Evaluating Translation of HIV-Related Legal Protections Into Practice: A Qualitative Assessment Among HIV-Positive Gay, Bisexual, and Other Men Who Have Sex With Men in Manila, Philippines

Abstract

Legal protections for people living with HIV (PLHIV) are important for protecting human rights, yet little research has examined how laws translate into awareness and understanding for key populations. The Philippines has recently revised their legal protections for PLHIV in response to its growing HIV epidemic, where HIV-positive gay, bisexual and other men who have sex with men bear the majority of cases. We present findings from interviews with 21 HIV-positive gay, bisexual and other men who have sex with men in Manila, Philippines regarding awareness, understanding, and needs regarding HIV-specific legal protections at the time just before new revisions to the omnibus HIV law were passed. Overall, there was no standardized way participants became aware of legal protections; few became aware through healthcare providers, while most learned through online resources, social media, and advocacy organizations. However, even after learning about HIV-specific legal protections, many found the law too complex to understand or did not understand how to use such protections. This led participants to preemptively take action to avoid HIV-related discrimination, even if they were protected by law. Participants demonstrated a strong desire for interventions and policies to improve legal awareness and understanding for PLHIV, government officials, and private businesses. This research demonstrates the value of increasing awareness and understanding in policy-specific interventions designed to improve quality of life for PLHIV. Interventions centered around legal protections are currently underdeveloped, providing a strong opportunity to integrate such interventions in existing practice or as stand-alone tools to decrease perceived stigmatization.

Background

Globally, countries have enacted laws focused on both prosecution and protection of people living with HIV (PLHIV), sometimes simultaneously (Gruskin, Ferguson, Alfven, Rugg, & Peersman, 2013). Much focus has been placed on laws that punish nondisclosure of HIV status and subsequent exposure or transmission of HIV, which can impact how PLHIV navigate their lives socially and politically (Adam, Elliott, Corriveau, & English, 2014; Lazzarini et al., 2013). Less focus has been dedicated to the study of how countries codify specific legal protections for PLHIV, including protections against discrimination or nonconsensual disclosure. Structural interventions like HIV-specific legal protections are uniquely suited to manage HIV stigma because stigmatization is, by nature, reflective of existing social processes aimed at devaluing and othering PLHIV, driving their disempowerment and social exclusion (Parker & Aggleton, 2003). Dynamic social processes that moralize HIV and produce stigmatization lead to difficulties in appropriate treatment and care, in addition to active labor by PLHIV in avoiding stigma (Chambers et al., 2015). HIV-positive men who have sex with men (MSM) face ‘dual stigma’ due to prejudice against both serostatus and sexual identity (Herek, 1999; Nemoto et al., 2003), and thus may face additional strains on their psychosocial health (Kennedy et al., 2013; Radcliffe et al., 2010). Overall, legal protections can alleviate stigma and promote inclusion of key populations in HIV prevention efforts (Burris, 1999; Mahajan et al., 2008), making them a key part of an effective response.

The Philippines is an important context for studying awareness and understanding of HIV-specific laws, because it is currently experiencing one of the fastest growing HIV epidemics (UNAIDS, 2017). Since 1998, the nation has had an omnibus HIV law, Republica Act 8504 (RA 8504), which includes specific protections for PLHIV. Specific anti-discrimination provisions in RA 8504 can be found in Supplemental Online Material 1 (Congress of the Philippines, 1998). Despite these legal safeguards, previous research documents substantive internalization of stigma among PLHIV in the Philippines (Adia et al., 2018; Trinidad, Quinto, & Naldoza, 2011). Gay, bisexual and other men who have sex with men account for 85% of new diagnoses (Epidemiology Bureau, Department of Health, 2019), making them a key population for consideration in the epidemic; despite this, little research centered on gay, bisexual and other men who have sex with men living with HIV in the Philippines exists (Restar et al., 2018).

The Philippines recently passed an update to RA 8504, Republica Act 11166 (RA 11166), in 2018, and the government began implementation in 2019. Specific anti-discrimination provisions in RA 111666 can be found in Supplemental Online Material 2 (Congress of the Philippines, 2018). Some improvements in RA 11166 include counseling for families of PLHIV on stigma and discrimination, additional protections against housing discrimination and bullying based on serostatus, and increased fines and maximum prison sentences for committing an act of discrimination based on HIV status. Under RA 11166, perpetrators of discriminatory practices based on serostatus are subject to heavier fines and longer maximum prison sentences upon conviction than they were under RA 8504. Moreover, the punitive extent of sanctions is contingent upon the type of offender: noncitizens of the Philippines can expect deportation, business corporations risk suspension or revocation of licenses and permits, and public officials face temporary or indefinite disqualification from office—all in addition to any fines and/or penalties of imprisonment already incurred.

Though President Duterte signed RA 11166 into law, his administration’s policies and practices have created major roadblocks to effective control of HIV. Most directly, Duterte’s War on Drugs and support of extrajudicial killings has prevented people who inject drugs from accessing essential care and harm reduction services, including services for HIV prevention (Dombrowski, Dorabjee, & Strathdee, 2017). Increases in incarceration as part of the War on Drugs have led to overcrowding, which has increased disease transmission (Macarayan, Ndeffo-Mbah, Beyrer, & Galvani, 2016). While several barriers to condom access exist across the country (Carlos H. Conde, 2016), Duterte downplayed the importance of condom usage in 2018 amidst the rising tide of HIV in the country (Mara Cepeda, 2018). Thus, RA 11166’s arrival coincides with several actions taken by the current government that directly conflict with RA 11166’s approaches, threatening to reduce its impact.

Awareness of laws that protect PLHIV is essential in maintaining protective and destigmatizing outcomes of HIV law (Burris, 1999), enabling protected individuals to enforce their rights and putting would-be discriminators on notice that discrimination carries legal sanctions. Classical economic analysis of law suggests that legal penalties raise the costs of unlawful behavior (Posner, 2014); a law protecting PLHIV from employment discrimination makes it costlier for companies to have discriminatory practices, given the costs of litigation and enforcement by governmental authorities. The magnitude of expected costs depends on the likelihood of a suit, likelihood of a successful claim, and expected penalties for violation. Since people must be aware of the law to sue, awareness factors into this cost-benefit analysis. High costs may drive large behavioral or institutional changes, while low costs may incentivize smaller or no changes. More recent research has suggested that laws may have an expressive effect that is distinct from these incentive impacts (McAdams, 2015). Specifically, laws can serve as a source of information about social norms, risks and benefits of regulated practices, and the likely behaviors of other people.

Even though awareness has multiple functions in law, few studies have assessed knowledge of HIV-specific legal protections among PLHIV. One study assessed legal knowledge among HIV-positive women in South Africa, but it assessed knowledge of protections on the basis of sex rather than on the basis of serostatus (Hill, Maman, Holness, & Moodley, 2016). Prior research from United Nations programs points to gaps between awareness and in-depth understanding of the legal process in the Philippines, as well as a lack of infrastructure for legal assistance and services (UNAIDS, 2011, 2012). In this paper, we present interviews with HIV-positive gay, bisexual and other men who have sex with men. These interviews took place shortly before the government passed RA 11166 into law. We assessed their experiences related to awareness of HIV-specific legal protections in RA 8504 and how they thought the provisions in RA 11166 could be implemented into practice. While insights regarding the law’s impact on empowerment and protection have been previously reported (Adia et al., 2019), this paper specifically focuses on awareness and understanding of laws, marking a significant point of departure. Using lessons from RA 8504’s implementation, we aim to identify ways RA 11166 can be executed to directly impact gay, bisexual and other men who have sex with men.

Methods

This study collected information from 21 gay, bisexual and other men who have sex with men with HIV who were residing in Metro Manila, Philippines. Each participant was interviewed for approximately one hour from July to August 2018 using a semi-structured interview guide (Supplemental Online Material 3). Participants were recruited using convenience sampling through a community-based organization which helps PLHIV access health and social services. Eligibility criteria included being at least 18 years old, self-identifying as a gay, bisexual or other man who has sex with men, being able to communicate in English, and self-reporting a positive HIV diagnosis. All interviews were conducted in English, which is one of the two national languages of the Philippines and is the primary medium of instruction in many schools.

No relationships were established with any specific participant prior to the conduction of the interview. Each interview was conducted in a private space in the office of the community-based organization. To maximize confidentiality and privacy by eliminating any written forms that could link participants to the study, participants were asked to provide verbal consent for the interview and audio recording after being informed about study details. Participants were asked about their awareness of laws and policies regarding HIV-specific protections, when they became aware of RA 8504 and its protections, and about the importance of specific protections for PLHIV. Participants were given 300 Philippine Pesos (approximately $6 USD) to compensate for time and transportation costs.

Interviews were audio-recorded and transcribed, and any identifying information was omitted during transcription. Data were subjected to thematic analysis (Braun & Clarke, 2006). Using NVivo 12, two members of the research team (ACA & CJL) coded the data set to identify themes. Members of the study team validated themes by reviewing memos created throughout the analysis process. The Brown University Institutional Review Board approved all study procedures.

Results

Sample demographics are presented in Table 1. We identified three themes related to awareness and understanding of law, which we describe below.

Table I.

Study Sample Characteristics (n=21)

Characteristics	Mean (Range) or Percentage (Count)
Age
Mean	35.2 (19–52)
Years Since Diagnosis
Mean	6.1 (1–19)
Education
High School or Less	23.8 (5)
Some College	76.2 (16)
Employment
Employed	33.3 (7)
Un-Employed	66.7 (14)
Self-Identified Sexuality
Gay	47.6 (10)
Bisexual	33.3 (7)
Man Who Has Sex with Men	14.3 (3)
No Answer	4.8 (1)

There was no standardized way gay, bisexual and other men who have sex with men with HIV became aware of RA 8504’s legal protections

Across our sample, the vast majority of respondents were not aware of specific nondiscrimination protections for PLHIV before they were diagnosed. Participant 9 explained how he was not initially aware and how he hoped the passing of RA 11166 would help the non-positive, or ‘non-pos,’ community become aware of protections:

Before I’m not yet positive. You know, I don’t know about the law, the rights, the amendment. So right now, we have the amendment for Congress to pass the law for HIV and we’re still waiting for it [the new HIV law]. Right now, we’re expecting too much for that amendment to pass in the Congress. After- maybe after passing the AIDS law…maybe the non-pos community they will be aware about- about PLHIV, our rights, and law.

This meant that respondents were frequently diagnosed with little to no prior knowledge of HIV-specific legal protections. As such, there were a variety of ways through which participants became aware of RA 8504, reflecting a lack of standardization for informing gay, bisexual and other men who have sex with men with HIV about their HIV-specific legal protections.

Subtheme 1: HIV-specific legal information from healthcare providers.

Few respondents were informed about HIV-specific legal protections through their providers after their diagnosis. Those who did learn about these rights in clinic settings had been linked to peer educators at social hygiene clinics, which specifically provide HIV-related services to gay, bisexual and other men who have sex with men (Ross et al., 2015). However, most were not diagnosed at these clinics and were instead left uninformed of their rights following diagnosis. Participants noted that clinicians may not have had training on discussing legal rights, and that constraints in the healthcare system often limited available time for discussion with physicians during appointments. Participant 7 spoke about the variety of reasons why, in retrospect, he didn’t expect his physician to discuss his legal protections with him.

I mean I have attending physician, he will not tell about the law. He or she will advise me about how could I take care of myself, have a healthy life. [laughs] …Because there’s a lot [of] patients, and we have a limited doctor who are trained on HIV healthcare, they only say only how to take care of yourself, you have the ARVs, monitor your health … that’s it.

A small minority of participants were informed by a counselor at the time of diagnosis due to clinic-specific programs. However, because counseling was generally limited to a single session, some remained confused afterward. Participant 3 discussed his experience:

When I was diagnosed I was counseled by an HIV counselor told me that there is a law that protects me. If you are going to read the law it’s very–it’s like this (gesture indicating length). It’s very hard to read all the sections, the definition of terms. There are technical words that as can only understand so we have to lay it down on a term that the general population can understand.

Because many did not learn about these protections at a clinic, participants described a lag between their diagnosis and when they learned about specific legal protections through other means.

Subtheme 2: HIV-specific legal information from online resources and social media.

Other respondents learned about HIV-specific legal protections in RA 8504 through online research and social media. However, some expressed concern that online resources may be inaccurate, leading to confusion about what protections actually existed. Participant 5 explained how he sorted through material about RA 8504 that he found online in order to inform himself and the risks of doing so:

I was doing my own research. However, I still validated those research because, unfortunately, not everything in Google is reliant. Not all of the information there are informative. So you have to really, as an individual, analyze these sentences that there is written there because it might lead you to somewhere else.

Interviewer: Do you think it’s important for the community of people living with HIV to do their own research and know about these laws and policies that are meant to protect them?

Yes, however, they need to know where to get-- where to get factual information. Otherwise, if they just use Google, most definitely it will cause so many disturbances, chaos and, at the same time, depression on their end. I got a lot of clients who were not HIV positive, undergone screening, but still at the end of the day, they’re still calling and texting me ‘Why is that stated in the internet... Why is that...?’

Subtheme 3: HIV-specific legal information from advocacy organizations

For some, advocacy organizations, including the one from which participants were recruited, offered opportunities to become educated on HIV-specific legal rights through formal resources like seminars about legal rights and volunteer opportunities that necessitated training in understanding RA 8504. Participant 1 described how he became aware of his protections through activities with the help of an advocacy organization:

When I was diagnosed and start to engage, there was this paralegal training and [advocacy organization] was always invited, not only me but with other peers. Because at that time there was only few support groups so every time there was activities they always considered us: self-actualization, consultation, until even the implementation of the project…There were different kinds of topics there that was being discussed, and after you undergo HIV 101 you should also learn about the law so that you will be aware about existing policy in the government and your rights.

Even when individuals knew about the RA 8504, they still found it overly complex or lacked knowledge about how to use it.

Despite being aware of their legal protections, many expressed confusion about RA 8504. This prompted some to express a desire for in-person discussion and counseling about nondiscrimination protections or an official website explaining the law.

Subtheme 1: Challenges in the RA 8504 itself

For some, the confusion was related to the sheer length of RA 8504 given its many articles and provisions. Participant 16, who was aware of the law and the changes that were being discussed, expressed confusion due to the sheer amount of text in the document:

The amendment bills now are passed in the Philippines and the law I think we have a Republica Act 8504.... It’s very wide, long here so I feel lost if I am reading those very, very huge articles or repu- or what do you call this article...we have lots of article here in the Philippines.

Others found difficulty with the language used in RA 8504, which may be too technical to understand without further education. This limited the extent to which gay, bisexual and other men who have sex with men in this population used RA 8504 to enforce their rights, as a lack of resources translating technical knowledge into easily understandable insights provided an insurmountable challenge for some respondents. Participant 3 discussed this issue and how he needed to explain terms used in RA 8504 to his friends:

It’s very hard to read all the sections, the definition of terms. There are technical words that as can only understand so we have to lay it down on a term that the general population can understand…If you are going to read the whole law it’s very technical. Technical people and us who are working in advocacy understand, but how about the general population?... some of my friends doesn’t know that there is an existing law, so I have to educate them I have to speak to them paragraph by paragraph, section by section so they could understand it.

Even resources intended specifically for gay, bisexual and other men who have sex with men contained technical language that failed to inform respondents of their protections in an accessible manner. Participant 17 spoke about this challenge:

There’s an available file of this which you can look on the internet. Look up RA8504 and just have to browse it. But since most of the words are hyphened you think it’s very hard to understand…Very technical, so it just leads to you know to [inaudible] law just to understand the different text, each article being there.

Subtheme 2: Challenges in the legal process

Awareness was simply the first barrier towards utilization of legal protections; even if participants knew that it was against RA 8504 to discriminate against someone based on serostatus, few knew specific information on how to enforce their rights against violators. Participant 10 explained his lack of understanding about where to go if someone discriminated against him or one of his friends:

I really don’t know where I’m going to run and aside from that... the number one thing that I just want to know what is the procedure in case people who, if someone suffers or experiences, what is the number one procedure...number two is who is the right person to go to contact...so this has been what I what I see. Because some other PLHIV I know, they experience that, but we advised to ‘okay you can file a case against them’, but who is the right person they need to get another lawyer? Is this free? So this is the one problem.

Participant 5 discussed the insufficiency of knowledge and his desire for greater clarity on whom to turn to after an act of discrimination:

Primarily, some of us know the law existed. However, if there would be occasions if a certain individual needs to, like have an attorney or an assistant to undergo court for this, it’s kind of difficult. There should be like, yes the Philippine National AIDS Council is there, however they should be also have like a song, voice, that ‘Hey we’re here, we’re gonna be the one that assists you! We’re gonna be like the one to work on your case.’

Increasing awareness and understanding of RA 11166 can improve quality of life for gay, bisexual and other men who have sex with men with HIV

Respondents discussed a variety of potential benefits from increasing awareness and understanding of HIV-specific legal protections.

Subtheme 1: Improving understanding among gay, bisexual and other men who have sex with men with HIV

First, respondents discussed how informing gay, bisexual and other men who have sex with men with HIV about RA 11166 would benefit them. Some described personal benefits to knowing about protections. For example, participants discussed their fears about housing discrimination or job loss, both of which are prohibited by RAs 8504 and 11166. Anxiety related to not knowing about their specific legal protections had direct impacts on quality of life; for example, some participants resigned from their jobs preemptively to avoid being fired or experiencing workplace discrimination due to HIV status. Participant 5 discussed how his lack of awareness meant that he unnecessarily suffered at his job:

Before I actually was engaged in doing counselings, doing tons of research, and at the same time, getting diagnosed, I was not aware of the law itself. Basically, this law should’ve been helping me long time ago. Because I was on a leave of absence from my work and I need to be undergoing a forced resignation, wherein I shouldn’t have.

Simply knowing about RA 11166 may enable gay, bisexual and other men who have sex with men with HIV to feel less fearful about facing discrimination. Participant 11 expressed his wish that he had known about his protections against employment discrimination:

No, I wasn’t aware. I was never aware. I only when I volunteered or got involved in the act of advocacy that’s where I learned of the law. No one told me, so it’s just ‘Oh, there’s a law for…’…It would have made a dent on my life because I am afraid of applying for a job privately, I wouldn’t be afraid…

Subtheme 2: Improving understanding among employers

Participants spoke about how improving knowledge about RA 11166 among private companies may empower gay, bisexual and other men who have sex with men with HIV by alleviating fears about discrimination in the workplace. After noting that he thought private companies were not generally knowledgeable about HIV, Participant 13 talked about how to improve their understanding about the condition:

I thought that they need more education…the prevention, the HIV and already they need to educate [about] the RA8504…at least to know the law to lessen discriminate the person living with HIV. It needs work already because many people living with HIV here really discriminate, they fired the employees because of the virus…So when the company knows the law, less discrimination, no discrimination.

Subtheme 3: Improving understanding among government officials

Because local officials may serve as the center point for accessing disability benefits related to HIV or for receiving complaints of discrimination, ensuring that government officials are knowledgeable about HIV-specific policies in RA 11166 may be essential to enforcement. Participant 20 explained how current deficiencies in local government officials’ awareness of nondiscrimination protections can reduce enforcement, which in turn can harm gay, bisexual and other men who have sex with men with HIV:

We have a law to protect the HIV person, but unfortunately the official, the lower official in the city hall or in the barangay is not well informed what to do when they encounter a person with HIV.…For example, before I don’t know the HIV is capable to get- to get a person with disability card…but some of the city hall are not giving this because they do not know what is HIV. So, they tell ‘you have more strength than other diseases so you can have work,’ but they don’t know what is inside of the law.

Discussion

Overall, this study illuminates how lack of awareness and understanding of the law may diminish its actual impact and provides a variety of ways policymakers, researchers, and community advocates can take advantage of the new law to maximize its impact. Few participants were aware of HIV-specific protections prior to diagnosis, and many remained unaware for a period of time after their diagnosis, leading to fear and anxiety about discrimination. Additionally, a lack of standardized information or education on HIV-specific legal rights creates the risk of misinformation. As such, specific legal rights for PLHIV ought be integrated into future educational efforts targeted at vulnerable subpopulations like gay, bisexual and other men who have sex with men writ large in order to normalize awareness and understanding among those not diagnosed with HIV. Efforts linking newly diagnosed gay, bisexual and other men who have sex with men with HIV to immediate counseling, including education regarding legal rights, may also lighten these burdens. To this degree, policymakers should support community-based organizations with resources and funding necessary to continue their already strong presence in increasing awareness and understanding of HIV-specific legal protections. We map findings from this study onto provisions in RA 11166 in Table 2.

Table 2.

Mapping Themes onto Policy Provisions

Target of Intervention	Opportunities in 2018 Act
Gay, bisexual and other men who have sex with men	Targeted modules as part of education of vulnerable populations and key subgroups
Gay, bisexual and other men who have sex with men with HIV	Integration of legal rights counseling as part of pre- and post-test counseling
Employers	Discussion of legal protections and empowerment of PLHIV as employees under specific workplace education programs led by the Department of Labor and Employment
Local Government Officials	Discussion of legal protections and empowerment of PLHIV as employees under specific workplace education programs led by the Civil Service Commission

Easily accessible information is necessary but insufficient. Participants raised concerns about the complexity and inaccessibility of existing information about RA 8504 and potential misinformation about HIV-specific legal protections online. Thus, efforts to improve awareness of RA 11166 must be framed in accessible ways. Simple solutions may include know-your-rights trainings and information briefs about legal protections distributed through the national and local departments of health websites and printed materials. This includes explaining current policies into easily understandable presentations, easily readable flyers and brochures written in Tagalog, infographics comprehensible for people below a 6^th grade reading level, and other accessible materials. Even when gay, bisexual and other men who have sex with men know and understand their rights, they may not understand the legal process enough to take action. Participants were unable to convey many details of how they might begin to file a lawsuit. Our findings on barriers to enforcement demonstrate the importance of providing not only comprehensive informational resources, but also access to (and advertisement of) affordable legal services. It is clear that a comprehensive toolbox of responses and initiatives will be necessary, although tailored resources and counseling can be used to mitigate this issue. Enlisting advocacy organizations to continue their already-effective capacities in spreading easily understandable messages may effectively reach gay, bisexual and other men who have sex with men with HIV affiliated with these organizations. These individuals might in turn disseminate knowledge more broadly to men who are not connected to services or advocacy groups.

Lastly, this research demonstrates the need to consider education regarding HIV-specific laws on a broader scale. Policy initiatives and interventions should consider targeting companies, physicians and healthcare providers, and local government officials to achieve systemic change. Prior work has shown that providers may not be aware of HIV-specific provisions against discrimination (Ortega, Bicaldo, Sobritchea, & Tan, 2005). Improving understanding among clinicians may not only decrease instances of provider discrimination, but may also help doctors become advocates and educators for the legal rights of gay, bisexual and other men who have sex with men with HIV. It is important to consider that interactions with people in positions of power have disproportionate influence on the wellbeing of gay, bisexual and other men who have sex with men with HIV. Acts of discrimination by employers, coworkers, or government officials may exacerbate feelings of invalidation, isolation, and internalized stigma among gay, bisexual and other men who have sex with men with HIV. As such, researchers and policymakers should propose and evaluate broader changes as part of the toolkit for improving legal awareness in the Philippines. For example, RA 11166 currently requires companies to have workplace policies on nondiscrimination related to HIV, which is a strong foundation that can be improved with better enforcement and investigation.

While we identify several ways RA 11166 could integrate a variety of new modules built off this research, various sociopolitical factors act as key barriers; substantial stigmatization of HIV (Adia et al., 2018; Trinidad et al., 2011), conservatism that has hindered progress in implementing other HIV policy responses (Carlos H. Conde, 2016), and the Duterte administration’s general tendency toward authoritarian populism above human rights (Dombrowski et al., 2017) all act in concert to make implementation of key programs far more difficult. While strategies that can aid in effectively translating research into policy do exist (Oliver, Innvar, Lorenc, Woodman, & Thomas, 2014), further work must go towards ensuring these methods are applied in the Philippines in the context of HIV, especially given the current political climate.

There are important limitations to this research. First, participants were recruited through purposive sampling, based primarily on targeting a community organization frequented by HIV-positive gay, bisexual and other men who have sex with men. As such, the narratives provided in this sample might not reflect individuals who do not have access or have not availed themselves to these types of spaces, as respondents in this sample may be more aware of HIV laws than those not connected to the organization. Second, this study focused on Metro Manila, in which social and clinical care services for PLHIV are more abundant compared to other settings in the Philippines. HIV-positive gay, bisexual and other men who have sex with men in other cities or in rural areas may have different resources or deficits, which may correspond to different experiences related to legal protections. Third, this study’s focus on HIV-positive gay, bisexual and other men who have sex with men means that further research is needed to identify awareness among other subgroups, including transgender men and women, female sex workers, young people, or people who use drugs. These findings should not be considered generalizable to these other key populations in the Philippines, and so specific research on these groups’ experiences regarding HIV-specific protections warrants further study.

Fourth, interviews were conducted only in English. Although English is one of the official languages of the Philippines, participants who were comfortable completing this interview in English may be different from those who may prefer to communicate with Tagalog with regard to discussions of technical laws and difficult experiences related to stigma and discrimination. Potential participants who were excluded due to lack of English proficiency may have distinct awareness of technical laws and may be more marginalized in ways than those who are proficient in English may be. Finally, this study did not examine differential awareness of legal protections between gay, bisexual and other men who have sex with men in this study; these groups may have substantial differences in organization and political awareness and action, necessitating further study (Tan, 2001). While this research’s focus was on identifying awareness of HIV-specific protections, identifying ways in which sexual orientation intersects with experiences regarding HIV-specific protections warrants future research.

RA 11166 offers a fresh opportunity to initiate campaigns to spread knowledge and understanding about HIV-specific legal protections. This research points to a clear need for more widespread knowledge about the improved law and offers a few ideas for policies, interventions, and future research. This study also highlights the complexities related to the current political climate and challenges to accessing essential care and harm reduction services due to the current administration’s War on Drugs. Given the rapidly increasing incidence of HIV in the Philippines, action to improve quality of life for those living with HIV is urgent, and dialogue and interventions to improve knowledge of HIV-specific legal protections are key parts of these efforts moving into the future.