TY - BOOK
T1 - Barriers and Facilitators to HIV Self-Testing for Black African Heterosexuals in the UK
AU - Gezehagn, Eden
N1 - Research submitted in partial fulfilment of the requirements for the degree of Doctor in Clinical Psychology (DClinPsy), Royal Holloway, University of London.
Lay Summary
HIV (Human Immunodeficiency Virus) is a virus that attacks the body’s immune system, making it harder to fight infections. If left untreated, it can lead to a serious illness where the body can no longer fight off infections, but with medication, people living with HIV can live long and healthy lives. In the UK, there has been progress in HIV prevention and management through advances in treatment and increased testing efforts. However, Black Africans in the UK are disproportionately overrepresented among those who present to clinics with advanced stages of the disease, increasing the risk of illness. HIV self-testing (HIVST) was introduced in the UK in 2015 as a new testing option, allowing individuals to test and receive indicative results at home, without the need to attend a clinic. This potentially could reduce many known barriers to testing for Black Africans in the UK, including the fear of being judged and concerns about confidentiality, but there has been limited research on how Black Africans in the UK perceive and experience self-testing. This thesis began with a review looking at theories and ideas from psychology that help explain why people do or do not test for HIV. Building on this, a study was carried out interviewing eight Black African adults in the UK to explore their views and experiences of HIVST. The study found that feelings and decisions towards self-testing were shaped by four main influences. First, access and external factors, such as whether people knew about self-testing, its cost, or the availability of kits. Second, cultural beliefs and stigma shaped attitudes, with many describing how HIV was linked to shame or judgment in their communities. These were passed down by families and shaped by messages from the media when they were young. Thirdly, relationships with family, friends and partners had an impact, with these relationships influencing how people thought about testing and HIV generally. Finally, emotional readiness played a role, as early messages about HIV created fear and anxiety that made self-testing feel difficult, even when people recognised its potential benefits. The findings suggest that HIVST can offer privacy and convenience, but many people also want reassurance and emotional support. Services can use these findings to make self-testing more accessible and supportive.
PY - 2025/9/18
Y1 - 2025/9/18
N2 - This thesis begins with a conceptual review of psychological theories relevant to HIV testing behaviours, followed by an empirical study focusing on HIV self-testing (HIVST). HIV testing is central to early diagnosis, treatment, and the prevention of onward transmission. Despite the importance of testing for initiating the HIV continuum of care, individuals delay or avoid HIV testing due to a combination of emotional, psychological and structural factors. The conceptual review evaluated key psychological theories and models applied to HIV testing behaviours, including cognitive models such as the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) and the Common-Sense Model of Self-Regulation, which highlights the role of emotions, such as anxiety and fear, stigma models such as Goffman’s Theory of Stigma, Earnshaw and Chaudoir’s HIV Stigma Model and Hatzenbuehler’s Psychological Mediation Framework (PMF). The Ecological Model was also applied to understand the broader societal and institutional influences on HIV testing. The review concluded that multi-level approaches, including cognitive, emotional, and structural factors, are needed to understand HIV testing. Building on this, the empirical study used a constructivist grounded theory–informed methodology to explore experiences and perceptions of HIVST among eight Black African heterosexual adults in the UK (five women and three men, aged 20–51). Black Africans in the UK are disproportionately affected by HIV, with higher rates of both new diagnoses and late diagnoses compared to other groups. Despite increasing availability of HIVST and home-based testing methods, there is limited understanding of how Black African heterosexual adults in the UK perceive, engage and experience HIVST. The analysis generated eleven theoretical codes, grouped into four interconnected conceptual categories: (1) Structural and External Influences, (2) Cultural Morality and Stigma, (3) Relational and Social Influence, and (4) Emotional Readiness and Internal Conflict. The resulting theoretical model conceptualises HIVST as a social and emotional process which is shaped by multiple layers of direct and indirect interacting influences, including access, knowledge, moral and anticipated stigma and emotional readiness. The findings highlight the need to integrate emotional and social support into HIVST delivery, supported with clear information, culturally relevant resources, as well as accessible testing services, including clinic testing.
AB - This thesis begins with a conceptual review of psychological theories relevant to HIV testing behaviours, followed by an empirical study focusing on HIV self-testing (HIVST). HIV testing is central to early diagnosis, treatment, and the prevention of onward transmission. Despite the importance of testing for initiating the HIV continuum of care, individuals delay or avoid HIV testing due to a combination of emotional, psychological and structural factors. The conceptual review evaluated key psychological theories and models applied to HIV testing behaviours, including cognitive models such as the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) and the Common-Sense Model of Self-Regulation, which highlights the role of emotions, such as anxiety and fear, stigma models such as Goffman’s Theory of Stigma, Earnshaw and Chaudoir’s HIV Stigma Model and Hatzenbuehler’s Psychological Mediation Framework (PMF). The Ecological Model was also applied to understand the broader societal and institutional influences on HIV testing. The review concluded that multi-level approaches, including cognitive, emotional, and structural factors, are needed to understand HIV testing. Building on this, the empirical study used a constructivist grounded theory–informed methodology to explore experiences and perceptions of HIVST among eight Black African heterosexual adults in the UK (five women and three men, aged 20–51). Black Africans in the UK are disproportionately affected by HIV, with higher rates of both new diagnoses and late diagnoses compared to other groups. Despite increasing availability of HIVST and home-based testing methods, there is limited understanding of how Black African heterosexual adults in the UK perceive, engage and experience HIVST. The analysis generated eleven theoretical codes, grouped into four interconnected conceptual categories: (1) Structural and External Influences, (2) Cultural Morality and Stigma, (3) Relational and Social Influence, and (4) Emotional Readiness and Internal Conflict. The resulting theoretical model conceptualises HIVST as a social and emotional process which is shaped by multiple layers of direct and indirect interacting influences, including access, knowledge, moral and anticipated stigma and emotional readiness. The findings highlight the need to integrate emotional and social support into HIVST delivery, supported with clear information, culturally relevant resources, as well as accessible testing services, including clinic testing.
KW - HIV
KW - HIV testing
KW - HIV self-testing
KW - HIVST
KW - Black African communities
KW - Qualitative
KW - Grounded theory
KW - Health psychology
KW - Public healtg
M3 - Doctoral Thesis
PB - Royal Holloway
CY - Egham, Surrey
ER -
