Abstract
Context: The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). The AutoTest-VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in Côte d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests to PLHIV so that they can offer the tests to their sexual partners.Methods: This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It consisted of (i) individual interviews with eight health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) seven observations of peer educator-led PLHIV group discussions. The interviews with health professionals and the observations notes have been subject to content analysis.Results: HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because, in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIVST distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status.Conclusion: It is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.
Highlights
For people living with HIV (PLHIV), HIV testing is the entry point for receiving life-saving treatment and care
The difficulties of offering HIV self-testing (HIVST) to partners of PLHIV raise fundamental questions related to HIV disclosure to sexual partners and the associated stigmatization
Our results highlight the potential role of interventions to support HIVST for index testing that does not rely on disclosure and that is adapted to local contexts to increase diagnostic coverage of partners of PLHIV who are not reached by traditional testing strategies
Summary
For people living with HIV (PLHIV), HIV testing is the entry point for receiving life-saving treatment and care. In 2019, 81% of PLHIV worldwide knew their HIV status; this proportion was estimated to be only 64% in West Africa [1] Such regional differences reflect difficulties in access to testing, which is related to stigma and discrimination against PLHIV [2]. This fear of stigmatization causing difficulties related to the sharing of serological status in general and within couples has been reported in this area. This encouraged the establishment of support programs for the disclosure of HIV infection. All the health professionals who were trained received the necessary materials for HIV self-test delivery. Data collection was carried out between September and November 2019 at the very beginning of the HIVST distribution in the facility, which started in August 2019
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