Differences in HIV risk and healthcare engagement factors in Filipinx transgender women and cisgender men who have sex with men who reported being HIV negative, HIV positive or HIV unknown

Abstract

Introduction Understanding HIV risk and healthcare engagement of at‐risk individuals by HIV status is vital to informing HIV programmes in settings where the HIV epidemic is rapidly expanding like the Philippines. This study examined differences in HIV risk and healthcare engagement factors among Filipinx transgender women and cisgender men who have sex with men (trans‐WSM and cis‐MSM respectively) who self‐reported being HIV negative, HIV positive or HIV unknown. Methods Between 2018 and 2019, we conducted Project #ParaSaAtin, an online cross‐sectional survey that examined the structural, social and behavioural factors impacting HIV services among Filipinx trans‐WSM and cis‐MSM (n = 318). We performed multinomial regression procedures to determine factors associated with HIV status (with HIV‐negative referent). Co‐variates included participant demographics, experiences of social marginalization, HIV risk, healthcare engagement and alcohol and substance problems. Results Self‐reported HIV status of the sample was as follows: 38% HIV negative, 34% HIV positive and 28% HIV unknown. Relative to HIV‐negative respondents, HIV‐positive respondents were more likely to be older (25‐ to 29‐year‐old adjusted risk ratio [aRRR]=5.08, 95% Confidence Interval [95% CI] = 1.88 to 13.72; 30‐ to 34‐year‐old aRRR = 4.11, 95% CI = 1.34 to 12.58; and 35 + years old aRRR = 8.13, 95% CI = 2.40 to 27.54, vs. 18 to 25 years old respectively), to live in Manila (aRRR = 5.89, 95% CI = 2.20 to 15.72), exhibit hazardous drinking (aRRR = 2.87, 95% CI = 1.37 to 6.00) and problematic drug use (aRRR = 2.90, 95% CI = 1.21 to 7.13). HIV‐positive respondents were less likely to identify as straight (aRRR = 0.13, 95% CI = 0.02 to 0.72), and were more likely to avoid HIV services due to lack of anti‐lesbian, gay, bisexual and transgender (LGBT) discrimination policies (aRRR = 0.37, 95% CI = 0.14 to 0.90). Relative to HIV‐negative respondents, HIV‐unknown respondents were less educated (some college aRRR = 0.10, 95% CI = 0.02 to 0.37, beyond college aRRR = 0.31, 95% CI = 0.09 to 0.99, vs. high school or below respectively), had lower HIV knowledge (aRRR = 0.30, 95% CI = 0.20 to 0.71), and were less communicative about safer sex (ARR = 0.29, 95% CI = 0.09 to 0.92). Moreover, HIV‐unknown respondents were also more likely to have avoided HIV services due to cost (aRRR = 4.46, 95% CI = 1.73 to 11.52). Conclusions This study highlights differences in HIV risks and healthcare engagement by HIV status. These findings show different barriers exist per HIV status group, and underscore the need to address Filipinx trans‐WSM and cis‐MSM’s poor engagement in HIV services in the Philippines.

Non-uptake of HIV testing among trans men and trans women: cross-sectional study of client records from 2017 to 2019 in a community-based transgender health center in Metro Manila, Philippines

“…Moreover, the Integrated HIV Behavioral and Serologic Surveillance embedded in the Health Sector Plan for HIV and STI 2015 to 2020 of the Philippine Department of Health (DOH), an active sentinel serologic and behavioral surveillance, suggested actions to increase HIV and HIV-related services both for the TG and men-having-sex-with-men (MSM) populations [43,44]. However, the guidelines for the increase in uptake of HTC services among the TW and TM should be further strengthened because of the existing barriers to testing [45]. Our study aimed to identify gender identity as a factor that enables the TG populations to refuse or decline HIV testing services.…”

HIV Testing Preferences Among Trans Men and Trans Women: A Retrospective Study of Client Records from 2017 to 2019 in a Community-Based Transgender Health Center in Metro Manila, Philippines

“…However, the guidelines for the increase in uptake for HTC services among the TW and TM should be further strengthened because of the existing barriers to testing. [33] Our study aimed to identify the factors that enable the TG populations to refuse or decline HIV testing services. Through medical records review, our study showed that most TM did not consent or accept HIV testing services from the VLY, and they are more likely to refuse HIV testing services compared to TG.…”

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

“…Of the total reported new HIV cases in January 2023, 3% were transgender women [ 5 ]. Unique concerns among transgender populations in the Philippines include differences in HIV knowledge, need for safe sex communication, and disparate access to healthcare services [ 17 ]. One study among trans men and trans women ( N = 525) in Metro Manila showed that as many as 82% declined HIV testing and counseling services [ 18 ].…”