Potential Interactions Between The Pathways To Diagnosis Of Hiv/Sti And Hiv Self-Testing: A Qualitative Study Of Gay Men In Singapore

Background 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 the benefits, but also potential knock-on implications of introducing HIVST in the context of other STI testing. Methods We conducted semi-structured, in-depth interviews with 30 gay, bisexual and other men who have sex with men (GBMSM) 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 an internal and external motivator, 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 prevention be balanced accordingly.