“When the self-test kit comes with the woman, it will be like she is overpowering you”: A qualitative study of men’s and women’s perspectives on HIV self-testing kits in South Africa.
Outcomes: Human Immunodeficiency Virus
View SourceKey Social Norms Take-aways Gender norms and unequal power within intimate relationships can substantially shape whether HIV self-testing is acceptable and safely implemented. In particular, norms positioning men as household decision-makers may make woman-delivered self-test kits appear to challenge male authority, potentially provoking mistrust, conflict, blame, or violence. The authors argue that programs should assess local gender and power dynamics and use gender-transformative approaches that promote equitable norms, shared health decision-making, and couples’ communication.
Objectives To explore men’s and women’s perspectives on HIV self-testing in KwaZulu-Natal, South Africa, and obtain feedback to inform the content, structure, and distribution of future interventions promoting HIV self-testing and pre-exposure prophylaxis uptake among postpartum women and their male partners.
Methods This qualitative study was conducted in Durban between October and November 2024. Researchers conducted two separate focus group discussions with 20 community-recruited participants (10 women and 10 men), ages 18–40, who had a child within the previous year. The semi-structured discussion guide was informed by the Integrated Behavior Model and explored attitudes, social norms, and agency related to HIV prevention and self-testing, as well as gender-specific barriers, family well-being, intervention preferences, and safety concerns. Discussions were conducted in isiZulu, transcribed and translated into English, and analyzed using qualitative content analysis.
Results Participants generally viewed HIV self-testing positively because of its privacy, convenience, autonomy, and ability to avoid clinic-based barriers and stigma. Protecting children and family health was an important motivation for testing, particularly among men. However, participants emphasized the need for emotional and informational support around testing and receiving results. Gender norms were a major barrier: women described limited ability to initiate HIV-related discussions in relationships where men controlled decision-making and feared that bringing a kit home could lead to accusations, conflict, or violence. Men could perceive woman-delivered kits as threatening their masculinity, authority, or implying infidelity.
Conclusions HIV self-testing has potential to increase testing during the perinatal period, but successful implementation requires more than making kits available. Programs should integrate emotional and informational support, couples-based communication and education, community outreach, and strategies that explicitly address gender norms and power inequalities. Couple-based or direct engagement with men may also reduce conflict associated with women independently distributing kits.
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