Article Text
Abstract
Objectives This study draws on qualitative insights on the barriers and facilitators to HIV testing, as well as perceptions of HIV self-testing (HIVST), to propose a framework to understand not only the benefits but also potential knock-on implications of introducing HIVST in the context of other STI testing.
Methods We conducted semistructured, in-depth interviews with 30 gay, bisexual and other men who have sex with men aged 18 and 39 years old in Singapore. Interview topics included barriers and facilitators to HIV and other STI testing, as well as perceptions of HIVST. Interviews were audio-recorded, transcribed, coded and analysed using thematic analysis.
Results For HIV testing, participants cited the perceived risk of acquiring, susceptibility to and symptoms of HIV as internal motivators, while social influence and accessibility of HIV testing services were external motivators. For STI testing, perceived symptoms and partner notification of STI were reported as internal and external motivators, respectively. Availability of bundle tests, starting a new relationship and instances of mandatory testing motivated both simultaneous HIV and other STI testing. The fear of a positive diagnosis and lack of confidentiality were cited as internal and external barriers to HIV testing, respectively, while low perceived severity of other STI and the cost of STI tests were cited as internal and external barriers to other STI testing, respectively. We identified pathways to HIV and other STI testing and discussed how the introduction of HIVST may reduce opportunities for other STI testing.
Conclusions The findings of this study suggest that introducing HIVST might weaken linkages to other STI testing if alternative strategies of promoting other STI testing are not simultaneously implemented. We recommend that future interventions address both the risks of HIV and other STI simultaneously, and that structural interventions promoting HIV and other STI preventions be balanced accordingly.
- HIV testing
- diagnosis
- gay men
- health services research
- HIV service delivery
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author.
Footnotes
Handling editor Adam Huw Bourne
Contributors RKJT: data curation; formal analysis; writing, original draft; writing, review and editing; visualisation. YYC: formal analysis; data curation; writing, review and editing; project administration. MABI: formal analysis; data curation; writing, review and editing; project administration. LPH: resources; writing, review and editing; visualisation. OZL: investigation; resources; formal analysis; data curation; writing, review and editing; project administration. BCHC: investigation; resources; formal analysis; data curation; writing, review and editing; project administration. MT-WC: resources; writing, review and editing; supervision; funding acquisition. MI-CC: conceptualisation; writing, review and editing; supervision; funding acquisition; project administration. CMW: conceptualisation; methodology; formal analysis; data curation; writing, review and editing; supervision; funding acquisition; project administration.
Funding This study was funded by Ministry of Education - Singapore (Grant number: R-608-000-072-112).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.