How do we address stigma and increase rates of self-testing for HIV among at-risk groups in Côte D’Ivoire?
A visit to the barbershop could save lives.
According to an estimate from the World Health Organisation only 75 per cent of people living with HIV know they have the virus, a shocking statistic and a serious design challenge.
Attempts to encourage a greater rate of testing in African countries such as Côte D’Ivoire have historically proven difficult. In such nations there can be powerful stigma around the idea of taking a test for HIV and around 80 per cent of men have never been tested, according to the WHO. A new program, funded by USAID, run by Johns Hopkins University’s Centre for Communication Programs and designed by ThinkPlace’s Kenya Studio aims to significantly change that and in doing so offers the prospect of saving lives through early detection and treatment.
As part of a pilot program, 2500 self testing kits have been recently sent to Côte D’Ivoire. These kits will be rolled out in three different regions of the West African nation.
“Many men are not going into the health centres. Somehow you need to bring the test to them. We need to make it as easy as possible for them to be tested. And we need to overcome the fear many men have of finding out whether they have HIV.” – Danielle Naugle, CCP researcher
Such self tests have been available for a short period of time but have not yet had a major impact in places such as Côte D’Ivoire. For ThinkPlace the design challenge was how to deploy this new capability in a way that will have impact in this specific cultural context.
If the trial is successful at raising rates of self testing this will not only improve the number of at-risk men who are being tested, it will also remove strain from the health centres currently carry out testing. The program could then be rolled out across Côte D’Ivoire and other African nations that currently face similar challenges.
How it works
The self-test is simple to administer and – importantly – given some of the cultural barriers around shame and embarrassment with HIV – can be carried out in private.
An individual simply swabs a sample of saliva and then deposits the swab in a solution for 20 minutes. Results are easy to read and function similarly to a home pregnancy test. One line for negative; two lines for a positive test.
What happens next? A critical part of the project is designing processes and interventions to make sure that a positive test leads to that person seeking treatment for HIV.
The design challenge
“The challenge for us as designers was really: ‘How might we best use HIV self-test kits to raise the level of testing amongst high-risk men?” – ThinkPlace Kenya’s Carlyn James.
“And by doing this, increase the amount of HIV+ men in treatment, and also increase the amount of high-risk HIV- men into preventative products and practices”
ThinkPlace and our design partners needed to find a way to motivate the men at highest risk of contracting HIV to accept self-testing as well as figure out how to most effectively get such people access to self-testing kits.
We also wanted to ensure that they were supported before, during and after the testing process so that people who did test positive would respond by initiating medical treatment.
The team spent time in locations where they could interact with potentially high-risk men in a way which made them comfortable.
ThinkPlace conducted research with men in their work environments, in bars and via online dating sites. The process also involved the perspective of health professionals, women who are partners of HIV positive men, female sex workers and even sex therapists to understand the feasibility, effectiveness and potential obstacles of self-testing in the country.
From this, a series of concepts and prototypes were developed which have proven to increase the use of self-test kits.
The pilot project promotes self-testing via barbershops – a key gathering point for men in Côte D’Ivoire, as well as through religious leaders and social media.
It will aim to convince men to undertake an online self-assessment tool that helps to determine their level of risk for contracting HIV.
Those who are assessed as high risk will then be offered a self-testing kit. The kit can be accessed in a variety of ways, through a local pharmacy or health centre or delivered by a peer navigator who can answer any questions and walk them though the process.
Deployed by local NGOs, peer navigators are trained to provide psychological and social support before, during and after HIV testing and the initiation of treatment.
There will also be tools to support men through the process of taking the test, including written instructions, online videos, and access to an HIV hotline, where workers will be trained in how to take a self-test, interpret the results and support men who receive a positive result into beginning treatment.
ThinkPlace designer Juanita Rodriguez says the success of the design lies with its effectiveness in reaching a group of people who have traditionally been extremely difficult to influence on this issue.
“Men who have been skeptical about getting tested, fear knowing their status and have never been tested for HIV, were those who needed a new alternative,” she says.
“The purpose was to introduce a relevant product for them through the right channels and to transform these men into the early adopters of the HIV self-test.”