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Evolving HIV Awareness in the Philippines: Digital Survey Insights Before and After the COVID-19 Pandemic

The Philippines has seen a rapid rise in HIV cases over the past decade, making it the country most affected by the HIV epidemic in the Asia-Pacific region. In 2012, an average of nine new HIV cases were diagnosed daily, but by 2023, this number surged to 50 per day—a staggering 500% increase. Alarmingly, 31% of these new infections occurred among individuals aged 15 to 24 years, with 96% of the cases among males and 83% among men who have sex with men (MSM).

Despite efforts to promote HIV testing, increase access to treatment, and raise awareness, progress remains slow, especially among the youth. Only 68% of people living with HIV (PLHIV) in the Philippines are aware of their HIV status, and the uptake of preventive measures like pre-exposure prophylaxis (PREP) remains low.

In light of these challenges, Tangere—a market research application—conducted digital surveys during and after the COVID-19 pandemic to assess HIV knowledge among young Filipinos. The survey aimed to evaluate changes in awareness, sources of HIV information, and public perceptions related to HIV transmission, prevention, and stigma.

Objectives and Methods
The primary objective of the study was to evaluate changes in HIV awareness among young Filipinos during and after the COVID-19 pandemic. Specifically, it sought to analyze:

Demographic characteristics of respondents.
Sources of HIV information.
Knowledge about HIV transmission, prevention, and stigma.

The survey targeted individuals aged 18-35 years, predominantly from the National Capital Region and Luzon. Developed in collaboration with TB-HIV Innovations and Clinical Research Foundation Corporation, Acquisions Apps, Inc. (Tangere), and Makati Medical Center, the questionnaire assessed general knowledge about HIV, modes of transmission and prevention, stigma, and awareness of government HIV programs.

Surveys were conducted on World AIDS Day in December 2020 and again in June 2022. The first survey received 4,500 responses, while the second garnered 2,000. An Independent-Samples Proportions procedure was used to compare HIV knowledge before and after the pandemic, analyzing data using SPSS version 27.

Key Findings

Demographic Shifts
Age and Gender Distribution: The majority of respondents were aged 26 to 35 years. However, the proportion of 18 to 25-year-olds decreased significantly from 35% in 2020 to 15% in 2022. Additionally, there was an increase in male respondents from 52% to 59%.
Civil Status and Socioeconomic Class: A shift toward more respondents being in partnerships was noted, with a decrease in single individuals and an increase in married respondents. Most participants were from socioeconomic classes D and E, consistent with Tangere’s overall subscriber base.

HIV Knowledge and Awareness
Improved Knowledge Post-Pandemic: There was a notable increase in knowledge about HIV transmission and prevention post-pandemic, particularly regarding preventive measures such as PREP and mother-to-child transmission (MTCT).

Primary Sources of Information: Social media and television were identified as the main sources of HIV information. The use of social media as a health information source increased significantly from 71% in 2020 to 82% in 2022.

Persistent Misconceptions and Stigma: Despite increased awareness, misconceptions about HIV persisted, including beliefs that PLHIV are forever contagious (13%), should be quarantined (23%), or should not be in intimate relationships (15%).

Knowledge Gaps and Stigma
Respondents showed improved understanding of the differences between HIV and AIDS, modes of transmission, and preventive measures. However, misconceptions about non-transmission routes (e.g., through kissing or casual interaction) were more prevalent in the second survey.
Stigma-related misconceptions also persisted, including the belief that PLHIV have no right to intimate relationships or that they should be isolated from society.

Discussion
The study highlights that while general knowledge about HIV among young Filipinos improved post-pandemic, persistent misconceptions and stigma continue to hinder public health efforts. The increased reliance on social media for health information presents an opportunity for targeted awareness campaigns. Social media platforms, with their rapid and wide reach, are ideal for engaging the youth—who are disproportionately affected by the HIV epidemic.

However, the findings also indicate that traditional misconceptions and stigmas about HIV remain deeply rooted. This underscores the need for more comprehensive and culturally sensitive educational campaigns. Additionally, the growing awareness of preventive measures such as PREP is encouraging, but the uptake of these interventions remains low.

Recommendations
Utilize Social Media for Awareness Campaigns: Leverage social media platforms to disseminate accurate information about HIV transmission, prevention, and treatment.
Address Stigma and Misconceptions: Develop culturally sensitive educational programs to dispel myths and reduce stigma associated with HIV.
Promote Preventive Measures: Increase public awareness of modern preventive measures, including PREP and the role of antiretroviral therapy (ART) in achieving undetectable viral loads.
Targeted Interventions for Youth: Given the high incidence of HIV among the youth, awareness programs should be tailored to resonate with this demographic.

Limitations and Future Directions
The study had several limitations, including the demographic shift between the two surveys and the reliance on smartphone users with internet access. Future studies should aim for a more representative sample of the Philippine population and address the observed demographic shifts. Additionally, including data on sexual orientation and other demographic variables could provide deeper insights into HIV knowledge and perceptions.

Conclusion
This study provides valuable insights into the evolving knowledge, attitudes, and perceptions about HIV among young Filipinos during and after the COVID-19 pandemic. Despite improvements in awareness, persistent misconceptions and stigma highlight the need for continued education and advocacy efforts.

The findings underscore the importance of utilizing social media as an effective platform for HIV awareness campaigns, particularly targeting the youth. By addressing knowledge gaps and stigma, the Philippines can move closer to achieving global HIV prevention goals and improving public health outcomes.

About the Authors
This study was conducted by Glyzelle Anne A. Lagason, MD, Judith Anne Rose Y. Ganaden, Martin Xavier D. Penaflor, Ericson P. Acapulco, Kristine T. Donayre, John Alexander L. Fellizar, and Ma. Tarcela S. Gler, MD, from the TB-HIV Innovations and Clinical Research Foundation Corporation, Acquisions Apps, Inc. (Tangere), and Makati Medical Center.

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