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Seen, Hidden, or Rejected: How Family Shapes HIV Stigma Among Filipino MSMs


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Cleofas, J. V., & Erasga, D. (2023). Sexual identity visibility and compounding stigma in the familial context: Life histories among Filipino MSMs living with HIV. In V. L. Gregorio, C. M. Batan, & S. L. Blair (Eds.), Contemporary Perspectives in Family Research: “Resilience and Familism: The Dynamic Nature of Families in the Philippines” (pp. 145–161). Emerald Publishing Limited. https://doi.org/10.1108/S1530-353520230000023009 

What this chapter is about

This chapter explores a difficult but important question: How does family acceptance—or rejection—of sexuality shape the way Filipino men who have sex with men experience HIV stigma later in life?

The authors focus on Filipino MSMs living with HIV. MSM means “men who have sex with men.” This term can include gay men, bisexual men, and men who may not identify as gay or bisexual but have sexual relationships with other men. In the Philippines, MSMs living with HIV may face stigma from two directions: stigma related to sexuality and stigma related to HIV status. 

The chapter argues that these two forms of stigma do not simply sit side by side. They interact over time. The authors call this compounding stigma. This means that stigma experienced earlier in life because of sexuality can shape how HIV stigma is experienced later. 

Why the family matters

The family is a major institution in Filipino life. It can be a source of care, support, protection, and belonging. But for LGBTQ+ people and people living with HIV, the family can also become a source of fear, shame, silence, rejection, or control. 

This matters because HIV stigma is not only experienced in hospitals or public spaces. It is also experienced at home: in conversations, silences, suspicion, differential treatment, secrecy, food practices, sleeping arrangements, and emotional distance.

The chapter asks us to see the family not as automatically supportive or automatically oppressive, but as a social space where sexuality and HIV status may become visible, hidden, accepted, or punished.

The key concept: sexual identity visibility in the family

The central concept of the chapter is sexual identity visibility in the family, or SIVF. The authors define SIVF as the family’s level of awareness and acceptance of the person’s sexual identity. It also refers to how freely the person can express sexuality within the family. 

Visibility here is not simply “being out.” It includes several questions:

  • Does the family know?
  • Does the family accept?
  • Does the person feel safe expressing sexuality?
  • Does the family treat sexuality as normal, shameful, suspicious, or invisible?
  • Does the family’s earlier response to sexuality shape how it later responds to HIV?

The chapter identifies three types of SIVF: full, partial, and invisible.

What the researchers did

The chapter draws from a larger qualitative dissertation project on stigma experiences among Filipino MSMs living with HIV. The authors analyzed the family life histories of 31 Filipino MSMs living with HIV. 

Participants were recruited through a community-based HIV organization. They were men aged 18–59, identified as HIV seropositive, and had contracted HIV through sex with other men. Most were in their 20s, and many were living with family members at the time of the interview. 

The researchers used narrative analysis, meaning they did not only code themes. They looked at the structure of life stories: childhood, sexual development, family awareness, sexual exploration, HIV diagnosis, and family response after diagnosis. 

What the chapter found

1) Full sexual identity visibility: family acceptance can become “compounding acceptance”

In the first narrative type, the person’s sexuality was fully visible to the family. These participants knew early that they were attracted to men, and their families were generally aware and accepting. 

Because the family already accepted their sexuality, these participants often had less difficulty accepting themselves. They could express femininity or same-sex desire more openly. Some could bring boyfriends home or talk more freely about sexuality. 

When they later became HIV positive, disclosure to the family was also less terrifying. Family members were more likely to provide care, emotional support, and involvement in HIV management. 

The authors call this low compounding stigma or compounding acceptance. In simple terms: acceptance of sexuality earlier in life can spill over into acceptance of HIV status later.

This is one of the most hopeful findings of the chapter. It shows that family acceptance is not only emotionally good in childhood or adolescence. It can have long-term protective effects on HIV coping, disclosure, care, and wellbeing.

2) Partial sexual identity visibility: family rejection can become enacted HIV stigma

In the second narrative type, the family knew or suspected the person’s sexuality, but did not fully accept it. The person’s sexual identity was partially visible: seen, but not welcomed. 

These participants often grew up with explicit or implicit homonegativity. Some were told that being gay was wrong. Some were pressured to act masculine. Some experienced physical punishment or emotional rejection because of feminine behavior or same-sex desire. 

Because sexuality was not safe at home, many had to hide or restrict their sexual expression. They explored sexuality in more hidden spaces: online dating sites, gay bars, bathhouses, cinemas, clans, or other queer spaces away from family surveillance. Some described risky sexual behaviors connected to secrecy, compensation, or lack of safe support. 

When they later became HIV positive, family responses could become harsh. Some were blamed. Some were treated as if HIV was the “consequence” of being gay. Some experienced isolation, separate utensils, separate sleeping areas, or moral judgment. 

The authors call this compounding enacted stigma. This means that family discrimination against sexuality earlier in life can spill over into direct discrimination against HIV status later.

In plain language: if a family already saw same-sex desire as shameful, HIV could become further “proof” of shame in the family’s eyes.

3) Invisible sexual identity: hidden sexuality can become internalized HIV stigma

In the third narrative type, the family did not know about the person’s same-sex desires or sexual activities. The person’s sexual identity was invisible in the family. 

Many of these participants identified or presented as heterosexual earlier in life. Some had girlfriends or wives. Some performed masculinity to avoid suspicion. Others had same-sex desires but kept them hidden because they had already internalized the idea that being gay was undesirable. 

Their same-sex sexual awakening often happened later, when they had more time away from home. Because their sexuality was hidden, they often lacked access to sexual health information targeted to openly gay or bisexual men. Some engaged in risky sexual behaviors without enough knowledge about condoms, HIV testing, or safer sex. 

When they were diagnosed with HIV, many experienced intense remorse, fear, and self-blame. Some had to disclose because they became seriously ill. Others remained silent, hiding both sexuality and HIV status from the family. 

The authors call this compounding internalized stigma. This means that internalized shame about same-sex desire can later intensify internalized shame about HIV.

This narrative is especially painful because the stigma may not always come from direct family rejection. Sometimes it comes from silence, fear, and the person’s own belief that the family could never accept the full truth.

Why the chapter’s concept matters

The chapter moves beyond the phrase “layered stigma” or “double stigma.” It argues that stigma is not only layered at one moment in time. It can compound across the life course. 

This is important because HIV stigma does not begin only at diagnosis. For many MSMs, the emotional groundwork for HIV stigma may be laid much earlier—through childhood messages about being bakla, family policing of gender expression, religious condemnation, shame, silence, or compulsory heterosexuality.

The chapter also gives Filipino language and culture a central place. It notes that “stigma” does not have one exact Tagalog equivalent. Related ideas include dungis, mantsa, and dusta, which suggest stain, blemish, or dishonor; and bansag or alyas, which suggest labels or monikers. 

This is useful because Filipino family stigma often works through the language of shame and family reputation. Being gay, bisexual, MSM, or HIV positive may be treated as kahihiyan sa pamilya—a shame or dishonor to the family. 

Bottom line

This chapter shows that family acceptance of sexuality can protect MSMs living with HIV from deeper stigma later in life. But family rejection, silence, or invisibility can make HIV stigma more painful. The key insight is that HIV stigma is not only about HIV. It is also shaped by earlier family histories of sexuality, visibility, shame, and acceptance. 

Policy/practice recommendations

  1. Promote LGBTQ+ acceptance early in family life
    HIV stigma prevention should not begin only after diagnosis. Families should be supported to accept children’s and young people’s diverse sexualities and gender expressions early.
  2. Include families in HIV counseling and care, when safe
    Family involvement can support coping and treatment, but only when disclosure is safe and consented to by the person living with HIV.
  3. Train HIV service providers to assess family stigma histories
    Counselors, nurses, and peer navigators should ask not only “Have you disclosed your HIV status?” but also “How has your family responded to your sexuality?”
  4. Create disclosure support that recognizes layered risks
    For MSMs living with HIV, disclosure may involve two disclosures: sexuality and HIV status. Services should help clients plan carefully, especially when family rejection is likely.
  5. Address internalized stigma in psychosocial care
    Some MSMs may not face direct family rejection because they remain invisible, but they may carry intense self-blame. Counseling should address internalized homonegativity and HIV shame together.
  6. Build family-centered SOGIESC and HIV education
    Public health programs should teach families accurate HIV information, challenge myths about transmission, and reduce moral judgment toward LGBTQ+ people and PLHIV.
  7. Avoid romanticizing the Filipino family
    The family can be a source of care, but it can also be a site of stigma. Policies and programs should recognize both possibilities.

Glossary of key terms

  • MSM / Men who have sex with men — A public health term referring to men who have sexual relations with men, whether or not they identify as gay or bisexual.
  • PLHIV — People living with HIV.
  • HIV stigma — Negative beliefs, fear, blame, shame, or discrimination directed toward people living with HIV.
  • G/B/MSM — Gay, bisexual, and other men who have sex with men; a term used in the chapter to capture identity and behavior. 
  • Compounding stigma — The chapter’s concept for how sexuality-related stigma and HIV-related stigma dynamically interact across the life course. 
  • Sexual identity visibility in the family / SIVF — The extent to which a family knows about and accepts a person’s sexual identity, and the extent to which the person can express sexuality within family life. 
  • Full SIVF — A situation where the family is aware of and accepting of the person’s sexuality.
  • Partial SIVF — A situation where the family knows or suspects the person’s sexuality but does not fully accept it.
  • Invisible SIVF — A situation where the family does not know about the person’s same-sex desire or sexual activity.
  • Compounding acceptance — A positive form of low compounding stigma, where family acceptance of sexuality spills over into acceptance of HIV status. 
  • Enacted stigma — Direct experiences of discrimination, mistreatment, rejection, or unfair treatment.
  • Internalized stigma — Shame, fear, or negative beliefs about oneself because of social stigma.
  • Homonegativity — Negative attitudes, beliefs, or behaviors toward homosexuality or same-sex desire.
  • Bakla — A Filipino term often used for gay men or gender-nonconforming males; it can be used affectionately, neutrally, or derogatorily depending on context. 
  • Posit — A clipped term from “positive,” used to refer to someone who is HIV positive. 
  • Dungis / mantsa / dusta — Filipino terms evoking stain, blemish, or dishonor; used in the chapter to explain local meanings close to stigma. 
  • Bansag / alyas — Filipino terms referring to labels, monikers, or aliases; used in the chapter to explain how stigma can operate through naming. 
  • Kahihiyan sa pamilya — Shame or dishonor to the family; an important cultural idea for understanding how sexuality and HIV stigma may be experienced in Filipino families.
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