Abstract
HIV self-testing increases recent and frequent HIV testing among female sex workers (FSWs) in urban Uganda. Using results from a randomized controlled trial, we aim to establish the effect of HIV self-testing delivery models on FSWs’ sexual behaviors in this setting. Clusters of one peer educator and eight participants were 1:1:1 randomized to: (1) direct provision of an HIV self-test, (2) provision of a coupon for facility collection of an HIV self-test, or (3) referral to standard-of-care HIV testing services. Sexual behaviors were self-reported at 1 and 4 months. From October to November 2016, 960 participants were enrolled and randomized. At 4 months, there were no statistically significant differences in participants’ sexual behaviors, including inconsistent condom use, across study arms. We do not find any changes in sexual risk-taking among FSWs in response to the delivery of HIV self-tests. Routine policies for HIV self-testing are likely a behaviorally safe component of comprehensive HIV prevention strategies.
Highlights
HIV self-testing has been proven to increase HIV testing in diverse populations and settings [1,2,3,4,5,6,7,8,9,10]
HIV self-testing may be beneficial for female sex workers (FSWs), who—according to the World Health Organization (WHO)— should test for HIV every 3 months, because they are at high risk of HIV acquisition [11]
How HIV self-tests were delivered to Ugandan FSWs affected how often they tested: FSWs tested for HIV more frequently when self-tests were delivered to them directly by peer educators (‘direct provision’) versus when they had to collect self-tests from a healthcare facility (‘facility collection’) [7]
Summary
HIV self-testing has been proven to increase HIV testing in diverse populations and settings [1,2,3,4,5,6,7,8,9,10]. When FSWs receive an HIV selftest directly from a peer educator instead of from a healthcare facility, they miss the opportunity to interact with a healthcare provider and receive services (e.g., counseling) or items (e.g., condoms) available at healthcare facilities. When FSWs pickup HIV self-tests a healthcare facility, they might collect condoms and other free items, but still forgo counseling services. Reduced uptake of counseling services and reduced access to free condoms might increase sexual behaviors associated with HIV risk among FSWs. it is plausible that HIV self-testing approaches decrease FSWs’ HIV riskrelated sexual behaviors. HIV self-testing may increase FSWs’ feeling of control and self-efficacy regarding HIV prevention, which may lead to greater sexual negotiation power and reduced risk behaviors [20, 21]
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