Theme one indicated that men experienced a lack of sufficient information on HIVST. Their perceived knowledge was poor, with less than half of the participants knowing the details of the HIVST. Responses from study participants indicated that they were drawing a conclusion on HIVST based on the name of the test process that implies one has to test themselves to obtain an HIV result. Participants’ responses indicated that they had insufficient understanding of HIVST. From their responses, the subtheme that health care institutions were severely lacking in information, education, and communication (IEC) materials, and other resources concerning HIVST emerged. The participant responses indicated that they were not informed about HIVST on their visits to health care institutions for routine healthcare.
The perceived knowledge of HIV self-testing varied by age group. Younger men were interested in trying out a new test that they described as a comfortable option:
I would definitely try out this test as I think it is comfortable. There is no harm associated with the collection of blood or finger-prick as with current tests available at health facilities. (18-year-old, does not know HIV serostatus).
At the individual level, perceived knowledge of HIV self-testing was mainly obtained from reading the local newspaper and included general information on specimen type and how long one would need to wait for results:
I read about it [HIV self-testing] in the newspaper some time back. They say it can work even on saliva and gives results in ten minutes. (25-year-old, does not know HIV serostatus).
From theme two, it was uncovered that some men were indifferent to HIVST. They were not interested in adopting it or knowing their HIV status. Interestingly, a subtheme emerged indicating that some men saw HIV testing as a woman’s responsibility. They indicated that they would infer their HIV status from their spouse or partner’s status:
I have never tested for HIV my whole life. But I am still healthy. I won’t say that I will not try HIV self-testing, but I also am not sure I will try it…. (29-year-old, does not know HIV serostatus).
……I know my wife will get tested. If she comes [with a] negative [HIV result], then I know I am negative. My wife is as good as me. If she is [HIV] negative then so am I. (27-year-old, does not know HIV serostatus).
From theme three, it emerged that most male youths perceived cost as the main barrier to HIVST but that, if it were offered free of charge, they were willing to adopt it. Men who were willing to adopt HIVST cited reasons such as confidentiality, convenience, fear of stigma, and privacy as reasons for acceptability of HIVST.
You know Rwanda is very small. If you go to the health center even to the big hospitals, you are most likely going to find someone you know working in those clinics. For some of us we even went to school with the staff there or they know our brothers and sisters. Self-testing will allow me to avoid all those people and just test when at home. I will use it. I like it. I just hope it will be offered for free maybe at places like condom kiosks (25-year-old, does not know HIV serostatus)
Theme four indicated that most men willing to adopt HIVST were concerned about the potential social harm and possible adverse events associated with HIVST. Men expressed concern over the perceived social harm associated with the lack of immediate post-test counseling.
…there are a lot; depression, if I tested myself and I find I am HIV positive, it will take me time to mention this to everyone around me, and this will lead to depression and even to suicide. I think that can be a harmful impact of this test. (27-year-old, does not know HIV serostatus).
The worse thing that would happen is to cause someone to have trauma, kill him/herself once you find out that you are HIV positive. …. For [HIV] self-testing because there is nobody behind you, [this] would be the reason, and [at] the clinic, [this] would happen rarely because it [HIV testing] is followed by counseling and other guidance that helps you to accept yourself and ways to get medicine. (30-year-old, does not know HIV serostatus).