Providing sex workers with HIV self-tests leads to high levels of partner testing
Sexual partner testing was high in Kenyan trial providing HIV self-tests to sex workers, with condom use increasing when men refused to test.
A Kenyan scheme that provided HIV self-testing kits to women engaged in transactional sex to pass on to steady partners and clients has resulted in high levels of men and couples getting tested and has also increased condom use.
The study, which began in 2017 and is still active, enrolled just over 1,000 women living in beach communities along Lake Victoria in Siaya County where one in five people are living with HIV. Fishing drives the local economy, and transactional sex in bars and hotels is common.
All the women in the trial were HIV negative and had two or more sexual partners in the past month. Each received five self-testing kits at the trial’s start and could replenish their supply every three months.
The women received training on how to use the kits and how to offer tests to steady partners and other men they were likely to have unprotected sex with. The training emphasised the need to assess the risk of violence when deciding whether to offer a man a test or not.
After six months, researchers reached around 900 of the women they had enrolled. The average age of these women was 28, two-thirds were married, and 94% reported having transactional sex.
Participants had received around eight self-testing kits each during the six months and had offered around three self-test kits to partners. The remaining self-testing kits were used by the women themselves (39%), were unused (12%) or had been given to others (3%).
Around 94% of women with a steady partner gave them a self-testing kit and 97% of these men used it. Couples testing was reported among 91% of these cases. Status disclosure was high with 98% of men opting to share their results. Around 2% had a reactive result.
In around two-thirds (65%) of transactional sex encounters, women offered a self‐test kit to their partner, of whom 93% accepted. In 84% of these cases, the woman and man tested together. Men disclosed their test results in 97% of these cases and 3% had a reactive result.
Condoms were used in around 90% of transactional sex encounters if the man refused to self‐test or had a reactive result, compared with 56% of transactional sex encounters where the man self-tested and had a negative result.
Around 14% of women said they had refused to have sex with someone because that person had either declined a self‐test or had a reactive result. Additionally, 12% of women said they had decided to use a condom with a sexual partner for these reasons.
The findings provide further evidence that women at higher risk of HIV are well-positioned to distribute self‐tests to regular and transactional sex partners, and that these men – who are also at higher risk of HIV – are willing to accept and use these tests.
Given that men in eastern and southern Africa are harder to reach with HIV testing than women, these findings may have considerable potential for preventing HIV.