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.

BACKGROUND: 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. METHODS: 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. RESULTS: 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.

Recommendations for Intersectoral Collaboration for the Prevention and Control of Vector-Borne Diseases: Results From a Modified Delphi Process.

BACKGROUND: Intersectoral collaboration in the context of the prevention and control of vector-borne diseases has been broadly described in both the literature and the current global strategy by the World Health Organization. Our aim was to develop a framework that will distill the currently known multiple models of collaboration. METHODS: Qualitative content analysis and logic modeling of data abstracted from 69 studies included in a scoping review done by the authors were used to develop 9 recommendation statements that summarized the composition and attributes of multisectoral approaches, which were then subjected to a modified Delphi process with 6 experts in the fields of health policy and infectious diseases. RESULTS: Consensus for all statements was achieved during the first round. The recommendation statements were on (1-3) sectoral engagement to supplement government efforts and augment public financing; (4) development of interventions for most systems levels; (5-6) investment in human resource, including training; (7-8) intersectoral action to implement strategies and ensure sustainability of initiatives; and (9) research to support prevention and control efforts. CONCLUSIONS: The core of intersectoral action to prevent vector-borne diseases is collaboration among multiple stakeholders to develop, implement, and evaluate initiatives at multiple levels of intervention.

Intimate Partner Violence and HIV Testing in Filipino Women: Analysis of the 2017 Philippine National Demographic and Health Survey.

We sought to determine the association between intimate partner violence (IPV) and HIV testing among a representative household sample of Filipino women, using data collected from the 2017 National Demographic and Health Survey. In our sample, we found that 23.63% experienced IPV, and only 1.99% were tested for HIV in the past 12 months. We found that IPV was associated with an increased odds of HIV testing in the past 12 months (aOR = 1.42; 95% CI = 1.02, 1.99). Our study highlights the need to consider formal encounters with IPV survivors as opportunities to engage them in the HIV prevention and care continua.

"An Evil Lurking Behind You": Drivers, Experiences, and Consequences of HIV-Related Stigma Among Men Who Have Sex With Men With HIV in Manila, Philippines.

The Philippines has a rapidly growing HIV epidemic, with men who have sex with men (MSM) accounting for a majority of known cases. Currently, there is little understanding about MSM's experiences of HIV-related stigma in the Philippines and how they influence behavior and quality of life. Twenty-one interviews with MSM living with HIV and with communitybased organization workers were conducted in Manila from June to August 2017. MSM participants were affected by the intersection of HIV-related stigma and stigma toward homosexuality that are rooted in connotations of morality, "dirtiness," and sin. We identified specific patterns by which MSM living with HIV experienced enacted, felt, and internalized stigma and discuss implications of stigma for mental health, delays in HIV testing, and avoidance of HIV health services. Findings support the development of public health strategies in the Philippines that address stigma at societal and individual levels to reduce stigma-related harms.