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1 MSc International Development Studies

Graduate School of Social Sciences

Master thesis

Queering sexuality education and sexual health in the Philippines

By

Agathe Nour Semlali 12736988 August 2020

Word count: 28622

Supervisor: Dr. Esther Miedema University of Amsterdam

Field supervisor: Anastacio Marasigan TLF Share, De LaSalle University Manila

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Acknowledgement

Sexuality education and sexual health are two topics that I incredibly care about. I want to express my deepest gratitude to all the individuals who helped me in this journey and made my dream project feasible.

Firstly, I would like to thank my thesis supervisor, Dr. Esther Miedema, for her patience, kind words and priceless advice. I am very grateful for her constructive feedback and support throughout this thesis process. I felt immense pride in working under your supervision.

Secondly, I thank my local supervisor, Anastacio Tacing Marasigan, for his guidance and help during the fieldwork. His work has been an inspiration since 2018 when I first met him as my Gender Studies teacher at De La Salle University in the Philippines. I am thankful for crossing his path again two years later.

Salamat to all the participants, who were introduced to me by Tacing. This research is dedicated to the members of CURLS Cebu, Gayon, Indigo, Pantay and TLF Share who willingly participated in this research and made sure I appreciate every incredible aspect of the Philippines. I will forever be admirative of their hard work for Filipino people. A special thanks to Ruffa, who shared many precious life stories with me. Her strength, pride and joy were an enormous inspiration.

Thank you to Helen Levy, who showed interest in this research. Her constructive feedback was precious to finish this thesis.

I also thank my mother, grandmother and sister, who always believe in me. They helped me to fly back to France when I was stuck on the other side of the world, but most importantly, to become the woman that I am today. May this thesis make them proud.

Lastly, a great thank you to all of my friends in the Netherlands, France and the Philippines, who created a supportive environment. I especially thank Ambrine, Marthe and Clara for their unconditional moral support and our countless study sessions between tears and laughter. Last but not least, a special thank you to Clara for our friendship, who has been by my side for the last four years of studying together and without whom writing both my bachelor and master’s theses would have not been possible. Looking forward to graduating from another degree with you.

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Abstract

This research examines LGBTQ+ community-based organisations’ efforts to provide inclusive sexuality education (SE) for and enhance sexual health (SH) of their communities in Quezon City, Legazpi City and Cebu City in the Philippines. Although the Philippines adopted its Responsible Parenthood and Reproductive Health Act (RH Bill) in 2012 to guarantee universal access to methods of contraception and sexual education, the use of contraceptives is very low and sexual education remains ‘abstinence’ oriented. HIV infection rates are still rapidly increasing, especially among transgender women and gay men. As LGBTQ+ organisations such as Curls Cebu, Indigo, Gayon, TLF Share and Pantay have argued, the RH Bill fails to recognize LGBTQ+ individuals’ sexual and health rights.

There is little research on sexuality education and sexual health for LGBTQ+ individuals. Drawing on theory on Comprehensive Sexuality Education and rights-based approaches to sexuality education (SE), as well as community engagement in the realm of sexual health (SH), this research analyses how do LGBTQ+ community-based organisations provide sexuality education and sexual health interventions in non-formal settings. In addition, this study examines how these organisations promote inclusion. The study addresses a knowledge gap regarding how Comprehensive Sexuality Education and rights-based approaches are conceptualized by community-based organisations providing sexuality education and sexual health services, with a focus on those working with underserved communities such as LGBTQ+ people. This qualitative research was based on data collected through focus group discussions, semi-structured interviews, document analysis and informal conversations with members of LGBTQ+ community-based organisations. Data presents first who the actors of inclusive SE and SH in non-formal settings are. The organisations are mainly helping young people, men who have sex with men and transgender women; they provide a diversity of SE and SH services to compensate for disruptions in accessing those services in traditional institutions (e.g. schools, hospitals). To design programmes and services, CURLS Cebu, Gayon, Indigo, Pantay and TLF Share make use of participatory methods to engage their communities. Findings are significant for the international development sectors of sexuality education and sexual health by providing insights on sexual health and sexuality education efforts led by LGBTQ+ community-based organisations’ members.

Key words: sexuality education, sexual health, LGBTQ+, inclusion, Philippines, community-based organisations.

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List of acronyms

AIDS: Acquired immune deficiency syndrome CBS: Community-based screening

CBO: Community-based organisation HIV: Human immunodeficiency virus

LGBTQ+: Lesbian, Gay, Bisexual, Transgender, Queer + MSM: Men who have sex with men

PLHIV: People living with HIV PWID: People who inject drugs SE: Sexuality education

SH: Sexual health

SHC: Social Hygiene Clinic

STI: Sexually transmissible infection TGW: Transgender women

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Table of contents

Acknowledgement ... 2 Abstract ... 3 List of acronyms ... 4 1. Introduction ... 9

1.1. Problem statement and relevance of the topic ... 9

1.2. Outline of the thesis ... 10

1.3. Concluding remarks ... 10

2. Theoretical Framework ... 11

2.1. Introduction ... 11

2.2. A rights-based approach to SE ... 11

2.3. Comprehensive Sexual Education: toward an inclusive SE ... 12

2.4. The inclusion of LGBTQ+ communities ... 13

2.5. Community engagement in health ... 15

2.6. Conceptual scheme ... 16

2.7. Concluding remarks ... 17

3. Contextual chapter ... 18

3.1. Introduction ... 18

3.2. Country background overview ... 18

3.3. LGBTQ+ Situation ... 18

3.4. Gender ‘non-conformism’ in the Philippines ... 20

3.5. The Anti-Discrimination Bill ... 20

3.6. Local versus national legislation ... 21

4. Research Methodology ... 22 4.1. Introduction ... 22 4.2. Research question ... 22 4.3. Research location ... 23 4.4. Methodology ... 24 4.4.1. Unit of analysis ... 24 4.4.2. Sampling ... 24

4.4.3. Data collection methods ... 25

4.4.4. Data analysis methods ... 27

4.4.5. Ethical considerations and positionality ... 27

4.4.6. Quality criteria ... 29

4.5. Concluding remarks ... 31

5. Community-based organisations: engaging with the facilitators of inclusive sexuality education and sexual health in the Philippines ... 32

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5.1. Introduction ... 32

5.2. The actors of non-formal sexuality education and anti-discrimination advocacy ... 32

5.2.1. Training of peer educators ... 33

5.2.2. Solidarity ... 35

5.3. Engaging with the key populations: young people, Men who have sex with men, transgender women, people living with HIV and people who inject drugs. ... 36

5.3.1. Key populations ... 36

5.3.2. Young people ... 37

5.4. Mapping solidarity: a network of community-based organisations ... 38

5.5. Incorporating Human Right in Sexual health and Sexuality Education ... 41

5.6. Presenting diversity: The SOGIE Framework ... 43

5.7. Obstacles faced by CBOs and their facilitators ... 45

5.7.1. State, religion & legislation ... 45

5.7.2. Culture & society ... 46

5.7.3. Stigma within the communities ... 48

5.8 Concluding remarks ... 48

6. Creating conditions for the provision of inclusive sexuality education and sexual health ... 49

6.1. Introduction ... 49

6.2. Providing (sexual) health and sexuality education services ... 49

6.2.1. Outreach activities ... 49

6.2.2. Commodities distribution: venues and challenges ... 52

6.2.3. Community-Based Screening ... 54

6.2.4. Systemic barriers to access general health ... 57

6.2.5. LGBTQ+ general health : the example of the VIBE centre in Cebu ... 59

6.2.6. Sexuality education ... 60

6.3. Creating spaces for community engagement and strengthening: learning from LGBTQ+ lived experiences ... 62

6.3.1. Community engagement – building – strengthening ... 62

6.3.2. Safe places and trust building ... 65

6.4. Concluding remarks ... 68

7. Conclusion and discussion ... 70

7.1. Answering the main research question and summary of findings ... 70

7.2. Theoretical reflections ... 73

7.3. Methodological reflection ... 75

7.4. Recommendations ... 76

7.4.1. Programme recommendations ... 76

7.4.2. Ideas for future research ... 77

7.5. Concluding remarks ... 77

8. Appendices ... 79

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List of figures

Figure 1 – Conceptual scheme………...p.17

Figure 2 – Map of the Philippines and research locations….………p.23

Figure 3 – Webinar on “Understanding SOGIE and Empowering Communities" organized by Gayon and the Forum for Family planning & Development of the Philippines………p.39

Figure 4 – Scheme of the relationships between the different CBOs.………...……p.40

Figure 5 - Cover of a STIs, HIV and AIDS prevention booklet of Gayon. ………p. 51

Figure 6 – Extract of Gayon’s booklet. ………p. 51

Figure 7 – Photo of a LGBTQ+ beauty pageant ball in Legazpi City.…….………p. 53

Figures 8, 9 & 10 – Screenshots of Grindr conversations to promote a community-based screening organized by Pantay in Quezon City………p.54-55

Figures 11, 12 & 13 – Photo of the Cebu Convention, with group activities organised by TLF Share and CURLS Cebu in Cebu City. ………p.57-58

Figure 14 – Scheme to summarise the different levels of actions of the CBOs………p.73

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1. Introduction

1.1. Problem statement and relevance of the topic

Sexuality Education (SE) and Sexual Health (SH) related issues are of highly concern in the Philippines: HIV infection rates are rapidly increasing (especially for transgender women and gay men), the use of contraceptives is very low and sexual education is ‘abstinence’ oriented (Restar et al., 2019). Men who have sex with men are the most affected by the HIV pandemic, but taboos against homosexuality contribute to the absence of public-awareness campaigns (Dakis et al., 2012).

In 2012, the Philippines adopted its Responsible Parenthood and Reproductive Health Act (hereafter referred to as the RH Bill) to guarantee universal access to methods of contraception, maternal care, and sexuality education. The provisions of the bill are mainly risk-oriented and have a very heteronormative definition of sexuality. The LGBTQ+ community has not yet acquired enough rights and again, the RH Bill fails to recognize particularly trans women’s sexual and health rights (Tanyag, 2015). Additionally, LGBTQ+ individuals face enormous disruptions in accessing (sexual) health care, such as crucial as HIV medication and gender-affirming treatments1 (Bishop et al., 2020). It is important to acknowledge the social, cultural, economic and political dynamics of the Philippines. Catholic conservatism is a strong barrier to any change regarding reproduction and sexuality as catholic elites are very present among political elites.

As agencies such as UNESCO (2018) have argued, sexuality education is critical for young people because SE develops the capacity to make informed decisions about our sexuality and bodies. However, SE tends to focus on penetrative heteronormative sex and protecting young people’s innocence, excluding therefore the LGBTQ+ community (Formby, 2011). As scholars in the Philippines have pointed out, given that most LGBTQ+ individuals do not benefit from any form of SE in high schools at all, it is also important to educate them throughout their adulthood as well (Human Rights Watch, 2017). Manalastas and Macapagal (2005) stress that queer individuals “expressed dissatisfaction about sexuality education in high school, both for its heterosexist bias and its restrictive philosophy” (p.141). Despite the growing awareness around the importance of sexuality education and its benefits for young people, it thus usually fails to address all identities and sexual orientations.

In recent years, two approaches have become increasingly dominant in SE discussions: Comprehensive Sexuality Education and Rights-based approaches (UNFPA, 2014). Those approaches differ from the ‘abstinence’ oriented approach to SE and seek to promote Human rights and gender equality principles, to empower youth regarding their sexual health, rights, and wellbeing (Berglas et al. 2014). Promoted and recommended by international development

1 Gender-affirming treatments focus on affirming one’s gender identity through different procedures

such as hormone therapy, surgery, facial hair removal, communication and speech interventions and behavioural adaptations (e.g. chest binding and genital tucking) (Deutsch, 2016).

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10 agencies from a top-down perspective, little is known about how those approaches are conceptualized and implemented on the ground. To address this gap, this study looks at SE initiatives of Filipino community-based organisations that seek to provide inclusive, rights-informed, gender-sensitive and age-appropriate SE.

Discourses around the risks women face and vulnerability have led to a strong focus on women and young women in sexual education and health studies and policies, and tended to leave other groups left behind, such as the LGBTQ+ community. In the Philippines Country Report on ‘Being LGBT in Asia’ by the UNDP and USAID (2013), the 2013 Philippine National LGBT Community Dialogue recommends the Filipino LGBTQ+ community that they include “topics beyond HIV when discussing health-related issues of the members of the community (…).” and to “amend the existing health curriculum to make it more inclusive of LGBT issues” (p.10). Research to assert the efforts made since this report regarding sexuality education and health is needed. This study aims to learn from the Philippines' experience and to support further sexuality education and sexual health initiatives promoting the inclusion of all genders and sexual orientations.

1.2. Outline of the thesis

This thesis is divided into nine chapters, the first of which has introduced sexuality education and sexual health as a subject of study and the relevance and motivations behind the research. Secondly, the theoretical framework of this research will be explained: two crucial approaches to SE, rights-based approach and comprehensive sexuality education. It also presents the theoretical claims behind the need to include the LGBTQ+ community in SE and how community engagement function in the realm of health. The following research methodology chapter links the topic of the research with theory with research questions, set the context of the research and detailed the methods used. The empirical chapters of the study will analyse the findings from the field, firstly engaging with the actors of non-formal SE and SH initiatives. The second empirical chapter will detail the conditions of the provision of inclusive SE and SH by community-based organisations. The concluding chapter will answer the research question by putting the findings in perspective with existing theory. This discussion will lead to drafting practices, programmes recommendations and future research avenues for inclusive SE and SH.

1.3. Concluding remarks

The above chapter introduces the subject and its challenges. LGBTQ+ communities face enormous disparities in accessing SE and SH services in the Philippines. On one hand, SE is very heteronormative and do not include LGBTQ+ issues in the curriculum; on the other hand, the LGBTQ+ communities lack adequate sexual health services. LBGTQ+ community-based organisations seek to include their communities in SE and SH curriculum. New approaches in terms of SE, such as a rights-based approach and Comprehensive Sexuality Education, are relevant to this research to study community-based SE and SH initiatives. The following chapter will examine these two approaches and set the theoretical framework of this study.

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2. Theoretical Framework

2.1. Introduction

The chapter presents the theoretical grounds of this study. The first and second section introduce two approaches sexuality education: a rights-based approach to SE and Comprehensive Sexuality Education. Within the rights-based approach, we can distinguish different sub-approaches; the research draws on the inclusion and empowerment approach to a rights-based approach to SE. Then, the next section defines LGBTQ+ communities and their challenges. In the last section, the study pays attention to community engagement, especially in the realm of health. This latest notion helps understanding health-related efforts led by community-based organisations.

2.2. A rights-based approach to SE

Sexuality education (SE) is the instruction of human sexuality. SE programmes may address issues such as responsibilities, anatomy, sexual activity, reproduction, sexual orientation, age of consent, reproductive health, reproductive rights, safe sex, birth control, and sexual abstinence. SE and SH are interconnected as SE can be a reliable source of sexual health (Human Rights Campaign, 2015). Different authors and international agencies expressed what SE ought to be. According to agencies such as UNESCO (2018), SE develops the capacity to make informed decisions about our sexuality and bodies. Sexuality education can help to change people’s behaviour regarding their sexuality and provides individuals with choices regarding their bodies, such as learning consent, respecting our bodies and others, avoiding risky sexual behaviour such as unprotected sex. People adopting healthy and informed behaviour will influence individuals with whom they interact, especially young people who rely a lot on their peers to socially learn about some taboo topics such as sexuality (UNESCO, 2018). For young people, formal SE, delivered in schools, for instance, is one of the only reliable sources of information on sexuality they receive and is expected to have positive outcomes such as reducing sexually transmitted diseases and unwanted pregnancies (Leng et al., 2019). Adolescents are sexual beings, and denying it, is one common mistake leading to misinformation and distrust on the part of young people concerning sexual health issues. According to Berglas et al., they should be able to explore and express their sexualities in ‘healthy, positive, pleasurable and safe ways’ (2014, p.1).

Within the realm of SE, different approaches to the matter exist (Miedema et al., 2011; Braeken & Cardinal, 2008). They vary depending on the country and its beliefs. The research here relies on a rights-based approach to SE.

Sexual education has been conceived for a long time through health and risks oriented approach, focusing therefore on preventing unwanted pregnancies and STIs, HIV/AIDS. However, this dominant approach is challenged by a rights-based approach. For 30 years, there has been an

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12 increasing commitment to the concept of human rights in the area of HIV and AIDS prevention and SE (Miedema et al., 2015). In HIV and AIDS-related education, concepts such as ‘choice’, ‘empowerment’, ‘rights’ and ‘participation’ are commonly found (Miedema et al., 2011). It implies to reframe SE with less emphasis on the purely biological and reproductive dimensions of sexuality as promoted in a health-based approach (Braeken, 2008) and instead, promote the integration of human rights and gender equality principles, to empower youth regarding their sexual health, rights, and wellbeing (Berglas et al. 2014). The core idea of the concept of right is that every human has basic rights that others must protect and respect (Miedema et al., 2015). This discourse is commonly used in International Development. Over the past decades, the recognition of sexual rights as human rights has been emphasized in international human rights commitments. A rights-based approach dedicates more attention to voice, power dynamics, and struggles (Miedema et al., 2015). The UN Commission on Population and Development resolution of 2012 calls governments to ensure “evidence-based comprehensive education on human sexuality, sexual and reproductive health, human rights and gender equality to enable [youth] to deal positively and responsibly with their sexuality” (UNESCO, 2018, p.121). However, this shared vision of SE has no consensus definition for this diverse approach (Berglas et al. 2014). As demonstrated in Miedema et al., we can distinguish two approaches within the rights-informed approach: a formal ‘accountability approach’, focused on the fulfilment of rights, versus a more informal approach, focused on the principles of empowerment and inclusion (2015). The first approach to rights-based sexuality education revolves around a discourse of rights-holders and duty-bearers with notions such as entitlements and accountability (Miedema et al., 2015). In the second framework, the principle of inclusion is crucial. Indeed, programmes working with the concept of rights tend to integrate notions of inclusion, empowerment of the rights-holders, and solidarity. In practice, it requires to look at programmes focusing on local needs, interests and inclusiveness with greater attention paid to topics such as sexual pleasure, sexual orientation and gender identity. These initiatives can be understood as more contextually informed, grounded in local realities, in which the population is not a mere target group but rather participants (Miedema et al., 2015).

2.3. Comprehensive Sexual Education: toward an inclusive SE

Comprehensive Sexual Education (CSE) is a recent form of SE, considered to be in line with the rights-based approach to SE. In theory, CSE goes beyond the reproductive and heteronormative dimensions of sexuality. CSE is seen as widely compatible with its partner organisations worldwide (UNFPA, 2014). This form of SE is supposed to empower individuals, teach them about their rights and entitlements and the use and availability of contraceptives, help them make informed decisions, and prevent risks. It must ensure that individuals are taught subjects applicable to their gender, and their sexual orientation in a safe gender empowering environment. Some programmes also integrate new notions of sexual pleasure and gender-violence (rape, homophobia, transphobia, etc).

Following the UNFPA’s ‘Operational Guidance for Comprehensive Sexuality Education’ (2014), CSE is defined as:

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A rights-based and gender-focused approach to sexuality education’ for young people, whether they are in school or out of school. (p.6)

CSE combines morality, health care, and human rights to promote the well-being and sexual health of individuals (Braeken, 2008), especially young people, and deconstructs the ‘abstinence-till-marriage’ form of SE. The latter approach claims that abstinence is the safest and best contraception to avoid pregnancy and sexually transmissible infections (STIs), HIV and AIDS. This form of SE is usually taught in religious countries. World Health Organisation (WHO) (n.d) defines ‘Young people’ as individuals between 10-24 years. ‘Youth’ refers to the 15-24 years age groups and ‘Adolescents’ covers the 10-19 age range. In this work, I mostly refer to young people but use ‘adolescents’ and ‘youth’ if a CBOs’ activity or initiative is specifically targeting those age groups. A Comprehensive Sexuality Education approach must address the voices, interests, needs and concerns of young people, since sexuality education is crucial in their education overall, and first and foremost, to provide visibility to marginalized voices (Berglas et al., 2014). While CSE exists, many programs do not address the needs and experiences of the LGBTQ+ community and fail to address the promised holistic and inclusive vision on SE. CSE should be representative and inclusive (Hague et al., 2017); however, it does not mean it is yet. For instance, the UNFPA ‘Operational Guidance for Comprehensive Sexuality Education’ of 2014 does not mention at all ‘LGBTQ+’, ‘Gay’, Queer’, nor ‘Trans-’. Arguably, SE cannot be considered ‘comprehensive’ if it fails to address the needs and experiences of those who do not fall under the hegemonic heterosexual lines. Heteronormative lifestyle and behaviours are being presented in SE curriculum in the Philippines. It is common for SE not to discuss non-heterosexual relationships and sexualities. CSE is a western approach to sexuality education and has been introduced in the international curricula of SE but is not yet widely accepted in conservative and religious countries (Elia & Eliason, 2010).

Little is known about the reality in schools and the level of inclusiveness of the LGBTQ+ (Keogh, et al. 2019). There is a lack of attention, in both literature and CSE programs, for non-normative sexualities (Hague et al., 2017). Plus, guidance comes from international agencies and has been presented as the ideal approach for sexual health and rights in the Global South (Hague et al., 2017). This top-down guidance can be disconnected from ground reality. Looking at how CSE is being conceptualized and materialized at the local level is, therefore, more relevant. Also, when governments do not provide such CSE programmes, NGOs and civil society organisations are filling this gap and operate outside the school system. To comply with this framework, this research will look at CBOs’ programmes and interventions engaging with CSE as it is not widely accepted in the traditional school system. Therefore, as this research believes that CSE should be inclusive, to restore its past failures of neglecting the LGBTQ+ community in practice, we associate the concept of Inclusion to CSE in our study.

2.4. The inclusion of LGBTQ+ communities

The following section will explore who are the LGBTQ+ communities and their struggles and will explore the need for inclusive sexuality education.

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14 We first need to define what we understand as a community. A community is a social unit of individuals with commonalities such as values, customs and identities. A community may also share virtual space (e.g. Grindr, forum) or non-virtual space (e.g. community-centre) (Ritzer, 2007). Community-based organisations have arisen within a community in response to a common challenge or need (The Global Fund, 2014). Often, the LGBTQ+ community is treated as one entity, but it is important to acknowledge their differences and their specific requirements in terms of sexual health care and rights (Mollon, 2012). In this study, the term ‘LGBTQ+ communities’ is used; however, it is acknowledged that this string of letters will never fully grasp the multiple nuances of identities.

The notion of intersectionality, coined by the legal scholar Kimberlé Crenshaw, helps us understand the structural discriminatory system depending on one’s identities (age, race, gender, class) (Settles, 2006). Identities constantly intersect and cannot be taught separately. The LGBTQ+ community is facing systemic barriers in terms of human rights and wellbeing (Bishop et al., 2020). As indicated earlier, this community is at higher risk to contract STIs, HIV and AIDS. One of the main reasons for this greater exposure is the lack of education, implying a lack of health-seeking behaviours (Human Rights Campaign, 2015; Gowen and Winges-Yanez, 2014). Lesbian, gay, bisexual, transgender2, queer and questioning individuals deserve to learn a representative SE of their sexualities to stay informed, safe and healthy. Many of them had negative experiences with their health care providers and the health care systems (Mollon, 2012). Yet, hetero-centric programs fail to address the diversity of LGBTQ+ identities and experiences (Human Rights Campaign, 2015).

SE lacks LGBTQ+ inclusive content (Human Rights Campaign, 2015). An inclusive SE curriculum could help individuals to understand their identities and orientation with age-appropriate and medically accurate information. It is also a way to dispel common stereotypes about non-heterosexual relationships and behaviours. Usually, LGBTQ+ youth have a limited number of trusted adults to talk to and seek advice, therefore they have a high tendency to get online information (Human Rights Campaign, 2015). Online content on sexuality might not be age-appropriate, or medically accurate. Misinformation and lack of education reinforce health disparities, and not only affect their sexuality: stigma, stereotypes, and discrimination are correlated to a higher incidence of substance abuse, suicide rate and mental disorders (Mollon, 2012). As advised by Elia and Eliason (2010), SE curricula need to “be inclusive: Diversity in all of its forms is considered and multiple viewpoints are discussed. Students learn how to listen to divergent viewpoints and engage in productive dialogue about difference” (p.43).Building on their study of inclusive SE curricula in the United States, Gowen and Winges-Yanez (2014) suggest that to be inclusive, SE should:

2 Transgender is the opposite of cisgender. Cisgender is a term for individuals whose gender identity matches their sex assigned at birth.

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[Focus] on topics that would be relevant to all young people, regardless of sexual orientation or gender identity. The topics these youth wished to see in their sexuality education classes were LGBTQ issues, access to resources, STI prevention, relationships, and anatomy. (p.794)

As suggested by the above quote, inclusive SE curricula need to present diverse identities, sexualities, viewpoints, relationships. The concept of ‘diversity’ is then relevant to identify LGBTQ+ inclusive SE initiatives.

LGBTQ+ communities and HIV and AIDS activists broaden the definition of sexual rights “in order to include the celebration of sexual diversity and sexual pleasure” (Garcia & Parker, 2006). Communities counter-movements have framed “the concept strategically with varying agendas including that of sexual health” (Garcia & Parker, 2006). LGBTQ+ communities negotiated new identities to reclaim more rights; they did not only focus on institutionalising sexual rights but organise themselves in the provision of sexual health services within their communities. This, it is crucial to look not only “at the formal institutionalization of sexual rights” (Garcia & Parker, 2006).

2.5. Community engagement in health

Community engagement is a central notion in the promotion of (sexual) health in non-formal settings. Community engagement leads to initiatives that can compensate for health disparities for a minority or a community (Attree et al., 2011). Attree et al. (2011) highlight the relevance of community engagement in the provision of health services in general:

[Community engagement] refers to community involvement in decision-making and in the design, governance and delivery of initiatives which aim to address the wider social determinants of population health and health inequalities. (p. 251)

In this research, we focus on sexual health and education but, this definition of community engagement is relevant to understand the involvement of the community by community-based organisations in the design of programmes, decision-making and delivery of SE or sexual health services. CBOs engage with their communities daily to develop programmes and services (Capire, 2015). CBOs are usually organisations that have arisen within a community in response to specific needs or issues and, they can operate at the community level, local level or be part of larger non-governmental organisations or organisations network at the national and international levels (The Global Fund, 2014).

In Moore et al. (2016), in the context of public health in Australia, community engagement is presented as a “key strategy” to improve health disparities that governments are not addressing. There is no consensus in existing literature regarding what constitutes a community engagement approach, that is, there is no one definition. However, drawing on a review of available literature on community engagement and community practices, Moore et al. (2016), conceptualise community engagement as a process. Specifically, the authors conclude that such engagement is :

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- proactively seeks out community values, concerns and aspirations;

- incorporates those values, concerns and aspirations into a decision-making process or processes; and

- establishes an ongoing partnership with the community to ensure that the community’s priorities and values continue to shape services and the service system.” (p.7)

The above process offers necessary clarity to examine the efforts led by the community-based organisations for the provisions of sexual health and education services by LGBTQ+ community-based organisations.

2.6. Conceptual scheme

The following figure is a representation of the conceptual scheme that directs the research. This scheme is a revised version, comprising concepts from the theoretical framework, literature and findings. The aim is to examine the strategies and initiatives to make sexuality education and sexual health inclusive of LGBTQ+ communities in the Philippines by community-based organisations in non-formal settings. To better understand the scheme, it is important to take into account a vulnerability context of LGBTQ+ communities (depicted by the overall blue rectangle): they face low access to adequate (sexual) health services, and exclusion or no representation in traditional SE curriculum in the Philippines. The community-based organisations are depicted inside of the LGBTQ+ communities as they emerge from it. CBOs provide a set of initiatives, practices and programmes in non-formal settings. Those efforts seek to provide inclusive sexuality education and sexual health services. Therefore, regarding the theory, it is relevant to see if the provisions of SE by CBOs have characteristics of the two approaches to SE: CSE and rights-based approaches. Another strategy of CBOs is community engagement. Community engagement emanates from CBOs but can also originate from the LGBTQ+ communities themselves. Community engagement, as impulsed by CBOs, aims to directly impact the initiatives, practices and programmes of CBOs as they want the LGBTQ+ communities to be involved in the programmes and practices design making.

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Figure 1.

2.7. Concluding remarks

The above chapter sought to set the theoretical framework of the research. It first exposes two approaches to SE that are relevant to the topic: a rights-based approach and Comprehensive Sexuality Education. Those two approaches provide numerous concepts to further analyse SE efforts of Filipino CBOs. Secondly, it argued that despite these two SE approaches, there is a crucial need to include LGBTQ+ communities in SE curricula. As the research focuses on Community-based organisations’ work, the chapter developed the idea of community engagement, especially in health. Indeed, as the SE and SH initiatives that are the interests of the study are being provided in non-formal settings and led by and for LGBTQ+ communities, community engagement is a crucial notion. All the above concepts are synthesised in the conceptual scheme which captures the core concepts of this research and their inter-relationships. The next chapter exposes the contextual framework to have a better understanding of the social reality of the study.

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3. Contextual chapter

3.1. Introduction

This chapter presents a contextual background of the Philippines. It first exposes the socio-economic context of the country. It then assesses the situation for LGBTQ+ individuals in the Philippines, before discussing gender non-conformism. Lastly, the chapter introduces the SOGIE Equality Bill, or the Anti-Discrimination Bill and how legislation functions at the local and national levels.

3.2. Country background overview

The Philippines, composed of 7107 islands, is in Southeast Asia in the Pacific Ocean. It is the 73rd largest country in the world with a population of 100 million people (Philippine Statistics Authority, 2015). Tagalog and English are the official languages of the country. Manila, based in the biggest island Luzon, is the capital city and is the second-largest city of the Philippines after Quezon City. Manila and Quezon City are hosting most of the educational and governmental institutions. 91.3% of the population is affiliated with Christianity (Philippine Statistics Authority, 2015). According to the Asian Development Bank (2020), 16.6% of the Filipino population lived below the national poverty line in 2018. However, since its first lockdown in March due to the COVID-19 pandemic, the Philippines is entering its harshest economic recession, threatening 1.5 to 5.5. millions of Filipino to fall into poverty (Abad, 2020).

The Human Development Index (HDI) value of the Philippines, assessing a long and healthy life, access to knowledge and a decent standard of living, is 0.712 in 2018, putting the country in the high human development category. The country’s HDI is ranked 106 out of 189. However, the inequality-adjusted HDI falls to 0.582 due to a lack of equal distribution of HID dimension (UNDP, 2019). The Gender Development Index3 (GDI) value of the Philippines is 1.004 but, the Gender Inequality Index value is at 0.425, ranking the country 98 out of 162 in 2018. This latest index measures gender inequalities by looking at reproductive health, empowerment, and economic activity (UNDP, 2019).

3.3. LGBTQ+ Situation

The Philippines is considered one of the most gay-friendly and LGBTQ+ tolerating countries (Milton, 2019), especially in Metro Manila. However, this apparent tolerance is questioned by scholars like Garcia who rather see tolerance and acceptance where LGBTQ+ identities and behaviours fulfil stereotypes (UNDP and USAID, 2014). Moreover, studies on LGBTQ+ rights in the Philippines is very limited (ibid). However, here are the main facts about to situate LGBTQ+ rights in the Philippines:

- Homosexuality is not condemned

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19 - Legal change of gender is not allowed

- Marriage between same-sex persons is not legalized

- Adoption for same-sex couples is not allowed but allowed for individuals

- Lesbian, Gay and Bisexual men can serve in the army since 2009 (Vanasco, 2009).

The country has a long history of LGBTQ+ activism but, most of the rights sought by activists and LGBTQ+ organisations remain elusive (Human Rights Watch, 2017). Indeed, LGBTQ+ issues are not much taken into account in the country’s political agenda. Religion, Roman Catholicism, strongly influences the Filipino society and the political agenda of the country. The Church has been a strong opponent to anti-discriminatory policies and continuously tries to influence public policy (UNDP and USAID, 2014) (see 4.6). However, the Department of Education (DepEd) developed a policy act to protect children from violence, abuse and exploitation regardless of sexual orientation and gender identity (UNDP and USAID, 2014).; the DepEd is also currently working on a Comprehensive Sexuality Education curriculum that could incorporate LGBTQ+ related topics.

Despite positive changes in favour of the LGBTQ+ communities, the Philippines has one of the worst records of cases of violence against transgender identities (Mosbergen, 2015). According to the Tvt Project, who document cases of hate crimes against transgender persons worldwide, there have been 41 crimes against transgender individuals between 2008 and June 2016 in the Philippines, being highest rate in Southeast Asia (Transgender Europe, 2020). Transgender persons are not the only ones facing violence; in the first half of 2011, 28 LGBTQ+ related crimes were reported (UNDP and USAID, 2014). LGBTQ+ youth is also very vulnerable. Despite the Child protection policy Act and the introduction of the SOGIE Bill in the Senate and House of Representatives, UNICEF Philippines and Council for the Welfare of Children introduced the 2015 National Baseline Study on the Violence Against Children exposing the following statistics in 2016:

Academic freedom is often used to justify policies and practices against LGBTQ+ and gender-nonconforming students: imposing dress codes and haircuts, exclusion of LGBTQ+ issues sensitisation in addition to a strong culture of bullying (UNDP and USAID, 2014; OFPRA, 2018). In reaction, many LGBTQ+ student organisations have been created, offering their support to LGBTQ+ students and sometimes organising Pride events. UP Babaylan was created in 1992 at the University of the Philippines Diliman and is the oldest LGBTQ+ Students organisations of the Philippines and possibly of Southeast Asia (UNDP and USAID, 2014).

• 75% of LGBT children experience physical violence • 78.5% of LGBT children experience psychological violence • 33.8% of LGBT children experienced sexual violence

• LGBT children are at higher risk of physical and psychological bullying at school • LGBT youth are at higher risk of sexual violence in school

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20 The student organisation is now one of the most influential LGBTQ+ organisation of the country.

LGBTQ+ communities face disruptions in accessing health services too; social stigma put them in a vulnerable situation (UNDP and USAID, 2014). Men who have sex with men and transgender women are the most vulnerable population to the HIV pandemic and lack protective policies. Adequate (sexual) health services and psychological support are lacking; to compensate, LGBTQ+ organisations have been trying to provide such services with a principle of non-discrimination since the 1990s (ibid).

Regarding SE (and LGBTQ+ rights in general), there is an urgent need for drastic changes in the Philippines. Countless stakeholders shape sex, gender and sexuality in the Philippines in fields as diverse as law, politics, religion, health, education, development, the media, the nonprofit sector, the arts, and the academy (Thoreson, 2012). On one side, the strong Catholic conservatism among political elites makes almost impossible changes in terms of sexuality education policies and rights at the national level. One the other side, even though no law provides a detailed curriculum regarding SE, the abstinence approach is the dominant one taught in schools. Therefore, a focus on civil-society organisations outside the traditional school system would be more relevant.

3.4. Gender ‘non-conformism’ in the Philippines

Post-colonial views on defining LGBTQ+ allow us to understand the variety of gender definitions and sexual orientation, and therefore the challenges that need to be addressed in SE. Gender non-conform identities can be traced back to the pre-colonisation era (UNDP and USAID, 2013). For instance, the Bakla figure (male born individual dressing as women but not necessarily defining themselves as women) in the Philippines is neither a gay man nor a transgender woman; sitting between gay, trans and queer, Bakla were renowned as community leaders (Patiag, 2019). However, the word ‘bakla’ has been mistranslated as ‘gay’ over the centuries even though this identity is not tied to sexual orientation. Indeed, this identity referred to specific roles within the society and the household or the capacity to handle both female and male ‘tasks’ and was not associated to any sexual orientation (McSherry et al., 2014). The lack of definition or mislabelling can make some minorities invisible.

3.5. The Anti-Discrimination Bill

The SOGIE (sexuality orientation, gender identity and expression) Equality Bill, or Anti-discrimination Bill, seeks to tackle Anti-discriminations regarding one’s sexual orientation, gender identity or expression in access to jobs, schools, universities, public spaces or to find housing (Colcol, 2017). The provisions of the bill will also criminalise any violent acts done against someone’s orientation, identity and expression. However, there are no provisions regarding access to sexual health services in this bill. The support of the Equality Bill is immense, but the anti-LGBT camp is showing a strong resistance against the ruling of this Bill (Arias, 2018). Many churches disapprove the enactment of the Bill because they fear the SOGIE Bill will open

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21 the doors to same-sex marriage. LGBT+ communities are only asking the passage of this bill because they believe they deserve LGBT rights and Human Rights (Arias, 2018). To pass, the Bill need to survive to the bicameral system of the Philippines composed of the Senate and the House of Representatives. The SOGIE Bill was first presented to the Congress in 2000 and passed its final reading by the House of Representatives in 2017 but died in the Senate (Outrage, 2017; Abad, 2019). This latest step would have ruled the SOGIE Bill as a law. However, the bill is strongly supported by the public and some political figures. It is now used as a reference for LGBTQ+ rights advocacy in the Philippines. LGBTQ+ community-based organisations are advocating for SOGIE-related programs from the government (TLF Share, n.d.). However, this milestone policy does not provide any sexuality education recommendations.

3.6. Local versus national legislation

Local governments (municipalities) have the power to legislate for the general welfare of their citizens according to the Local Government Code (Ignacio, 2017). It results in local ordinances, as long as they do not violate national laws or the Constitution. Therefore, many LGBTQ+ organisations advocated at the local level to pass local anti-discrimination, based on sexual orientation and gender identity, ordinances. However, only 15% of Filipinos live in areas protected by anti-discriminatory ordinances (Human Rights Watch, 2017). They also work and advocate for LGBTQ+ rights at the very local level: the barangay level. A barangay within Quezon City, and later Quezon City in 2003, were the first local governments to adopt anti-discriminatory ordinances (OFPRA, 2018).

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22

4. Research Methodology

4.1. Introduction

Having situated the research within the existing theory, this chapter identifies the research question and its sub-questions that are guiding this study. Then, the chapter will detail the context of the research during fieldwork period in mainly Quezon City, but also Cebu city and Legazpi City, within the period of the 1st February 2020 to 15th March 2020.

4.2. Research question

To respond to a lack of SE and SH services available for LGBTQ+ communities, CBOs try to compensate for it by providing services themselves. It is then relevant to look at the different aspects of the provision of SE and SH interventions. This research aims to investigate who are the actors providing non-formal sexuality education (SE) and sexual health (SH) services to young people, men who have sex with men and transgender women, how they develop their strategies and programmes and how inclusion is being conceptualised among them.

How do LGBTQ+ community-based organisations provide sexuality education and sexual health interventions in non-formal settings, and how do they seek to promote inclusion in their interventions?

Sub-questions:

a. Who are the main actors of non-formal sexuality education and sexual health, and which are the main communities they target?

b. How do these actors conceptualize inclusion and its core elements within sexuality education and sexual health?

c. What are the different services and programmes in terms of sexuality education and sexual health provided by community-based organisations?

d. How do they develop inclusive sexuality education and sexual health programmes and services?

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23

4.3. Research location

Figure 2 – Map of the Philippines

The research took place in four different locations in the Philippines: Quezon City, Manila, Legazpi City, and Cebu City. Quezon City and Manila will be the main research areas. Three organisations were involved: TLF Share, based in Quezon City, Indigo from the Bulacan Province but often work from TLF’s office in QC Gayon in Legazpi, Bicol, and CURLS, the Cebu United Rainbow LGBT Sector, based in Cebu City. They provide a human rights approach to SE, peer education, community-based HIV screening, counselling, support, and anti-discrimination, and LGBTQ+ policy lobbying.

These organisations are presided by local individuals and self-declared members of the LGBTQ+ community.

Quezon City

Quezon City, located in Metro Manila, is the richest and most populated city of the Philippines. The city is home to many universities, institutions and non-governmental organisations. Quezon City was chosen as the main research location as it hosts most community-based organisations of the country. There, regular meetings with TLF Share were organised, as well as one interview with a member of TLF Share, one interview with the president of Pantay and a focus-group discussion with board members of Indigo.

Cebu City

Cebu City is the capital city of the Cebu Province and the second-largest metropolitan area of the Philippines. Highly urbanised, the oldest city of the Philippines is located in a rural region. In Cebu City, I assisted to a three-day conference, co-hosted by TLF Share and CURLS Cebu. CURLS Cebu invited several community-based organisations of the province that are usually located in rural areas. In Cebu City, one focus-group discussion was organised with members of CURLS, one interview took place with the president of the organisation. The rest of the three-day there were spent observing the activities organised by TLF Share and CURLS for people-living-with-HIV, people-who-inject-drugs, MSM and transgender women.

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24 Legazpi City

Legazpi City is the capital city of the Bicol region, southern Luzon. 520 kilometres south of Metro Manila, the city is the most dynamic and economic-friendly city of its region. The area is urbanised but not as much as Cebu City and Quezon City. The city is surrounded by rural areas. In Legazpi, observations were conducted during a three-day workshop organised by Gayon and Layer-Tech. One focus-group discussion with members of Gayon was organised as well as one interview with Gayon’s youngest peer educator (18).

4.4. Methodology

4.4.1. Unit of analysis

To analyse the initiatives in terms of sexual health and education by CBOs in the Philippines, the units of analysis of this research are the initiatives and services of the community based organisations to provide inclusive of SE and SH. To analyse these, I rely on members of the CBOs. They are transgender women and men having sex with men (MSM) members for TLF Share, CURLS Cebu, Gayon Albay, Pantay and Indigo. The participants from these organisations provide a human right approach to SE, peer education, community-based HIV screening, anti-discrimination, and LGBTQ+ policy lobbying. These organisations are chaired by local individuals and self-declared members of the LGBTQ+ community. The research focused on their work and views regarding SE, but also their experiences as MSM and transgender women in the Philippines. It also looked at the establishment of inclusivity in different settings, from lobbying to grass-root activism.

Initially, before arriving in the field, it was decided to gauge the needs and interests of the LGBTQ+ youth. After meeting my local supervisor, I decided to only look at the CBOs side, not the recipient one, and broaden my research to initiatives directed to the youth, MSM and transgender women in general, not only the LGBTQ+ youth.

4.4.2. Sampling

Participants were purposely selected based on different intersectional factors: class, ethnicity sexual orientation, gender expression: any cisgender or transgender Filipino individuals considering themselves as part of the LGBTQ+ communities and working or volunteering for an LGBTQ+ organisation. The LGBTQ+ communities encompass a large range of different identities in the Philippines. It was, therefore, important to gather data from a range of different sets of members of these communities to develop insight into the different experiences from the spectrum. However, after establishing contact with the first organisation, TLF Share, which also plays the role of an umbrella organisation, the research was mainly conducted among MSM and transgender women as these two communities are the population for whom CBOs are advocating. Contacts with CURLS, Indigo, Gayon and Pantay were established thanks to TLF Share’s network. Most of those organisations comprise and advocate for MSM and transgender women. Focusing on these two groups was relevant since MSM and transgender women have

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25 different experiences and needs. They were 18 participants (see Annex 2.). Ten participants identified as gay or bisexual men, six of them identified as transgender women and two of them as cisgender women. The youngest participant was 18 years old. The oldest one was in his early sixties. They occupied a large range of job activities (university professor, teacher, students, nurse and more) and different roles among the organisations (peer educators, programmes designers, community-based screening facilitators, etc).

Access to more participants was granted thanks to Anastacio Marasigan, my local supervisor, and TLF Share. From TLF Share’s network, participants were selected regarding their relevance to the research based on their position in a community-based organisation.

Before going to the field, it was planned, with the help of my local supervisor, to meet and interview members of TLF Share, CURLS Cebu and Gayon Albay; they are self-declared MSM and transgender women, they can also reflect on their past experiences and help us understand the CBOs' initiatives and strategies. Once in the field, participation was extended to the president of Pantay and two members of the board of Indigo. Samples were drawn from urban and semi-urban areas.

4.4.3. Data collection methods

A qualitative methodology was used for this study. Qualitative methods are more suitable to understand the lived experiences of participants and answer ‘why’ and ‘how’ questions. Research methods associated with a qualitative methodology such as participant observation, semi-structured interviews and focus group discussions were employed; these methods leave more room for new concepts and theories to emerge (Bryman, 2012).

Semi-structured interviews:

Semi-structured interviews were conducted with four members of TLF Share, CURLS Cebu, Gayon Albay, and Pantay. The designed interviews were relevant to answer all sub-questions, piloted by me with my local supervisor. Interviews started with questions to get to know the participants and the organisations for whom they work. Then, most of the interviews centred around the strategies and initiatives carried out by those organisations. Questions would change depending on whether the organisation was working primarily on lobbying or grassroots activities. Topics guide has been drawn from the operationalization table established prior to going to the field (see Annex 1.). To conclude the interviews, broader questions involving their personal opinions were asked to open a discussion on the topic of sexual education in the Philippines and LGBTQ+ inclusion. Open questions enabled the emergence of new ideas. The questions were prepared before every interview but sometimes evolved as the conversation developed. All interviews were conducted in English and audio-recorded with permission. Notes were also taken. The interviews took place in the organisations’ offices and after some events and workshops. Interviews lasted between 24 minutes and 55 minutes.

Focus Group Discussions:

Focus group discussions (FGD) are more open to discussion and help to grasp group dynamics (Bryman, 2012). However, on the topic of sexuality and inclusion, it is critical to ensure that a

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26 safe place is created for the participants and that this method is not too extractive. FGD brought together two to eight people. Similar to interviews, the guiding questions of the conversation were drawn from the operationalisation table (see Annex 1.). The first FGD was organised with five CURLS members, but one participant withdrew his participation. We discussed the strategies and advocacy of CURLS, how participants conceptualise SE and the challenges faced by the LGBTQ+ communities in Cebu. It took place during the three-day conference organized by TLF Share and CURLS in Cebu City with the supervision of Anastacio Marasigan. The second one was with Indigo’s president and vice-president at TLF Share office in Quezon City, also supervised by Anastacio Marasigan. Similar to the first FGD, we discussed what was the scope of actions and motivations of Indigo before talking about SE and SH services for LGBTQ+ individuals in the Philippines more broadly. My local supervisor facilitated the FGD by organizing them with CURLS and Indigo. The last FGD has been organized at the last minute; the president of Gayon gathered most active members of the organisation in a small restaurant, in which he offered to turn the meeting into an interview. As my questions for the FGD were already prepared, I set up an FGD. We first discussed Gayon’s activities and initiatives in terms of SE and SH, they presented the different programmes they work on and we further focused on the provision of SE for young people. Data collected from FGD helped answer all sub-questions, but more specifically sub-questions a and b (see 3.1.).

Participant observation:

Participant observation was conducted among TLF Share, CURLS Cebu and Gayon. This type of observation allows the researcher to immerse herself in the social context of the participants. First, observations of the activities and the persons working within TLF Share, CURLS Cebu, and Gayon Albay were organised. Observation focused on the activities and conferences organised by the CBOs and was recorded through notes and pictures on the spot. Some notes were taken a few hours after informal discussions with participants. The observation schedule was in line with the organisations’ activities and workshops and was followed by informal discussion outside of the activities and events. The method was used throughout the whole fieldwork period, but especially during two weekends spent among CURLS Cebu in Cebu City and Gayon Albay in Legazpi. I observed different activities such as community consultation workshops, peer-education workshops, digital skills enhancement, and data training, FGD organised by TLF Share and CURLS Cebu with people living with HIV and outreach activities in the cruising streets of Legazpi. This method helped answer the first (a) and third (c) sub-questions (see 3.1.). Besides, I visited Cebu City to attend a three-day event co-hosted by TLF Share and CURLS Cebu directed towards people living with HIV, MSM and transgender women, syringe drug users. There were 20 to 25 participants, in addition, the presence of members of the board of CURLS and TLF Share. The community consultation was about access to HIV treatment hubs in the province of Cebu and surrounding islands. During this visit to Cebu City, I sometimes helped members of CURLS and TLF Share to set group activities and take part in get-to-know-each-other activities. I also used this time to observe brain-storming activities, group discussions and activities (e.g. activity mapping, timelines, tree-scheme drawing) to identify LGBTQ+ communities responses to the lack of formal information on HIV treatment and accessibility to treatment hubs. Next, I visited the CBO Gayon in Legazpi City where members of the CBOs attended a three-day course on how to make reliable data and

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27 evidence-based campaigns. After this, the vice-president of Gayon took me on an outreach activity.

This research technique is a great opportunity to interact with participants, ask questions and sometimes take part in the activities. Moreover, it led to many informal conversations outside of the activities scheduled and opportunities to spend time with participants. For instance, after a day of participant observation of Gayon activities, participants invited me for dinner and an LGBTQ+ ball, and we discussed many relevant topics. Participant observation is also a good method to further gather data; after observing activities of CURLS Cebu and Gayon, two FGD and two interviews took place and integrated questions about what has been previously observed.

Document analysis:

Organisations are a great source of content and documents. Documents such as those discussing SE programs, prevention and educative campaigns on social media, teaching materials, SOGIE advocacy papers, reports, and statistical information were shared by the organisations for the research and found on their social media and official website. The quality of the documents was assessed first: authenticity, meaning/relevance, credibility (Scott, 1990 in Bryman, 2012). Authenticity, credibility and meaning were asserted by checking the sources and their reliability, the evidence, the potential bias and the clarity of the documents. All the documents presented by the CBOs were evidence-based and from reliable sources. Other than documents presented by CBOs, this research includes documents or extract from CBOs’ social media and website. Documents in Tagalog have been translated by Alliyah The and Sky Dominique, two friends that were not involved in any CBO.

4.4.4. Data analysis methods

Raw data generated through the semi-structured interviews and FGD were transcribed verbatim using Microsoft Word. As some of the methods used, specifically semi-structured interviews, and Focus Group Discussions leave more room for new concepts and theories to emerge, an inductive approach was used (Bryman, 2012). The software Atlas-ti is well suited for inductive coding; new ideas and concepts emerge from inductive coding and orientate new directions for additional data collection. Atlas-ti was used without any pre-conceived codes; the codes emerged from the data, resulting in key themes. Key themes were beneficial in structuring the findings.

4.4.5. Ethical considerations and positionality

Throughout the fieldwork in the Philippines with the help of the organisation TLF Share, voluntary participation, informed consent, safety, confidentiality, and trust were ensured.

My participants were approached through my local supervisor and TLF Share’s network. I gave a brief overview of the research project for all of them. It was made clear no financial compensation would be given. Participation was entirely voluntary, and participants were told that they could withdraw at any moment. One of the participants withdrew from the research

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28 right after a focus group discussion as he found his participation ‘irrelevant.’ He only spoke once, and his comments were removed from the transcripts. Consent was verbally requested before every interview and recording. Before observing workshops, I presented my role and let the participants know that notes would be taken. Audio recordings were deleted once I had completed transcriptions and the participants were informed that the data would only be used by me and potentially shown to my local supervisor and supervisor at the University of Amsterdam.

The broad topic of sexuality encompasses sexual violence and can trigger past traumas. Additionally, young people perceived as non-conforming are more likely to suffer violence and discrimination based on their sexual orientation and gender identity/expression. LGBTQ+ youth is more exposed to bullying, mental health issues, and harm (UNESCO, 2018). Therefore, to ensure that I did not re-traumatize participants and to safeguard their mental health, I avoided asking questions about their personal lives. I gave participants the possibility to review the questions before I conducted the interview and sent these to them beforehand if requested.

I do not make use of pseudonyms in this thesis since all participants indicated they did not want to remain anonymous. Participants’ safety would not be in danger if I used their names and it was thus decided to use their names or nicknames after acquiring their informed consent. Data collection took place within the organisations’ offices or rented public rooms for conferences and often supervised by my local supervisor, friend or colleague to most of the participants; the settings were already a safe place for the participants. There is no conflict of interests, illicit activities undertaken by the participants or harmful data. If disclosed, their sexual orientation and gender identity were already known in their personal and professional circles. Outside of the research, I was able to spend time with some of my participants, especially during my trip to Legazpi City, resulting in a lot of trust-building as we gradually got to know each other more and break the researcher-researched barrier.

As for my safety, the only risk taken during the fieldwork was when I accompanied one of my participants in the cruising streets of Legazpi City at night. She took me to the safest cruising streets, and we made sure that we always stayed together during the outreach activity. It was also a risk for the organisation since bringing a foreigner during the outreach activity could potentially scare away their clients who seek extreme anonymity. The organisation defines clients as the individuals reached during outreach activities in potential need of help concerning sexual health. Thefollowing protocol was strictly followed: no name or sexual orientation was disclosed, and I would never address the clients directly.

My local supervisor provided me with a strong network of participants. As he is a well-known activist and a “Mother” in the Filipino LGBTQ+ communities, being recommended by him helped me to gain the trust of my participants. Someone is referred to as a Mother when they have been part of the community for a long time and took the younger LGBTQ+ ones under his/her/their wing.

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29 Positionality

Before the fieldwork, I acknowledged additional factors such as my age, race, gender as I am a Western cisgender woman. Being Western can subconsciously establish power dynamics. Therefore, I made sure that I let my participants know I was there to learn from them and get to know their living experiences, every time I saw them/spoke to them. The short period of six weeks in the field could only give me a small insight into the LGBTQ+ experiences in the Philippines; I could never understand the discriminations and oppression they encountered in their lifetime. A helpful factor was that most of my Filipino friends from a prior stay in the country were gay men, non-binary and transwomen. Spending time with them helped me understand a little bit more about their living experiences, benefiting from more opinions regarding my research and again, lessen the gap between myself and my participants.

Lastly, I had to put aside my definitions of the different identities in the LGBTQ+ spectrum common to Western LGBTQ+ studies and white feminism to allow new identities and concepts to break even more gender norms I unknowingly projected.

4.4.6. Quality criteria

As indicated earlier, only qualitative data collection methods were used for this study. As suggested by Lincoln and Guba (date), I used the set of criteria of trustworthiness for qualitative research comprising credibility, transferability, dependability, and confirmability as well as the criteria of authenticity (1985; in Bryman, 2012). The fieldwork was shortened due to the COVID-19 virus situation in the Philippines, which as I will detail in the next sub-section, impacted the research slightly.

Trustworthiness a) Credibility

Triangulation of data collection was undertaken using individual interviews, focus group interviews, observations, and document analysis to reinforce internal validity. Alternating between individual and group interviews challenges the respondents’ opinions. The interviews were structured in a way that participants spoke as representatives of their respective NGOs but also, as individuals to encourage them to share their personal views.

Furthermore, analysing how some activists use social media, individually or for organisations’ communication strategies, helped to grasp how they express their opinions to a wider audience. Five organisations were represented, in order to benefit from diverse opinions and to give a realistic account of the non-formal sexual education actors in the Philippines; some of them focus on lobbying at the national or municipality levels while others are grass-root organisations, working at the very local level. My local supervisor, a former professor of mine, provided me most of my contacts which helped me gain the trust of my participants. However, I was independent and did not conduct the research on behalf of any organisation.

b) Transferability

This research was conducted among community-based organisations working with men having sex with men and transgender women regarding sexuality education and sexual health. The

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