Stigma, privacy concerns, sexual behaviors, and testing history shape willingness to use HIV self-testing among African refugee male sex workers in Italy – A mixed method study - BGSH-023

Marginalized populations such as African refugee male sex workers (ARMSWs) in Italy face systemic barriers to HIV testing, including stigma, privacy concerns, and structural inequities. Despite the potential of HIV self-testing (HIVST) to overcome these barriers, limited research exists on its acceptability among ARMSWs. This study examines HIVST willingness and associated factors among ARMSWs to inform targeted interventions A mixed-methods sequential exploratory design was employed, combining quantitative surveys (n = 150) with qualitative interviews (20 in-depth interviews, 2 focus group discussions) among ARMSWs in Italy. Participants were recruited through venue-based and snowball sampling in partnership with a community organization. Quantitative findings revealed moderate willingness (44.4%) to use HIVST, driven by convenience (47.1%), privacy (23.5%), and stigma avoidance. Key barriers included concerns about test accuracy (27.0%), emotional distress from positive results (20.9%), and limited kit access (32.2%). Qualitative insights emphasized occupational relevance, empowerment, and fears of community stigma if seen with kits. Multivariate analysis identified religious affiliation (aOR = 78.27), health insurance (aOR = 14.56), prior HIV testing (aOR = 20.37), HIVST awareness (aOR = 3.24), and HIVST prior usage (aOR = 4.12) as significant predictors of willingness. Structural challenges, such as immigration-related healthcare barriers, amplified interest in HIVST as a discreet alternative. The study calls for community-driven interventions addressing accuracy concerns, subsidized access, and psychosocial support. Integration of HIVST with peer-led education and linkage-to-care services could enhance uptake. Policymakers should prioritize stigma reduction and equitable distribution strategies to align with global HIV targets for marginalized populations.