Addressing stigma,enhancing social support and improving mental health among men who have sex with men in the Philippines

Dear Editor,

Zhao et al. highlighted the importance of strong social support and reducing stigmatization, particularly from families, for the mental well-being of HIV-positive men who have sex with men (MSM) in China. ¹ Similarly, increasing social support has been emphasized as essential for the mental health and psychosocial well-being of MSM in the Philippines. ² However, challenges in Philippine society, aside from the stigma of HIV, can limit the social support received by Filipino MSM. Addressing stigma based on sexual orientation is also imperative, given the shortage of mental health professionals and the growing HIV epidemic in the country, where MSM are the predominantly affected population.^3,4

In the Philippines, MSM can face stigmatization due to their sexual orientation.^5,6 As a predominantly Catholic country, MSM can be condemned for perceived religious immorality, leading to discrimination and prejudice.^5,6 For example, a report from the UNDP and USAID revealed that one individual began offering sexual services at 10 years old after his father violently abused him upon discovering he was gay. ⁶ It also described a father pouring boiling water on his gay son after learning about his sexual orientation. ⁶ Beyond the family, MSM also face discrimination in schools and workplaces, where they can be bullied and harassed by their peers. ⁶ Despite this pervasive discrimination and violence, the Philippines lacks a national policy protecting individuals from sexual orientation-based discrimination. ⁶ Given the link between stigma and poor mental health, including among Filipinos,^1,7 it is crucial to address these adversities faced by Filipino MSM.

First, efforts to decrease stigma can be strengthened through enhanced information and education campaigns on sexual orientation across communities and digital platforms. Likewise, schools can incorporate sexual orientation topics within their sexual education courses, and workplaces can include these topics in their gender and development programs. By decreasing stigma, these social support systems of MSM can be better leveraged to support their mental health.

Second, there are limited mental health professionals in the Philippines. For instance, there are only about 500 psychiatrists for a population of over 110 million in the country. ⁴ This challenge can necessitate empowering other healthcare workers involved in providing healthcare to MSM, including those working in HIV-related services, to provide mental health support. These healthcare workers can be trained to provide mental health support, including topics such as mental health screening, basic counseling, and psychological first aid, to better respond to the mental health needs of their patients.

Lastly, a national policy protecting sexual minorities, including MSM, from sexual orientation-based discrimination is needed. Therefore, Filipino MSM, together with their advocates and allies from different sectors, can enhance their advocacy by incorporating their campaigns into national events related to sexual orientation-based discrimination, including World HIV Day, Mental Health Month, and Gender Awareness Month.

Overall, addressing stigma related to HIV and sexual orientation is essential for improving the mental health of Filipino MSM. As a start, information and education campaigns can be strengthened, healthcare workers involved in HIV care can be trained to provide mental health support, and anti-discrimination legislation can be advocated.