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HIV testing barriers and intervention strategies among men, transgender women, female sex workers and incarcerated persons in the Caribbean: a systematic review
  1. Akeen Hamilton1,
  2. Stephen Shin2,
  3. Tamara Taggart3,4,
  4. Guy-Lucien Whembolua4,
  5. Indira Martin5,
  6. Henna Budhwani6,
  7. Donaldson Conserve1
  1. 1 Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA
  2. 2 University of North Carolina at Chapel Hill, Department of Sociology, Chapel Hill, NC, USA
  3. 3 George Washington University, Department of Prevention and Community Health, Washington, DC, USA
  4. 4 Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
  5. 5 Government of the Bahamas Ministry of Health, Nassau, Bahamas
  6. 6 University of Alabama at Birmingham, Department of Health Care Organization and Policy, Birmingham, AL, USA
  1. Correspondence to Dr Donaldson Conserve, Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA; conserve{at}


Background This systematic review summarises evidence on the HIV testing barriers and intervention strategies among Caribbean populations and provides pertinent implications for future research endeavours designed to increase rates of HIV testing in the region.

Methods We used a systematic approach to survey all literature published between January 2008 and November 2018 using four electronic databases (MEDLINE/PubMed, Embase, Web of Science and Global Health). Only peer-reviewed articles published in English that examined HIV testing uptake and interventions in the Caribbean with men, men who have sex with men, female sex workers, transgender women and incarcerated individuals were included.

Results Twenty-one studies met the inclusion criteria. Lack of confidentiality, access to testing sites, stigma, discrimination, poverty and low HIV risk perception were identified as key barriers to HIV testing. These barriers often contributed to late HIV testing and were associated with delayed treatment initiation and decreased survival rate. Intervention strategies to address these barriers included offering rapid HIV testing at clinics and HIV testing outreach by trained providers and peers.

Conclusion HIV testing rates remain unacceptably low across the Caribbean for several reasons, including stigma and discrimination. Future HIV testing interventions should target places where at-risk populations congregate, train laypersons to conduct rapid tests and consider using oral fluid HIV self-testing, which allows individuals to test at home.

  • Barriers
  • Caribbean
  • HIV
  • Key Populations
  • Systematic Review
  • Testing
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  • Handling editor Jackie A Cassell

  • Contributors All coauthors have both contributed substantially to the paper and approved the version being submitted.

  • Funding AH was supported by the Minority Health International Research Training (MHIRT) (grant no T37-MD001448) from the National Institute on Minority Health and Health Disparities, National Institute of Health (NIH). TT was supported by a postdoctoral fellowship supported by Award Numbers T32MH020031 and P30MH062294 from the National Institute of Mental Health (NIMH), and a scholar with the HIV/AIDS, Substance Abuse, and Trauma Training Program (HA-STTP), at the University of California, Los Angeles (R25DA035692). DC was supported by a training grant from NIMH (#R00MH110343) and NHLBI (#5R25HL105444-07). HB was supported by a training grant from NIH/NIMH (1K01MH116737). This work is also partially supported by an ASPIRE grant from the Office of the Vice President for Research at the University of South Carolina. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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