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; Emmanuel S Baja; Amiel Nazer C Bermudez; Ma Irene N Quilantang; Godofreda V Dalmacion; Ernest Genesis Guevara; Rhoda Myra Garces-Bacsal; Charlotte Hemingway; Miriam Taegtmeyer; Don Operario; Katie B Biello

doi:10.1186/s12889-022-14834-x

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. 2022 Dec 16;22(1):2362. doi: 10.1186/s12889-022-14834-x.

Authors

Olivia T Sison^{1

2

3

4}, Emmanuel S Baja^{5

6}, Amiel Nazer C Bermudez^{7

8

9}, Ma Irene N Quilantang^{8

10

11}, Godofreda V Dalmacion⁶, Ernest Genesis Guevara⁵, Rhoda Myra Garces-Bacsal¹², Charlotte Hemingway¹³, Miriam Taegtmeyer^{13

14}, Don Operario^{8

15}, Katie B Biello^{7

10}

Affiliations

¹ Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA. otsison@up.edu.ph.
² The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI, USA. otsison@up.edu.ph.
³ Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Metro Manila, Philippines. otsison@up.edu.ph.
⁴ Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Metro Manila, Philippines. otsison@up.edu.ph.
⁵ Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Metro Manila, Philippines.
⁶ Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Metro Manila, Philippines.
⁷ Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
⁸ The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI, USA.
⁹ Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Metro Manila, Philippines.
¹⁰ Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
¹¹ Department of Behavioral Sciences, College of Arts and Sciences, University of the Philippines Manila, Manila, Metro Manila, Philippines.
¹² Department of Special Education, College of Education, United Arab Emirates University, P.O. Box 15551, Al Ain, UAE.
¹³ Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Palace Liverpool, Liverpool, L3 5QA, UK.
¹⁴ Tropical Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
¹⁵ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.

Abstract

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.

Keywords: Anticipated HIV testing stigma; HIV self-testing; Men who have sex with men (MSM); Philippines; Provider mistrust.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
HIV
HIV Infections* / diagnosis
HIV Testing
Homosexuality, Male
Humans
Male
Philippines
Self-Testing
Sexual and Gender Minorities*

Abstract

Publication types

MeSH terms

Grants and funding