Acceptability of HIV self-testing among sexual health service providers and Two-Spirit, gay, bisexual, and queer men in Ontario, Canada

In 2020, Health Canada approved the INSTI human immunodeficiency virus (HIV) self-test. Adoption and distribution of alternative HIV testing interventions, like self-testing, are essential in meeting the United Nations 95-95-95 goals. We explored the acceptability of HIV self-testing among sexual health service providers and Two-Spirit, gay, bisexual, and queer men (2SGBQM). Between 2020 and 2021, peer researchers conducted virtual focus groups (13) and interviews (18) with providers (n = 18) and 2SGBQM (n = 38) across Ontario, Canada, and analysed data using community-based participatory research approach and reflexive thematic analysis. HIV self-testing was highly acceptable among both providers and 2SGBQM. Both groups identified 'increased access to HIV testing' as a benefit. Providers identified 'client empowerment' and 'reduced workload for providers' as other perceived benefits. 2SGBQM highlighted 'convenience' as a key benefit and rationale for self-testing, though some expressed concerns and hesitance due to 'fear of needles/blood' and 'perceptions of lower accuracy and reliability' of self-test results. Providers and 2SGBQM referred to the 'potential for missed connections to care', and 'self-harm' with positive test results as additional concerns for self-testing. Both groups suggested that first-time or inexperienced testers should be tested in-clinic, compared with experienced or regular testers who may benefit from self-testing. Participants expressed that HIV self-testing should be widely available for free, or a modest fee up to $20 CAD. Providers and 2SGBQM both found HIV self-testing highly acceptable, particularly when self-administered by experienced testers. Clinic-based testing remains important, especially for first-time testers and 2SGBQM who have concerns or hesitance regarding self-testing.