Abstract
HIV self-testing (HIVST), which allows people to test in private, is an innovative testing strategy that has been shown to increase HIV testing among men. Delivering HIVST kits to men via women is one promising assisted partner service strategy. Little research has been conducted on HIVST secondary distribution to men by women living with HIV (WLWH) in the Caribbean and other settings. The purpose of this study was to assess the perspectives of WLWH, their male partners, and healthcare professionals on the perceived advantages and disadvantages of HIVST, and recommendations for implementing HIVST in Haiti, with a focus on secondary distribution of HIVST to men by WLWH. Sixteen key informant interviews and nine focus groups with 44 healthcare workers, 31 Option B+ clients, and 13 men were carried out in Haiti. Key informants were representatives of the Ministry of Health and of a non-governmental agency involved in HIV partner services. Focus group members included program leads and staff members from the HIV care and treatment program, the Option B+ program, the community health service program, and the HIV counseling and testing services from 2 hospitals. Perceived HIVST advantage included an increase in the number of people who would learn their HIV status and start treatment. The perceived disadvantages were lack of support to ensure self-testers initiate treatment, uncertainty about male partner’s reaction, risk of violence towards women delivering HIVST kits after receiving an HIVST kit from a woman, and the inability of women to counsel a man in case his self-test result is positive. Recommendations for integrating HIVST and secondary distribution of HIVST by WLWH included coupling HIVST distribution with public information, education, and communication through media and social marketing, relying on community health workers to mediate use of HIVST and ensure linkage to care, piloting HIVST programs on a small scale. HIVST is an appropriate and feasible strategy HIV prevention for men and women; however, more research is needed on how best to implement different strategies for this approach in the Caribbean.
Highlights
HIV prevalence in Haiti has remained relatively stable for the last 10 years at 2.0% [1], among the highest HIV prevalence levels in the Caribbean region
Instead of women-delivered HIV self-testing (HIVST) kits, stakeholders recommended that community health workers (CHWs) deliver the HIVST kits to male partners to provide the necessary follow-up support and prevent potential harm to the woman
Reasons for stakeholders’ concerns about HIVST and secondary distribution were related to the lack of follow-up services for self-testers, potential harm for women living with HIV (WLWH) who may deliver HIVST kits to their male partners, non-disclosure, and linkage to care among self-testers who receive a positive self-test result
Summary
HIV prevalence in Haiti has remained relatively stable for the last 10 years at 2.0% [1], among the highest HIV prevalence levels in the Caribbean region. Haiti has recorded significant progress in increasing access to HIV testing services within the last decade. HIV testing increased from 5% to 20% among men and 8% to 28% among women between 2005–17 [1]. The persistently high levels of the adult population who have never tested for HIV and the disparity between men and women are concerning for HIV testing and initiation of antiretroviral therapy (ART) [3]. Evidence from a nationally representative sample of heterosexual men demonstrated that condomless sex is high [4] and that HIV testing is associated with less condomless sex [5], indicating the importance of promoting HIV testing among men
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