Kenyan women can distribute HIV self-test kits to their sexual partners without a significant risk of intimate partner violence

The distribution of HIV self-testing kits by women to their sexual partners doesn't increase women's risk of intimate partner violence, according to Kenyan research published in the Journal of Acquired Immune Deficiency Syndromes.

Prevalence of intimate partner violence was as high as 47% when the women were first recruited to the study. This fell during follow-up and only four women reported experiencing intimate partner violence as a consequence of offering an HIV self-testing kit to a sexual partner.

“Despite high underlying IPV [intimate partner violence] prevalence in the study setting, a majority of women reported safely distributing self-testing kits to their primary sexual partner,” comment the researchers. “A central finding of this study is that IPV risk during the 3-month intervention period was greatest among those who reported IPV before the intervention, and moreover, only 4 of the women who experienced IPV during the intervention attributed it to the offer or distribution of self-testing kits to their sexual partners.”

Diagnosis is a key part of the HIV care continuum and an essential first step in the attainment of UNAIDS' 90-90-90 targets (90% diagnosed; 90% of diagnosed individuals on treatment; 90% of people on treatment virally suppressed). But global diagnosis rates are currently well below the UNAIDS target. In Kenya, an estimated 62% of men and 48% of women with HIV are unaware they are infected. Innovative new testing strategies are therefore needed to boost diagnosis rates.

One such strategy is self-testing for HIV. This has been shown to be feasible and acceptable in a wide range of settings and among diverse populations. Secondary distribution of self-testing kits – in which individuals are asked to give kits to their sexual partners – has the potential to further extend the reach of testing.

Investigators in Kenya wanted to see if women distributing self-testing kits to their sexual partners were at increased risk of intimate partner violence.

They therefore designed a prospective study involving a diverse group of women aged between 18 and 39 years. On recruitment, participants completed a questionnaire asking about their experience of intimate partner violence in the previous 12 months. They were then instructed how to perform oral HIV testing and given testing kits to distribute to their sexual partners. Participants were then followed monthly for three months and asked to report if they had experienced intimate partner violence and if this was related to the distribution of a self-testing kit.

All the participants were HIV negative at baseline. A total of 280 women were recruited to the study, including 61 individuals receiving antenatal care, 117 individuals in post-partum care and 102 female sex workers. The majority – 95% – completed follow-up.

Self-testing kits were distributed to a sexual partner by most women, including 91% of those in antenatal care, 86% of post-partum women and 75% of female sex workers.

There was a high prevalence of intimate partner violence at baseline, reported by 27% of women in the antenatal group, 46% of the post-partum group and 44% of female sex workers. Prevalence was lower during follow-up: 14% for the antenatal care group, 17% in the post-partum group and 21% in the female sex worker group.

Experiencing intimate partner violence at baseline was strongly associated with such violence during follow-up (p < 0.001).

Very few participants (4% of female sex workers; 6% in the antenatal group; 2% of the post-partum group) reported intimate partner violence during follow-up but not at baseline.

Only four cases of intimate partner violence during follow-up were reported to be associated with the distribution of a self-testing kit. Two of these individuals reported partner violence when recruited to the study.

“These results underscore the reality that women are at very high risk of violence even in the absence of HIVST [HIV self-testing] interventions,” write the authors. “The introduction of self-tests by women does not necessarily heighten the risk of IPV.”

The investigators believe that their research is likely to reflect real-world experiences, especially because the women who volunteered to participate felt comfortable offering self-tests to their sexual partners.

“Our results dispel fears regarding safety of HIVST,” conclude the authors. “Women attending services at health facilities can offer self-testing to men, thereby increasing HIV testing among them.”