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Research Article - Journal of Public Health Policy and Planning (2018) Volume 2, Issue 3

Exploring challenges and problems faced by LGBT students in Philippines: A qualitative study.

Xijia Tang, Ak Narayan Poudel*

Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, United Kingdom.

Corresponding Author:
John P. Breinholt
Department of Pediatrics University of Texas
Health Science Center 6410 Fannin Street Suite 425
Houston, Texas, USA
Tel: +1-713-500-5737 E-mail: [email protected]

Accepted date: 15th, 2018

Citation: Tang X, Poudel AN. Exploring challenges and problems faced by LGBT students in Philippines: A qualitative study. J Public Health Policy Plann. 2018;2(3): 9-17.

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Abstract

The Philippines is considered as a gay-friendly country. However, it is reported that Filipino Lesbian, Gay, Transgender and Bisexual (LGBT) community, especially LGBT students are struggling with bullying and discrimination from families, communities and schools. This paper aims to explore the works conducted by the first Filipino student LGBT organization (UP Babaylan), major barriers experienced by the organization, the challenges and problems faced by LGBT Filipino students, and the possible solutions to address these issues. This is a qualitative study and 13 members of the ‘UP Babaylan’ were interviewed after getting written informed consent. All the interviews were transcribed and thematically analyzed using NVivo 11. Findings of the study suggest that the organization has conducted a number of activities, such as educating and sensitizing, coordinating with HIV clinics and other organizations to help LGBT students, lobbying to pass the anti-discrimination bill and conduct UP Pride at the University of Philippines. The main barriers of the organization were the poor support from the government along with the lack of funding and workforce. The lack of legal protection, mental health issues and discrimination at different places were big challenges to Filipino LGBT students. The religion was also not supportive towards LGBT and showed powerful influence on many aspects, including education and politics. To address these issues, educating and sensitizing more people, and engaging LGBT individuals into advocacy were mostly expected. It is recommended to the government to act positively to pass the ‘anti-discrimination bill’ that was already prepared. Other several recommendations were made for different stakeholders including the government, community and universities.

Keywords

Discrimination, LGBT students, HIV, Mental health, Philippines, Policy.

Introduction

The bullying and discrimination has severely influenced the health of Filipino LGBT students [1-7], but what little there is in the literature, does not focus on this group specifically and only talks about limited aspects [7]. For instance, in ‘Let us be’ [7], they provided rich information about politics, culture but little about the religious aspect. In ‘Being LGBT in Asia: The Philippines Country Report’ [3], many aspects were discussed but it did not target particularly LGBT students. Neither of them was based on the perspective of LGBT organization. Therefore, it is worthy to explore the challenges they are facing and figure out the causes of those issues and their possible solutions. Besides, to understand why this country is thought of as a gayfriendly nation even though it has been strongly impacted by a religion profoundly against LGBT issues [8-10], will also be meaningful for both LGBT community and the whole society.

Considering the sensitivity of the topic, this study was conducted in an indirect way. This means, instead of interviewing general LGBT students, we interviewed executive members of an LGBT student organization to understand experiences of LGBT students as well as their own as an LGBT and also an executive member of their organization. In that way, there was no need to ask about the negative experience of general LGBT individuals directly. The chosen organization was UP Babaylan, the first student LGBT organization in the Philippines. It was not only well-known among the students but authorized by the school administration too. The members of UP Babaylan had always been active in LGBT advocacy for 26 years and had made impressive efforts such as lobbying for LGBT bills. Their actions were noticed by the government as well [11]. Therefore they could provide perspectives from political, religious and social aspects based on their experience, which normal LGBT individuals might not know much about. In addition, members in Babaylan were all LGBT people, so they could provide abundant views on both as an LGBT individual and as an advocate at the same time. All above are the reasons why UP Babaylan and it’s executive members were chosen. This study is a unique in the sense that it is the first LGBT related research conducted in UP Babaylan.

The aim of this study is to understand problems and challenges experienced by LGBT students in the Philippines and explore possible solutions to those issues.

The three objectives of the study are: i) to know about services provided by UP Babaylan to LGBT students in the University of Philippines; ii) to explore main challenges and problems faced by LGBT students through the working experience of Babaylan members; and iii) to figure out possible solutions to the challenges and problems, and provide recommendations to relevant stakeholders (e.g. Ministry of Health, education department, etc.) to build a better environment for Filipino LGBT students.

Methods

This study was conducted in the University of the Philippines, Diliman campus, Quezon City, Philippines. Interviews were carried out in the working place of UP Babaylan in the Palma building. As this research aimed to explore a certain phenomenon through people’s experience, it was designed as a descriptive qualitative study, specifically ‘phenomenology’, which is helpful to obtain rich information ‘concerning the current situation of the phenomenon and to describe "what exists" in a situation’ [12]. It is because the phenomenology is concerned with the lived experiences of the people involved in the research [13] and it is powerful tool for understanding subjective experience and gaining insights into people’s inspiration and actions [14]. The homogeneous sampling strategy was used in this study since it is suitable to look for participants who have similar certain characteristics or experiences [15]. As we would like to select people who work in the same organization and have similar working experiences, this approach fit our aim very well. All the executive members (current or former) were students of the University. Since college students in the Philippines are mostly older than 18, we set the age range as 18 years and older to recruit all the potential participants. The criteria for recruitment were:

The inclusion criteria:

• The University students who self-identified as LGBT and are current or former executive members of UP Babaylan;

• All the people who meet the requirement should also be 18 years old and above; and

• They should be in both sound physical and mental conditions, being able to talk with other for 30-45 min.

The exclusion criteria:

• Students who are not LGBT or who self-defined themselves as LGBT but not executive members of UP Babaylan;

• People who are executive members but younger than 18 years old; and

• People who are executive members but unable to talk for at least 30 min (e.g. due to illness).

The data were collected by semi-structured interviews, which is an appropriate approach to explore people’s perspective [15]. A topic guide was used by the interviewer in the process, which was adjusted to fit in the context better after two pilot interviews. All the interviews were audio-recorded with consent given. The information sheet and consent forms were provided more than 24 h prior to the interview to allow thinking time to the participants. These forms were presented in English as Filipino students are taught in English, therefore, there was no need for translation. Written informed consents were obtained from each participant before conducting the interviews. The aim of the research was verbally explained prior to starting the interview although information sheet was provided beforehand. 13 interviews were completed in total when the saturation of information had been met. The word ‘saturation’ in research field was first used in a book titled ‘The Discovery of Grounded Theory: strategies for qualitative research’ written by Glaser and Strauss [16]. According to them, saturation is achieved if the researcher gets similar information over and over and no additional information is received from the extra participants of the study [16,17]. Specifically, the researcher (XT) continued to iteratively collect interview data until there was thematic saturation, which means no new themes were uncovered. The duration of interviews varied from 24 min to 49 min with an average of 35 min. The interviews were recorded to collect the nuances of conversation intact rather than these being subjected to selective forgetfulness or skewed by bias on the part of researchers.

The phenomenological approach was used for data analysis in the study as it works well in studying people’s perspective and describes contents that are suitable for the research with small sample size [15]. All the audio-recordings were transcribed into texts fully and anonymously. The data was analyzed using a thematic analysis demonstrated by Joffe [18]. The main processes were: 1) familiarize the transcripts, and code the segments relevant to the research question; 2) examine the codes and sort them into emerging themes that related to the research question; 3) review the themes and create initial definition according to the objectives. Make new themes or subthemes if some codes didn’t fit the existing theme; 4) construct the final form of each theme after mapping and illustration. Each interview was analyzed in the same way by one researcher (XT) and reviewed by another researcher (ANP). All the steps were performed in NVivo 11 software. Figure 1 shows the whole process of data collection and analysis. The ethical approval (FMHREC-17-1.2) was provided by the Leeds Institute of Health Sciences Research Ethics Sub-Committee. There was no need to get the ethical permission from the Philippines as this is not a national-level international researching effort [19]. The information sheet and consent form were provided to every participant, informing that their confidentiality would be ensured and they were free to withdraw until three days after the interview.

Figure 1: The process of data collection and analysis.

Results

There are four main parts of the findings, which are described in this section: 1) The work of UP Babaylan; 2) The barriers they experienced in the working process; 3) The challenges and problems faced by the LGBT students; and 4) Possible solutions of the challenges and problems (Table 1).

Country Homosexuality is …. and punishable by…. Gender expression is protected
Illegal Protected Death Prison Whipping
Brunei Yes No Yes No No No
Singapore Yes No No Yes No No
Myanmar Yes No No Yes No No
Malsysia Yes No No Yes Yes No
Indonesia Yes, in some areas No No No No No
Philippines No Limited
(some local areas only)
No No No No
Thailand No   No No No Yes

Table 1: LGBT rights in Southeast Asia.

Characteristics of the participants

Table 2 shows that more than half of the participants were from 18-19 years age group (53.8%), all were undergraduates (100%), more than half of them used to be Roman Catholic (53.8%), and majority of them worked in the UP Babaylan for 1 or 2 years (61.6%). For detail characteristics, please see the Table 2 below.

Characteristics Frequency (N) Percentage (%)
Age
18-19 years
20-21 years
>22
7
4
2
53.8
30.8
15.4
Education
Undergraduate
Postgraduate
13
0
100
0
Religion
None
Used to be roman catholic
6
7
46.2
53.8
Duration in the organisation
> 3 years
2-3 years
1-2 years
3
2
8
23.0
15.4
61.6
Position at UP Babylon
Current or former president, vice-president or secretary
Current or former financial committee member
Current or former membership committee member
Other (education and research, or internal committee member)
4 4 3 2 30.8 30.8 23.0 15.4

Table 2: Participants’ characteristics.

The work of UP Babaylan

The UP Babaylan was established in 1992 as a support group [11]. They gradually involved into LGBT advocacy and created the first draft of the national anti-discrimination bill. With the huge contribution made in past decades, UP Babaylan has become well known among students and outside the university.

According to the participants, main activities conducted by UP Babaylan are: education and sentisation, conducting UP Pride annually, cooperating with HIV clinics and other organizations working for LGBT rights, lobbying to pass antidiscrimination bill, and providing necessary support to LGBT students. Among these events, UP Pride is recognized as an official university campaign.

Educate and sensitise people: According to the participants, they conduct education and sensitisation activities in and outside the university. For example, they hold SOGIE (Sexual Orientation Gender Identity and Expression) discussion every semester, they also conduct talk programme on the international day against homophobia, transphobia and biphobia.

We do education and discussion. We go to communities and organizations within the university to talk about SOGIE (sexual orientation, gender identy and expression), human rights, HIV/ AIDS. We do these to spread basic knowledge so that more people will know about what we are fighting for” [P3, 20 years] (Note: ‘P3’ means the 3rd participant).

Conduct UP pride: The participants reported that they also conduct UP pride every year in the university. They march in the university and also conduct a concert at that time to sensitise people about LGBT. “We also have a UP pride event which is the very first pride celebration established in the university in the Philippines” [P3, 20 years].

We do projects and conduct marches and pride in the university to show other people that we are here and proud of who we are” [P8, 18 years].

Cooperate with HIV clinics and other organizations: They reported that UP Babaylan works in collaboration with HIV clinics where students can have free HIV testing as well as awareness sessions. “We are partners of (HIV) clinics where students can have free HIV testing” [P1, 23 years].

According to the participants, they also work in partnership with other organizations to empower LGBT in schools and colleges. They have sister organizations in other universities. They also have community-based organizations in different communities such as-farming and fishing.

According to a participant: “The second thing we do is community-based partnerships with organizations in different kinds of communities like farming, fishing and urban, rural, MSM and transgender community” [P3, 20 years].

Other participant said: “We are really trying to engage the LGBT in the community. Even in other campus, we have sister organizations which Babaylan is cooperating. And, they can help to establish the LGBT organization in other schools. We conduct partnership event with them so there would be safe spaces in their universities” [P5, 19 years].

Lobbying to pass anti-discrimination bill and other policies: The participants are lobbying with the government to pass the anti-discrimination bill. They also mentioned that they are pushing to change the policies and legislations in the universities to protect LBGT students. “Also lobbying, especially anti-discrimination bill in the Philippines. It is one of our work and also one of our objectives. That also means a lot because you cannot only protect LGBT students but also the whole LGBT community in the country” [P5, 19 years].

Support LGBT students: The main job of the UP Babaylan is to support LGBT students. According to them, they are supporting the students in their personal and professional aspects, providing shelter to needy students. They also support on emotional aspects, provide help to receive mental health service and conduct hotlines to help them.

A participant said, “The LGBT community is more vulnerable to mental health issues. We try to connect with the services here in the UP and also other mental health organizations in and outside UP. We have the hotlines and talk to the organization outside so that we could give these people the help they need” [P11,19 years].

Barriers experienced by the UP Babaylan

Although UP Babaylan is working on above-mentioned fields to sensitise people, prevent HIV/AIDS and protect rights of LGBT students, they are still facing many barriers. Poor support from the government, lack of funding and lack of work force are the main barriers they met, which are described below.

Poor support from the government: According to the participants, lobbying for the anti-discrimination bill is one of the most important work of UP Babaylan. Even though the bill was drafted 20 years ago, the government is delaying it’s approval. With the lack of approval, LGBT people in the Philippines do not feel protected even with strong legal evidence when the discrimination occurs.

“In the Philippines, we don’t have the anti-discrimination law. It means a lot. Inside the legislation, you can pass a lot to protect everyone’s sexual orientation and gender identity and expression. That means to protect everyone from gender based discrimination” [P4, 19 years].

However, a number of politicians are indirectly opposing and trying to delay the whole process. Although the bill has already come to the third reading, which is the furthest it has gone so far, the government as a whole is not supporting enough to give the full approval, and some people in power are opposing it, learnt from the participants.

“Some senators are delaying the implementation of the bill and its passing. It is really hard because we can only do so much. We insist and are determinate to push and fight for the bill. But people in the government don’t show their support and it is hard for the community when people of the power discriminate us” [P8, 18 years].

They also thought that the reasons this situation exists were firstly, because Filipino people, including the senators and politicians, grow up with the strong impact of religion which thinks being homosexual is a sin. Secondly, some government officials lacked of SOGIE knowledge. They still hold negative stereotypes towards LGBT community, which makes it very difficult to pass the bill.

“Most legislators are very against us, and have a very strong religious objection to the LGBT organization” [P6, 22 years].

“Because the bill is still not passed, we don’t have the safe guard from the law that could help us and protect us from the discrimination. It is harder for us as an LGBT to live a decent life just because we are LGBT” [P10, 19 years].

Lack of funding: According to the participants, lack of funding is another major barriers of UP Babaylan to support LGBT students. As the school administration did not provide financial support to student organizations, Babaylan had to generate income by themselves, such as selling T-shirts and umbrellas inside campus. But the outcome can be constrained because of the limited workforce. They could also get sponsorship from companies. However, considering the sensitivity of LGBT issue, only few companies are willing to sponsor, and the funding is usually too little to cover the expenditure. Additionally, some companies only want to sponsor for the popular events like UP Pride rather than providing long-term financial help. Given that, the financial stability cannot be ensured, which would impact the launch of the advocacy.

“Getting sponsorship can be really difficult as a lot of companies are not that friendly and open yet. Every year we have a UP pride, which is a week-long, so we need a lot of money. What happens is we may get to company, we try to cooperate with them, retail food and any sponsor we possibly get. And more often, we get only a few” [P12, 20 years].

Lack of workforce: There is a misconception that UP Babaylan is a huge organization with hundreds of members. According to the participants, they have just 25-30 formal members, of whom only around 15 are active. The reasons of this situation were: firstly the fear of being recognized; many LGBT students are afraid of coming out to their families, whereas joining Babayan would make them identifiable to the public. Also, some parents discourage their children to join Babaylan because they want to hide their children’s sexual orientation. Secondly, the migration of the members to other places. On one hand, members need to graduate every year or focus on other priority like job hunting, which distracts them working for Babaylan; on the other hand, the process of applying for UP Babaylan is complex and this makes some people give up the application. Due to the lack of workforce, UP Babaylan cannot ensure the quality and continuity of some projects.

“From outside, we look like a big organization but we now have only 20-30 members. Although alumni also count, they have to work or other priorities. It slows down our progress. The lack of manpower could lead to a lower quality of the events” [P13, 22 years].

Challenges and problems faced by LGBT students in the Philippines

Known from participants, discrimination from different sides, mental health issues and the lack of recognition from public are main challenges faced by LGBT students in the Philippines.

Discrimination and bullying

(1) Discrimination from academic stuff

Professors and administration employees are highly respected by students, however even in an open-minded place like UP, many of them still would say or do something disrespectful to LGBT students although the students have expressed their dissatisfaction.

“Once in a (….) class, the professor refused to use the female pronoun to call a transgender woman. I think she requested the professor to refer her with female form, but the professor did not agree. Some professors will call a transgender woman ‘Sir’ and it makes her uncomfortable” [P1, 23 years].

Furthermore, in some Catholic schools, LGBT students can be dismissed just because of their sexual orientation and gender identity.

“I know someone who was kicked out by the school because he was gay and it was a Catholic school” [P9, 20 years].

(2) Discrimination from family, friends and employers

The particpants stated that Filipinos have been strongly influenced by the religion and culture. The parents’ generation seems to be hard to accept LGBT and SOGIE knowledge. Some LGBT students were even kicked out by their families and had to live in the shelter. As for friends, some people will judge LGBT students and isolate them if they reveal their gender identity. In the view of Babaylan’s members, being hurt by the closest people in the life can bring the most serious fear and trauma. That makes LGBT people feel more scared to come out to the public and it is also the main cause of mental illness.

“I came from a family that doesn’t recognize LGBT people. I’ve been kicked out by my family because they can’t accept me as a transgender woman, so they sent me out of the house” [P3, 20 years].

“The reason why I did not come out to some of my friends is that I am scared if they find out, they would not be my friends any more. Some friends would not be that close to you. They say negative stuff about you behind your back. It makes it hard to come out because of that fact” [P8,18 years].

The discrimination from work places and schools are also common. Many LGBT students can’t be employed or paid less than others because of their sexual orientation. Cases of sexual harassment and physical or verbal violence still occur to Filipino LGBT students.

“Sometimes LGBT can’t get jobs, they are not paid well because they are thought that they don’t deserve the jobs. People discriminate them in the working places” [P6, 22 years].

“I have been dragged by my classmates for being a gay, from the first floor to the fourth floor in our school building when I was young. Others even have been punched, slapped. Verbal and physical violence occur” [P3, 20 years].

Mental health issue: The participants reported that mental health issue is a severe challenge of LGBT students. The negative experience in daily life, the fear of coming out and being identified by families could all cause mental issues. Those pressures will be added and triggered when a person is mentally ill and an LGBT at the same time. Many people cannot handle their work and study because of the depression, anxiety, or suicidal thoughts. To be specific, four suicide cases were reported in the UP during the last 3 months. A lot of members in Babaylan are diagnosed with mental illness. It influences not only their health but also slows the working process because the organization has to put members’ well-being as the priority.

“It really adds up to the problems they are facing, because it will cause the depression, anxiety, most seriously the death. You are always afraid that people will see you and tell your parents that you are a LGBT person” [P7, 20 years].

The lack of recognition by the public: From the perspectives of the participants, the LGBT community is not well recognized in the country. The public are not willing to know about SOGIE related information and are still having stereotypes towards this minority group.

One typical example is misgendering the transgender and bisexual community. People do not think that a transgendered woman is a real woman. Even those who know a little about SOGIE still believe that there are only gays and lesbians in the world. One possible reason for this binary thought is that in Tagalog (the Filipino language), there are only words for gay (bakla) and for lesbian (tomboy), and no equivalent terms for transgender and bisexuality. Therefore, people think these two minorities don’t really exist and they express themselves differently just to be sexually attractive.

“Sometimes it hurts me when my friends misgender me and it triggers my dysphoria. I still work hard to explain my identity, even if I do, people still split it off” [P12, 20 years].

The participants revealed that some bars and organizations do not allow transgender people to enter or apply. The discrimination also happens when they use the bathroom. For example, in some shopping malls and universities, transgender people are not permitted to use the bathroom which they prefer. The poor recognition has brought them extra pressure and led to mental illness.

“I have a trans-friend who entered female bathroom, she was wearing feminine clothing, the guard shouted at her to go out. She argued, she explained her identity as a transgender girl, the guard didn’t have it. He kept making her go to the male bathroom until the argue is getting loud and people were staring, so she had to walk away and went to the opposite restroom. This triggered her for sure” [P11, 19 years].

The knowledge about HIV is also limited. People will strongly associated HIV/AIDS with gay people and the whole LGBT community, with the thought that it is a disease which only gays have. This stereotype affects not only LGBT community but also stigmatises people living with HIV.

Additionally, people who are against LGBT would attack the LGBT community on social media, a platform that quickly spreads messages, stated by a participant. Aggressive comments can be reposted over hundreds of times. People who read it would easily believe the posts and form the negative impression to LGBT. It harms the reputation of the whole community and makes advocacy harder.

“My friend saw the tweets and asked me why LGBT are problematic. The power of language is very strong. Our advocacy and events are invalidated, we lose support just because one person said something and others support it. It hurts the advocacy” [P13, 19 years].

Besides, some participants believed that the social hierarchy is a Filipino-particular factor that leads to the surface-level recognition. As a lower middle-income country, poverty has been considered as the priority among all the social issues, so LGBT issues, which is considered a middle-class struggle, cannot be emphasised more than the poor’s struggle. According to the particiants, the LGBT community has been always blamed that they never concern and help poor people but only concentrate on themselves. However, Babaylan’s members think that LGBT people exist in every class and actually most of them come from the lower class, so their issue belongs to the lower class, and LGBT rights are human rights rather than something special. Thus, they are standing by the intersectionality of social problems and pushing forward not only the equality of this minority but of the whole society.

“So they attack us because we don’t help the poor or the events don’t focus on the poor. But that’s not true because even inside the organization, our social class are not the same. We solve each problem in the same manner and time frame, basically the intersectionality. What we are fighting for is not all about gender but struggles that everyone faces” [P13, 19 years].

Possible solutions of the challenges and problems faced by the LGBT students

A number of suggestions were provided by the participants to resolve the challenges faced by the LGBT students in Philippines. These are to separate the church from government activities and decisions, to improve access of LGBT to medical services, to pass anti-discrimination bill and to conduct more education and sensitization activities.

More education and sensitization: Many participants gave emphasis on education and sensation of more people to improve current discrimination against LGBT. According to them nothing improves unless they do not understand about Sexual Orientation, Gender Identification and Expression (SOGIE) issues. They think there are still a number of misconception about the LGBT community and these misconception should be removed by educating and sensitizing more people.

We want to educate everyone so they would understand oh this is why they fight for it, this is why the advocate for LGBT rights. If the public and the government can be educated, it will become much easier, as these conception like SOGIE are sort of difficult to understand, and you are not going to advocate something that we don’t understand, so we have to bring the education to the public, so that we can make the wide-spread change and action for LGBT community [P11, 19 years].

Pass anti-discrimination bill: According to the participants, they will be lobbying continuously to pass the antidiscrimination bill. They keep pushing the government because they think that if the anti-discrimination bill will be passed, only then they will feel secured.

“This information was institutionalized by the government, for example, if LGBT were recognized by law, and antidiscrimination bill can be passed, that would be the law protecting us” [P12, 20 years].

“For the government, pass the (anti-discrimination) bill, make the bills, and make the country safer for LGBT people” [P9, 20 years].

Separate church: The participants reported that there is big role of church for delaying bill to be passed by the government. They think the government could pass the bill if the church does not interfere the government. Therefore, they want the church should work separately and should not interfere the government work.

A participant stated: “We have to insist on the separation of the church (to pass the bill), which is already provided by the constitution” [P3, 20 years].

Other: The participants also provided other suggestions to resolve the problems faced by LGBT students. According to them, there should be better access of LGBT students to medical services and there should be partnership with mental health organization to resolve mental and other health issues suffered by the LGBT students.

A participant said: “I think what we could provide is the partnership with the mental health orgasitaion and find LGBT and mental health cases …. Since obviously we can’t make every LGBT student to join Babaylan to help the advocacy, but providing those service is much hard” [P11, 19 years].

Another participant talked about the freedom to unite and make LGBT organizations: “I think university should give LGBT students the freedom to organise, there are not many LGBT organizations in schools as the country is religious. In other universities, when people want to have LGBT organization, they are not allowed because their school is Catholic school. In UP, it is easier because we are a state university instead of Catholic or private one” [P9, 20 years].

Discussion

UP Babaylan is an LGBT organization established by the students of the University of Philippines in 1992. Since its establishment, the organization has done many activities to support the LGBT students [11]. The members have been involved in LGBT advocacy, contributed to draft the antidiscrimination bill to pass by the government, educated and sensitise people, and coordinated with HIV clinics and other organizations to support problems and issues faced by LGBT communities in and out of the university. The organization has done considerable work to protect LGBT communities in their health, social, and political dimensions.

The Philippines held the earliest LGBT advocacy in Asia [6] and made great contribution in the past decades. For example, some cities passed local ordinances to protect LGBT community, and the national anti-discrimination bill has reached the final reading recently [20,21]. Therefore, it is not surprising that the country could rank one of the most LGBT-friendly nations [6]. But found from this study, the acceptance of LGBT community is still at the surface-level. The community, especially LGBT students have been struggling with bullying, discrimination and severe mental health issues. It was the gap between the progress and the remained problems that caused this misconception.

The society in general is showing a more positive attitude towards LGBT community than before, proved by Tubeza’s [22] 2013 survey – 73% Filipinos agreed that LGBT community deserved the acceptance, comparing with 9% in 2002. But what the findings implicated was that LGBT students were still experiencing a passive tolerance rather than fully accepted. The government was not supportive, which was the main cause of the lack of legal protection [7,23]. This kind of social atomosphere made it hard for LGBT organizations to get enough fund and workforce. Likewise, discrimination and bullying were still taking place. For instance, the transgender people were not allowed to use the bathroom they prefer and LGBT students were treated unfairly at schools and work places, and even kicked out by their families. The findings were also supported by previous studies [24,25] . A study in the Philippines had reported that half of the bixesual people experienced insults from their friends and they were not accepted by their families [26]. These findings are in line with our study. Thus, LGBT are experiencing many negatives from different stakeholders of the society, which triggers their dysphoria and leads to mental illness, even suicides. However, this problem was generally poorly addressed in the Philippines and worldwide [27].

The findings indicated that UP Babaylan tried to offer the first response to members stuck with mental health issue, but the quality of services could be impacted due to the lack of training and poor connection with professional institutes. The similar situation also occurred in Canada [28]. Therefore, the possible solution of this issue could be conducting more trainings on psychological skills and establish a stronger partnership with mental health institutes, so that more people would be helped effectively.

Another challenge which particularly exists in Filipino context is the powerful religious impact. The Catholic Church ‘imposes conservative moral ideologies, influencing the public and policies on education, LGBT representation in government, and medical services’ [10]. Although the constitution declared that ‘the separation of Church and State shall be inviolable and full respect for all Filipinos' human rights’ [7,23], same-sex marriage, the approval of anti-discrimination bill and LGBT involvement in election were all hampered their authority. The given reason being that was ‘offending religious beliefs’ [7,29]. Therefore, to separate the church was frequently mentioned by participants as an essential solution as it would not only help to pass the bill but also reduce constraints when conducting LGBT advocacy.

Besides, education should be used as the fundamental solution to address the poor public awareness towards the LGBT community [30]. The LGBT organizations should be responsible in conducting educational campaigns about SOGIE knowledge. It is important to reach the core population, including government officials, teachers, and community leaders [7] because more senators and politicians would possibly support passing anti-discrimination legislation if they are equipped with proper knowledge, and the community would be more open to accept these campaigns if leaders were well-educated at first. For schools, many participants reported that they have limited access to SOGIE knowledge with heterosexual students and teachers not being educated well [7]. Even in the United Kingdom (UK), nearly 80% secondary school teachers did not receive any specific training [31]. Therefore, more educational activities should be held, especially in Catholic schools in order to deliver related information to teachers and students.

Media and the internet can also be utilised to educate people. Although there were some TV programmes for LGBT representatives in the Philippines, it’s still too few to draw people’s attention [3]. The education would reach a larger population if more opportunities can be provided to LGBT organizations or individuals on these platforms [3].

As for engaging LGBT people, there are several things can be done. Firstly, help the advocates who are in trouble to get back to work, by means like providing psychological consultation and the temporary shelter for the homeless members. Secondly, it is significant to establish LGBT organizations in universities which don’t have any, so that more LGBT individuals could involve in the advocacy [7,22] as the institutional support can make the environment safer for LGBT [7,23] . Finally, to simplify the application process if it is too complex for applicants to fully complete. In that way, the organization could recruit more members.

Conclusion

In conclusion, the findings indicated a slow progressive living environment of Filipino LGBT students, who lack legal protection; suffer from mental health issues, opposed by religion and so on. The possible solutions such as separating church from the government’s work, educating and sensiting more people, and organising and engaging LGBT individuals were suggested by the study. The findings have significant international health implication because it could draw people’s attention of the wellbeing of LGBT students not only in conversative countries but also in ‘gay-friendly’ nations like Philippines. The mental and physical health of LGBT community, especially students should be paid much attention.

Speficially, following recommendations are made for different stakeholders:

• We would like to recommend all LGBT organizations working in the Philippines to conduct more professional trainings to deal with mental health issues of LGBT students, working with the universities and mental health clinics to treat serious issues of mental health.

• We would like to suggest the LGBT organizations which have complicated application process to simplify it so that they could recruit more members for their organizations to increase helping hands in the advocacy and other supportive works.

• We want to recommend the LGBT organizations and students to participate more in social media debates, such as in TV programmes, YouTube videos, online discussion or in activities to deliver SOGIE information.

• We would like to recommend the Philippino communitybased organizations to organise SOGIE related trainings to the community administers, as well as families who have LGBT children, with the help of LGBT organizations.

• We would like to recommend schools and universities in the philippines to establish supportive policies, which include the freedom to LGBT students be organised, establish LGBT organizations, hold LGBT advocacy, wear uniforms and access facilities consistent with students’ self-expressed gender identity, and provide quicker response system to mental health issues of the students.

• We would also like to recommend to provide training to school or college teachers and staff to respond bullying and harassment; and integrate comprehensive SOGIE knowledge with other courses.

We would like to recommend the Government of Philippines to advance passing of the anti-discrimination bill; separate the obligations with the church according to the Constitution, especially when it comes to LGBT issues; and ensure the equal rights of LGBT community on education, healthcare (mainly sexual and mental health) and employment and to organise themselves.

Limitation of the Study

We included only the executive members of the UP Babaylan in this study and there is lack of opinions from other stakeholders, such as the university staff, government official, NGOs and INGOs working with LGBT. This hindered to obtain a wide range of opinioins on the issues we discussed in this study. Therefore, there is lack of triangulation of the findings obtained in this study. This limits generability of our findings. However, collecting and analyzing qualitative data from various stakeholder groups was not the original aim of this study. Therefore, we have left this for further research inquiry.

Abbreviations

AIDS: Acquired Immunodeficiency Syndrome; HIV: Human Immunodeficiency Virus; HRW: Human Right Watch; LGBT: Lesbian, Gay, Bisexual and Transgender; SOGIE: Sexual Orientation, Gender Identity and Expression; UN: The United Nations; UP: The University of the Philippines; USAID: United States Agency of International Development; WHO: World Health Organization

Acknowledgments

We would like to thank all our participants involved in this study for providing their valuable time and opinions. We were always being impressed by these amazing people. Their perspectives were more than just research data, but also a precious lessons we learnt. We would like to thank our host, Ron Vincent Delos Angeles, for his kindness and support to organize all the interviews. Even though the monsoon slowed down the process, he still managed to help us to recruit the participants. This study can’t be completed in time without his continuous support. We would also like to thank our families and friends for their continuous moral supports throughout the study. We would like to thank all the staff of Nuffield Center for International Health and Development, University of Leeds, for their warm comfort and strong support to complete this study successfully.

References