# HIV self-testing lived experiences of female sex workers in the Garden City, Eastern Nigeria

## TL;DR

Female sex workers in Nigeria value HIV self-testing for its privacy and convenience but face barriers like cost and stigma, which need to be addressed for wider adoption.

## Contribution

This study provides insights into the lived experiences of FSWs with HIV self-testing in Nigeria and identifies actionable strategies to improve its uptake.

## Key findings

- HIV self-testing was highly accepted due to its privacy and convenience.
- Barriers included cost, limited awareness, and anxiety about self-testing.
- Participants recommended subsidized test kits, peer support, and public education to improve adoption.

## Abstract

HIV self-testing (HIVST) provides a private and convenient alternative to traditional testing, addressing barriers such as stigma, fear of discrimination, and accessibility challenges. Female sex workers (FSWs) face a disproportionate burden of HIV and limited access to facility-based testing, making HIVST a critical tool for advancing Joint United Nations Programme on HIV/AIDS (UNAIDS) 2030 targets.

To explore the lived experiences of FSWs with HIVST and identify strategies to enhance its uptake and accessibility in Nigeria.

This was a qualitative study utilizing a phenomenological approach to explore the shared lived experiences of participants.

This qualitative study utilized in-depth interviews with 15 brothel-based FSWs in Port Harcourt, Nigeria. Participants were purposively sampled to capture diverse perspectives. Thematic analysis was conducted using NVIVO-12 software to identify key themes.

HIVST was highly accepted due to its convenience, privacy, and autonomy. However, barriers such as cost, limited awareness, perceived inaccuracy of results, and anxiety about self-testing were reported. Participants emphasized affordability, peer support, and targeted education as key facilitators. While concerns about stigma and result interpretation were evident, participants recommended integrating HIVST into public health programs, subsidizing test kits, and expanding awareness initiatives to improve adoption.

HIVST has significant potential to increase HIV testing rates among FSWs in Nigeria. Addressing financial, educational, and structural barriers, while leveraging peer-driven support and community engagement, is essential for optimizing HIVST uptake. These strategies align with UNAIDS’ 2030 goals and can contribute to reducing HIV-related disparities among key populations.

Not applicable.

Exploring how female sex workers in Nigeria experience HIV self-testing and how it can be improved

This study explored the experiences and preferences of female sex workers in Nigeria regarding the use of HIV self-testing (HIVST).

Why was the study done?

Female sex workers face a much higher risk of HIV compared to the general population. However, many encounter stigma and fear when trying to access traditional HIV testing services at health facilities. HIV self-testing provides a way for individuals to test themselves privately and at their own convenience. This study explored the real-life experiences of FSWs with HIVST in Nigeria, to better understand what helps or prevents them from using it.

What did the researchers do?

The research team interviewed 15 brothel-based FSWs in Port Harcourt, Nigeria. Interviews were done face-to-face in private settings using open-ended questions to understand participants’ feelings and experiences related to HIVST. The researchers used a thematic analysis approach to identify patterns and important themes across the interviews.

What did the researchers find?

Participants reported that they appreciated HIVST because it allowed them privacy, control, and convenience. However, several barriers were raised, including the cost of kits, fear of test inaccuracy, emotional stress when testing alone, and concerns about stigma if others discovered their HIV testing. To make HIVST more accessible, participants suggested reducing the price of kits, using peer networks to promote self-testing, and launching wider public education campaigns. Some participants recommended integrating HIVST kits into government health programs to make them easier to access.

What do the findings mean?

This study highlights that HIVST is valued by FSWs but needs to be made more affordable, accessible, and better supported to increase uptake. Tailored education efforts, community-based distribution, and peer-led strategies could significantly strengthen HIV testing coverage among FSWs. These findings can help guide future policies and programs aimed at expanding HIV prevention for one of the most vulnerable populations in Nigeria.