Feasibility and Acceptability of Human Immunodeficiency Virus Self-Testing for Men of Middle-to-Upper Socioeconomic Status in Botswana: A Pilot Study at 4 Worksites in the Financial Sector

Abstract

Background Although Botswana has made great progress in expanding HIV testing, men are less likely to get tested for HIV and test at a later stage compared to women. For Botswana to increase HIV testing coverage among men, HIV self-testing (HIVST) may be a promising supplement to standard, healthcare facility-based HIV testing. We conducted a pilot test of the feasibility and acceptability of HIVST for men of middle-to-upper socio-economic status in Botswana. Methods Thirty-five men were recruited through 4 workplaces (banking sector). Wellness officers emailed all potentially eligible male employees about the opportunity to participate. Men were surveyed at baseline and follow-up on basic socio-demographic characteristics; HIV testing history; HIV stigma; use of the HIV self-testing kit (at follow-up); and confirmatory testing and linkage to care if a preliminary positive result is obtained (at follow-up). Results All 35 men used the kit. The proportion who agreed with the statement that getting tested for HIV helps people feel better increased significantly from 80.7% at baseline to 100% at follow-up. In open-ended questions, men described the advantages of HIVST, including improved privacy and convenience, lowered HIV stigma, and enhanced control over testing. HIVST concerns included potential negative mental health consequences due to not getting pre-and post-test counseling, and not linking to care after a reactive result. Conclusion Results suggest that an intervention in which HIVST is discrete, private, and under men’s control can help to overcome stigma around HIV testing, resulting in a greater number of men tested.