The Effect of HIV Self-Testing Delivery Models on Female Sex Workers' Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda

AIDS Behav. 2019 May;23(5):1225-1239. doi: 10.1007/s10461-019-02393-z.


HIV self-testing increases recent and frequent HIV testing among female sex workers (FSWs) in urban Uganda. Using results from a randomized controlled trial, we aim to establish the effect of HIV self-testing delivery models on FSWs' sexual behaviors in this setting. Clusters of one peer educator and eight participants were 1:1:1 randomized to: (1) direct provision of an HIV self-test, (2) provision of a coupon for facility collection of an HIV self-test, or (3) referral to standard-of-care HIV testing services. Sexual behaviors were self-reported at 1 and 4 months. From October to November 2016, 960 participants were enrolled and randomized. At 4 months, there were no statistically significant differences in participants' sexual behaviors, including inconsistent condom use, across study arms. We do not find any changes in sexual risk-taking among FSWs in response to the delivery of HIV self-tests. Routine policies for HIV self-testing are likely a behaviorally safe component of comprehensive HIV prevention strategies.

Keywords: Condom use; Female sex workers; HIV self-testing; Sexual behaviors; Uganda.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control
  • HIV Infections / psychology*
  • Humans
  • Mass Screening / methods*
  • Serologic Tests / methods*
  • Sex Workers / psychology*
  • Sex Workers / statistics & numerical data*
  • Sexual Behavior / statistics & numerical data*
  • Uganda / epidemiology