Intrapersonal,interpersonal,and institutional levels of minority stigma among sexual minority males in the Philippines

Boardman et al. emphasize the imperative for healthcare professionals, managers, and organizations to address institutional, interpersonal, and internalized stigma and discrimination. ¹ This is especially essential for enhancing the timely diagnosis of HIV, particularly among key populations like sexual minorities. ¹ However, combating stigma through health education and promotion can be notably challenging in low and middle-income countries (LMICs) due to resource constraints. In this respect, this paper aims to highlight the lessons learned from addressing sexual health disparities and stigma among sexual minority males in the Philippines—an LMIC within Asia.

Before the advent of the COVID-19 pandemic, the country already had one of the highest HIV incidence rates globally. ² The country’s HIV crisis further escalated during the COVID-19 pandemic, manifested in decreased accessibility, delivery, and funding of HIV-related services and programs. ³ Notably, the HIV epidemic disproportionately affects sexual minority males, with 70% of cases in January 2023 occurring among males in same-sex relationships and an additional 17% among those involved with both males and females. ⁴ Emerging evidence emphasizes the role of sexual minority-based stigma in exacerbating these disparities.^2–4

Sexual minority stigma permeates various levels of Philippine society, with institutions such as the government and religious bodies contributing to discrimination against sexual minority males. ⁵ For example, Catholic values promoting heterosexuality as the societal norm impact national discussions on policies like the two-decade-old pending SOGIE equality bill in the Philippine Senate.^5,6 This bill aims to address discrimination based on sexual orientation and gender identity and expression (SOGIE).^5,6 Derogatory remarks from politicians, such as viewing sexual minority males as “worse than animals,” are also employed against the bill.^6,7

At the interpersonal level, stigma manifests in various aspects of the lives of sexual minority males in the Philippines. Some, especially those from Muslim families, face disownment due to their sexual orientation.^6,7 Instances of violence against sexual minority males, even perpetrated by their parents and peers, are also reported. For example, UNDP and USAID reported a young gay individual who started offering sexual services at 10 years old after his father physically abused him and placed him in a sack upon learning about his sexual orientation. ⁷ Likewise, sexual minority males in the Philippines grapple with intrapersonal stigma, concealing their identities to conform to societal norms, including marriage to women.^7,8

Encouragingly, recent developments indicate progress. Despite the absence of a national policy, advocates and local leaders collaborate to enact city ordinances safeguarding against SOGIE-based discrimination, thereby addressing institutionalized sexuality-based stigma.^5,7 Similarly, rights groups collaborate with the government and professional organizations to educate families and provide sexual health services and psychological therapies for sexual minority Filipinos.^6,7 Furthermore, community-based organizations help ensure confidentiality and accessibility to HIV testing and public education on SOGIE, thereby reducing stigma and enhancing overall well-being for sexual minorities.^4,5,7

Overall, the challenges and initiatives in the Philippines provide valuable insights and imperatives for addressing sexual health disparities, including HIV, among sexual minority males, These endeavors serves as exemplars for other LMICs grappling with resource limitations.