Association between stigma and discrimination index to the intake

of sexual health screening among key populations of Iloilo City

A Research Proposal

In partial fulfillment of the requirements for the course

Nursing Research 1

Submitted by:
Benjamin Gane Jr.
Mark Jun Reyes
Angelica Marie Sanchez
Tahinay, Ma. Sussenette
BSN III-D

Version 1.0
[ 2020/10/06 ]
 TABLE OF CONTENTS

Content Page

I Introduction 3

Background and Rationale 3

Statement of the Problem 4

Aims and Objectives of the Study 5

Hypothesis Formulation 5

Research Framework 5

Definition of Terms 9

Significance of the Study 10

Scope and Limitations of the Study 10

II. Review of Related Literature 11

Conceptual Literature 11

Research Literature 12

Synthesis of the Literature Review 12

III. Methodology 13

Rationale of the Study Designs 13

Study Setting, Population, and Justification of the Sample Size 13

Criteria of the Study Population 14

Recruitment Process 16

Plans for Data Processing and Analysis 16

Workplan Schedule and Timeline 20

Ethical / Biosafety Clearance 20

Budgetary Requirements 22

References 23

2
I. Introduction
1. Background and Rationale
Human immunodeficiency virus (HIV) and Acquired
immunodeficiency syndrome (AIDS) remain a worldwide epidemic. HIV is a
condition which erodes people's immune system thereby weakening protection
against infections and medical complications; and may be acquired through
unprotected sexual intercourse, blood transfusion, sharing of infected needles
during drug use, or needlestick injury (WHO 2020). As of December 2019,
there are a total of 71,077 people diagnosed as people living with HIV
(PLHIV) in the Philippines, and only about 60% of whom are on antiretroviral
therapy (DOH-Epidemiology Bureau, 2019). There are multitude of
underlying factors that fuel the increase of HIV cases in the Philippines.
Among others, stigma and discrimination remains unexplored and potentially
threatens the efforts in curbing this fastest-growing epidemic.Stigma and
discrimination may prevent PLHIV and other key populations of men who
have sex with men (MSM), transgender people (TG), and people who inject
drugs and their sexual partnersfrom seeking preventive and medical
management.Antiretroviral therapy (ART) is a biomedical approach of
providing long-term medications to suppress the viral load count of a PLHIV
and virtually limits their chances of infecting others and enabling them to live
as normally as possible. However, approximately 40% among those diagnosed
with HIV not on ART (DOH-Epidemiology Bureau, 2018). This is a challenge
for health providers in augmenting the continuous increase in the number of
new HIV cases in the country.
Stigma and discrimination play significant roles for the hesitancy in
seeking treatment smong PLHIV. HIV-related stigma is defined as negative
attitude and judgements to the person who acquired and at risk for HIV.
According to the study conducted among Sub-Saharan Africa, Southeast Asia
and Northeast Asia (Gray et. al., 2019), stigma is the main barrier in seeking
health care services, compounded by the lack of knowledge about the disease
and accessibility of HIV screening and treatment. Furthermore, (Coleman J.D.
et al. 2016), acknowledged that the HIV-related stigma influenced by religious
belief also aggravates the barrier for the promotion of HIV screening and
treatment among key populations. Understanding the underlying factors may

3
 help for the development of a plan of action to lessen the refusal and
encourage key populations to have sexual health screening and ART
treatment. In addition, (Hatzenbehler et al, 2013) emphasizes that Stigma and
its extensiveness, affecting many realms of life such as social interactions and
adaptive strategy of a person and attitudes among public health.
HIV-stigma and discrimination are the most common adversities that
limits key population from seeking sexual health care screening and treatment
.Furthermore, Key population are the most at risk for aquiring HIV/AIDS and
STI and composed of sex workers, transgender persons, men who have sex
with men, people who use drugs. Rresearch as evidence in Iloilo City focusing
on the HIV-related stigma and discrimination that may improve the quality
of healthcare services are lacking.
This research aims to explain the effects of stigma and discrimination
on the key population to the intake of sexual health screening in Iloilo City.
This study also aims to describe the factors affecting the key populations' (i.e.
men who have sex with men, sex workers, transgender persons, and people
who use drugs) sexual health because of stigma and discrimination in Iloilo
City.

2. Statement of the Problem

HIV/STI-related stigma and discrimination are pervasive worldwide
and serves as a challenge for healthcare professionals to stop the constant
increase in the number of HIVSTI cases in the country. This study will
provide the data data for promotion of better quality of healthcare services .
The result of this study will give information and awarenes to the
public how serious the effect of stigma and discrimination as well as the
importance of sexual health screening and Treatment as this research conduct
online surveys to gather primary data. This study will also contribute to the
development of intervention to improve healthcare services. This study will
evaluate the effects of stigma and discrimination and as a result, this reseach
will become a basis for the formulations of interventions and recomendations
highlighting the data that this research will produce in promoting better quality
of healthcare services in Iloilo City.

4
3. Aims and Objectives of the Study
This is to explain and describe the effects of stigma and discrimination
on the intake of sexual health screening among key population in Iloilo City.
The result of this research will improve better quality of healthcare services by
investigating the effect of these barriers in seeking healthcare assistance.
Identifying factors impacting the frequency of sexual health screening and
ART treatment among key population may contribute in the development of
scheme that will help in improving the interventions and quality of
services.This study also targeted to construct and produce recommendations
for the management in terms of stigma and dicrimination to increase the
number of key populations that undergo sexual health screening and ART
treatment.

4. Hypothesis Formulation
H0:
The stigma and discrimination has no effects on the refusal to the intake of
sexual health screening among key population in Iloilo City.

H1:
The stigma and discrimination has led to increase the refusal to the intake of
sexual health screening among key population in Iloilo City.

H2:
The stigma and discrimination has led to decrease the refusal to the intake of
sexual health screening among key population in Iloilo City.

5. Research Framework
HIV-related stigma and discrimination is present worldwide and it is
the currents issue that giving the key population the reason to halt in accessing
healthcare screening and ART treatment. According to (Stangl et al., 2019)
HIV-related stigma and discrimination has greatly affect the psychological
well-being and perceptions of every individuals. And this varies according to
the sociocultural norms, religious beliefs, environmental factors, and even
policies and laws are the major hindrance for the key population in the

5
accessibility to seek health care assistance. On the other hand , these factors
will lead to another stigma experience which is self-stigma related to the
feeling of social exclusion. Thus, it will impede on the HIV/ AIDS,STI
screening and treatment and may pilot for the severity of the disease. This
framework tend to explain the association between the stigma and
discrimination and the halt on the intake of sexual health checks among key
population. In Addition,to the Potential role such as socioeconomic status,
poor health services, stress and anxiety, poor coping mechanism, attitude of
every individual, and mistrust for the health care professionals will also
become barriers among the key population to their sexual health intake. As
this study aims to explain the assocoation of stigma and discrimination to the
intake oh sexual health screening and ART treatment among Key population.
This may help for the recommendation of the improvement and development
of intervention to encourage the key population to seek help from medical
professionals. As well as giving the healthcare providers knowledge about the
effect of stigma and discrimination.

6
 Conceptual framework adapted from :
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6156
-4
Channel 1 connects to the knowledge and awareness ( factor 1 as F1)
that contributes and affects HIV/AIDS STI screening and treatment.
Knowledge and awareness will help and change the perspective and reduced
self-stigma (factor 2 as F2) and reduced (factor 3 as F3) that will contribute to
the reduction of stigma and discrimination (factor 4 as F4) to increased
socialization (factor 5 as F5) to improved the HIV/AIDS STI cases in Iloilo
City.

Channel 1: knowledge and awareness help to change perspective and

behavior to reduce stigma and discriminiation and increased HIV/AIDS STI
screening and treatment.

Increased knowledge and awareness (F1): Knowledge and awareness

can be the most powerful means to increase the HIV/AIDS STI screening and
treatment. By means of awareness strategies and programs will increase the
knowledge and encouragement of the key population in seeking medical
assistance.

Channel 2: knowledge and awareness help to change perspective and

behavior to reduce stigma and discriminiation and increased HIV/AIDS STI
screening and treatment.

Reduced self-stigma (F2)

Self-stigma is developed when a key population is being excluded by the community.
Promoting and improving quality of services including counselling will help them
reduce the feeling of self-stigma as the health workers are being pursuing the methods
to help them.

Reduced Doubt (F3)

Doubt on health care providers is one contributing factor that key-population is
worried about. But supplementing them with information that will give them

7
knowledge about the importance of screening and treatment might encourage them
to be tested and treated. counselling and orienting them that health care providers are
there to help them during the screening and treatment procedures.

Channel 3: knowledge and awareness help to change perspective and behavior to

reduce stigma and discriminiation and increased HIV/AIDS STI screening and
treatment.

Reduced stigma and discrimination (F4)

Stigma and discrimination are present worldwide. In order to get rid of these,
counselling and orientation is a must regarding the effects of these factors on the
key-population and how these factors alter their HIV/AIDS STI screening and
treatment..

Increased socialization (F4)

-Counselling strategies will help key-population interact and socialize with other
people and will be able to help them verbalize their feelings and needs. These may
assist healthcare professionals develop and improve quality of services that will
persuade key-population to be tested and treated.

6. Definition of Terms
Stigma​-defined as negative attitude and judgements to the person who
acquired and at risk for HIV. It could be a contributing factor on the mental
status and well being of people with HIV or PLHIV. (UNAIDS)
Discrimination​- defined as sexism and treating other people differently
because of HIV/AIDS, STI. (Marriam Webster)
Key population- ​consist of men who have sex with men, sex workers,
transgender persons, and people who use drugs these people are higly at risk to
aquire HIV/AIDS and STI (UNAIDS 2016)
Antiretroviral Therapy-​combination of drugs used to subdue the HIV virus
and stop the progression and growth of HIV disease(WHO).
Human Immunodeficiency Virus-​ condition which erodes people's immune
system, Thus, weakens protection against infections and diseases​.​ This may
acquire through unprotected sexual intercourse,blood transfusion,needlestick
injury (WHO 2020)

8
 Acquired ImmunoDeficiency Syndrome-​primarily caused by HIV and the
most advanced HIV case.(WHO 2020)
Sexually Transmitted Infections-​obtaining from sexual intercourse cause by
such, parasites, bacteria and viruses (WHO2020)
Treatment-​ Procedure or therapy used to treat certain conditions or diseases.
(Merriam Webster)
Accessibility-​ the act of obtaining treatment for HIV (Merriam Webster)
MSM​- men who have sex with men
PWID​- people who inject Drugs (UNAIDS)
TGW​-”Transgender woman” denoting or realating to a person whose sense of
personal identity and gender does not correspond with their birth sex (Oxford
dictionary)
FSW​-Female sex workers (UNAIDS)
MSW​-Male sex workers (UNAIDS)

7. Significance of the Study

This study is important because HIV-related stigma and
discrimination is literally what key population are facing right now and their
intake of sexual health screening is affected. Thus, health care professionals
are experiencing the challenge in controlling the constant increase in number
of HIV cases worldwide. This study will help determine the effects of stigma
and discrimination on the intake of sexual health screening among key
population and this will contribute to the development of interventions that
will encourage the key population to seek medical assisstance for their own
risk. Additionally, Iloilo City has limited research study as an evidence to
provide that the stigma and discrimination has to do with the intake od
treatment and screening.

8. Scope and Limitations of the Study

This research will be utilizing a ​Non-experimental study​ that will
randomly select participants and will gather data via online surveys
specifically for key populations. In this way we can provide the confidentiality
and anonymity of every participant as we send them the direct email to ask for

9
 consent if they will allow us to make them as our research respondents. . This
study will be focusing on identifying and assessing the factors that can affect
the intake of sexual health checks of key populations in Iloilo City. On the
contrary, this research is designed to have a thorough knowledge about the
effects of stigmas towards the frequency of health checks of key populations
in Iloilo City. The​ study aims t​ o give the key population the idea of what
programs and policies that will protect them. Besides, this research will
considered every aspects and factors that has an impact of stigma to the intake
of sexual health screening,
Religious belief, social and cultural norms, violence,socioeconomic
status, poor health services, mistrust for health care services and providers are
factors that will threaten the result of the study. But as the research title itself
we are focusing on the HIV-related stigma and discrimination to the intake of
sexual health checks among key population. Manageability of the extraneous
variable will be controlled using the tangible and specific inclusion criteria to
guarantee that confounders will not intervene to the outcome of the study.
The timing of the study and the field work for actual surveys will be
affected as well as the selection of the respondents for this research may be
limited to online surveys and analysis of data. While restricted public transport
and community quarantined are present due to the Covid19 pandemic. This
study will not conduct an experimental research as we cannot manipulate the
effects of stigma and discrimination among key population. To all intents and
purposes this study cannot provide the specific names of every respondents as
this research will be maintaining anonymity and confidentiality.

II. Review of Related Literature

1. Conceptual Literature
International Literature
The study entitled, ‘’Stigma, Discrimination and living with
HIV/AIDS: A Cross-Cultural Perspective" (Addo-Atuah et. al 2015), address the
existing ignominiously about the dilemma related to this individual with
HIV/AIDS through constructing the extended study. In addition, the focal point
of this study is to focus on the intolerance that the PLWHA encounters in
countries such as Thailand, India, Columbia ,China ,Australia, South Africa

10
,United States and UK. Those countries stated a layered disgrace that PLWHA
had lived through stigmatized communities . In many cases, these people are just
the victim of judgement that the society created. In order to break the cycle of
discrimination against these people we should change our unlawful behavior so
that we can improve our situation and create a opportunity that can lead to a
productive and lawful lives.

Local Literature
Human Immunodeficiency Virus or HIV became globally pervasive
and the Philippines turned out to have a national contingency epidemic. The
bureaucrats were given notice by Dr.Rossana Ditangco about the extensive
outbreak and she stated that ’’we can’t control the rapid rise of HIV infection”.
According to the latest data, Philippines became the highest in ASIA Pacific
region on UNAIDS 2017 report. HIV malady in the, country grew rapidly from
2010-2016 , with new identified HIV infections carrier aged 15 to 24 year old as
men who had been performed a sexual intercourse with the same sex. Hence,
Paulyn Jean Rosell Ubial states that healthendow scheme that can increase the
finding in having an antiretroviral treatment for those individuals with HIV. In
addition, to have a safe space and environment for this people, the health
department also offered a quicked response like testing and other health service
that can lessen the effect of any health related risk factors .Therefore, government
officials must have plan to address this kind of concerned so that it could lessen
the stigma and we can’t risk this people aside from that, school must also offer
sex education in order to enlighten the students about having a proper and safe
sex. Moreover by this it could eliminate the shame and we can step up into a
brighter tomorrow.

2. Synthesis of Literature Review

That stigma and discrimination are the major issue for both key
population and healthcare professionals as they are combating the HIV/AIDS and
STI epidemic as it is present worldwide. Conversely, religous belief, socioecomic
status ,sociocultral norm, also contribute to HIV-related stigma and

11
 discrimination. These barriers will keep the key population away from getting
tested and treated. And PLHIV are usually interiorized the stigma and
discrimination they experienced and start to develop self stigma.
HIV-related stigma and discrimination has been affecting the intake of
sexual health screening among key population. This is considered a notable issue
that must be pursued to develop the interventions needed to decrease the number
of HIV-related cases. In evaluating the effects of HIV-related stigma and
discriminaton we must have concrete data that will assist in formulation of
interventions and recommendations to highlight in order to encourage key
populations to seek medical assistance. Moreover, The argument for the
inquisitive aspects of investigation will be the most interesting part in the study
that will give insights to the readers of what this study aims to produce.

III. Methodology
1. Rationale of the Study Designs
Quantitative research i​ s an approach which underpins the numerical
data analysis that helps rule out the effects of HIV and STI-related stigma and
discrimination that impedes the key population from being tested and treated.
The ​cross-sectional quantitative​ approach through an online survey that will
gather and analyze data regarding the effects and nature of HIV and
STI-related stigma and discrimination. The stigma index questionnaire
adapted to (Siane et al. 2020) will aid in data gathering from key population
consisting MSM, PWID, FSW/MSW and Transgender woman. The data
gathered from this research will establish information to understand the nature
and effects of Stigma and discrimination among key population in Iloilo City.
This investigation will contribute to the development and improvement of
health services to encourage key populations to seek medical assistance.
Descriptive-correlational design​ will be used to establish the
relationship among stigma and discrimination and intake of screening..

2. Study Setting, Population, and Justification of the Sample Size

- Study setting: Open-access survey link for community-based key
populations (MSM, TGW, PWID, FSW).

12
 The online survey questionnaire with the target sample size of 380
participants and will be conducting and disseminated in Iloilo city particularly
among key populations that is at risk for acquiring such HIV and STI’s
The following agencies will help distribute the said questionnaires:
➔ Western Visayas Medical Center
➔ Family planning organization of the Philippines (FPOP) Iloilo
➔ The Medical City- Iloilo IREACT UNIT
➔ St. Pauls’ Hospital - Mother Candide Health Center

Duration of data Gathering:

Online survey- Respondents that will fit in the inclusion criteria will
answer the questionnaires with 10 closed-ended questions at the maximum of
15 minutes and the survey form will be open until the target sample size is
met.

Study Activities:
Online survey- facilities and centers will help in decimating the online
surveys. The survey questionnaire will be confidential and respondents have the
choice to withdraw and refuse the offer to be part of the investigation and it will be
distributed on an online platform specifically messenger. Thus, Survey monkey will
be used in calculating the total respondents needed.The data will be
password-protected and the researchers are the one that can access the data and
responses.

Population Size: Get the estimated key population from UNAIDS

From the latest key population estimated by UNAIDS (2019), there are
a total of 830,000 MSM, 190,000 TGW, 7,400 PWID, and 210,000 FWS in the
Philippines. These estimated population sizes were the primary bases of the study’s
calculation of required sample size. Table 01 below summarizes the calculation
results using the ready-made sample size calculator found on SurveyMonkey.com:

Table 01. Summary of Required Sample Size per Key Population Members

13
 Key (N) (n) Minimum Confidence
Populations Estimated Population Sample target of Interval (CI) and
Size (UNAIDS, Size survey Margin of Error
2019) required respondents (%)

MSM 830,000 384 95 95%CI @

p=0.05 level of
TGW 190,000 384 95 significance

PWID 7,400 366 95

FSW 210,000 384 95

Average Sample Size 380 n=95 per key

population
members

Justification of sample size:

At about 380 possible respondents and 95 subjects per key population
members are supposed to accomplish the online survey.) 5% or 0.05 is the margin
error and 95 is the confidence interval. Using a ​convenience sampling ​data will be
taken from people by availability or easy to reach people. The online survey will be
available for a month until the target number of respondents are met. Convenience
sampling will be used for this investigation particularly on the key population of Iloilo
City.
In calculating the sample size deploy an estimated sample size of
MSM, PWID, TRANS. FSW/MSW as members of a key population.
UNAIDS (2019) provided the estimated population size that will be used in
calculation via SurveyMonkey.com.
The data is very significant as Iloilo city has no available present
study particularly for the key population. Statistical analysis will be done after
the estimation and calculation in sequence to sort out any potential error in the
research.

3. Criteria of the Study Population

Figure 1: Process Protocol:

14
Adapted by: “Assessment of sexualized drug use and risk for HIV and STI among
Filipino cisgender men who have sex with men in the Philippines: An exploratory
mixed-method approach (Olete 2019)
Inclusion Criteria:
● 18 years old and above
● Member of key population
● Native ilonggos
Exclusion Criteria
● People who are unable to sign informed consent ( minor amd
people who diagnosed with mental illness and under the influence of
drug during the survey)
● Filipino who are not living in Iloilo city are considered excluded for
this research.

Exclusion of minors :
Respondents should fit into the appropriate age limit of 18 years old
and above. As this could be against the Republic Act of 6809
mandated for the majority commences at the age of 18 years. Minors
are still under their parents authority.

15
4. Recruitment Process
Informed Consent: Via private messages through messenger app: This
App is persuasive and one of the most used apps of filipinos citizens online
survey will commence a month before the actual data gathering.
Introduction of the research:
Explaining and informing the respondents about the aims and purpose of the
said investigation will be included in the survey that can be read by the
possible participants of the investigation.
Filtering: Inclusion and exclusion criteria must meet according to the process
protocol (see figure 1).
Survey forms: The possible respondents for the investigation will answer the
online survey using 10 closed-ended questions maximum for 15 minutes .

5. Plans for Data Processing and Analysis

A semi-structured, online questionnaire will be used in gathering the

data necessary to achieve the outcomes of this investigation. The questionnaire
is divided into five major parts: (1) Demographic Data, (2) Perception towards
HIV and other STIs, (3) HIV/STI Stigma Index, and (4) Attitude towards HIV
and STI testing, (5) Sexual Health Profile. The table below will provide a
better illustration of the intended questionnaire:

Online survey form will be distribute​d to online platform specifically

messenger Application. The ​ Perception towards HIV and other STIs,
HIV/STI Stigma Index, questions​ are adapted from “ ​Validation of a modified
Berger HIV stigma scale for use among patients with hepatitis C virus (HCV)
infection” (Siane et al. 2020) ​https://doi.org/10.1371/journal.pone.0228471
and will be using likert scale that will help measure the responses in the said
survey investigation.

16
Data Gathering Approach
1. Data collection
- Will focus on census,
demographics, and estimated
population size.
Survey
- Will use a newly developed tool
that will be translated to
Hiligaynon which is the native
language of Ilonggos or people
in Iloilo City.
2. Perception towards HIV and
other STI’s
3. HIV and STI stigma index
Outcomes/Data Collected
● Demographic profile of allkey
population includes:
-nickname (optional)
-Sex assigned at Birth
- Religion
- Civil Status
● Demographic profile of all key
population
-Age
● Aggregate data from UNAIDS
for estimated population
● Filtering of respondents using
inclusion and exclusion criteria
● 10 Semi-structured closed ended
questions
● Secured and will be stored in a
password protected device
Most People think that a person with
HIV and STI is disgusting.
a.Strongly Agree
b.Agree
c.Neither
d.Disagree
E.Strongly Disagree
People seem afraid of me once they
have learned that I have HIV and STI.
a.Strongly Agree
b.Agree
c.Neither
d.Disagree
E.Strongly Disagree
17
4. Attitude towards HIV and STI I need to get tested for HIV and other
testing STIs every three months if I were
sexually active .

a.Strongly Agree
b.Agree
c.Neither
d.Disagree
e.Strongly Disagree

5. Sexual health profile: When was the last time you had
unprotected sex?

a. more than one year ago

b. 6 months to 1 year ago
c. 1 to 3 months ago
D. less than three weeks ago

When were your last HIV and STI

testing?

a. more than one year ago

b. 6 months to 1 year ago
c. 1 to 3 months ago
e. less than three weeks ago

Research investigator/Data management officer is responsible to ensure that

data will be protected. The research associate will help store the data after
each response to an online survey and identifiers of participants must remain
confidential.The principal investigator supervised the overall data gathering
and analysis to make sure that data is stored properly. All data gathered for the
entire investigation will be stored in a password-protected device and only the
researchers can access such data.Co-investigator verifies that all relevant data
required for analysis and understanding will be collected properly and will
oversee for uploading and recording responses from the said survey.

Data application and storage

All data collected from online surveys will be stored and uploaded and
stored in a password-protected device. After the approval or publication of the
research outcome the database will be completely destroyed.

18
 Data application and storage ensure by the following process:
➔ Quantitative data will be collected using a secured online survey and
saved into a password-protected device.
➔ The personal identifiers of respondents are securely-protected and not
gonna be revealed in a research paper.
➔ All data collected will be gathered for research purposes only.
➔ Quantitative data collection and gathering using online surveys with 10
closed-ended questions in a maximum of 15 minutes.

Data quality control:

Online survey data will contain 10 structured closed-ended questions
and will be translated from english to Hiligaynon which is the native language
of Ilonggos (Iloilo) to make sure that participants can fully understand the
content of the survey form.

Outcome:
Primary outcome of this study is to explain the relationship of stigma
and discrimination index to the frequency of sexual health checks among key
population in Iloilo city.
Secondary outcome of this research is to explain and describe the
effects of HIV-STI-related stigma and discrimination to the frequency of
sexual health checks among key ppulation (MSM,PWID,TRANS,FSW/MSW)
that will help to target contructions and recommendations for the management
in terms of stoping stigma and discriination that will encourage an increase
number of key population that will undergo treatment and screening.

Data Analysis:
The outcome of this investigation will deploy quantitative data
analysis. Cross-sectional data will be outlined using a ​frequency distribution
table to group and cluster accordingly for numerical analysis.

Statistical Technique:
Gathered​ data from online surveys will be analyzed using​ Descriptive
and inferential statistics for summarization of the characteristics of the data set

19
 that will test the hypothesis . ​Chi-square​ test will be used to establish the
association of variables between stigma and discriminaton and intake of
screening and how it affects their possibilities to be treated and tested.

6. Work Plan Schedule & Timelines

Oct Nov Dec Jan Feb Mar

Development for the purpose and aims of ★

the investigation.

Formulating temporary outcome through ★

literature

Establishment on how to collect data ★

Estimating the target sample size for the ★

investigation

Preparing for the protocol and data for the ★

online survey.

Title defense presentation ★

Data collection and releasing of online ★

survey

Data analysis,encoding and finalization and ★

submission of final data

Final defense presentation ★

7. Ethical / Biosafety Clearance

Human subjects considerations:
Informed consent:
Informed consent must sign by every individual that will participate in
the investigation before the actual data gathering through online surveys. The
content of the consent must be understandable using hiligaynon as native
language of Iloilo citizens to obtain signature of the participants ensuring that
they would understand the purpose of this investigation. Signed consent must
strictly require, for formality and security purposes.

20
 Confidentiality:
All data gathered and collected from the participants will be stored using a
password-protected device and only the researcher can access the said
responses and data gathered. All participants' identifiers are blocked and will
not be able to be revealed to the final research paper as against the Data
Privacy Act of 2012 (Olete 2019). Google forms will be used for the collection
of data and personal information will not be included in the form except for
the data required for the investigations analysis.
Vulnerable subjects:
MSM- has experienced HIV-STI-related stigma and discriination and has the
highest risk for acquiring HIV,AIDS and STI.
PWID- they’re named as addict (Olete 2019) and at risk for HIV for sharing
needles and engaging unprotected sex.
TGW- considered as gender bias, that's why being marked as immoral to the
eyes of people and religion. Religion considered only 2 genders (male and
female)
FSW/MSW- are not exception to the stigma and discrimination as it is named
by the public as “pokpok” considered as sinful for having multiple sex partner
accpording to the community.
The vulnerability of the subjects are being considered and respected by this
research. The data cannot be obtain in Non-vulnerable subjects as research
focuses on group of people that has higher risk for acquiring HIV-STI stigma
and discrimination.

Data sharing agreements;

All data collected will be stored and protected. These investigations are
for research purposes only and all identifying information of participants will
not be included in the final research paper for confidentiality and privacy of
every subject.
Withdrawal of participation:
All participants have the right to withdraw, refuse and stop their
participation for the said investigation. Their decision will be respected.

21
 Budgetary Requirements

One month Total

Phone credit for data 10 (each) 3,800

consumption of every
participants

Phone credit for data 299 (each) 1,196

consumption of every
researcher’s

Payment for Adviser 3,000

7,976

References:

Book review: Stigma, discrimination, and living with HIV/AIDS: a cross-cultural

perspective ​ (Addo-Atuah et. al 2015)
https://www.frontiersin.org/articles/10.3389/fpubh.2015.00242/full

Philippines HIV Epidemic Declared a 'National Emergency' (Conde 2017)

https://reliefweb.int/report/philippines/philippines-hiv-epidemic-declared-national-em
ergency

Social Determinants of HIV-Related Stigma in Faith-Based Organizations (Coleman

J.D. et al., 2016)
https://ajph.aphapublications.org/doi/10.2105/AJPH.2015.302985

Stigma as a Fundamental Cause of Population Health Inequalities (Hatzenbehler, M.

L. et al, 2013)
https://ajph.aphapublications.org/doi/10.2105/AJPH.2012.301069

Stigma reduction in relation to HIV test uptake in low- and middle-income countries:
a realist review (Thapa et al 2019)
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6156
-4

The Health Stigma and Discrimination Framework: a global, crosscutting framework

to inform research, intervention development, and policy on health-related
stigmas (stangl et al., 2019)
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1271-3?

22
 fbclid=IwAR2FjPB2PANwyHOTyBR9sQ7g1PE8G5Mc6Our0hLiob4Mso5E
5-Xs3uKarx0

UNAIDS 2019 (Country factsheet) Philippines 2019:

https://www.unaids.org/en/regionscountries/countries/philippines

UNAIDS 2019 (country estimated size) Philippines 2019

​https://aidsinfo.unaids.org/

UNAIDS 2017 report on ASIA Pacific region

https://unaids-ap.org/resources/reports/

Validation of a modified Berger HIV stigma scale for use among patients with
hepatitis C virus (HCV) infection (Saine et al 2020)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228471

Validation of a modified Berger HIV stigma scale for use among patients with
hepatitis C virus (HCV) infection​ (February 5, 2020)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228471

Why I Can’t, Won’t or Don’t Test for HIV: Insights from Australian Migrants Born in
Sub-Saharan Africa, Southeast Asia and Northeast Asia (Gray et. al., 2019)
https://doi.org/10.3390/ijerph16061034

WHO 2020 (key facts about HIV and AIDS):

https://www.who.int/news-room/fact-sheets/detail/hiv-aids
1

Research Team, Roles, and Responsibilities:

23
Appendix: Curriculum Vitae of Research Team and Adviser
EVALUATION OF THESIS TITLE DEFENSE (LAST PAGE)

24
25
26
27