“I wanted evidence that my status had changed, so that is why I tested”: experiences with HIV self-testing among female sex workers in Malawi

ABSTRACT

HIV testing among female sex workers (FSWs) is an established global health priority. HIV self-testing (HIVST) seems to have the potential to address issues of confidentiality, privacy and convenience among this key population. HIVST, however, may result in unintended consequences as its implementation unfolds in a complex sex work context characterised by unequal power relations, stigma and high HIV prevalence. We aimed to explore the experiences of FSWs with HIVST in the context of retesting and antiretroviral usage in Blantyre, Malawi. We used an ethnographic approach to understand meanings and views around HIVST and retesting. We found high levels of retesting, especially among those on antiretroviral, two of which received “false-negative” results. We identified three broad narratives: (1) retesting in response to experiences in the sex work context, (2) retesting driven by the desire to self-monitor HIV-negative status, and (3) retesting in the hope of sero-reversion. The FSWs’ experiences indicate that the implementation of HIVST in this context is complex with potential for unintended harms such as coercive testing. HIVST programmes must include clear and appropriate messaging to reduce retesting while on ART and implement strategies to address FSW concerns and anxieties about the accuracy of their HIV-positive test results.

KEYWORDS:

• Female sex worker
• HIV self-testing
• HIV retesting
• antiretroviral therapy

Acknowledgements

The authors are grateful to all the study participants for spending time with us and sharing their experiences. The photograph was taken by one of the photovoice participants and we obtained written consent for publication. The authors are also grateful to the STAR project Malawi team and Pakachere Institute for Communication Development for hosting the study.

Disclosure statement

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

ORCID

Wezzie S. Lora http://orcid.org/0000-0002-0246-3549

Eleanor E. MacPherson http://orcid.org/0000-0002-7142-1158

Additional information

Funding

Wezzie S. Lora is being supported by the Commonwealth Scholarships Commission [grant number MWCS-2016-801] and Wellcome Trust through Malawi Liverpool Wellcome Trust-Clinical Research Programme PhD studentship.