MSM and TGW welcomed the idea of introducing HIVST, especially blood-based diagnostic
kits, accessed via reputable outlets. They liked the convenience and confidentiality
of HIVST in a stigmatised context. Key informants shared enthusiasm for HIVST but
also raised concerns regarding antecedents within the health, regulatory and legal
system that were at odds with the beneficiaries’ desire for convenience and confidential
HIV testing in a stigmatised context. In addition key informants held different views
on priorities to address this urgent HIV epidemic.
HIVST: Big Benefits and High Demand from Target Users.
HIVST availability was considered by all participants as being a beneficial addition
to the HIV testing strategy in the Philippines, particularly in reaching high-risk
groups such as young MSM. All key informants stated a major benefit for HIVST would
be increased access to testing.
“it [HIVST] will increase access to HIV testing and other populations that are not
reached through our routine testing…..because of the stigma, discrimination that is
still experienced in this country” Laboratory participant
A majority of MSM and TGW showed enthusiasm and willingness to perform HIVST in the
future after watching a video of the testing procedure.
The appealing factors for HIVST in both groups included awareness of HIV status in
a confidential, private and convenient manner in comparison to current facility testing,
an opinion shared by most key informants.
“For me, it’s just for myself whether I’m HIV positive or not, nobody else will know
if you’re positive” MSM FGD high socio-economic status
“People don’t want to go to clinics, it is stigmatising. They don’t want to be seen
in those clinics, they may know someone in the facility, or in the area of the facility.
They don’t want to get judged” Service provider
MSM and TGW highlighted that self-testing would be empowering, and allow individuals
to take responsibility of their own health.
“It [HIVST] would be easier, you can do it anywhere, anytime, you're at home, in your
room, in the toilet, you won't be hassled to go to the clinic, and wait there” TGW
MSM and TGW showed interest in partner testing, and felt HIVST could lead to a shift
in relationship dynamics, with increased decision-making regarding sexual intercourse.
TGW believed HIVST could make their relationships stronger by increasing mutual trust.
Over half of key informants felt that HIVST would most likely benefit those with good
knowledge and previous testing experience, and thus the broader appeal of HIVST would
be limited to only a small portion of MSM.
“The most beneficial [group are those] who have their test before, because they have
been orientated with HIV 101, they will know the consequences of the test if they
ever are positive” Doctor
Doctors and service providers viewed educating the public on HIV as an essential pre-requisite
to create demand for a HIVST program, but could be challenging within the religious
and conservative culture present in the Philippines.
“To sustain the use of a HIV self-test, and sustain its market ability, people should
understand what the benefits are of using this and this is just not done through marketing,
but really making people aware of what HIV is” NGO representative
Concerns were expressed regarding the current knowledge of HIV amongst the public.
This was reflected in the varying knowledge of HIV amongst FGD participants as some
MSM from urban poor areas showed poor knowledge, requiring misconceptions to be corrected.
“There are no medicines for HIV, right?” MSM FGD 1 urban poor area
Desirable characteristics of HIVST kits and access
Over half of MSM and TGW participants preferred blood-based to oral fluid HIVST kits
as they felt it would be more accurate.
“Blood is better, because you'll know if you have HIV, because it's blood-to-blood”
They felt the kit should have instructions in Tagalog, access to a video demonstration
and telephone hotline to aid those with literary difficulties.
All key informants, MSM and TGW felt that a high price would restrict access of HIVST,
but this was especially so among participants from poor urban areas.
Distribution and linkage to care
A range of options for distribution were mentioned by key informants, MSM and TGW
regarding the most suitable avenue for acquiring HIVST kits. Popular options amongst
all participants included clinics, community sites and pharmacies. These sites were
favoured by MSM and TGW as they were considered trustworthy. Online purchase was favoured
by 1 MSM and 1 TGW due to the convenience of buying the product and its delivery,
which would eliminate the stigma. However key informants and most MSM and TGW disagreed,
and were concerned about fake kits being sold or being discovered by family members.
Two program implementers argued for multiple avenues for distribution such as vending
“Self-testing should be real self-testing, there should be no human-human interaction
to get that kit” Program implementer
Linkage to HIV services following a reactive result was a frequent concern raised
by all participants. All groups emphasised the need for clear information to be included
with HIVST kits regarding the processes a tester can expect after a reactive test
result. This included the requirement for a confirmatory test, accuracy of test kits,
and the location of HIV services.
“They should be familiar with what they should do, once the results are positive,
because you cannot stop at just testing, and not knowing what to do afterwards” Doctor
“There is a problem of that linkage to care, to me is also very important, because
you don’t want them to test and then nothing happens” Program Implementer
Regulation, Readiness and Priority
Key informants recognised addressing the urgency of the epidemic and were enthusiastic
about HIVST, however they felt regulatory, policy and the current health system required
changes prior to its implementation (figure 1 in the Supplementary Files).
All key informants stated that HIVST should be regulated, and identified the FDA as
the organisation to oversee this. Regulation was considered essential to ensure accurate
test kits were available to the public. The National Laboratory was also identified
to be responsible for conducting a performance assessment of HIVST kits. Those which
pass the accepted in-country threshold for sensitivity and specificity would be recommended
to the FDA.
“The accuracy of performing the test, and then how they interpret it because the quality
of testing is very important because getting a false positive or false negative result
might have a tremendous implication for the patients, so it’s very important to get
an accurate test” Doctor.
Knowledge regarding the use of HIVST in other contexts was evident amongst all key
informants. Most key informants were also aware of HIVST kits being available via
the internet. Two MSM participants had prior knowledge of HIVST, and its availability
via the internet and also stores within the city.
“The prevention of abuse of sales of unregistered kits, that is my concern and that
is my reservation for HIV self-testing” Laboratory participant.
Key informants found there to be no current policy which supported HIVST in the Philippines.
They identified two sections of the Republic Act No.8504 (HIV/AIDS Prevention and
Control Act of 1998) which would be a challenge for implementing self-testing, namely
pre and post-test counselling by an accredited counsellor, as well as the requirement
that HIV testing can only be conducted by a medical technologist. They were however
optimistic that the promotion of HIVST as a screening program as opposed to testing,
could lift these restrictions. In the Philippines, the testing guidelines from 2017
draw a distinction between screening and testing. While testing is only performed
by trained medical technologist, screening is seen as an additional procedure prior
to testing that can be performed by lay trained provide, midwives, nurses and physician
using rapid diagnostic tests.
Both key informants, MSM and TGW highlighted counselling as important, especially
for first-time testers. They recognised that counselling could take several modalities
including remote counselling. Peer counsellors and telephone services were popular
“If you get this test result and then you are not properly counselled, you don’t know
where to go, what does it actually mean, then you can end up with a lot of people
depressed, angry at the world, so it can cause more harm than good, without the proper
set of interventions that go with the introduction of self-testing” NGO representative
Although all key informants were supportive of HIVST, views differed as to the priority
for implementation in the Philippines. Some service providers stated this as a high
priority program, to provide new tools to fight the growing HIV epidemic. Whilst a
few participants stressed strengthening the current health system in terms of HIV
testing, linkage to care, increasing ART coverage and reducing loss to follow-up.
“I think in the Philippines there are more systemic testing issues, and the testing
system, that if they were changed and addressed, they would make much more of a change
in terms of testing coverage, rather than, more than the introduction of self-testing”