Exploring HIV Self-Testing: Barriers and Facilitators Among Undergraduate Students in Nairobi, Kenya

Dear Editor,

The article “Exploring HIV Self-Testing: Barriers and Facilitators Among Undergraduate Students in Nairobi, Kenya” by Muendo et al. provides a timely and invaluable contribution to the discourse on HIV prevention and testing strategies, particularly in low- and middle-income countries (LMICs) such as Kenya [1]. We wish to commend the authors for their thorough exploration of HIV self-testing (HIVST) among a key demographic — undergraduate students — who are both at risk and highly influential in shaping societal norms around health practices.

The findings that fear of positive results and stigma remain significant barriers to HIVST resonate deeply with broader challenges faced in LMICs, where cultural perceptions and limited access to confidential testing options often hinder effective prevention efforts [1, 2]. The emphasis on media-driven initiatives, such as the “Chukua Selfie” campaign, is particularly noteworthy, underscoring the transformative potential of targeted public health campaigns in raising awareness and normalizing self-testing practices.

Of special interest is the study’s revelation that a substantial proportion of participants demonstrated significant HIV knowledge and awareness of pre-exposure prophylaxis (PrEP). This contrasts with findings in other regions and highlights the importance of context-specific interventions [3, 4]. It also underscores the role that academic institutions can play in fostering awareness and promoting health-seeking behaviors among young people. Integrating HIVST into school-based prevention programs, as suggested, is an actionable strategy that could be replicated in other LMICs to bridge gaps in testing and care.

This discussion parallels the growing recognition of school-based initiatives to promote HPV vaccination in LMICs [5, 6]. Just as HIVST campaigns can destigmatize testing and enhance accessibility, HPV vaccination programs can benefit from early and consistent engagement with young populations, leveraging trusted institutions like schools to disseminate accurate information and normalize preventive health measures. Both interventions aim to reduce stigma, improve accessibility, and address misconceptions, ultimately enhancing health outcomes and advancing public health goals [5-7].

The article’s call for destigmatizing HIV and ensuring privacy in testing aligns with global health priorities and should inspire stakeholders to strengthen community-based interventions [1]. Moreover, addressing misconceptions through evidence-based education can further empower young individuals to embrace HIVST as a critical step toward safeguarding their health and that of their communities [8].

In conclusion, this study’s insights are not only relevant to Kenya but also hold broader implications for other LMICs grappling with similar challenges in HIV prevention. The authors’ work serves as a clarion call for collaborative efforts between governments, academic institutions, and public health organizations to optimize HIVST programs. Drawing lessons from successful school-based HPV vaccination campaigns, stakeholders can work toward integrating and normalizing preventive health measures, thereby accelerating progress toward global HIV and HPV-related health targets.

References

1. Muendo NK, Thigiti J, Tembu O, Mohamed A, Audi S, Karanja M. Exploring HIV Self-Testing: Barriers and Facilitators Among Undergraduate Students in Nairobi, Kenya. Annals of Family Medicine. 2024;22(6):502-8.
2. Madiba S, Ralebona E, Lowane M. Perceived stigma as a contextual barrier to early uptake of HIV testing, treatment initiation, and disclosure; the case of patients admitted with AIDS-related illness in a rural hospital in South Africa. Healthcare 2021; 9 (8): 962.
3. Shamu S, Shamu P, Khupakonke S, Farirai T, Chidarikire T, Guloba G, Nkhwashu N. Pre-exposure prophylaxis (PrEP) awareness, attitudes and uptake willingness among young people: gender differences and associated factors in two South African districts. Global Health Action. 2021;14(1):1886455.
4. Vega-Ramirez H, Torres TS, Guillen-Diaz C, et al. Awareness, knowledge, and attitudes related to HIV pre-exposure prophylaxis and other prevention strategies among physicians from Brazil and Mexico: cross-sectional web-based survey. BMC Health Services Research. 2022;22(1):532.
5. Afroze L, Rahman MS. Community-based interventions to reduce cervical cancer in low-and middle-income countries: a call to action. International Journal of Gynecologic Cancer 2024:ijgc-2024.
6. Rahman M, GÜLTEKİN M, Lassi Z. Effective approaches towards eliminating cervical cancer from low-and middle-income countries amid COVID-19 pandemic. International Journal of Gynecological Cancer. 2020;30(11): 1848-1849.
7. Petersen Z, Jaca A, Ginindza TG, et al. Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Women's Health 2022;22:486.
8. Sambayi GL, Bwire GM, Kilapilo MS, Myemba DT, Mosha IH, Kilonzi M, Magati RB, Amour M, Mwakalukwa R, Mangara AN, Bakari M. Barriers and Enablers to Retention in HIV Care and Adherence to Antiretroviral Therapy: Evidence from Dar es Salaam, Tanzania. HIV/AIDS-Research and Palliative Care. 2024:301-11.