Perceptions of an HIV self-testing intervention and its potential role in addressing the barriers to HIV testing among at-risk heterosexual men: a qualitative analysis

Abstract

ObjectivesVoluntary HIV testing rates are still low in several Asian countries including Singapore. HIV self-testing (HIVST) has the potential to increase testing, leading to earlier diagnosis and better prognosis. However, the views of at-risk individuals, especially heterosexual men (HSM), who are not coming forward for testing are still poorly understood. In this study, we examined the barriers and facilitators to and delivery preferences for HIVST in order to implement an effective intervention in Singapore.MethodsFrom May 2017 to June 2018, 48 in-depth interviews were conducted with HSM aged 21–66 years and at risk of HIV infection. Participants were purposively sampled based on ethnicity, age and testing behaviour. Recruitment was done mainly at brothels and entertainment establishments in Singapore. Participants gave their views on HIV testing, factors affecting HIVST use and their preferred HIVST service delivery model.ResultsMost participants preferred HIVST over conventional testing for its convenience, privacy, anonymity and autonomy, but older men still preferred conventional testing. Low self-perceived risk, low awareness and self-efficacy for HIVST, and non-comprehensive test for other STIs were reported as barriers to HIVST. There were mixed opinions on kit preference. A blood-based kit was favoured for higher accuracy, while the oral-fluid-based kit was favoured for ease of use. Participants wanted a human touch for post-test counselling and linkage to care only if they self-tested positive. Traditional media, internet and social media, and venue-based outreach were potential advertising platforms mentioned.ConclusionsA locally acceptable and feasible HIVST intervention must address the barriers and facilitators of using HIVST in order to improve HIV testing rates among this at-risk population who might otherwise delay or fail to present for testing.

HIV self-testing for men who have sex with men in Sweden. A cross-sectional study concerning interest to use HIV self-tests

“…The formal legal context differs between countries, with some countries fully allowing HIVST, others only partially authorizing HIVST for either sale, use, or distribution, and some (e.g. Singapore) making it explicitly illegal [ 16 , 17 ]. Further, other countries such as Sweden have no formal policies regarding HIVST [ 16 ].…”

Implementation of unassisted and community-based HIV Self-Testing (HIVST) during the COVID-19 pandemic among Men-who-have-sex-with-Men (MSM) and Transgender Women (TGW): A demonstration study in Metro Manila, Philippines

“…In a study in Singapore, HIVST's advantage of being completely anonymous, ease of access, and autonomy, made it preferable, with an inclination towards blood-based testing. However, the participants did not feel confident in using blood-based testing due to fear of pricking themselves, which they felt could affect the result [22].…”

Preferences, beliefs, and attitudes about oral fluid and blood-based HIV self-testing among truck drivers in Kenya choosing not to test for HIV

“…In contrast, some preferences for test type were found in several of the limited studies focusing on both oral fluid and blood-based testing. Studies among MSM in South Africa ( 16 ), adolescents in Thailand ( 43 ), heterosexual men in Singapore ( 44 ), and MSM in the UK ( 45 ) found that participants preferred blood-based HIVST on average for reasons such as rapidity of results and trust in the perceived accuracy of results. However, within these studies, some participants cited benefits of oral fluid HIVST such as ease of use and ability to avoid fear of needles.…”