Factors associated with a reactive HIV blood self-test result among female sex workers and men who have sex with men in Yaoundé and Douala, Cameroon: a cross-sectional study
This cross-sectional study of female sex workers and men who have sex with men in Yaoundé and Douala, Cameroon, found that reactive HIV self-test results were frequent (23.3% overall) and significantly associated with location (higher in Yaoundé), lower education levels, STI symptoms, and a higher number of sexual partners, highlighting the need for geographically targeted and differentiated prevention strategies.
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In many parts of the world, the fight against HIV has shifted from a broad, general approach to one that targets specific groups of people who face the highest risks. Among these groups are men who have sex with men and women who exchange sex for money. In countries where these activities are illegal, the fear of arrest or social shame often keeps these individuals away from standard health clinics, leaving many unaware of their infection status. To bridge this gap, health workers have turned to HIV self-testing. This method allows a person to collect their own blood sample, perform a test in private, and read the result without ever stepping foot in a hospital. While a positive result from such a test is not a final diagnosis—it requires a follow-up visit to a clinic for confirmation—it serves as a crucial first step to bring hidden infections into the light. Understanding who is most likely to test positive with these kits helps health officials decide where to send resources and how to design better support systems.
In Cameroon, researchers recently set out to understand the patterns behind these self-test results among two key groups: female sex workers and men who have sex with men. The study took place in the country's two largest cities, Yaoundé and Douala, between late 2021 and mid-2022. The team recruited nearly eight hundred participants from community groups that already support these populations. Each person was given a blood-based self-test kit to use on their own, with a trained observer nearby to ensure the process was done correctly and to provide immediate counseling. After the test, the participants answered questions about their lives, their health history, and their behaviors. The goal was not just to count how many people tested positive, but to find out what factors made a positive result more or less likely.
The results revealed a striking picture. Overall, nearly one in four participants received a reactive result, meaning the self-test indicated the presence of HIV. This rate was almost identical for both groups: about 23 percent of the women and 23 percent of the men. However, the location where a person was tested mattered more than anything else. In Yaoundé, the capital city, the rate of reactive tests was more than three times higher than in Douala. In Yaoundé, nearly 38 percent of participants tested positive, while in Douala, the figure was just over 12 percent. This massive difference suggests that the spread of the virus is not uniform across the country but is concentrated in specific local areas, likely due to differences in how the epidemic has taken hold in each city.
When the researchers looked closer at the women, they found that education played a major role. Women who had never attended school were far more likely to have a reactive test than those who had completed primary, secondary, or higher education. The lack of schooling appeared to be a stronger predictor of infection than many other factors. Additionally, women who reported symptoms of sexually transmitted infections in the six months before the study were much more likely to test positive. Surprisingly, for this group, how often they used condoms or how many partners they had did not show a clear link to the test results in the final analysis.
For the men, the story was slightly different. Like the women, men in Douala were less likely to test positive than those in Yaoundé. Among the men, having a secondary education was linked to a lower chance of a reactive result. The number of sexual partners a man had over the previous six months was also significant; for every additional partner, the likelihood of a positive test increased slightly. Interestingly, men who reported drinking alcohol were less likely to have a reactive test than those who did not, though the researchers noted this finding was unexpected and might be due to complex social factors rather than alcohol itself offering protection. Other common factors, such as the use of drugs or the frequency of condom use, did not show a clear connection to the test results for this group.
The study highlights that while self-testing is a powerful tool for reaching people who avoid clinics, the results point to deep structural issues. The high concentration of infections in Yaoundé suggests that prevention efforts need to be tailored to specific cities rather than treating the whole country the same. For women, the strong link to a lack of education implies that health programs might need to go beyond simple medical advice and address broader social needs, such as literacy and economic opportunities. For men, the connection to the number of partners suggests that those with many partners are a priority group for prevention services. The researchers emphasize that because these tests are just a first step, the ultimate goal is to ensure that everyone with a reactive result gets the confirmatory testing and medical care they need. By understanding these local patterns and specific risk factors, health officials can better direct their efforts to where they are needed most.
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