title: A qualitative study of secondary distribution of HIV self-test kits by female sex workers in Kenya.
abstract: Promoting awareness of serostatus and frequent HIV testing is especially important among high risk populations such as female sex workers (FSW) and their sexual partners. HIV self-testing is an approach that is gaining ground in sub-Saharan Africa as a strategy to increase knowledge of HIV status and promote safer sexual decisions. However, little is known about self-test distribution strategies that are optimal for increasing testing access among hard-to-reach and high risk individuals. We conducted a qualitative study with 18 FSW who participated in a larger study that provided them with five oral fluid-based self-tests, training on how to use the tests, and encouragement to offer the self-tests to their sexual partners using their discretion. Women demonstrated agency in the strategies they used to introduce self-tests to their partners and to avoid conflict with partners. They carefully considered with whom to share self-tests, often assessing the possibility for negative reactions from partners as part of their decision making process. When women faced negative reactions from partners, they drew on strategies they had used before to avoid conflict and physical harm from partners, such as not responding to angry partners and forgoing payment to leave angry partners quickly. Some women also used self-tests to make more informed sexual decisions with their partners.
authors.affiliation: University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, North Carolina, United States of America.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maman
authors.affiliation: FHI360, Durham, North Carolina, United States of America.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Murray
authors.affiliation: Research Triangle International, San Francisco, California, United States of America.
authors.forename: Sue
authors.initials: S
authors.lastname: Napierala Mavedzenge
authors.affiliation: Impact Research and Development Organization, Kisumu, Kenya.
authors.forename: Lennah
authors.initials: L
authors.lastname: Oluoch
authors.affiliation: Impact Research and Development Organization, Kisumu, Kenya.
authors.forename: Florence
authors.initials: F
authors.lastname: Sijenje
authors.affiliation: Impact Research and Development Organization, Kisumu, Kenya.
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
authors.affiliation: University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, North Carolina, United States of America.
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
mesh_terms: D000293:Adolescent; D000328:Adult; D003657:Decision Making; D059026:Diagnostic Self Evaluation; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007630:Kenya; D036301:Qualitative Research; D011933:Reagent Kits, Diagnostic; D012309:Risk-Taking; D011477:Sex Work; D060386:Sex Workers; D012747:Sexual Partners; D047568:Unsafe Sex; D055815:Young Adult
chemical_list: D011933:Reagent Kits, Diagnostic