Citation: de Lind van Wijngaarden JW, Ching AD, Settle E, van Griensven F, Cruz RC, Newman PA (2018) “I am not promiscuous enough!”: Exploring the low uptake of HIV testing by gay men and other men who have sex with men in Metro Manila, Philippines. PLoS ONE 13(7): e0200256. https://doi.org/10.1371/journal.pone.0200256

Abstract

The Philippines faces a severe HIV epidemic among gay and other men who have sex with men (MSM). HIV testing uptake remains low. A case series of 12 men from Metro Manila were interviewed to explore barriers to uptake of HIV testing services. Most did not see the need to get tested for HIV despite significant risk, based on the misconception they were feeling well or showed no symptoms. Being of a higher socioeconomic class, feeling morally superior to other gay men, distance of the testing facility, fear of what will happen once infected, fear of HIV- and sexual stigma, fear of side effects of antiretroviral drugs and fear of high health care expenses after testing positive for HIV were key reasons why MSM kept postponing their test. Misconceptions about HIV risk, disease, and treatment and care need to be addressed in order to increase uptake of HIV services in this population.

Introduction

The Philippines is in the middle of a rapidly expanding HIV epidemic among gay men and other men who have sex with men (MSM), people who inject drugs and transgender people [1]. In June 2016, 841 new HIV cases were reported diagnosed in the Philippines, which was the highest since record-taking began; 95% of new cases were men, and 82% of all cases were MSM. Of the new cases, 23.7% were MSM age 15–24 years. Sixty-three people were reported to have died of AIDS in June 2016 alone, bringing the total number of reported deaths for 2016 to 291; again, the vast majority was MSM [2]. HIV prevalence data and data on HIV testing uptake among MSM in 10 selected Metro Manila cities found a range of HIV prevalence of .45–5.50% (average 2.84%), with HIV testing uptake (defined as “HIV tested in the past 12 months and knowing the result”) ranging from 1–41% across cities (average 20%) [3].

A Department of Health evaluation report on HIV behavior change communication programs commented on counseling practices observed in the Philippines [4]. It identified a widespread practice of counselors and medical personnel handing clients an HIV test result in a sealed envelope, without the counselor being aware of the result. Lab technicians mistakenly believed that they would be breaking confidentiality laws if they informed the counselor of the client’s test result. Hence, no post-test counseling takes place at all in these instances, and linkages to antiretroviral therapy (ART) care services were non-existent.