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      “I am not promiscuous enough!”: Exploring the low uptake of HIV testing by gay men and other men who have sex with men in Metro Manila, Philippines

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          Abstract

          The Philippines faces a severe HIV epidemic among gay and other men who have sex with men (MSM). HIV testing uptake remains low. A case series of 12 men from Metro Manila were interviewed to explore barriers to uptake of HIV testing services. Most did not see the need to get tested for HIV despite significant risk, based on the misconception they were feeling well or showed no symptoms. Being of a higher socioeconomic class, feeling morally superior to other gay men, distance of the testing facility, fear of what will happen once infected, fear of HIV- and sexual stigma, fear of side effects of antiretroviral drugs and fear of high health care expenses after testing positive for HIV were key reasons why MSM kept postponing their test. Misconceptions about HIV risk, disease, and treatment and care need to be addressed in order to increase uptake of HIV services in this population.

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          Most cited references15

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          Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options

          The immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients initiating antiretroviral therapy (ART) results from restored immunity to specific infectious or non-infectious antigens. A paradoxical clinical worsening of a known condition or the appearance of a new condition after initiating therapy characterizes the syndrome. Potential mechanisms for the syndrome include a partial recovery of the immune system or exuberant host immunological responses to antigenic stimuli. The overall incidence of IRIS is unknown, but is dependent on the population studied and its underlying opportunistic infectious burden. The infectious pathogens most frequently implicated in the syndrome are mycobacteria, varicella zoster, herpesviruses, and cytomegalovirus (CMV). No single treatment option exists and depends on the underlying infectious agent and its clinical presentation. Prospective cohort studies addressing the optimal screening and treatment of opportunistic infections in patients eligible for ART are currently being conducted. These studies will provide evidence for the development of treatment guidelines in order to reduce the burden of IRIS. We review the available literature on the pathogenesis and epidemiology of IRIS, and present treatment options for the more common infectious manifestations of this diverse syndrome and for manifestations associated with a high morbidity.
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            A peer-led, community-based rapid HIV testing intervention among untested men who have sex with men in China: an operational model for expansion of HIV testing and linkage to care.

            To examine outcomes of a peer-led, community-based intervention providing rapid HIV testing and case management for linkage to care for untested men who have sex with men (MSM) in China.
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              Patching a leaky pipe: the cascade of HIV care.

              We reviewed recent literature on the cascade of HIV care from HIV testing to suppression of viral load, which has emerged as a critical focus as HIV treatment programs have scaled up. In low- and middle-income countries, HIV testing and diagnosis of people living with HIV (PLHIV), although rapidly expanding, are generally relatively low. Linkage and retention in care are global challenges, with substantial attrition between diagnosis, laboratory or clinical staging, and antiretroviral therapy (ART) initiation, and additional substantial attrition on ART due to loss to follow-up and death. ART coverage is rapidly expanding but is still relatively low, especially when considered as a percentage of all PLHIV. Adherence is also suboptimal and virological suppression is incomplete. Taken together, the attrition at each step of the cascade of care results in overall low levels of viral load suppression in the total population of PLHIV. More robust monitoring from the facility to global levels and implementation of established and emerging interventions are needed at each step of the cascade to enhance HIV diagnosis, linkage to and retention in care, ART use, and adherence, and ultimately reduce viral load, improve clinical outcomes, and reduce HIV transmission.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – original draft
                Role: Investigation
                Role: Funding acquisitionRole: Project administration
                Role: Formal analysisRole: Supervision
                Role: Supervision
                Role: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                6 July 2018
                2018
                : 13
                : 7
                : e0200256
                Affiliations
                [1 ] Faculty of Public Health, Burapha University, Bang Saen, Chonburi, Thailand
                [2 ] HASH Community Centre, Manila, Philippines
                [3 ] United Nations Development Programme, Bangkok, Thailand
                [4 ] Thai Red Cross AIDS Research Center, Bangkok, Thailand
                [5 ] Division of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
                [6 ] Department of Health, Quezon City, Philippines
                [7 ] Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
                Cardiff University, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-2611-8739
                Article
                PONE-D-17-30748
                10.1371/journal.pone.0200256
                6034862
                29979766
                485601e8-ea41-43c7-8045-533217f4b5ef
                © 2018 de Lind van Wijngaarden et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 August 2017
                : 24 June 2018
                Page count
                Figures: 0, Tables: 0, Pages: 12
                Funding
                Funded by: United Nations Development Programme
                Award ID: Several
                Award Recipient :
                The study was funded by the United Nations Development Programme. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
                Immunodeficiency Viruses
                HIV
                Biology and life sciences
                Organisms
                Viruses
                RNA viruses
                Retroviruses
                Lentivirus
                HIV
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Retroviruses
                Lentivirus
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Retroviruses
                Lentivirus
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Retroviruses
                Lentivirus
                HIV
                People and Places
                Population Groupings
                Sexuality Groupings
                Men WHO Have Sex with Men
                Medicine and health sciences
                Epidemiology
                HIV epidemiology
                Medicine and health sciences
                Diagnostic medicine
                HIV clinical manifestations
                Medicine and health sciences
                Public and occupational health
                Preventive medicine
                HIV prevention
                Medicine and health sciences
                Diagnostic medicine
                HIV diagnosis and management
                Medicine and health sciences
                Infectious diseases
                Viral diseases
                HIV infections
                People and Places
                Geographical Locations
                Asia
                Philippines
                Custom metadata
                The ethical review application form and research proposal stipulate that the information is not shared beyond the lead researcher (JWDLVW) and the interviewer (ADC). However, if requested, the data underlying our study can be made available to qualified researchers upon request and with proper confidentiality agreements in place by contacting the secretary of the national ethics committee, Ms Anthea Maliz V. Cortez, amvcortes@ 123456pchrd.dost.gov.ph -- if the committee approves such a request, the lead author will share the data.

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