“He Told Me to Check My Health”: A Qualitative Exploration of Social Network Influence on Men’s HIV Testing Behavior and HIV Self-Testing Willingness in Tanzania

Abstract

Men continue to test for HIV at a low rate in sub-Saharan Africa. Recent quantitative evidence from sub-Saharan Africa indicates that encouragement to test for HIV from men’s network members is associated with higher previous HIV testing and HIV self-testing (HIVST) willingness. Leveraging this positive network influence to promote HIVST among men is a promising strategy that could increase HIV testing. This study investigated the reasons and strategies men used to encourage their peers to test for HIV and the outcomes in order to inform the development of a social network-based HIVST intervention for men called STEP (Self-Testing Education and Promotion). Twenty-three men from networks locally referred to as “camps” were interviewed to explore reasons for encouraging HIV testing, strategies to encourage HIV testing, and outcomes of HIV testing encouragement. Reasons men reported for encouraging their peers to test for HIV included awareness of their peers’ risky sexual behavior, knowing an HIV-positive peer, and having HIV testing experience. Strategies for encouraging testing included engaging in formal and informal conversations and accompanying friends to the clinic. Encouragement outcomes included HIV testing for some men while others remained untested due to lack of privacy in the clinic and fear of HIV stigma. Willingness to self-test for HIV and an interest to educate peers about HIVST were other outcomes of HIV testing encouragement. These findings underscore the potential of leveraging men’s existing HIV testing encouragement strategies to promote HIVST among their peers.

Feasibility of an HIV self-testing intervention: a formative qualitative study among individuals, community leaders, and HIV testing experts in northern Tanzania

“…However, when they arose in the interviews and discussions, they were supportive of HIVST. These findings are consistent with findings from other studies [35,[48][49][50][51]. According to IBM, both injunctive and descriptive norms are important constructs of social influence in social identity and might influence the uptake of recommended behavior, such as HIVST [31,35].…”

Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis

“…As a result of the research method used (qualitative or mixed methods), qualitative data from the sixteen included studies were extracted. The included studies were conducted in the following countries: Zambia [24], Malawi [11,25], South Africa [12,[26][27][28][29][30], Tanzania [31][32][33], Uganda [34,35], Zimbabwe and Malawi [36], and Kenya [37]. Twelve studies were predominantly qualitative and four were mixed methods.…”

“…Evidence on knowledge of HIVST was reported on in four articles [12,[31][32][33]. In two studies conducted in Tanzania, the majority of the men had no prior knowledge of HIVST [31,32].…”

“…Poor knowledge of HIVST did not vary depending on whether a country was implementing HIVST or not. Although this was the case, once the participants became aware of its benefits, they were willing to utilise HIVST after it was introduced to them and promote its use among their peers [12,31]. Some male participants indicated the need to conduct HIVST awareness campaigns to increase HIVST knowledge and ensure the successful implementation [32,33], as illustrated by one participant in Tanzania:…”

“…The evidence on acceptability was reported on in nine studies [11,12,25,26,[31][32][33][34]37]. The majority of men showed a willingness to use HIVST in studies conducted in Malawi [11], Tanzania [32,33], South Africa [26], and Kenya [37], with most of the participants having administered HIVST in the past in Tanzania [33].…”