HIV self-testing values and preferences among sex workers, fishermen, and mainland community members in Rakai, Uganda: A qualitative study

Abstract

HIV self-testing may encourage greater uptake of testing, particularly among key populations and other high-risk groups, but local community perceptions will influence test uptake and use. We conducted 33 in-depth interviews and 6 focus group discussions with healthcare providers and community members in high-risk fishing communities (including sex workers and fishermen) and lower-risk mainland communities in rural Uganda to evaluate values and preferences around HIV self-testing. While most participants were unfamiliar with HIV self-testing, they cited a range of potential benefits, including privacy, convenience, and ability to test before sex. Concerns focused on the absence of a health professional, risks of careless kit disposal and limited linkage to care. Participants also discussed issues of kit distribution strategies and cost, among others. Ultimately, most participants concluded that benefits outweighed risks. Our findings suggest a potential role for HIV self-testing across populations in these settings, particularly among these key populations. Program implementers will need to consider how to balance HIV self-testing accessibility with necessary professional support.

HIV Testing and Counseling Among Female Sex Workers: A Systematic Literature Review

“…Sex work criminalization in Kenya, Zimbabwe, Uganda and South Africa, Canada, Uzbekistan and Russia [24, 25, 27, 32, 51, 52, 54] and fear of registration as a drug-user in Russia [24, 34] are seen to have hampered access to healthcare, including testing.…”

“…In one study examining hypothetical circumstances around self-testing, participants reported to anticipate significant benefits (entire privacy, avoiding travel and time costs, ability to test before sex early diagnosis), although these same features raised concerns when associated with lack of supportive counseling and linkage to care [54]. …”

Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis

“…Studies conducted in Malawi, Tanzania, Uganda, and South Africa also supported the importance of pre-and post-HIV counselling for men to ensure that men are not left isolated [11,12,26,28,29,31,35]. The pre-HIVST counselling would likely assess men's readiness to respond to a potential HIV positive test outcome [32].…”

“…As a result of the research method used (qualitative or mixed methods), qualitative data from the sixteen included studies were extracted. The included studies were conducted in the following countries: Zambia [24], Malawi [11,25], South Africa [12,[26][27][28][29][30], Tanzania [31][32][33], Uganda [34,35], Zimbabwe and Malawi [36], and Kenya [37]. Twelve studies were predominantly qualitative and four were mixed methods.…”

“…The evidence on the importance of counselling prior to using HIVST was reported in eleven articles [12,[24][25][26][27][28][29][30][31][32]35]. Studies conducted in Zambia, South Africa, Tanzania, and Malawi indicated that conducting pre-test and post-test counselling is crucial to address potential psychological and physical harm because people are likely to react differently to HIV positive test results.…”