The Management of Social Standing: Characterizing the Influence of HIV Stigma on HIV Talk and Testing Behavior in Philippine Key Populations Using a Grounded Theory Approach

We characterize the way human immunodeficiency virus (HIV) stigma hinders HIV conversations and testing. Using grounded theory principles, we analyzed in-depth interviews of the experiences of select Philippine key populations (groups with high HIV burden) and their families: 19 men who have sex with men (KPM), 16 transgender women (KPW), and 16 parents of KPM/W. Results show how KPM/W protect the state of being respected by others (management of social standing), a task they engage in by strategically modulating behavior in different life domains, including when considering HIV conversations and testing. Our results specify the management of social standing as an object being threatened by stigma and as a process making KPM/W behavior susceptible to the influence of HIV stigma, even for KPM/W who may not possess the mark of positive serostatus. This raises questions about the theorizing of stigma, which traditionally has focused on the susceptibility of marked but not unmarked individuals.