From Loneliness to Statistics: The Economic Cost of Neglect and HIV Among MSM in the
Philippines
By Alexandra Lucille Y. Navarez and Toribio Noel Luis A. Ilao
__________________________________________________________________
Odd and different. These are the words that have always been etched in my mind since I was
young. Frankly speaking, I used to get so livid when someone called me “bakla” or “bakling”
back in elementary school. I didn’t have many friends growing up—only a few female
classmates who acted as my saviors whenever the boys would tease me.
Things changed when I moved to Manila for high school, where I found myself completely
alone. As a probinsyano, it was incredibly hard to fit in. I was scared to approach anyone for fear
of being ignored or mocked. I was very lonely and insecure. Now that I’m an adult, I find myself
yearning for things—comfort and belonging—that were denied to me as a child. As they say,
healing your inner child. To make things worse, my parents separated when I was young. And as
the middle child—often called the “forgotten sibling”—I felt neglected.
In an attempt to fill that emotional void, I began seeking validation through sex with different
men. Those hookups and one-night stands, although unhealthy, momentarily eased the emptiness
and loneliness that had always lingered. For once, I felt wanted—something I didn’t often feel
growing up. I craved that feeling more and more, until I reached the point of no return.
I didn’t even know I had contracted HIV until I was hospitalized multiple times over the course
of two months. I was completely unaware of the risks back then—ignorant and naïve. I lost so
much weight, and the illnesses became persistent and severe. That was when a doctor suspected
HIV, and they were right. Because of the late detection, I had already progressed to the AIDS
stage—the most critical phase of HIV. I also developed cytomegalovirus (CMV) retinitis, which
left my left eye partially blind.
I felt terrible for my parents, who were terrified that I might not survive. They did everything
they could for me during the lowest point in my life. The stress, the fatigue, the
hopelessness—they were overwhelming. I was so scared of dying during that time that I was
diagnosed with depression and began experiencing hallucinations. To make matters worse, my
father had to spend millions just to keep me alive. But thankfully, I survived. And here I am,
sharing my story. I am currently undetectable due to my compliance with antiretroviral therapy
(ART).
I may not be proud of the mistakes I made in the past, but I am more than just another tally in the
Department of Health's record of people living with HIV. I am more than the disease that will
stay with me for the rest of my life. And with that, I’ve chosen to live with purpose.
I will do my best to return all the good my parents have done for me. Most importantly, I believe
in redemption. Ironic, isn’t it? In my desperate search for belonging, I ended up with blood
brothers—connected by this very disease.
That is my story.​
— Anonymous
Stories like these remain uncommon in the Philippines —a predominantly conservative and
Catholic country where LGBTQ+ individuals often face discrimination, and sex education is
lacking or censored. These gaps contribute significantly to the spread of preventable issues like
teenage pregnancy and HIV. For further context, HIV, also known as Human Immunodeficiency
Virus, attacks white blood cells, weakening the immune system. Early symptoms include fever,
rashes, sore throat, and headaches. If untreated, it progresses to AIDS (Acquired
Immunodeficiency Syndrome), causing severe immune damage and increased risk of infections
like tuberculosis and cancer (WHO, 2024). In other circumstances, people who have debilitating
diseases like HIV-AIDS opt not to seek further treatment due to several factors such as stigma,
discrimination, poverty, or lack of access to facilities (Brown University School of Public Health,
2021). This essay seeks to shed light on addressing the barriers in effective HIV prevention,
testing, and treatment among vulnerable populations, such as members of the LGBTQIA+
community, who face significant challenges in accessing necessary healthcare and services.
Historical Context of HIV/AIDS
The HIV-AIDS epidemic gained attention in the 1980s in the United States, with rising cases
among gay men and some women, particularly among women of color (i.e., African women or
underage girls). At the time, HIV was particularly called the “gay disease” as the majority of
those affected were gay men who often engaged in unprotected sex. Furthermore, the response
of the American government was slow—only to be formally addressed in 1985 after an 89%
surge in cases. The delay in urgent initiatives from the Reagan administration in congressional
hearings led to a backlash due to delays in addressing the surge in cases (CANFAR, 2025). It did
not help that the majority of the supporters within the Reagan cabinet were mainly religious and
far-right, influencing socially conservative policies that alienated gay men, incentivizing
homophobia and apathy among people with AIDS. The lack of transparent and substantial
answers about AIDS by reinforcing the “insignificance” of AIDS left the world ignorant,
deterring domestic pressure to address the epidemic.
The AZT, the first drug to treat HIV/AIDS, was approved in 1987 but had harsh side effects and
was not a cure. Moreover, the drug was very expensive, forcing those without insurance to pay a
higher amount, which ultimately hinders patient to a drug that could extend their lives (Liedtka,
2006). In the economics aspect, the fundamental policy of the Reagan administration was the
rigidity of “Reaganomics,” wherein the main objective was to reduce government spending–a
popular policy among American conservatives during that period. Therefore, funding for public
health sectors was scarcely limited. Although the budget for AIDS related initiatives increased
from $8 million to $500 million between 1982 and 1986, government funding remained
minuscule to combat the AIDS epidemic. Therefore, the politicization of HIV/AIDS led to
senseless deaths and a false sense of security by appeasing the administration’s main political
base (Ortiz, 2023).
In the late 1990s to early 2000s, HAART or Highly Active Antiretroviral Therapy significantly
improved survival rates, which increased the efficacy of treating HIV (Watson & Wiginton). In
addition, Dr. Mark Wainberg had significant contributions to the development of 3TC – a
combination of drug therapy which led to a decline of AIDS-related deaths and hospitalizations
by 60-80% of patients who can afford and access healthcare (CANFAR, 2025). Does this mean
that HIV-AIDS-related health issues would have been fully eradicated or contained? Globally,
there are two directions in which nations have been combating the disease. Developed countries
like the U.S. and the U.K. have strong healthcare and prevention systems, which have access to
the drugs developed by renowned researchers mentioned above. On the other hand, developing
countries, such as those in Central Africa and Haiti, struggle with limited access, funding, and
education (National Academies Press, 1986).
​
HIV-AIDS in the Philippines: What happened and how are we faring?
The societal structure of the Philippines can be explained through the Grossman Model in Health
Economics, in which the model views health as a form of capital, specifically, human capital.
The health capital does not depreciate instantly and lasts over time. Furthermore, individuals or
legally employed individuals are seen as active producers of their own health by investing time
and resources. The concept emphasizes that health is a productive capital, yielding labor
productivity. Hence, higher demand for income and education increases demand for health by
reducing cost and increasing health benefits. However, the prevalence of HIV-AIDS
disproportionately affects our country. Furthermore, behavioral and institutional factors play a
big role (i.e., safe sex education and religious beliefs), determining how investments are made in
health or non-health factors, which could be a person's lifestyle factors. The argument can be
applied to Filipino men who have sex with men (MSM) who do not opt for condoms due to a
higher trust in their sexual partners, diminished pleasure, or extra costs of buying condoms.
Therefore, we can say that our country aligns more with the second category, knowing that the
Philippines ranks first in terms of rapidly increasing HIV cases (Butler, 2023).
Figure 1. Estimated annual new HIV infections among individuals 15 years old and above from
2000–2021 globally and in the Philippines, based on UNAIDS estimates
SOURCE: Ganguangco & Estaquio (2023).
In essence, the Philippines’ surging HIV cases contrasted by the decreasing number of cases
recorded globally indicate that our country is facing a rapidly expanding epidemic, mirroring
other impoverished countries in Africa. This likely indicates that global initiatives implemented
in countries affected by HIV have begun to reduce transmissions through effective government
control and prevention. It signifies that the Philippines is an outlier compared to its neighboring
countries, which face a unique and persistent epidemic. Despite some progress, it is currently
facing one of the fastest-growing HIV epidemics in the Western Pacific Region, with a
staggering 411% increase in cases. Projections indicate this may grow by another 200% by 2030.
The epidemic is largely driven by male-to-male sexual contact, which accounts for roughly 70%
of infections.
Figure 2. Distribution of diagnosed HIV cases, by age group, Jan 1984 – March 2024
Source: Health Technology Assessment Study Group (2024)
To highlight the urgency of the health epidemic, Figure 2 shows that an increasing number of
HIV diagnoses are predominantly seen in age groups between 15-24 and ages 25-34, indicating
that the majority are youth or working age individuals are at risk. Other at-risk groups include
transgender women, sex workers, trafficked girls, overseas Filipino workers (OFWs), and people
who use injectable drugs. In 2023, transgender women accounted for 3% of newly reported
cases. Many in these groups face compounded challenges: limited HIV awareness, deeply
ingrained stigma, and poor access to appropriate healthcare services (Gangcuangco and
Eustaquio, 2023). If we are to underscore this, a significant portion of people diagnosed with
HIV since 2020 are in their most economically productive years, and the epidemic is impacting
individuals earlier in their careers. Why should we take this matter urgently? HIV/AIDS heavily
affects the private sector as morbidity and mortality rates increase, which directly affect
employee productivity and increase costs. On the other hand, there is a higher burden on public
finances, and effective interventions are urgently needed to mitigate the human cost, but also
manage the growing burden. Given that the majority of diagnosed individuals are within these
age groups, understanding how the transmission of the disease occurs is crucial to designing
effective responses. Not only should we become more aware, but understand the policymaking,
societal, and cultural attitudes that perpetuate an ineffective system.
In Figure 3, the overwhelming majority of HIV transmissions are acquired through sexual
contact, particularly MSM, which shows a rapid surge in cases apart from those who engage in
male-female Sex. Furthermore, it highlights that transmission through needles remains relatively
low for all HIV transmission cases. Hence, the focus on prevention and treatment efforts in the
Philippines is heavily centered on curbing the growing cases of HIV among MSM through the
aid of social hygiene centers in public hospitals, as well as Love Yourself PH.
Figure 3. Distribution of diagnosed HIV cases, by mode of transmission, Jan 1984 - March 2024
​
​
Source: Health Technology Assessment Study Group (2024)
These facts only showcase that HIV-AIDS is not only a public health issue, but it has negative
implications for economic growth, income per capita, and economic development. In a better
view of this, the study of Haacker (2004) entitled HIV/AIDS The Impact on the Social Fabric
and the Economy indicates that HIV impacts households by decreasing income, higher health
expenses, and having a long-term impact on a person’s well-being. Therefore, this negatively
affects human and physical capital, leading to a decline in savings and investment. The
theoretical implication would affect those regardless of socioeconomic means. How about
vulnerable populations in poverty? Haacker’s argument states that impoverished households that
are struck with HIV-AIDS are less equipped to handle economic shocks. It is just that the
Philippines will demand health-related goods and services. Hence, household income will shrink
while demand for healthcare services will continue to increase. In the private sector, HIV-AIDS
affects worker productivity as mortality and morbidity rates increase, which will lead to
increased costs. The government’s financial resources will deplete, which will slow down tax
revenue as health expenditures increase. The prevalence of the disease disproportionately affects
numerous stakeholders in an economy. Hence, a government’s initiative to handle HIV/AIDS is
an indicator of its living standards. What does this say about our government's initiative? Where
do they fall short? And what must we do to instill awareness and urgency? The government has
implemented initiatives to address the public health crisis, such as the Republic Act of 11166 or
the Philippine HIV and AIDS Policy Act of 2018, to strengthen the policy implementation of
HIV-AIDS prevention, treatment, and support. Furthermore, it also includes the reconstitution of
the Philippine National AIDS Council (PNAC), appropriation of funds, health and support
services, counseling, education programs, and anti-discrimination measures. Apart from the
implemented measures, the law allowed for the shift to a decentralized rapid HIV diagnosis
algorithm (rHIVda) from a centralized HIV diagnosis confirmation method (Cordero, 2025). The
former is a testing approach utilized to improve the efficacy of HIV diagnosis in the Philippines
by utilizing a series of rapid diagnostic tests (RDTs) and immunoassays to properly confirm HIV
diagnosis compared to more traditional methods. Moreover, the rHIVda is designed to
accommodate the general population and marginalized groups, enabling earlier detection and
treatment. Furthermore, the country has established the HIV & AIDS Surveillance of the
Philippines (HASP), which primarily serves as an authoritative source of ART outcomes,
tracking performance, and HIV diagnoses. As of 2024, laboratories increased from 26 to 50,
improving diagnostic capacity, facilitating early detection, and data collection. The government
has implemented other prevention strategies, such as the dissemination of pre-exposure
prophylaxis (PREP), which recorded an increase of over 34,000 enrollments, targeting MSMs,
transgender women, and those who inject drugs. Furthermore, the country has integrated
community engagement, outreach programs, and tailored interventions to gain access to
vulnerable groups (Health Technology Assessment Study Group, 2024).
Despite efforts from the Department of Health (DOH) and various NGOs to expand testing and
treatment facilities, barriers remain. Chief among them is stigma, rooted in conservative cultural
norms, religious teachings, and even within families and healthcare settings. For MSM, this
stigma is often layered: they are marginalized for both their HIV status and sexual orientation,
leading to what scholars refer to as “intersectional stigma.” Key gaps apart from stigma state that
around 57% of estimated PLHIV are diagnosed, which indicates room for further improvement
(Health Technology Assessment Study Group, 2024). Additionally, there is limited access to
testing kits and service availability, especially in remote regions. The current environment may
still deter people from seeking testing or treatment, allowing the epidemic to quietly spread.
Furthermore, the Dangerous Drugs Act of 2002 hinders needle and syringe programs from
providing safer access in reducing HIV-AIDS transmissions (Gangcuangco and Eustaquio,
2023). For one, conservative cultural norms and religious teachings alienate people who live
with HIV-AIDS; thereby, affecting their engagement in HIV-related health services. It also does
not help that the Catholic church’s conservative stance prevent the full implementation of sexual
education and contraceptives. Second, gay men who live with HIV/AIDS face challenges due to
perceived and experienced discrimination by healthcare workers, inconvenient location of HIV
hubs, or concerns regarding HIV awareness (Cordero, 2025). The lack of effective
implementation among healthcare providers hinders competency to provide context-specific care
and diagnosis, or gender-sensitivity and sexual orientation needs. Therefore, stigma, as a barrier,
perpetuates vulnerability, which leads to discrimination or any other self-validation of negative
societal experiences. It creates attitudes that reduce the urgency to seek HIV treatment and
healthcare, and impedes disclosure of HIV status, delaying necessary treatment. Hence, these
factors, along with cultural and religious stigma, hinder societal measures. Third, the utilization
of artificial contraceptives such as condoms remains low, and the rise of online dating platforms
that contribute to risky sexual behaviors like unprotected intercourse or casual sex contributes to
the increase of cases, as these issues are rampant among MSM and transgender women
(Ganguangco & Estaquio, 2023). Therefore, this underscores the importance of our advocacy
efforts and should serve as a wake-up call for readers interested in this issue. It is essential to
recognize that members of the LGBTQ community, particularly MSM and transgender women,
face significant challenges, including stigma and discrimination, which hinder their access to
care. Addressing these barriers requires the development and implementation of improved,
tailored healthcare services that are sensitive to their unique needs and identities.
Conclusion
The growing HIV/AIDS epidemic in the Philippines is not merely a public health
issue—it is a reflection of deep-rooted neglect from the very institutions meant to protect and
nurture us: the family, the Church, society, and the state. Contracting HIV is often less about
personal failure and more about systemic exclusion—being left without a safe space, support, or
access to knowledge.
For many, loneliness and neglect are at the heart of the HIV experience. There is the
ever-present fear of alienation from family and loved ones upon revealing one's status. In
conservative households, this can mean outright rejection or condemnation, where one’s identity
is vilified rather than understood. From the Church, there is the lingering sense of judgment—an
institution that should have offered compassion instead often becomes a source of shame. This
spiritual and emotional abandonment drives many to suffer in silence, choosing secrecy over
support.
The stigma extends into the broader community, where a diagnosis can reduce someone’s
identity to a stereotype—labeled as reckless, immoral, or undeserving. While the Philippine
government, particularly its public health agencies, has taken steps to respond to the epidemic,
these efforts are often undermined by legislative inaction. Many lawmakers, influenced by
deeply rooted conservatism and religious pressure, have stalled or weakened policies that could
have advanced comprehensive, inclusive, and age-appropriate sex education and awareness
programs. As a result, critical interventions are delayed or diluted, leaving many young people
uninformed and unprotected.
Ultimately, the rise in HIV cases among MSM in the Philippines is not just a statistic—it
is a symptom of deeper social and institutional failures. It is a wake-up call to address the
emotional, cultural, and political neglect that continues to fuel the epidemic. To curb this crisis,
we must start by rebuilding the very systems that failed to protect us in the first place—and that
includes the courage to legislate with compassion, evidence, and inclusion in mind.
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