Social determinants of HIV infection among men who have sex with men in the Philippines
Since 2007, the number of prevalent HIV cases in the Philippines has been growing exponentially each year. In 2014, 84% of the new cases were attributed to sexual transmission by men who have sex with men (MSM). To provide insight on this rising epidemic, social determinants of HIV infection among MSM were analyzed using a social ecological model, consisting of individual, network, community, and public policy levels. The following determinants were found most relevant to MSM in the Philippines: (1) individual: genital ulcer disease, number of male partners, injection drug use (IDU) and non-IDU substance abuse; (2) network: receptive and unprotected anal sex, and social media usage; (3) community: the lack of access to preventive services, VCT and ART, and stigma; (4) public policy: homophobia, condom availability, and sexual health education. Stigma was found to interact with multiple determinants at every level. Condom use was found to be a key determinant to target for expansion. Using health belief model constructs, barriers to self-efficacious behavior might be identified for future interventions. Lastly, individual, network, and community levels might be the most feasible in HIV prevention for MSM until attitudes toward MSM and condom use change at the societal level.