HIV self-tests– these women loved them!

Editor’s notes: Encouraging HIV testing, particularly among hard to reach populations such as men, young people and people who do not regularly attend health services is one of the key challenges for the HIV response.  Many countries have adopted the UNAIDS treatment target of 90:90:90, the goal of which is that 90% of all people living with HIV should know their status. WHO has recently released new guidance on the use of HIV self-tests [1] as a screening test and on approaches to partner notification to encourage greater uptake of HIV testing. An interesting qualitative study by Maman S and colleagues explored in depth the attitudes and experiences of 18 female sex workers drawn from a larger ongoing study of HIV self-test approaches.  These women described to the researchers how they had distributed up to five oral fluid based self-test kits to their partners, friends and clients.  The results demonstrate the wide range of potential ways that such distribution might help not only with accessing HIV testing but also increasing dialogue about risk reduction.  Two of the women did experience verbal or sexual abuse, but it is important to realize that women were selected from the larger parent study precisely because they had reported such abuse, in order to understand the context better.  The women remained enthusiastic about distributing self-tests and felt that the benefits outweighed the risks in the challenging environment in which they work.  Nonetheless, as the authors point out, the potential considerable benefits of scaling up HIV self-testing approaches need to be combined with ensuring that there is good communication about the risks, efforts to increase the agency of vulnerable women and support services for women experiencing intimate partner violence whether related to HIV testing or not.

A qualitative study of secondary distribution of HIV self-test kits by female sex workers in Kenya.

Maman S, Murray KR, Napierala Mavedzenge S, Oluoch L, Sijenje F, Agot K, Thirumurthy H. PLoS One. 2017 Mar 27;12(3):e0174629. doi: 10.1371/journal.pone.0174629.eCollection 2017.

Promoting awareness of serostatus and frequent HIV testing is especially important among high risk populations such as female sex workers (FSW) and their sexual partners. HIV self-testing is an approach that is gaining ground in sub-Saharan Africa as a strategy to increase knowledge of HIV status and promote safer sexual decisions. However, little is known about self-test distribution strategies that are optimal for increasing testing access among hard-to-reach and high risk individuals. We conducted a qualitative study with 18 FSW who participated in a larger study that provided them with five oral fluid-based self-tests, training on how to use the tests, and encouragement to offer the self-tests to their sexual partners using their discretion. Women demonstrated agency in the strategies they used to introduce self-tests to their partners and to avoid conflict with partners. They carefully considered with whom to share self-tests, often assessing the possibility for negative reactions from partners as part of their decision making process. When women faced negative reactions from partners, they drew on strategies they had used before to avoid conflict and physical harm from partners, such as not responding to angry partners and forgoing payment to leave angry partners quickly. Some women also used self-tests to make more informed sexual decisions with their partners.

Abstract [2]  Full-text [free] access  [3]

HIV testing [5], Key populations [6]
Africa [7]
Kenya [8]
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