Perception of people living with HIV in Bhutan on disclosing HIV status and willingness to distribute HIV self-testing kits to their sexual and drug-injecting partners

In Bhutan, HIV testing uptake among key populations remains low, with most cases diagnosed late. Evidence shows index testing and partner notification services (PNS) enhance diagnosis among partners of people living with HIV (PLHIV). However, traditional PNS are limited by HIV related stigma, fear of disclosure, and partner reluctance to visit health facilities. Integrating HIV self-testing (HIVST) within the PNS provides an alternative for earlier diagnosis. This qualitative study used in-depth interviews to explore the feasibility and acceptability of index testing using HIVST among PLHIV. Deductive and inductive thematic analysis conducted. Three themes emerged: bridging HIVST knowledge; trust and power in HIVST distribution; and reimagining support systems. Participants reported knowledge gaps due to fragmented information, undermining confidence in HIVST uptake for partner notification (PN), and suggested instructional videos and printed guides. Experiences of assisted PN (aPN), including fear of misunderstanding, relationship breakdown, and judgment, negatively influenced willingness to use index HIVST. Trust and emotional preparedness shaped perceptions of HIVST distribution, with most participants preferring aPN as the primary strategy and index HIVST as an alternative. Misconceptions, inadequate post-test counseling, and stigma may hinder uptake. HIVST could increase testing in Bhutan, but effectiveness depends on addressing stigma and structural barriers through provider-assisted distribution strategies.