‘When I have these kits … I have confidence’ – HIV self-testing provides agency for women in their sexual decision-making

ABSTRACT

Oral fluid-based HIV self-testing (HIVST) has emerged as a promising approach to increasing HIV testing coverage, particularly among high-risk populations. Understanding the experiences of women using self-tests and offering them to their sexual partners (secondary distribution) is crucial for determining the potential of HIVST. Qualitative in-depth interviews were conducted among 32 women at high risk of HIV infection, including women who engage in transactional sex, who participated in a cluster randomised trial of a secondary distribution strategy in western Kenya. Interviews explored how women used self-tests within relationships and how this affected their sexual decision-making. Three key themes emerged: women used HIVST to assess risk prior to engaging in sex with partners; HIVST provided women with increased agency to engage in or end relationships; and women appreciated these benefits and urged expanded access to self-tests. HIVST has the potential to support HIV prevention objectives in settings with high prevalence of HIV.

Trial registration: ClinicalTrials.gov identifier: NCT03135067.

KEYWORDS:

• HIV self-testing
• secondary distribution
• transactional sex
• female sex worker
• Kenya

Acknowledgements

The authors would like to thank the Qualitative Research Assistant team who collected the data used for this analysis, including Millicent Omoya, Lennah Oluoch, Olivia Okumu, Ezinah Kemunto, Lillian Ouma, Nancy Ounda and Veronica Onyango. Financial support from the National Institute of Mental Health is acknowledged.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committees of the University of Pennsylvania (828100) and Maseno University (MSU/DRPI/MUERC/00296/16). This study was registered on Clinicaltrials.gov (NCT03135067).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Informed consent to publish de-identified research results was obtained from all individual participants included in the study.

Data availability statement

De-identified qualitative data may be made available upon request.

Additional information

Funding

This study was funded by the National Institute of Mental Health (R01MH111602).