Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

A Systematic Review in Literature in

Trends and Challenges in HIV Risk and
Prevention Research in the Philippines
Gemelyn S. Hermosura1*; Zyrene Joy Ethyl Arobio2; Shane M. Landicho3; Gecelene C. Estorico4*
1,2,3,4
Chemical Engineering Technology Department, Technological University of the Philippines–Taguig, Taguig City, Philippines
4
De La Salle University – Dasmariñas Dasmariñas, Philippines

Corresponding Author: Gecelene C. Estorico4*

Abstract:- The Philippines is experiencing a rapid rise in I. INTRODUCTION

HIV cases, placing it among the fastest growing HIV
epidemics in the Asia-Pacific region. The epidemic The introduction of different exotic floras and wide
disproportionately affects key populations including distribution of invasive alien species in forest ecosystem are
MSM, transgender women, sex workers, and PWID-men threatening the biodiversity across Asia. The Philippines
and women who inject drugs. The members of these reported its first case of HIV in 1984, and the prevalence of
groups face a number of barriers to accessing HIV this virus had been estimated to be low for more than two
prevention and treatment services, including stigma and decades [1]. HIV/AIDS still ranks as one of the most
discrimination as well as inequalities in access to significant public health concerns for the Philippines. Recent
healthcare across geographic regions. The objective of statistics from the Department of Health reveal that, at 55
this systematic review is to review the trends, risk factors, new cases a day, the country ranks within the top tiers in new
barriers, and effectiveness of HIV prevention HIV infections within the Asia Pacific region. While there is
interventions in the Philippines, focusing specifically on a marked decrease in the rates of HIV elsewhere in the region
studies published between 2000 and 2024. Utilizing the [2]. It tends to focus on specific population groups, including
PRISMA methodology, 21 studies were identified based MSM, PWID, sex workers, and young adults between the
on relevance to HIV risk and prevention among critical ages of 15 and 24 years. Each of these populations carries
populations. Thus, it shows that there is a worrying distinct risk factors that raise the likelihood of their becoming
upward trend in HIV incidence, especially among PWID, HIV positive, including stigma, lack of access to healthcare
with prevalence peaking at 75% in 2010 in Metro Cebu. services, and minimal intervention targeted at these
Stigma and provider mistrust, as well as significant subpopulations [3]. It's at this juncture that the rising cases
barriers related to access to healthcare facilities, will only heighten the call for the scrutiny of trends and
determined low testing rates and delayed treatment. challenges in HIV risk and prevention research specific to the
Promising interventions included rights-based education, Philippines [4].
community-led HIV care models, and HIVST, each
demonstrating positive outcomes in increasing testing Defining this populations is essential, Men who have
and treatment initiation. However, for these programs to sex with men (MSM) refers to males who at any point or
achieve long-term effects, they must be scaled up and consistently practice sexual intercourse with other men,
sustained. The results point to the urgent need for regardless of labeling themselves in any waybe it 'gay',
culturally relevant interventions and policy reforms that bisexual, and even heterosexual in their conception. MSM
will combat stigma, ensure comparable access to services make up some of the population that highly suffers from
for all marginalized groups, bridge prevailing gaps in this being a leading group in this Philippine country's HIV
research, including regarding young persons and the outbreak because, due to socially associated discrimination,
rural sector, and increase the public health response and they barely receive easy access to health-related services for
imperative inclusive approaches to change the trajectory treatment [5]. On the other hand, People Who Inject Drugs
of the HIV epidemic in the Philippines. (PWID) are people who use injectable drugs and, through the
sharing of needles, are more exposed to HIV. The
Keywords:- Rapid Rise in HIV Cases, Key Populations, MSM criminalization of drug use and resultant stigma pose further
(Men Who Have Sex With Men), PWID (People Who Inject challenges for PWID in the Philippines in their efforts to seek
Drugs), Stigma and Discrimination, Inequalities in Access to healthcare [6].
Healthcare.

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Despite the implementation of various HIV prevention Identification. During the initial search phase, all
strategies, the Philippines continues to face significant records retrieved from academic databases will be screened.
barriers to effective intervention, particularly for Titles and abstracts will be assessed to determine initial
marginalized groups. According to Joint United Nations relevance.
Programme on HIV/AIDS, commonly referred to as
UNAIDS, surveillance reports, the Philippines is lagging Screening. Duplicate records will be removed, and the
behind in the steps towards achieving HIV/AIDS 90-90-90 remaining studies will undergo a preliminary review based
treatment for people living with HIV and knowing their HIV on the inclusion and exclusion criteria outlined above. Full
status, on treatment, and are virally suppressed. That is, 67 texts of potentially eligible studies will be retrieved for
percent know their HIV status, 32 percent are on treatment, further assessment.
and 29 percent are virally suppressed as HIV infections rise
in the Philippines [7]. The data from national surveillance Eligibility. Full-text articles will be assessed against the
show that the incidence of new HIV cases in the Philippines final inclusion and exclusion criteria. At this stage, any
started to increase alarmingly over the past decade. An studies that do not meet these criteria will be excluded, with
increase from 311 cases identified in 2007 to 8,151 cases reasons documented.
identified in 2016 – that's a 26-fold increase in new HIV
diagnoses. Inclusion. Studies that meet all eligibility criteria will
be included in the final synthesis. Data extracted from these
This growing HIV incidence in the country reflects gaps studies will be analyzed according to thematic and
in the current strategies of prevention and intervention that, quantitative synthesis methods as described.
if not addressed, will pose a greater public health crisis [8].
Hence, the pervasiveness of HIVrelated stigma in the PRISMA Flow Diagram. PRISMA flow diagram will
Filipino social context also creates a strong disincentive for be provided to visually represent the study selection process.
HIV testing and treatment among other marginalized groups This diagram will illustrate the number of records identified,
such as MSM and PWID due to fear of stigma and screened, assessed for eligibility, and ultimately included in
discrimination [9]. Issues such as this need understanding of the review, with reasons for exclusion at each step.
the causes of the epidemic, the urban area where resources
could be found, and in rural settings where healthcare All the steps in the PRISMA process will be well-
accessibility may be much lower. Reviewing existing documented to ensure reproducibility. Throughout the
research on HIV trend and prevention strategies will guide process, systematic recording of search results, study
policymakers and public health professionals to design more selection, and quality assessment will be maintained. Thus,
effective interventions for the Philippine context. this comprehensive approach based on the PRISMA
framework ensures that the review remains transparent,
This systematic review aims to identify and analyze reproducible, and unbiased.
trends in HIV risk and prevention research in the Philippines,
with a particular focus on the year(s) with the highest HIV A. Data Gathering
incidence. By examining available literature from 2000 to the Systematic search of the databases are as follows:
present, this review will offer a comprehensive view of the PubMed, Google Scholar, Scopus, and Web of Science,
epidemic’s progression and identify gaps in research and Philippinespecific resources Philippine E-Journals were
interventions. considered, and grey literature of reports from government
offices, theses, and publications by NGOs were also
Specifically, the review aims to: (1) Examine the impact incorporated.
of HIV on different populations, particularly key affected
groups such as MSM, PWID, and sex workers; (2) B. Literature Search
Identifying and evaluating the main prevention and This systematic review search strategy is going to
intervention strategies deployed over the past two decades; ensure full coverage of relevant studies on HIV trends and
(3) Highlighting the challenges researchers and public health challenges in the Philippines. Searches will be carried out
professionals have faced in implementing HIV prevention across several academic databases, including PubMed,
and treatment programs in the Philippines; and, (4) JSTOR, ScienceDirect, Google Scholar, and Scopus. The
Determine how have key populations, such as MSM, PWID, chosen databases are comprehensive and offer extensive
and sex workers, been impacted by the HIV epidemic, and coverage of literature within the public health, medical, and
what specific strategies have been employed to address their social sciences domains.
needs.
A combination of keywords and controlled vocabulary,
II. METHODOLOGY for instance, MeSH terms will be used to capture all relevant
literature, grouped into three main categories: population,
This systematic review will adhere to the PRISMA location, and topic. The Boolean operators will combine the
framework at every stage for transparency and proper terms effectively. Terms involving population will make use
reporting. PRISMA is widely used in systematic reviews to of "Men who have sex with men," "MSM," "People who
enhance methodological clarity and ensure all relevant inject drugs," "PWID," "sex workers," "female sex workers,"
studies are included without compromising on quality. [7]. "commercial sex workers," "youth," "young adults," and

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"general population." Geographical terms will use discuss HIV prevention, treatment, and its risk factors. To
"Philippines" and "Filipino." Topic terms involve varied encompass the comprehensive breadth of insight, studies
aspects related to HIV: "HIV prevention," "HIV risk," "HIV must apply (4), including qualitative, quantitative, and mixed
trends," "HIV epidemic," "HIV prevalence," "HIV research," methods designs. Additionally, (5) the literature must discuss
"HIV intervention," and "HIV transmission." Sample search the challenges faced in implementing HIV prevention and
may look something like this example: ("HIV prevention" treatment programs in the Philippines to provide a
OR "HIV risk" OR "HIV trends" OR "HIV epidemic" OR comprehensive view of the barriers to effective intervention.
"HIV prevalence") AND ("Philippines" OR "Filipino") AND
("Men who have sex with men" OR "MSM" OR "People who Exclusion criteria will eliminate studies not relevant to
inject drugs" OR "PWID" OR "Sex workers" OR "female sex the intent of the review. Studies: (1) not carried out in the
workers" OR "commercial sex workers" OR "youth" OR Philippine setting are excluded since they cannot be used
"young adults" OR "general population"). In controlled directly to enhance the understanding of the HIV epidemic in
vocabulary-supported databases, equivalent MeSH terms or the Philippines; (2) non-peer-reviewed sources, opinion
subject headings will be used to increase precision. pieces, and articles with limited data or no analysis regarding
HIV trends are excluded in order to have a very high level of
Filters will particularly be applied to narrow down the evidence. In addition, literature that does not target key
specific results to those published from the year 2000 and up populations nor addresses HIV risk and prevention will not
to date, but in the English language and also limits study be considered so that all the considered studies relate to the
types such as original research articles or review articles and aims of the review.
programmatic evaluations but excludes opinion piece
articles, editorials and other non-peerreviewed sources that D. Search Results
might be included. The initial search conducted across the chosen
academic databases obtained a total of 800 records. After
To include all the relevant data possible, grey literature deleting all the duplicated records (50 records), the
sources, including World Health Organization (WHO), remaining records were supposed to be filtered based on
UNAIDS, and Department of Health (DOH) Philippines, will inclusion and exclusion criteria that is, 750 records. After the
be used to obtain reports, government publications, and NGO screening of titles and abstracts, 550 records were excluded
research. Manual searches will also be performed by because they had nothing to do with the trends and
perusing the reference lists of included studies to identify prevention of HIV in the Philippines or focused on other key
articles not captured in the database searches. populations. Then, the remaining 200 studies were reviewed
further for full-text analysis on their depth and quality
References will be imported into reference relevance. Further down the line, other exclusions included
management software, such as EndNote or Mendeley, for 179 studies without adequate data on HIV trend, focusing on
citation management and removal of duplicates. There will regions other than the Philippines, and even with no
be two rounds of screening: title and abstract screening to discussion about HIV risk and prevention among key
filter for preliminary relevance and full-text screening to affected populations. In this case, only 21 studies satisfied all
assess the studies against the inclusion and exclusion criteria. of the inclusion criteria. The stages of study selection and
results are presented in the PRISMA flow diagram (Figure
All the steps taken in the process of the search shall be 1).
documented. The search date, search terms and key words
employed, numbers of articles reaped on every database and
decisions in and out, all decisions not to include every point
to be excluded in the systematic process. In this process, a
balanced review literature about HIV risk, HIV prevention,
and challenges related to intervention would be completed.
All significant studies representing the research agenda will
be established.

C. Inclusion and Exclusion Criteria

The inclusion criteria for this systematic review are
designed to capture studies that are highly relevant to
understanding HIV trends and challenges in the Philippines.
Eligible studies must (1) include exclusivity to the Philippine
setting so that findings can be applied directly to the peculiar
social, economic, and healthcare setting of the country. The
review will include studies (2) involving key populations
affected by HIV, for instance, men who have sex with men
(MSM), people who inject drugs (PWID), sex workers, and
the general population. Out of the included studies, the
literature review will only source three peerreviewed journal
articles, program evaluations, or government reports that

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Fig 1: Schematic Diagram Representing the Stages of Study Selection and Results Presented in the PRISMA Flow Diagram

E. Data Extraction To this end, time series will be carried out in determining
For the systematic review, data extraction will involve the patterns of trends associated with the incidence of HIV
gathering and organizing relevant data from each selected cases between 2000 up to present, helping reveal significant
study such that there will be sufficient and consistent analysis increase or decline throughout the time under review with
of trends and challenges in HIV problems in the Philippines. specific trends for peak reports. Growth rates are to be
The study will use a standardized form for data extraction to computed by utilizing the statistical software such as SPSS or
carry out systematic collection of the information with R. Application of regression models will make data
accuracy and comprehensiveness across studies. First, there visualization possible for revealing trends and deeper insight
will be information on the basic publication: author(s), title, on how the epidemic is evolving along the time axis. Trends
year of publication, name of journal, and location of study, in the data would therefore need critical analysis in the
whether it is urban, rural, or nationwide. Such data will put the determination of impact of prevention and intervention
study in context and help categorize studies according to their programs implemented during the years.
publishing time and place. The study population details will
then be documented, which include the specific groups The study of HIV among the Philippines will further find
affected in particular. This encompasses MSM, PWID, sex depth in understanding if conducted as a comparative analysis
workers, youth, and the general population. Understanding the involving differences in prevalence, risk factors, and
demographic and targeted risk groups is essential to assess the outcomes between groups such as MSM versus the general
epidemic's impact on different communities. population or urban vs. rural settings. To test for statistical
significance between the observed differences, tests applied
F. Statistical Analysis will include t-tests or chi-square tests.
The statistical synthesis of this systematic review will
involve quantitative findings on the trends, risk factors, and Finally, sensitivity analyses will involve the removal of
the effectiveness of the prevention strategies of the studies in which there was a serious risk of bias or outlier
Philippines. This will be through descriptive statistics, values to ensure the robustness of the results. Otherwise, the
whereby the process of summarizing key variables, such as overall conclusions have to be the same, rendering the results
HIV incidence and prevalence rates across the different years more reliable. The results of these analyses will be presented
and key populations, is a summary of the process used in the in tables and graphs, showing trends over time, group
synthesis. comparisons, and summary statistics that clearly and
comprehensively portray HIV trends, risk factors, and
intervention outcomes in the Philippines. This statistical

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approach aims to provide an evidence-based understanding of These studies are mainly situated in the urban settings,
HIV risk and prevention, offering valuable insights for public particularly in Metro Manila and other key cities, such as
health initiatives in the country. Cebu. Other studies target rural populations, which creates
unique challenges in terms of access to healthcare. This is seen
III. RESULTS in Bustamante and Plankey's (2022) review of barriers to HIV
testing in various settings; it makes a point that these have to
This systematic review encompasses 21 articles on HIV be tailored in an urban as well as in a rural setting. The studies
risk and preventive research in the Philippines, showcasing a differ in terms of temporal scope since some are time-specific,
variety of approaches, populations, and areas of focus. This such as the significant rise in HIV cases reported in 2010 while
variation enriches the understanding of the intricacies of the others offer longitudinal data for trends over time. A trend
HIV epidemic in the Philippine environment. analysis from 2010 to 2022 is done by Montegrico et al. in an
attempt to trace the dynamics of the HIV epidemic in the
The studies included a range of research designs, Philippines. Longitudinal data of this nature is essential for
including pilot quantitative studies, cross-sectional analyses, knowing the trend of the epidemic and can be useful in
retrospective cohort studies, qualitative interviews, and designing future interventions.
literature reviews. For instance, quantitative methods are
applied in studies such as Urada et al. (2016) and Eustaquio et Many of these researches also evaluate the interventions
al. (2021), which evaluate the effectiveness of specific that are specifically focused to reduce HIV transmission and
interventions, while qualitative studies, like that by de Lind ultimately improve health outcomes. They include human
van Wijngaarden et al. (2018), discuss barriers to HIV testing rights-oriented services for sex workers, online
among MSM through interviews. Such diversity of HIV self-testing interventions among communities, and
methodologies can afford to understand both statistical results harm reduction programs among PWID. The evaluation of
and a life as that which affected individuals' life experience such intervention programs will serve as significant lessons on
when it was stricken with HIV. The studies target diverse high- what works best in the Philippines and areas where
risk populations, such as MSM, transgender women, sex improvement is needed. Common limitations in the studies
workers, and PWID. Importantly, the focus is on these include reliance on self-reported data, which might be pronZ
populations, for they carry a larger burden of HIV in the to biasing, and small sample size, thereby limiting their
Philippines. For example, Restar et al. (2022) addresses generalization to a larger population. Many of the studies have
problematic drug use among transgender women and localized focus and target certain regions or populations;
cisgender men who have sex with men by identifying hence, they cannot generalize to the general Filipino
intersecting vulnerabilities of these populations. This would population infected with HIV. These limitations recommend
ensure that the results are applicable and relevant to the most multi-site studies that have more extended participation to
affected groups. view the epidemic. +

 Nature of the 21 Studies Identified

Table 1: Summary of Studies on HIV Risk and Prevention in the Philippines

No. Author(s) Title Year Study Study Key Findings Interventions/ Challenges/
Population Design Prevention Barriers
1 Urada et al. A human 2016 Sex Workers Quantitati Increased HIV Kapihan High abuse
rightsfocused HIV ve pilot awareness, program: rights rates, low
intervention for study motivation for education initial testing,
sex workers in testing, integrated with drug use
Metro reproductive skill-building
Manila, health
Philippines understanding
2 Sison et al. Association of 2022 1. Cisgender Secondar Stigma and Recommends Stigma,
anticipated HIV men who y analysis provider HIVST as a mistrust of
testing stigma have sex mistrust supplementary providers, fear
and provider with men influence option of facility
mistrust on (cis-MSM) preference for based testing
preference for in Metro HIV
HIV self-testing Manila, self-testing
among cisgender Philippines
men who have
sex with men in
the Philippines
3 Restar et al. Problematic Drug 2022 Transgender Crosssecti 29% engaged in Integrated HIV Stigma, lack of
Use Among women onal problematic and harm harm reduction
Transgender an analysis drug use; linked reduction access
Women and d with sex work services
Cisgender MSM cis-MSM and HIV status.
in the Emerging

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HIV Crisis
4 Olete et al. ChemsexPH: 2024 MSM Quantitati Chemsex linked Comprehensive Limited
Chemsex, HIV ve to HIV-positive harm reduction chemsex
status, and ART (Crosssec status; tailored to awareness and
adherence in tional 79% ART MSM engaging services
MSM online adherence in chemsex.
5 Eustaquio et al. HIV care cascade 2021 Cisgender Retrospec 78% ART Early Late
among cisgender men who tiv e initiation, 84% intervention presentation,
men who have have sex study of viral and improved advanced
sex with men in a with men medical suppression; KP-led HIV stages,
key (cisMSM) records late-stage HIV programs co-occurring
population-led diagnosed impacts STIs
community with outcomes
center in the HIV
Philippines
6 de Lind van “I am not 2018 Gay men Qualitativ Misconceptions, Community- Stigma,
Wijngaarde n et promiscuous and other e, case fear of stigma, based confidentiality
al. enough!”: men who series testing costs testing and concerns,
Exploring the have sex deter HIV destigmatizing healthcare
low uptake of with men testing HIV costs
HIV testing by (MSM) testing
gay men and
MSM in Metro
Manila,
Philippines
7 Bustamante J, Identifying 2022 Men who Literature Stigma, Sexual health Religious
Plankey Barriers to have sex Review misconceptions, education, self- stigma,
MW HIV Testing with men financial testing options, inconsistent
Among Men (MSM) constr NGO healthcare
Who Have Sex aints limit HIV collaboration policies
with Men (MSM) testing
in the Philippines
8 Restar et al. Restar et al. 2022 Cisgender Web- 75% aware of PrEP education Limited
men who based PrEP, 89% integrated with awareness,
have sex survey interested; HIV PrEP cost,
with men associated with testing reliance on
(cisMSM) HIV knowledge informal
and social sources
networks.
9 de Torres et al.. The HIV Care 2024 Persons Qualitativ Adherence Person- Social stigma,
Adherence with HIV e study journey centered inconsistent
Journey for (PWH) and (intervie involves interventions care,
Persons With health care ws) emotional, for resilience emotional
HIV providers social, and and health struggles
navigational empowerment
challenges
10 Amit et al. Knowledge, 2022 Filipino Crosssecti Low HIV Culturally Discrepancies
Attitudes, and MSM (men onal knowledge specific between
Sexual Behaviors who have study (48%); high- programs attitudes and
of Filipino MSM sex with risk sexual promoting behaviors, low
men) behaviors (54% sexual health health-seeking
unprotected behavior
sex)
11 AmadoraNolasco Knowledge, Risk 2001 Registered Interview Freelance Targeted safe- Socioeconomi
et al. Perception, and and based workers had sex programs c pressures,
Condom Use in freelance survey more partners, for freelance lack of
Female Sex female higher sex workers regulation,
Workers se perceived risk, inconsistent
x and inconsistent health-seeking
workers condom behavior
use
12 Hernandez & MSM 2009 MSM Mixed MSM face high- Tailored Stigma,
Imperial Identiti ( methods: risk behaviors, interventions masculinity
es, men who environm internalized addressing expectations,
Sexualities, and have sex ent stigma, and MSM- limited access
HIV with men) al coping, limited specific needs to services
interview

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Vulnerabilities in s, FGDs, health-seeking

the Delphi behavior
Philippines technique
13 Morisky et al. HIV Risk 2004 High-risk Longitudi Condom use Peer Social
Reduction male nal increased by coun stig
Through heterosexual quasiexpe 10%, STI selors ma,
CommunityBase population rimental incidence promoting safe limit
d Approach dropped by 5% sex and ed condom
in intervention behavior accessibility
groups change
14 Eustaquio et al. Online HIV 2022 Cisgender Retrospec High reporting Online HIVST Limited PrEP
SelfTesting men who tiv (99%) and kits with and ART
During have sex e linkage to care assisted options access, urban-
COVID-19 with men (85.7%), but rural
(cis-MSM) cohort low PrEP disparities,
and study (0.3%) and ART stigma.
transgender initiation (51%)
women
(TGW)
15 Estacio et al. Relationship of 2021 Drug 392 Substance users Community- Stigma, abuse,
Psychosocial us with abuse based harm and limited
Factors, HIV, and ers engaged history had reduction HIV testing
Sex Work Among in sex work higher odds of programs access
Filipino Drug engaging in sex
Users work; low HIV
testing rates
16 O’Connor et al. Risk Factors 2021 HIV- 426 79% reported Targeted harm Treatment
Affecting ART positive ART adherence; reduction for fatigue,
Adherence in the adults on longer drug/alcohol stigma,
Philippines ART ART duration use; social inconsistent
correlated with support condom use
lower adherence initiatives
17 Rowalt Psychological 2022 Young adult 119 Depression Mental health Depression,
Alibudbud Factors and HIV Filipino correlated with screenings limited sex
Risk Among MSM higher risk integrated with education,
Young MSM behaviors (e.g., HIV stigma
unprotected services
intercourse)
18 Verdery et al. Social Network 2017 People who Not High needle- Focused Limited
Clustering and inject drugs specified sharing prevention resources, high
the Spread of (PWID) clustering in targeting high- HIV
HIV/AIDS Cebu risk sharing transmission
Among Persons accelerates HIV networks rates in
Who Inject Drugs spread sharing
in 2 Cities in the compared to clusters
Philippines Mandaue
19 Telan et al. The Early Phase 2011 Injecting Crosssecti HIV prevalence Monitoring and Undetected
of an Drug Users onal among IDUs harm reduction rapid HIV
HIV Epidemic in (IDUs) analysis rose from for HCV- spread, limited
a Population 0.52% (2007) to positive IDUs harm
Exposed of 75% (2010) in reduction
Previously to HIV/HC Metro Cebu programs
HCV in the V
Philippines trends
20 Urada, Underage Youth 2014 Female sex Crosssecti Underage FSWs Policies to Exploitation,
L.A., Trading Sex in workers onal less educated, protect minors; lack of
Silverman, the Philippines: aged analysis work in illegal targeted education,
J.G., Tsai, L.C., Trafficking and 14–48 of HIV brothels, education and HIV mis
Morisky, D.E. HIV risk pressured into prevention information
Risk factors condomless sex
among
underage
FSWs
21 Montegrico A 13-Year Trend 2024 Males aged Trend Continuous rise Community- Stigma,
, J., Lee, J.- Analysis of HIV 25– 3 analysis in HIV cases; based early limited access
M., De Los males 25–34 detection and to testing and
Santos, J.A. most affected treatment,

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Epidemiology in prevention socioeconomic

the Philippines programs factors
(2010 to
2022)

IV. DISCUSSION C. Effectiveness of Current Interventions and Areas for

Improvement
This systematic review provides key findings about Despite all these challenges, several research findings
trends, risk factors, barriers, and effectiveness in the indicate that rights-based and community-led interventions
Philippines on HIV prevention interventions. Indeed, the somehow seem to improve the health of populations that have
escalating trends of HIV incidence are mostly reported among high risks. For example, the evidence of significant
key populations like MSM, transgender women, and PWID, improvements as per Urada et al. (2016) resulted in knowledge
where intervention is urgently needed. Thus, it places the and testing amongst HIV-related knowledge among sex
findings in a broader context of implications for public health, workers; empowerment of vulnerable groups helps them reach
identifies actionable insights, and points out areas for further for care. More favorable results in initiation of ART and viral
research and policy development.. load suppression were reported by Eustaquio et al. in 2021
within a community-based HIV care model, showing that such
A. Rising Incidence and High-Risk Populations models can be expanded to improve the service delivery and
The analysis reveals a rather worrying upward trend in health outcomes of MSM and other key populations.
HIV infections throughout the last decade where HIV
prevalence among injecting drug users in Metro Cebu peaked This finding has also demonstrated that HIVST is a very
at 2010 when prevalence rose up from 0.52% in 2007 up to feasible approach for facilitybased testing and will be a much
75% in 2010 as reflected by Telan et al. This significant better choice for those bearing stigma and mistrust. The
increase forms not only a critical juncture of the HIV epidemic provision of HIVST as an adjunct offer is indicative of
in the Philippines but also emphasizes the need for immediate expanded coverage and early diagnosis, therefore it is
and effective public health responses. From the data presented, recommended that HIVST should be used as an adjunct to the
it reveals that high risk groups, especially MSM and available choices (Sison et al., 2022). Nevertheless, while
transgender women, are highly vulnerable as there were promising, these interventions must scale up and be
studies that reveal 29.38% of transgender women had sustainable in the long run with continued support and
problematic use of drugs, adding another layer of vulnerability resource allocation.
to HIV (Restar et al., 2022). This coincidence with a broader
set of sociocultural factors, such as stigma and discrimination, D. Gaps in Research and Future Directions
particularly creates a challenging environment for HIV There is a significant gap in the research, especially in
prevention. terms of underrepresented populations. These include youth
and rural communities. Targeted research including
B. Implications of Barriers to Prevention and Treatment capturing their experiences and challenges would be necessary
Despite a host of other challenges, stigma is the key to note unique barriers these groups face. In addition,
challenge in HIV testing and treatment seeking. Many integrating HIV prevention with mental health support and
members of a stigmatized group are concerned about stigma substance use treatment will give a more holistic response to
and avoid services, especially among MSMs and sex workers, the epidemic (O'Connor et al., 2021).
whom stigma is normally expected. Provider mistrust
exacerbates this issue as many providers have experienced or Long-term effects of recent interventions must also be
witnessed themselves being treated shabbily by healthcare sought out by future research-a critical review not only at the
providers. These barriers have resulted in lower testing rates, point of intervention effectiveness but also on sustainability at
since the results only show 17% of MSM as knowing their later times. A combination of social, economic, and health
HIV status after having positive attitudes toward testing (Amit perspectives in a more holistic multidisciplinary analysis
et al., 2022). would best describe HIV risks and prevention in the country.

Besides, unequal geographical access to health care is a E. Policy Recommendations

contributor to the complexity of the HIV prevention landscape The final conclusion of this systematic review requires
in the Philippines. Rural communities do not usually have major policy changes in the society to remove the hindrances
access to the health facilities and equipment that cities have. to HIV prevention and treatment. Legal protections and
Health care provision and information distribution are some of decriminalization of sex work and anti-stigma campaigns are
the major issues affected by such inequitable access. necessary for creating an allinclusive healthcare environment
According to Eustaquio et al. (2021), there is a call for that makes the marginalized feel safe seeking care.
community-based interventions aimed at achieving an Community health nurses and local organizations will be
equitable allocation of HIV prevention and treatment services leaders in such efforts, pointing out that community
in different regions. engagement and education play a key role in HIV prevention
strategies, as shown by Montegrico et al. (2024).

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V. CONCLUSIONS [5]. Lopez, S. M. J., Ramiro, V. R., & Roxas, E. (2017).

Measuring stigma and discrimination towards people
This systematic review identified continuing challenges living with HIV among health care workers in a
and trends in HIV risk and prevention in the Philippines, tertiary, government teaching hospital in the
particularly among high-risk groups: MSM, transgender Philippines. Acta Medica Philippina, 51(4).
women, sex workers, and drug users. The slow and relentless https://actamedicaphilippina.upm.edu.ph/ind
increase of cases for the past ten years with a remarkable spike ex.php/acta/article/view/502
in 2010 strongly speaks to the urgent need for targeted, [6]. Cáceres, C. F., Konda, K., Segura, E. R., & Lyerla, R.
culturally responsive interventions. Stigma, lack of trust for (2008). Epidemiology of male same-sex behaviour and
healthcare providers, and inequalities in health care access are associated sexual health indicators in low-and middle-
major obstacles to successful HIV prevention and treatment; income countries: 2003–2007 estimates. Sexually
whereas there are a few promising interventions, such as transmitted infections, 84(Suppl 1), i49-i56.
human rights-based programs and community-led HIV care https://sti.bmj.com/content/84/Suppl_1/i49.s hort
models. [7]. Joint United Nations Programme on HIV/AIDS
(UNAIDS). (2017). UNAIDS Data 2017. Available
It identifies many critical gaps in the present body of at: http://www.unaids.org/sites/default/files/me
research and challenges further research into how such dia_asset/20170720_Data_book_2017_en.pdf
interventions, integrating HIV prevention with mental health [8]. Oguya, F. O., Kenya, P. R., Ongecha, F., Mureithi, P.,
and substance use support, can be implemented in order to Musyoka, H., Muraguri, N., Mundia, B., Angira, C.,
reach the particular needs of the rural populations and youth. Shose, M., Basheeb, T. A., Mohamed, A. A., Oyore, J.
Further expansion in research about self-testing and other P., Ochieng, O. G., Dida, G. O., Abdalla, S., & Abdool,
innovative approaches could enhance testing uptake among R. (2021). Rapid situational assessment of people who
populations confronting stigma and difficulties in access to inject drugs (PWID) in Nairobi and coastal regions of
healthcare. Kenya: a respondent driven sampling survey. BMC
Public Health, 21(1). https://doi.org/10.1186/s12889-
The state of HIV risk and prevention research in the 021-11373-9
Philippines reflects increasing understanding of the [9]. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron,
complexities of the epidemic but shows several areas that I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L.,
require improvement in significant ways. The focus areas for Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R.,
shifting the trajectory of the HIV epidemic in the Philippines Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu,
include reducing stigma, rights-based approaches, and M. M., Li, T., Loder, E. W., Mayo-Wilson, E.,
inclusive healthcare policies. Continued investment in McDonald, S., & McGuinness, L. A. (2021). The
research and policy reform will be necessary to build a more PRISMA 2020 statement: an Updated Guideline for
equitable and effective HIV prevention landscape that is Reporting Systematic Reviews. British Medical
accessible to and meets the diverse needs of those most Journal, 372(71). https://doi.org/10.1136/bmj.n71
affected. [10]. Alibudbud, R. (2022). Social and Psychological
Factors Influencing HIV Sexual Risk Behaviors among
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