Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

Abstract

Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania.Methods: We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software.Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST.Results: A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants' support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants' perception that HIVST would be provided only through unassisted modality.Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available.Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

Willingness to use and distribute HIV self-test kits to clients and partners: A qualitative analysis of female sex workers’ collective opinion and attitude in Côte d’Ivoire, Mali, and Senegal

“…15–17,19,21,22 Confidentiality is one of the advantages of HIVST, which was found in almost all perception analyses among female sex workers. 17,19,23 HIVST can help reduce the fear of a confidentiality breach by providers and through peer gossip. 23 In addition, women value perceived empowerment and self-responsibility as a benefit of choosing when and where to test and seek care, as described elsewhere.…”

“…As described elsewhere, this study found the perceived benefits of saving time and financial resources related to transportation costs to facilities. 17,21,23 The oral fluid-based nature of the test, as opposed to bloodbased, was also seen as an advantage in this study, as it was in most studies among key populations. 24,25 The reluctance toward oral testing expressed in one focus group in this study is justified because female sex workers were familiar with using blood tests.…”

“…Perception studies among female sex workers in Eastern and Southern Africa have found that they are generally enthusiastic about the opportunity to use HIVST kits. 14,[17][18][19] In francophone West Africa, a few studies on HIVST self-tests have been conducted among female sex workers. Until now, the literature has only included the results of a quantitative survey in Senegal, which indicated good acceptability of HIVST by key populations, including female sex workers.…”

Factors associated with adherence to HIV testing guidelines among HIV negative female sex workers in Kampala Uganda

“…The more the diverse sources of social support, the more the FSWs are likely to seek care including routine HIV testing. This underscores the need for strengthened programmatic and sustained peer to peer support among female sex workers, an intervention that has been proven to support increased access to HIV services among FSWs (14,42) yet largely dependent on external funding with little funds allocation from governments (43) . As such, predictable program financing for sex work broader HIV prevention programs including financing community support systems and behaviour change communications where feasible, is a strong pillar for sustained support for FSWs HIV testing programs.…”

HIV/AIDS research in Africa and the Middle East: participation and equity in North-South collaborations and relationships

“…Indeed, for every 10 African men who are HIV-positive, there are 12 to 13 infected women; moreover, 55% of adults who acquire HIV are women, with profound implications for mother-to-child transmission [10]. In consonance with this fact, a greater number of women participate and work on HIV care programs in Africa, and a large proportion of the clinicoepidemiological investigations in these settings are based on care program data [52].…”