“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

Abstract

HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of �500 cells/mm, early diagnosis and <500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, healthcare system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/ inconvenient clinic times, low perception of risk, limited HIV knowled ge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.

Stated and revealed preferences for HIV testing: can oral self-testing help to increase uptake amongst truck drivers in Kenya?

“…The DCE revealed that those who chose a provider-administered test had a strong preference for in-person counselling, while those who chose to self-test (some of whom took a test kit for home use with telephonic post-test counselling) had no preference regarding the type of counselling. This may be an indication of differences in the perceived utility gained from the personal interaction and support available from counsellors at healthcare facilities, affirming similar assertions made in previous studies [ 13 , 43 ]. Other studies have also found that in different settings, HST under the supervision of a healthcare provider was preferred over HST without supervision, a further indication of the importance of in person support [ 44 , 45 ].…”

“…Ensuring that HIV testing continues to be offered free of charge to truck drivers in Kenya, regardless of the type of test on offer, is likely to be important for facilitating uptake. Making test kits available for purchase is unlikely to be successful in increasing uptake of HIV testing among truck drivers based on current preference structures[ 13 , 43 ]. The DCE results show that offering small financial incentives to test is also unlikely to significantly alter the decision to test, suggesting that participants prefer HIV testing to be unlinked to money in either direction.…”

Underlying reasons why some people haven’t tested for HIV – a discourse analysis of qualitative data from Cape Town, South Africa

“…We explored the reasons why people choose not to test for HIV despite increased access to HIV testing services in our setting. The findings, considered from a purely content-based approach, are analogous to those outlined in previous research – lack of facilities, lack of trust in the facilities, fear of community judgement and a lack of time (MacPhail, Pettifor, Moyo, & Rees, 2009 ; Meehan, Draper, Burger, & Beyers, 2018 ; Musheke et al, 2013 ; Okal et al, 2020 ). Individuals do not choose to test mainly because services are not available with sufficient convenience.…”

Enthusiasm for Introducing and Integrating HIV Self-Testing but Doubts About Users: A Baseline Qualitative Analysis of Key Stakeholders' Attitudes and Perceptions in Côte d'Ivoire, Mali and Senegal

“…The underachievement of the first rate can be explained by social factors that negatively influence HIV testing services (HTS) uptake in sub-Saharan Africa. They include fear of HIV, which is a barrier to testing uptake (4), low perceptions of exposure to HIV risk, which can positively (5), or negatively (6)(7)(8) influence adherence to testing; and HIV-related stigma and discrimination, which are the main barriers to HTS utilization (7)(8)(9)(10)(11). Stigma is reported to be more pronounced in West Africa than in Eastern and Southern Africa (12).…”