Department of Sexual and Reproductive Health, National Institute for Medical Research, P.O Box 1462, Mwanza, Tanzania.
Sauti Program, Jhpiego Tanzania - an affiliate of Johns Hopkins University, P.O Box 9170, Dar es Salaam, Tanzania.
BMC Public Health. 2020 Jun 18;20(1):959. doi: 10.1186/s12889-020-09105-6.
HIV testing is a gateway to HIV care and treatment for people diagnosed with HIV and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub-optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored the acceptability of FSWs towards the introduction of HIVST in Tanzania.
We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software. The analysis was informed by the social-ecological model and focused on factors associated with the acceptability of HIVST.
We conducted 21 PGD sessions involving 227 FSWs. Twenty three IDIs were conducted to complement data collected through PGD. Our study has demonstrated that FSWs are enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants' support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with a reactive test. Very likely, concern about adverse effects of HIVST was linked to the study participants' lay perception that HIVST would be provided only through unassisted modality.
FSWs demonstrated high enthusiasm to use the HIVST once it becomes available. Expectations for increased confidentiality, autonomy, and reduced opportunity costs were among the leading factors that attracted FSWs to HIVST. The major obstacles to the acceptability of HIVST included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.
艾滋病毒检测是艾滋病毒感染者获得艾滋病毒护理和治疗的途径，也可以将阴性结果的人与艾滋病毒预防服务联系起来。尽管艾滋病毒检测服务（HTS）在艾滋病毒控制中非常重要，但撒哈拉以南非洲（SSA）的女性性工作者（FSW）对 HTS 的接受程度仍然不理想。与性工作相关的污名化以及对 HIV 检测结果公开后丧失生计的担忧，是 FSW 利用医疗保健机构提供的 HTS 的一些限制因素。引入艾滋病毒自检（HIVST）可能会减轻一些接受 HTS 的障碍。本研究探讨了坦桑尼亚 FSW 对引入 HIVST 的接受程度。
我们采用深入访谈（IDI）和参与式小组讨论（PGD），在坦桑尼亚选定地区对 FSW 进行了探索性研究。研究参与者通过滚雪球抽样招募。两名分析师使用 NVivo 软件对数据进行了主题分析。分析受社会生态学模型的指导，并侧重于与 HIVST 可接受性相关的因素。
我们进行了 21 次 PGD 会议，涉及 227 名 FSW。进行了 23 次 IDI 以补充通过 PGD 收集的数据。我们的研究表明，FSW 对 HIVST 非常感兴趣。方便（节省时间和成本）以及认为 HIVST 将增加隐私和保密性的信念，促使参与者支持自我检测方法。参与者确实对自己解释和信任测试结果的能力表示担忧。参与者还表示担心 HIVST 可能会造成个人伤害，包括对反应性测试呈阳性的个体造成严重困扰和自我伤害。很可能，对 HIVST 不良影响的担忧与研究参与者的看法有关，即 HIVST 仅通过无人协助的模式提供。
FSW 对可用的 HIVST 表现出很高的热情。对增加保密性、自主权和降低机会成本的期望是吸引 FSW 使用 HIVST 的主要因素。接受 HIVST 的主要障碍包括对 HIV 反应性测试的恐惧和不信任自我诊断。我们的研究结果强调了提供足够的咨询和转介服务与 HIVST 相结合的重要性。
