Factors Shaping Initial Decision-Making to Self-test Amongst Cohabiting Couples in Urban Blantyre, Malawi

Abstract

In sub-Saharan Africa, most new HIV infections occur in stable relationships, making couples testing an important intervention for HIV prevention. We explored factors shaping the decision-making of cohabiting couples who opted to self-test in Blantyre, Malawi. Thirty-four self-tested participants (17 couples) were interviewed. Motivators for HIV self-testing (HIVST) emerged at three main levels. Individual motivations included perceived benefits of access to treatment, and self-checking of serostatus in the hope of having been cured by prolonged treatment or faith-healing. HIVST was considered convenient, confidential, reassuring and an enabling new way to test with one’s partner. Partnership motivations included both positive (mutual encouragement) and negative (suspected infidelity) aspects. For women, long-term health and togetherness were important goals that reinforced motivations for couples testing, whereas men often needed persuasion despite finding HIVST more flexible and less onerous than facility-based testing. Internal conflict prompted some partners to use HIVST as a way of disclosing their previously concealed HIV positive serostatus. Thus, the implementation of community-based HIVST should acknowledge and appropriately respond to decision-making processes within couples, which are shaped by gender roles and relationship dynamics.

‘If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV’: HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda

“…However, in relationships where women did not communicate regularly about health issues with their male partners, including in situations where the male partners were not usually around in the home, there were delays in delivering the kits. These observations suggest that partner communication is an important element in enhancing the delivery and eventual use of HIVST kits by male partners [21,22]. However, some of the tactics used by the women, especially the misinformation and failure to provide accurate information, could be potentially detrimental.…”

What are the constraints and opportunities for HIVST scale‐up in Africa? Evidence from Kenya, Malawi and South Africa

“…In contrast to the belief that HIVST can expand testing of target populations through the freedom and opportunity to test at one's convenience, in any location [22,31,38,39] key informant stakeholders in all contexts strongly advocated the health facility route. This may have been informed by concerns regarding the lack of counselling and poor linkage to care associated with self-testing [31,40].…”

Discordance, Disclosure and Normative Gender Roles: Barriers to Couple Testing Within a Community-Level HIV Self-Testing Intervention in Urban Blantyre, Malawi

“…Our previous paper described how the community counsellors (CC) provided HIVST to community members through a community-based model and how participants of this study were recruited [15]. This study recruited participants who self-tested within the CRT and who had no prior knowledge of the interviewers before commencement of data collection.…”

“…HIV self-testing (HIVST) is a novel HIV screening approach that involves an individual performing an HIV test and interpreting the test results in private [8] and has great potential for increasing the uptake of couples testing and reaching male partners [14, 15]. A recent couple-targeted clinical trial in Kisumu, Kenya demonstrated a high uptake of couple testing achieved through the use of oral-fluid-based HIV test kits delivered through antenatal and postpartum women [16].…”