# Opportunities for Low-Barrier HIV Testing in the U.S. Deep South: Findings from a Survey in Alabama

## TL;DR

This study explores how mobile and self-HIV testing can help overcome barriers to HIV testing in Alabama's Deep South, particularly among Black women and low-income individuals.

## Contribution

The study provides insights into the acceptability and feasibility of mobile and self-HIV testing in a high-risk, underserved population in Alabama.

## Key findings

- Mobile-based HIV testing was highly rated for acceptability, appropriateness, and feasibility.
- Community-level HIV stigma was high, but individual stigma was less of a barrier than fear of a positive result and lack of care knowledge.
- Over half of participants were aware of HIV self-testing, and nearly half expressed interest in using it in the future.

## Abstract

The HIV epidemic remains a critical public health challenge in the Southern U.S., where barriers such as healthcare shortages, structural racism, and social determinants of health exacerbate disparities. Mobile- and self-HIV testing offer promising approaches to address these barriers. Partnering with a community-based healthcare organization in Alabama, we surveyed 181 individuals accessing facility- and community-based HIV testing from August 2022 to November 2023. Most participants were Black (92%), women (78%), and heterosexual (83%), with 73% reporting annual incomes below $50,000. While 72% felt unlikely to acquire HIV, a fifth reported forgoing healthcare due to competing financial needs like housing (23%) and food (21%). Barriers to care were rated as “very slight” to “somewhat of a problem,” and medical mistrust was highest in group disparities (mean 27.2/60). Community-level HIV stigma averaged 3.45/5, while social support scored 61.1/100. Mobile-based HIV testing was favorably rated for acceptability (3.9/5), appropriateness (4/5), and feasibility (4/5). Among participants, 61% were aware of HIV self-testing, 21% had used it, and 47% expressed interest in future use. Findings reveal low perceived HIV risk and significant community stigma, though individual stigma was less of a barrier than factors like fear of a positive result and lack of knowledge about care. This study highlights the need for tailored interventions to improve HIV testing access for vulnerable populations across Alabama and other rural U.S. settings.