HIV self-testing is a powerful tool, particularly if delivered through an approach that meets people where they are. Making self-tests available can promote uptake by offering people privacy, independence, and control as they decide when and where to take an HIV test. By increasing access and empowering individuals, HIV self-testing is an innovative way to help Canada achieve the 95-95-95 targets by 2025. It can also be an opportunity to connect individuals to health care, treatment, and supports.
There are also risks associated with HIV self-testing. Self-testing can be used in a coercive manner (e.g. by someone forcing their partner to take the self-test), a positive HIV test can lead to unexpected legal risks, and there can be implications around disclosure. For example, when a confirmatory test is done anywhere but at a designated anonymous testing site, the person’s name and contact information will be reported to public health authorities. People may then lose control over disclosure of their HIV positive status.
In addition, a positive test (even without laboratory confirmation) can trigger criminal law obligations to disclose one’s HIV positive status. People living with HIV in Canada continue to be charged, prosecuted, and convicted of aggravated sexual assault even when even when (i) there is no allegation of HIV transmission, (ii) there is no intention to transmit, and (iii) the sexual activity in question poses negligible to zero risk of transmission. Black people, Indigenous women, and gay, bisexual, and other men who have sex with men are disproportionately charged and convicted in Canada.
People should understand these implications before they take a test. Failing to provide information about the many consequences of a positive HIV test risks further marginalizing people and communities who are more likely to be criminalized, and/or who may already face many barriers to care and supports.
We can lessen the harms stemming from the risks by taking an approach to HIV self-testing that respects a person’s privacy, independence, and control throughout the testing process and after a positive test result. Supporting a person’s right to make informed choices about who they tell, how, and when can increase their safety and enhance their engagement and retention in care.