been the establishment of social hygiene clinics to allow for regular examination and sexually transmitted infection (STI) treatment for establishment-based female sex workers [ 5 , 15 , 22 ]. The prevalence of ulcerating STIs, which are believed to facilitate HIV transmission [ 24 , 25 ], is relatively low [ 13 ]. There is also a low occurrence of penile-anal sex in the Philippines [ 13 ] and a high rate of circumcision, ~93% [ 9 , 26 ], which is known to reduce the risk of males acquiring HIV in heterosexual intercourse [ 27 - 29 ].

Some countries, such as Vietnam, Indonesia and Papua New Guinea, have shown that a delayed HIV epidemic is possible [ 6 , 30 ]. While HIV prevalence has remained "low and slow" [ 5 , 6 , 31 ], the presence of many conditions for a large, increasing and generalized HIV epidemic are in place in the Philippines. These include: a low rate of condom use; unsafe injecting practices among IDUs; large migration rates; increasing trends in extramarital and premarital sex; a lack of education and common misconceptions about HIV/AIDS; and cultural factors that inhibit public discussion of issues of a sexual nature [ 10 ]. We will now expound these factors.

The Philippines has the lowest documented rates of condom use in Asia [ 2 , 32 ], at 20-30% among groups at highest risk of HIV (including sex workers) [ 4 , 5 , 8 , 17 , 21 , 33 , 34 ]. This is concerning since the vast majority of HIV transmission in the Philippines is through sexual contact [ 10 , 13 , 17 , 32 ]. A survey published in 2003 found that 63% of male respondents said that they had never used a condom [ 2 ]. Condom use among any extramarital partners is also rare [ 8 ].

There are various factors that may contribute to low condom use in the Philippines. A common perception is that condoms are only for birth control and not for protection against HIV and other STIs [ 8 ]. This perception is reinforced by the view that condoms are discouraged by the Roman Catholic Church. Government family planning programmes have policies against supplying condoms to unmarried people [ 4 , 35 ].

The cost of condoms is also relatively high [ 18 ]. The majority of the supply of condoms is from international aid agencies (e.g., USAID) [ 8 , 35 ]. Many female sex workers assert that "knowing" their client was reason enough to not use a condom [ 8 ]. Filipino women also tend to believe that the decision to use a condom is up to the man [ 8 ]. Men tend to feel the need to maintain their machismo image to the extent that they refuse to practice safe sex [ 36 ]. Culturally-sensitive but influential promotion of condoms appears to be an obvious gap in the Philippines HIV/AIDS response.

There is anecdotal evidence among numerous media sources and organizational reports that casual sexual activity, particularly among the male population aged 15-25, has been increasing. A study from over a decade ago estimated that 55% of young men have engaged in premarital sex compared with 23% of young women [ 4 ]. While most premarital sex in the Philippines is with the person who becomes a future spouse, men are more likely to have at least one additional partner compared with women [ 2 , 4 , 8 ]. Most casual sexual encounters are unprotected [ 21 , 37 , 38 ].

However, all of this evidence is based on relatively old data. There is a great need for behavioural surveillance data to be collected and reported systematically and regularly in order to monitor risk activities, particularly around casual sex, associated with transmission.

Injecting drug users

The most recent estimates of the size of the IDU population in the Philippines suggests that the number is relatively low [ 39 ]. However, serosurveillance of IDUs has only been available at one site, in Cebu City, and no data exist for other cities. It is possible that the actual number of IDUs is considerably greater than previously thought.

A 2004 report by the Philippines National AIDS Council estimated that only 48% of IDUs reported using sterile injecting equipment the last time they injected, and most IDUs reported that they regularly share injecting equipment [ 6 ]. A 2008 report published by the Joint United Nations Programme on HIV/AIDS (UNAIDS) indicated that the prevalence of sharing injecting equipment is still very high, with 29% of IDUs self-reporting use of an unsterile needle/syringe the last time they injected [ 39 ]. Sharing HIV-contaminated injecting equipment is an efficient mode of HIV transmission [ 40 , 41 ]. Given the experience of neighbouring countries, IDUs could be an important population group for the spread of HIV in the Philippines if the size of the IDU population increases.

Overseas Filipino workers

There are approximately 7.5 million Filipinos working in 170 countries around the world, with more than 2000 workers departing from the country daily [ 32 , 42 ]. By participating in casual unprotected sex or other risky behaviour while overseas in higher prevalence settings, overseas Filipino workers (OFWs) become a substantial source of new HIV cases in the Philippines upon their return home.

Of all the HIV/AIDS cases reported in the Philippines, OFWs account for ~30-35% of all cases (this level has remained relatively steady over the past decade) [ 5 , 13 , 32 ]. Heterosexual sex is the dominant mode of transmission for OFWs, and the main occupations of OFWs who are infected with HIV are seafarers and domestic helpers. OFWs may be a bridge population for the spread of HIV and other STIs [ 32 , 43 , 44 ]. This population will undoubtedly be important in any HIV epidemic in the Philippines.

HIV/AIDS education and social factors

Even though awareness of the disease is high [ 5 ], misconceptions of HIV/AIDS are widespread among health workers, as well as in the general population [ 2 ]. For example, a survey of 1200 males found that many respondents believed that antibiotics, prayer and keeping fit would protect against HIV/AIDS [ 32 ]. Many young people also believe that HIV/AIDS can be prevented or treated by a concoction of drinks, douching with detergents, interrupting coitus and washing the penis [ 5 ]. The Young Adult Fertility Survey found that a large proportion (60%) of young people believed that there was now a cure for HIV/AIDS and, as such, they could become more complacent [ 45 ].

Women in the Philippines are not largely empowered to protect themselves and negotiate for safe sex due to cultural, physiological and socio-economic factors. An estimated 43% of women have admitted to being forced into sex, and 15% believed that they were obligated to have sex with their partners [ 5 ].

Condom use is also low among the population of men who have sex with men (MSM) [ 5 , 6 ]. Unprotected penile-anal sex is a highly efficient mode of HIV transmission [ 46 - 51 ]. Discrimination, harassment and intolerance of homosexuality, particularly male homosexuality, have resulted in MSM becoming a "hidden" population group, even though 20% of reported HIV cases involve male-to-male transmission [ 5 ]. With intolerance still high, it is difficult to provide MSM with HIV/AIDS information, education and treatment.

The current epidemiological state of HIV in the Philippines

In this section, we present HIV/AIDS surveillance data in the Philippines and analytical findings based on monthly diagnoses reported from March 2003 to June 2008 [ 11 ]. There is a steady increase in the cumulative number of HIV notifications in the Philippines (Figure ​ (Figure1 1 ).

An external file that holds a picture, illustration, etc.
Object name is 1758-2652-13-16-1.jpg

Cumulative number of HIV diagnoses in the Philippines by month from March 2003 to June 2008 . Year on figure indicates data at the start of the year.

However, the trends in HIV notifications differ between the genders. The cumulative number of HIV notifications among females has been increasing at a steady rate (p < 0.0001), suggesting that incidence is approximately constant and at an endemic equilibrium. In contrast, the trend among males is not constant, incidence levels are substantially greater than in females, and the rate of new notifications is increasing (evidenced by the curvature away from linear). This suggests that there may be an emerging HIV epidemic among Filipino MSM.

The emergence of an increasing HIV epidemic in the Philippines is evident from trends in monthly reported HIV diagnoses (Figure ​ (Figure2). 2 ). In mid-2003, there were 10 to 15 monthly HIV notifications and there are currently 30 to 50 notifications per month; that is, a three-fold increase over five years. The trend has increased even further from 528 notifications in 2008 to 835 in 2009 (a 58.1% increase in one year) [ 52 ]. This suggests that the epidemic could be approaching a large expansion phase.

An external file that holds a picture, illustration, etc.
Object name is 1758-2652-13-16-2.jpg

Cumulative number of HIV diagnoses in the Philippines by month to June 2008, by gender .

However, the divergence in HIV diagnosis rates between men and women could also reflect possible differences in testing rates. There are no data to suggest differences in testing rates, and the Philippine AIDS Prevention and Control Act of 1998 encourages HIV testing of all individuals at high risk of contracting HIV, with informed consent [ 53 ]. But this alternate explanation for the epidemic trends cannot be ruled out until reliable testing data are available.

Diagnoses of HIV in the Philippines are notified according to various categories of likely route of exposure. These include: heterosexual contact; male homosexual contact; bisexual contact; blood transfusion; injecting drug use; needle prick injury; or perinatal exposure. Bisexual contact refers to men who have had sex with both men and women. It cannot be determined whether the initial actual transmission event was male-to-male sexual contact or transmission from an infected woman. It is more likely that the transmission was via male-to-male sexual contact due to biologically higher transmission rates, but the bisexual category accurately reflects a degree of uncertainty in the route of exposure.

The dominant mode of HIV transmission in the Philippines is sexual (~92%). But the largest increases in the rate of new HIV notifications are due to homosexual and bisexual contact, and not heterosexual contact (Figure ​ (Figure3). 3 ). Over the period, 2003-2008, there was an increase in the monthly number of diagnoses, from 328 for homosexual contact and 92 for bisexual contact to 704 and 289, respectively; that is, respective increases of 114% and 214%. Therefore, there appears to be an increasing epidemic of HIV among men who have sex with men. The increase among bisexual men also has important consequences for the spread of HIV to the general heterosexual population. However, data on testing rates would help to elucidate the extent to which these diagnoses rates are reflective of underlying incidence.

An external file that holds a picture, illustration, etc.
Object name is 1758-2652-13-16-3.jpg

The cumulative number of HIV diagnoses in the Philippines by month to June 2008, by route of exposure .

It should be noted that some of the rise in HIV diagnoses could be attributable to an increase in testing rates. This is evident by the decreasing proportion of all HIV cases that are detected with AIDS disease: ~33% of diagnoses in 2003 were in AIDS stage disease and this has decreased to ~24%. However, the disproportionate trend in diagnoses between genders and between different routes of exposure strongly suggests that the trends in diagnoses reflect actual trends in population incidence. But since a substantial proportion of infections is detected in late-stage disease, it is likely that the majority of all HIV cases are currently undiagnosed in the Philippines [ 5 ].

The cumulative number of AIDS deaths is increasing approximately constantly (p < 0.0001), suggesting that AIDS death rates are relatively constant (Figure ​ (Figure4). 4 ). It could be expected that there will be a delay of a number of years before the rise in HIV diagnoses translates to a rise in AIDS-related deaths.

An external file that holds a picture, illustration, etc.
Object name is 1758-2652-13-16-4.jpg

Cumulative number of AIDS deaths by month from March 2003 to June 2008 .

AIDS is now a reversible HIV-related condition due to combination antiretroviral therapy (ART). The number of people receiving ART in the Philippines has been increasing since 2004, with a rate of approximately 10% of diagnosed cases receiving treatment in 2006, and ART coverage has now increased to approximately 30% [ 10 , 54 ]. But this is still considerably less than desirable levels. Universal treatment access for HIV-infected people is becoming a reality in some of the poorest countries of the world. Since HIV is relatively contained in the Philippines, there is the opportunity to substantially scale up treatment access before the number of HIV cases increases out of control. Treatment should be universal for HIV-positive pregnant women for preventing mother to child transmission (PMTCT) [ 55 ]. However, PMTCT is relatively uncommon in the Philippines.

One of the reasons for such low rates of ART is that funding for such care and treatment of HIV-infected persons makes up a mere 1.6% of the Philippines HIV/AIDS budget [ 56 ]. While expenditure on treatment and care is currently low, the Philippine National AIDS Council's 4 th AIDS Medium Term Plan and its country report for the period, January 2006 to December 2007, to the United Nations General Assembly Special Sessions (UNGASS) states that it will endeavour to improve access to treatment, care and support to HIV-infected persons [ 13 , 21 ]. Treatment not only sustains life among HIV-infected people, but by reducing their viral loads, it reduces infectiousness. At the population level, this would likely prevent considerable numbers of secondary transmissions of HIV [ 57 - 59 ].

The average age at HIV diagnosis in the Philippines was ~35-36 years prior to 2005, but recently, the average age at diagnosis has been decreasing (p = 0.0067) (Figure ​ (Figure5). 5 ). It is now ~29 years of age. Although it is possible that increased testing rates mean infections are detected earlier, the extent of decrease in ages cannot be attributable to changes in testing rates.

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Object name is 1758-2652-13-16-5.jpg

Trend in the average age at HIV diagnosis for three-monthly notifications in the Philippines .

The trend in decreased age at diagnosis is likely to reflect a decrease in age at infection. Younger age groups tend to have greater sexual activity. The fact that the average age is decreasing is a strong indicator that HIV incidence could increase substantially in the future in the Philippines. This trend is also in contrast to most other settings where epidemics are being controlled [ 60 ]. However, younger age is not necessarily indicative of greater sexual activity among all population groups, particularly among men who have sex with men, as suggested from other settings [ 61 ]. As men who have sex with men are the population group greatest affected with HIV in the Philippines, the decreasing age at diagnoses may not necessarily suggest a future increase in HIV.

The Filipino government and other stakeholders have responded to the HIV/AIDS threat in the Philippines in a number of ways in order to circumvent a large HIV epidemic from arising. The Philippine National AIDS Council (PNAC) was created in 1992 to act as an advisory body to the President for the development of policy for the control of AIDS. The PNAC consists of members from the government, public, civil society, private sector and non-governmental organizations (NGOs), and is the central advisory, planning and policy-making body for the comprehensive and integrated HIV/AIDS prevention and control programme [ 5 ]. But its small budget has limited its ability to instigate implementation of large intervention and education campaigns.

The official response of the Philippines Government to the HIV threat was to enact the Philippine AIDS Prevention and Control Act of 1998 (Republic Act No. 8504) [ 53 ]. This Act was enacted by Congress after a long process of deliberation and advocacy by the PNAC and other stakeholders [ 19 ]. The Act called for: a comprehensive nationwide HIV/AIDS educational and information campaign; full protection of the human rights of known and suspected HIV-infected persons; promotion of safe and universal precautions in practices and procedures that carry risks of HIV transmission; the eradication of conditions that aggravate spread of HIV infection; and recognition of the important role that affected individuals could have in promoting information and messages about HIV/AIDS. The Act also states that local governments are to provide community-based HIV/AIDS prevention, control and care services.

While the Act is a step in the right direction, it is far from effective due to a lack of monetary commitment from the government, relying heavily on NGOs for funding for HIV/AIDS education and prevention programmes, and the current government's seemingly unwilling attitude to promote wide condom use for fear of angering the Roman Catholic Church [ 35 ]. Its statements are also broad and do not outline targeted strategies with specific goals.

Other programmes have also been established for monitoring the spread, understanding key epidemic drivers and planning the control of HIV in the Philippines. There are currently four types of surveillance systems in place in the Philippines:

1. The HIV/AIDS Registry was established in 1987 and is a passive surveillance system. It continuously records Western Blot-confirmed HIV cases reported by hospitals, laboratories, blood banks and clinics that are accredited by the Department of Health.

2. The HIV Sentinel Surveillance System (HSSS) was established in 1993 with a grant from the USAgency for International Development (USAID). It monitors 10 key cities: Baguio City, Angeles City, Iloilo City, Zamboanga City, Pasay City, Quezon City, Cebu City, Cagayan de Oro City, Davao City and General Santos City. It pays particular attention to establishment-based female sex workers, freelance female sex workers, MSM and IDUs [ 3 , 6 , 32 ].

3. Behavioral Sentinel Surveillance was added at the 10 HSSS sites in 1997 and is a systematic and repeated cross-sectional survey of behaviour related to the transmission of HIV and other STIs [ 3 , 32 , 62 ]. Its major purpose is to detect trends among vulnerable populations and groups at high risk whose behavioural change would have the greatest impact on the HIV epidemic.

4. The Sentinel STI Etiologic Surveillance System was set up in December 2001, but made operational in 2003. It monitors STI trends that could guide programme interventions to prevent the transmission of HIV.

These surveillance systems have been monitoring the progress of HIV in the Philippines and have provided valuable data to inform appropriate response measures.

The PNAC's 4 th AIDS Medium Term Plan for 2005 to 2010 is one of the plans that utilized data from the surveillance systems [ 5 , 21 ]. This plan aligns with the Philippines AIDS Prevention and Control Act, with the aims of scaling up and improving the quality of preventive interventions and the quality of treatment, care and support services for people infected with and affected by HIV/AIDS. It also aims to integrate stigma reduction measures in the preventive treatment, care and support services and in the design of management systems.

The current state of HIV in the Philippines is not attributable to any one factor. While the Philippines response is associated with effectively controlled levels of HIV, there is no guarantee that a large HIV epidemic will be avoided in the near future. Indeed, an expanding HIV epidemic is likely to be only a matter of time as the components for such an epidemic are already present in the Philippines.

Mathematical modelling studies have shown that even in countries where overall HIV prevalence has remained relatively low (e.g., Bangladesh), moderate changes in behaviour or HIV infections could initiate a large epidemic that may otherwise have taken numerous decades to develop [ 63 , 64 ]. Current data from the PNAC show that young adults, men who have sex with men, male and female sex workers, injecting drug users, overseas Filipino workers, and the sexual partners of people in these groups are particularly vulnerable to HIV infection [ 13 ].

The current behavioural, social and epidemiological conditions suggest that an HIV epidemic in the Philippines may be unavoidable in the near future. The number of diagnoses is increasing, particularly due to homosexual and bisexual contact; there are low condom-use rates; and the age at diagnosis is decreasing. The underlying cause of these symptoms needs to be addressed in order to prevent an emergent epidemic. The promotion of HIV prevention and education messages is underfunded and has been relatively ineffective. It is recommended that more investment be made into these programmes in order to maintain the "low and slow" development of HIV in the Philippines.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

ACF conducted the extensive literature search, collated available data, produced the figures and wrote the first draft of the manuscript. DPW conceived and supervised the review project and contributed to the writing of the manuscript. Both authors read and approved the final manuscript.

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The state of HIV epidemic in the Philippines

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The state of HIV epidemic in the Philippines

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IMAGES

  1. Making the Philippines Safer from HIV

    hiv awareness research paper in the philippines

  2. Treatment of AIDS and HIV-Related Conditions-1999

    hiv awareness research paper in the philippines

  3. INFOGRAPHIC: HIV epidemic in the Philippines

    hiv awareness research paper in the philippines

  4. HIV Vaccine Awareness Day

    hiv awareness research paper in the philippines

  5. HIV Prevention

    hiv awareness research paper in the philippines

  6. AHF Philippines

    hiv awareness research paper in the philippines

COMMENTS

  1. The State of the HIV Epidemic in the Philippines: Progress and

    As of January 2023, there were 110,736 HIV cases reported in the Philippines [].Although this number seems low considering that the country has over 109 million people [], 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 ...

  2. A study of awareness on HIV/AIDS among adolescents: A ...

    11 Altmetric Metrics Abstract Acquired Immunodeficiency Syndrome caused by Human Immunodeficiency Virus (HIV) poses a severe challenge to healthcare and is a significant public health issue...

  3. Trends and emerging directions in HIV risk and prevention research in

    Based on an a priori systematic review protocol, we searched PubMed, PsycINFO and CINAHL databases for quantitative studies conducted in the Philippines that reported on HIV risk groups factors and interventions to prevent HIV. The search included studies published as of April 2018. Results

  4. HIV crisis in the Philippines: urgent actions needed

    The Philippines is facing the fastest growing HIV epidemic in the western Pacific, with a 174% increase in HIV incidence between 2010 and 2017. There were 1047 new cases in August, 2018, alone. Although national HIV prevalence remains below 0·1%, men having sex with men are disproportionately affected, accounting for 84% of all new infections.

  5. The State of the HIV Epidemic in the Philippines: Progress and ...

    PMC10224495 10.3390/tropicalmed8050258 Abstract 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.

  6. The Philippine HIV crisis and the COVID-19 pandemic: a worsening crisis

    It had the fastest-growing HIV epidemic in the western Pacific region between 2010 and 2017, where a 174% increase in HIV incidence was noted. 1 Notably, HIV infection in the Philippines disproportionately affects men who have sex with men (MSM), accounting for more than 80% of all new infections.

  7. Reimagining the Future of HIV Service Implementation in the Philippines

    The government passed the updated Philippine HIV and AIDS Policy Act (Republic Act 11166) in 2019, committing to a multi-sectoral approach to ensure access to prevention and testing programs as well as investment in treatment, care, and support services for persons living with HIV [ 3 ].

  8. Stigma, politics, and an epidemic: HIV in the Philippines

    The Philippines has the fastest-growing HIV epidemic in the world. According to UNAIDS, there was a 203% increase in the rate of new infections between 2010 and 2018, concentrated among men who have sex with men, drug users, and sex workers.

  9. HIV in the Philippines

    The barriers to condom access in the Philippines have raised particular concern. "In terms of HIV/AIDS control, the biggest obstacle in this country is the lack of promotion of condoms and the lack of awareness of their effectiveness", stated Conde. In 2015, 81% of new HIV infections in the Philippines were among MSM.

  10. Association of anticipated HIV testing stigma and provider mistrust on

    The rate of increase in new HIV infections in the Philippines is alarming [].On average, 42 new HIV cases per day were diagnosed in 2022 compared to 25 cases per day in 2016 and nine cases per day in 2012 [2,3,4].Eighty-five percent of all diagnosed HIV cases in the Philippines from 2017 to 2022 were among men who have sex with men (MSM), the majority of whom were adolescents (30%) and young ...

  11. Determinants of HIV testing among Filipino women: Results from ...

    Background The prevalence of having ever tested for HIV in the Philippines is very low and is far from the 90% target of the Philippine Department of Health (DOH) and UNAIDS, thus the need to identify the factors associated with ever testing for HIV among Filipino women. Methods We analysed the 2013 Philippine National Demographic and Health Survey (NDHS). The NDHS is a nationally ...

  12. HIV/AIDS risk in the Philippines : focus on adolescents and young

    34 p. Authors Balk, Deborah Cruz, Grace Brown, Tim This paper focuses on HIV/AIDS risk in the Philippines, especially adolescents and young adults. Themes AIDS Education Regions Asia and the Pacific Philippines Resource types Case Studies & Research Languages English Record created by Bangkok

  13. PDF HIV/AIDS Knowledge and Sexual Behavior of Female Young Adults in the

    HIV/AIDS knowledge and sexual behavior of female young adults in the Philippines Michael R.M. Abrigo October 20, 2017 1 Introduction Reproductive health issues, including government-sponsored mandatory sex education, have always been a contentious issue in Catholic-majority Philippines.

  14. Youth awareness of HIV/AIDS drops to all-time low

    Based on the 2021 Young Adult Fertility and Sexuality Study (YAFS5), 76% of young Filipinos aged 15-24 have heard of HIV and/or AIDS, a 19-percentage point drop from 1994 when awareness stood at 95%. This sustains the decrease observed in 2013, when the share of youth who have heard of HIV and/or AIDS declined to 83% from 95% in 2002 (Figure 1).

  15. Addressing the HIV crisis in the Philippines during the COVID-19

    Addressing the HIV crisis in the Philippines during the COVID-19 pandemic Before the COVID-19 pandemic, the Philippines enacted a new HIV law that lowered the age of HIV testing without parental consent, incorporated HIV testing into prenatal care, and expanded public health insurance coverage to HIV treatment.

  16. Knowledge, Attitudes, and Practices on HIV/AIDS among College Students

    This cross-sectional, descriptive study used a self-administered questionnaire to assess HIV/AIDS knowledge, attitudes, and practices among 565 college students aged 18-24 from three Pampanga higher educational institutions Philippines. A questionnaire was used to gather data on KAPs regarding HIV/AIDS transmission and prevention.

  17. Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention

    Insights in this paper point to a growing need and demand for PrEP in the Philippines for populations highly impacted by HIV, such as cis-MSM populations. The potential for the rollout of PrEP-based interventions and programming is contingent on public health efforts to increase levels of PrEP awareness of and interest in taking PrEP among cis ...

  18. As AIDS, HIV awareness among PH youth declines, cases, deaths rise

    Without treatment, AIDS can lead to death. Based on DOH data, AIDS-related deaths in the Philippines have increased by 315 percent—from 200 in 2010 to 820 in 2020. In 10 years, 4,890 in the Philippines had died of the disease. Lack in deep knowledge of HIV, AIDS

  19. Strengthening the fight against HIV in the Philippines

    With 22 new cases of HIV infection reported every day, the Philippines has one of the fastest growing HIV epidemics, an anomaly to the declining HIV prevalence trends observed across the world.

  20. HIV cases rising at 'fast and furious' rate, group says

    According to Dr. Edsel Maurice Salvaña of University of the Philippines Manila, Section of Infectious Diseases, in his article The Philippine HIV/AIDS epidemic: A call to arms, prevention and awareness campaigns remain by far potentially the most effective means of controlling HIV/AIDS in the Philippines. With the knowledge, awareness, and ...

  21. An HIV epidemic is ready to emerge in the Philippines

    A review of the conditions for HIV spread in the Philippines is necessary. Methods We evaluated the current epidemiology, trends in behaviour and public health response in the Philippines to identify factors that could account for the current HIV epidemic, as well as to review conditions that may be of concern for facilitating an emerging epidemic.

  22. HIV/AIDS in the Philippines

    The Philippines is a low-HIV-prevalence country, with 0.1 percent of the adult population estimated to be HIV-positive, but the rate of increase in infections is one of the highest. [7] As of August 2019, the Department of Health (DOH) AIDS Registry in the Philippines reported 69,629 cumulative cases since 1984. [8]

  23. The state of HIV epidemic in the Philippines

    Dec 1, 2023 8:00 AM PHT Rappler.com This page links to 'The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023,' a research paper by Louie Mar A. Gangcuangco and...

  24. A call for awareness in encephalitis

    In a survey of nurses and physicians in accident and emergency services across six countries (Australia, Germany, India, the Philippines, the UK, and the USA), 328 (53%) of 614 did not consider infectious encephalitis and 481 (78%) of 614 did not consider autoimmune encephalitis as differential diagnoses in patients presenting with established signs and symptoms for these diseases.