Client-initiated, provider-initiated, or self-testing for HIV: what do South Africans prefer?

HIV testing is a critical gateway to HIV prevention, treatment, and care, but uptake of HIV testing remains disappointingly low in many sub-Saharan African countries. The purpose of this study was to investigate which HIV-testing model a sample of South Africans (N = 466) preferred if given a choice between client-initiated, provider-initiated, or self-testing. A semi-structured questionnaire was used. Results indicated that 66.1% preferred client-initiated counseling and testing, 11.6% preferred provider-initiated counseling and testing, and 22.3% preferred self-testing. Themes associated with the choice of testing model were patient autonomy, violation of human rights, confidentiality and privacy, fear of discrimination and stigma, confusion when being offered an HIV test for unrelated conditions, suspicion of government motives, and an aversion to mandatory face-to-face counseling. It was concluded that HIV-testing models in South Africa should be revised to include a multi-faceted approach to give clients a wider choice in how and where to test.