Stigma, privacy concerns, sexual behaviors, and testing history shape willingness to use HIV self-testing among African refugee male sex workers in Italy – A mixed method study - BGSH-023

Stigma, privacy concerns, sexual behaviors, and testing history shape willingness to use HIV self-testing among African refugee male sex workers in Italy – A mixed method study - BGSH-023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Stigma, privacy concerns, sexual behaviors, and testing history shape willingness to use HIV self-testing among African refugee male sex workers in Italy – A mixed method study - BGSH-023 Gamji Rabiu Abu-Ba’are, Henry Delali Dakpui, Mubarik Sena Saaka, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6421791/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Marginalized populations such as African refugee male sex workers (ARMSWs) in Italy face systemic barriers to HIV testing, including stigma, privacy concerns, and structural inequities. Despite the potential of HIV self-testing (HIVST) to overcome these barriers, limited research exists on its acceptability among ARMSWs. This study examines HIVST willingness and associated factors among ARMSWs to inform targeted interventions A mixed-methods sequential exploratory design was employed, combining quantitative surveys (n = 150) with qualitative interviews (20 in-depth interviews, 2 focus group discussions) among ARMSWs in Italy. Participants were recruited through venue-based and snowball sampling in partnership with a community organization. Quantitative findings revealed moderate willingness (44.4%) to use HIVST, driven by convenience (47.1%), privacy (23.5%), and stigma avoidance. Key barriers included concerns about test accuracy (27.0%), emotional distress from positive results (20.9%), and limited kit access (32.2%). Qualitative insights emphasized occupational relevance, empowerment, and fears of community stigma if seen with kits. Multivariate analysis identified religious affiliation (aOR = 78.27), health insurance (aOR = 14.56), prior HIV testing (aOR = 20.37), HIVST awareness (aOR = 3.24), and HIVST prior usage (aOR = 4.12) as significant predictors of willingness. Structural challenges, such as immigration-related healthcare barriers, amplified interest in HIVST as a discreet alternative. The study calls for community-driven interventions addressing accuracy concerns, subsidized access, and psychosocial support. Integration of HIVST with peer-led education and linkage-to-care services could enhance uptake. Policymakers should prioritize stigma reduction and equitable distribution strategies to align with global HIV targets for marginalized populations. Infectious Diseases Sociology Marginalized populations HIV self testing African Immigrant Sex workers HIV INTRODUCTION Despite global advancements in HIV prevention and care, testing uptake remains suboptimal among some of the most marginalized populations, including migrants, refugees, men who have sex with men (MSM), sex workers (SW), and racial minorities. (UNAIDS, 2024). These groups experience significant barriers to HIV testing, treatment, and care due to a combination of legal, financial, and social constraints. Migrants and refugees often face restrictive healthcare policies and economic hardship that limit access to HIV testing services. (Ekerin et al., 2024; Ndumbi et al., 2018). While MSM and SWs experience heightened stigma and discrimination that deter them from seeking HIV testing (Babel et al., 2021; Schweitzer et al., 2023), racial minorities experience structural inequalities, including systemic racism in healthcare settings, further limiting their access to HIV testing services (Pattillo et al., 2023). Understanding how these barriers intersect is crucial for designing targeted interventions that improve HIV testing uptake across diverse populations. Immigrants and refugees from Sub-Saharan Africa (SSA) in Europe, particularly MSMs and SWs, have heightened vulnerability to HIV, mirroring that of SSA (Hessou et al., 2019). Due to intersecting structural, social, and economic barriers, many experience severe marginalization, stigma, and discrimination, which limit their access to essential healthcare services, including HIV prevention and testing (Brandenberger et al., 2019; Nakakawa et al., 2025; Zigah et al., 2023a). For migrants, fear of deportation further discourages engagement with healthcare systems (Galanis et al., 2022; Mona et al., 2021a). Additional obstacles include language barriers, financial hardship, and the lack of culturally competent providers (Puthoopparambil et al., 2021). For SWs in particular, societal and internalized stigma suppress interest in routine HIV testing, leading to undiagnosed infections and ongoing transmission (Reeves et al., 2017; Weitzer, 2018) Although male sex work has existed throughout history (Kaye, 2014), it has rarely been the focus of HIV research in Europe due to the prioritization of female sex workers (FSWs) in research and intervention efforts. There is well-documented information on FSWs' HIV prevalence and their experience due to gendered policy approaches to sex work, and the greater visibility of FSW networks. (Giomi et al., 2022; Platt et al., 2013; Segala et al., 2024; Trani et al., 2006). As a result, male sex workers (MSWs), particularly those from refugee and immigrant backgrounds, have been largely overlooked despite their documented vulnerability to HIV and other sexually transmitted infections (STIs) (Brandenberger et al., 2019; Ekerin et al., 2024; Pattillo et al., 2023; Segala et al., 2024). The limitations extend to social policies and intervention programs, creating a significant gap in understanding the unique challenges faced by African immigrant and refugee male sex workers (ARMSWs). This research gap limits the development of tailored interventions that address the specific barriers RMSWs encounter, such as stigma, legal restrictions, and lack of targeted healthcare services. Without focused research on their experiences, policies and programs risk being ineffective or exclusionary, further marginalizing this population within the broader HIV prevention and care landscape. HIV testing services are essential for managing Italy's HIV epidemic (Galli et al., 2020). (Scognamiglio et al., 2018; WHO, 2012). In Italy, most testing occurs through client-initiated approaches, where individuals seek testing at healthcare facilities, community centers, or outreach programs as well as through provider-initiated testing in clinical settings, where healthcare professionals routinely recommend tests, especially for patients with conditions associated with higher HIV vulnerability (European Centre for Disease Prevention and Control, 2023; Galli et al., 2025; Scognamiglio et al., 2018). Yet, barriers persist: stigma, fear of discrimination, confidentiality concerns, low awareness of testing options, apprehension about a positive result, and limited access, particularly among undocumented migrants, refugees, and marginalized groups, keep many unaware of their HIV status (Alvarez-del Arco et al., 2014; Deblonde et al., 2010; den Daas et al., 2016; Fakoya et al., 2017; Lagi et al., 2023; Mirandola et al., 2017). Moreover, research indicates that many MSWs in Italy engage in transactional sex under risky conditions, often with little ability to negotiate safe practices due to economic necessity and power imbalances between the MSWs and their clients (Scott et al., 2021). Criminalization and policing further force these men into hidden networks, restricting their access to HIV prevention and treatment services (UNAIDS, 2022). Despite the availability of services, low awareness and limited willingness to undergo routine testing remain significant challenges, as global studies consistently highlight substantial barriers to HIV testing and care for this population (Baral et al., 2012; Dada et al., 2024; Dakpui et al., 2024; Gallego et al., 2022; Rodriguez-Rincon et al., 2020; Shamrock et al., 2023; Zigah et al., 2023b) Given these persistent barriers, alternative testing strategies such as the HIV self-testing (HIVST) remain essential in improving HIV testing among RMSWs in Italy. HIVST has proven promising in expanding testing access, particularly among populations facing entrenched healthcare disparities(Abu-Ba’are, Shamrock, et al., 2024; Figueroa et al., 2018; Jamil, Guy, et al., 2017; Jamil, Prestage, et al., 2017; Wang et al., 2018). HIVST allows individuals to test privately, addressing concerns related to stigma, discrimination, and confidentiality breaches (World Health Organization, 2016). Recognizing its potential, the WHO strongly recommends HIVST as a key strategy for increasing diagnosis rates, and Italy approved its use in 2016 (Pittalis et al., 2017; World Health Organization, 2016). The current study. Despite the growing recognition of HIVST’s potential, little is known about the willingness to use (WTU) HIVST among SSA RMSWs in Italy. Studies on other key populations, including MSMs and female sex workers, have shown that WTU HIVST is often influenced by stigma, privacy concerns, and previous experiences with healthcare discrimination (Boisvert Moreau et al., 2022a; Dirisu et al., 2020; Lippman et al., 2018; Shava, Manyake, Mdluli, Maribe, Monnapula, Nkomo, Mosepele, Moyo, Mmalane, & Bärnighausen, 2020). These findings suggest that similar factors may shape the willingness of RMSWs to engage in self-testing, yet no research has specifically examined this population in the Italian context. Studying this group in Italy is particularly relevant given the country’s role as a major entry point for SSA migrants and refugees into Europe, as well as the structural challenges they face in accessing healthcare services. The intersection of migration policies, legal barriers, and social exclusion uniquely shapes the healthcare experiences of RMSWs, necessitating targeted research to understand their HIV testing behaviors and inform effective interventions. To address these gaps, we employed a mixed-methods approach to measure associations between key factors and WTU HIVST, as well as the lived experiences and perceptions that influence the WTU HIVST among RMSWs in Italy. Our specific research questions are: 1) Are African RMSWs in Italy willing to use HIVST? and 2) What factors are associated with WTU to use HIVST among African RMSWs in Italy. The insights gained can help inform targeted interventions, such as community-based HIVST distribution, peer-led support programs, and policy recommendations aimed at reducing stigma and improving access to testing within this population. Theoretical framework : This study is guided by the Health Belief Model (HBM), a widely used framework for understanding health behaviors(Alizade et al., 2021; Appau et al., 2024; Seif et al., 2025). The HBM is a psychological framework used to explain and predict health behaviors by examining individuals' beliefs about health risks and the benefits of preventive actions. (Green et al., 2020; Jones et al., 2015). It consists of six key constructs: perceived susceptibility (belief about the risk of contracting a disease), perceived severity (belief about the seriousness of the condition and its consequences), perceived benefits (belief in the effectiveness of a health behavior), perceived barriers (obstacles preventing action), cues to action (triggers that encourage behavior change), and self-efficacy (confidence in one's ability to perform the behavior)(Green et al., 2020). In the context of HIVST, the HBM helps us understand how risk perception, stigma, access barriers, and personal agency shape WTU self-testing, offering insights into how interventions can be designed to improve uptake among vulnerable populations. Based on the model, we posit that individuals' willingness to engage in health-related behaviors, such as HIVST, is influenced by their perceptions of disease susceptibility (e.g., HIV). The severity of its consequences, the perceived benefits of an action, and potential barriers to engagement. METHODOLOGY Research Design We employed a mixed-method sequential exploratory design, integrating qualitative and quantitative approaches to comprehensively examine WTU HIVST among African RMSWs in Italy. The qualitative component provided in-depth insights into individual perceptions and decision-making processes regarding the use of HIVST, while the quantitative component allowed us to analyze descriptive statistics and predictors of WTU HIVST. By combining these methods, we strengthened the study by offering a more comprehensive understanding of the barriers and facilitators affecting HIVST uptake among RMSWs. Participants and Setting We conducted this study in collaboration with Circolo Pink (Pink Refugees), a community-based human services nonprofit with established access to the target population in Italy. Data collection took place in safe and accessible locations within their office spaces in Verona and a sister institution in Turin, Northern Italy. To be eligible for the study, participants had to meet the following inclusion criteria: (1) be a refugee from the SSA region, (2) currently reside in Italy, (3) be at least 18 years old, (4) speak and understand English or Italian fluently, (5) self-identify as a sex worker, and (6) have engaged in sex work within the past six months. Data Collection Procedures Process. In the qualitative phase, we conducted 20 in-depth interviews (IDIs) and two focus group discussions (FGDs) with African RMSWs to explore their experiences, barriers, and facilitators related to HIV testing and WTU HIVST. Based on insights from these interviews, we developed and administered a structured survey to 150 RMSWs to assess the generalizability of the qualitative findings on WTU HIVST. We used RedCap, a secure mobile survey platform, to collect quantitative data, while all FGDs and IDIs were conducted in person at Pink Refugees and its sister location, audio-recorded (with consent), and supplemented by detailed field notes. Given the hidden nature of RMSWs, we employed a venue-based and snowball recruitment strategy through Pink Refugees. Two peer-research assistants, who were also RMSWs, facilitated recruitment by identifying and engaging their peers during weekly meetings at Pink Refugees. Additional participants were recruited through referrals from FGD participants for IDIs and online surveys. Nature of Questions. The primary outcome of this study was WTU HIVST, assessed through both qualitative and quantitative methods. For the qualitative assessment, we used a semi-structured interview guide to explore themes related to HIV testing behaviors, prior experiences, and WTU HIVST. Participants viewed a short demonstration video of the OraQuick HIV self-test, after which we asked: "Would you be willing to use an HIV self-testing kit in the future?" "What factors would influence your decision to use or not use HIVST?" Participants also responded to open-ended questions about their perceptions of HIVST, previous testing experiences, and potential facilitators or barriers to self-testing. For the quantitative survey, we assessed WTU HIVST using structured questions. Participants first received a brief description of the HIV self-test: " The Oral HIV self-test is a convenient method that allows individuals to perform the test themselves using oral saliva. It eliminates the need for laboratory equipment and can be conducted at home or any preferred location. However, if the test result is positive, confirmation through additional testing at a healthcare facility is necessary for appropriate guidance and further steps." Following this, we measured WTU HIVST using the question: "Would you be willing to use an HIV self-testing kit in the future?" (Response options: Yes/No). We assessed WTU HIVST as the primary outcome, coded as a binary variable (1 = Yes, 0 = No). Key independent variables included socio-demographic factors (age, education, marital status, religious affiliation), healthcare access and testing behavior (health insurance status, prior HIV/STI testing, experiences of stigma), and sex work-related characteristics (client volume, condom use, engagement in transactional condomless sex). Variables were coded as categorical or binary, as detailed in Table 1. Table 1: Descriptions of measurements Variable Description Coding Primary Outcomes WTU HIVST Willing to use HIVST in the future 1 = Yes, 0 = No Socio-Demographic & Structural Factors Age Participant's age 0 = 18-24, 1 = 25+ Gender Identity Self-identified gender 1 = Man 2 = Transgender 3 = non-binary Education Highest level of education completed 1 = Primary or less 2 = Secondary or more Marital Status Current marital status 0 = Unmarried 1 = Married Number of Children Number of children 0 = No children 1= One or more children Religious Affiliation Whether participant belongs to any religion 0 = No religion 1 = Belong to a religion Rank of Religiosity How religious the participant is 0 = Not religious 1 = Religious Length of Stay in Italy How long participant has been in Italy 0 = A year or less 1 = More than a year Sexual Orientation Participant’s sexual orientation 0 = Gay 1 = Bisexual Sex role Sexual role preference 0 = Top 1 = Bottom 2= Versatile (Verse) Employment Beyond Sex Work Any other job apart from sex work 0 = No 1 = Yes Healthcare Access & Testing Behavior Distance to Healthcare Facility (Km) Distance in kilometers 0 = 1 – 5km 1 = 6km or more Healthcare frequency Frequency of accessing healthcare 0 = Never 1 = Have ever Health Insurance status Covered by health insurance 0 = No 1 = Yes Immigration challenge in healthcare access Encountered difficulties in access healthcare due to immigration status 0 = No 1 = Yes Experienced stigma or discrimination at the hospital Experienced stigma or discrimination at the hospital 0 = No 1 = Yes Awareness of testing facilities Do you know where to go for STI/HIV testing and care? 0 = No 1 = Yes Tested for STI Ever tested for any STI 0 = Never tested 1 = Ever tested Tested for HIV Ever tested for HIV 0 = Never tested 1 = Ever tested HIV test frequency Frequency of HIV testing 0 = Once a year or less 1 = More than once a year HIV test result Self-reported HIV test result 0 = Negative 1 = Positive Awareness of HIVST Ever heard of HIV self-testing 0 = No 1 = Yes Ever used HIVST Used an HIV self-test before 0 = No 1 = Yes Sex Work-Related Factors Venue for meeting client Where participants find clients 0 = Offline 1 = Online No. of client in past 2month (Men) Number of male clients in the past 2 months 0 = Less than 20 1 = 20 or more No. of client in past 2 month (Women) Number of female clients in the past 2 months 0 = Less than 10 1 = 10 or more Vaginal sex Engaged in vaginal sex 0 = No 1 = Yes Condom use for vaginal sex Consistency of condom use for vaginal sex 0 = Sometimes/Never 1 = Always Anal sex Engaged in anal sex 0 = No 1 = Yes Condom use for anal sex Consistency of condom use for anal sex 0 = Sometimes/Never 1 = Always Lubricant use for anal sex Consistency of lubricant use for anal sex 0 = Sometimes/Never 1 = Always Transactional condomless sex Engaged in unprotected transactional sex 0 = No 1 = Yes Data Analysis We used descriptive statistics to summarize the socio-demographic characteristics of respondents, reporting categorical variables as frequencies and percentages, and continuous variables as means with standard deviations or medians with interquartile ranges. To analyze WTU HIVST, we dichotomized responses as 1 (willing to use) and 0 (not willing to use). We first conducted chi-square analyses to examine associations between WTU HIVST, and independent variables. Variables showing statistical significance (p < 0.05) in chi-square analysis were included in a multiple logistic regression model to explore their relationship with WTU HIVST. Statistical significance was set at p < 0.05. For qualitative data, we transcribed IDIs and FGDs verbatim and analyzed them using a summative content analysis process. To ensure interrater reliability, two independent researchers reviewed each transcript, summarized recurring themes related to HIVST acceptability and willingness, and wrote independent summaries. The researchers then met to consolidate their independent summaries into a single summary for each transcript, ensuring all salient themes were captured and discrepancies addressed through discussion. The lead author then reviewed each summary, categorized key themes, and iteratively refined them by revisiting transcripts. The final themes were organized based on our research questions to provide context for the quantitative findings. Ethical Approval This study received ethics approval from the National Ethics Committee for Clinical Trials, Italian Ministry of Health, number AOO-ISS - 04/07/2023 - 0031228. We obtained written informed consent from all participants prior to data collection and adhered to Italy’s requirements for anonymous data transfer and use for vulnerable groups. Written informed consent was sort from all IDI and FGD participants before data collection commenced. Participation in the survey was voluntary, and informed consent was implied through the completion and submission of the survey after participants reviewed an online information sheet outlining the study's purpose, confidentiality, and their rights. RESULTS Sociodemographic Characteristics of Respondents A total of 150 male sex workers participated in the study. The mean age was 30.6 years (SD = 5.9), with the average age at which they commenced sex work being 23.3 years (SD = 4.6). The majority (96.67%) identified as men, while the remaining 3.3% identified as others or non-binary. More than half (57.33%) were single, while 35.33% were married to females. Educational attainment varied, with 49% having completed senior high school or vocational training, 26% having tertiary education, and 4.67% having no formal education. Most participants (87.33%) were refugees, and 57.33% originated from Nigeria. In addition to the survey, 35 ARMSWs participated in the qualitative phase of the study. Participants in the IDIs had an average age of 28 years, while the 15 participants in the FGDs had an average age of 32.1 years. Participants were primarily from Nigeria and Cameroon, with a few from Côte d'Ivoire Objective 1: Are ARMSWs in Italy willing to use HIVST? A significant proportion (44.4%, n = 51) expressed WTU an HIVST kit in the future. The most common reasons included convenience and privacy (n = 24, 47.06%), avoidance of stigma and discrimination at healthcare facilities (n=12, 23.53%), concern about potential HIV exposure (n = 6, 11.76%), and ease of use (n=8, 15.69%). Table 2: Willingness to Use HIVST among ARMSWs Variable Frequency (n) Percentage (%) Would you be willing to use an HIV self-testing kit in the future? (n=115) Yes 51 44.40 No 64 55.60 What are the reasons you would consider using an HIV self-testing kit in the future? (51) It's convenient and private 24 47.06 Worried about potential HIV exposure 6 11.76 I want to avoid stigma and discrimination at hospitals/clinics 12 23.53 It's easy to use 8 15.69 I can't easily go to the hospital 8 15.69 Qualitative findings on WTU HIVST Participants in both IDIs and FGDs expressed strong interest in HIVST, highlighting various factors that influenced their WTU the test. These factors included convenience, privacy, occupational safety, perceived effectiveness, and a sense of empowerment over their health. Convenience and Accessibility. One of the most frequently cited reasons for WTU HIVST was its convenience, as it will allow ARMSWs to test at any time and in any location of their choice. Many participants noted that the ability to conduct an HIV test independently, without visiting a hospital or clinic, was highly beneficial. Participants from FGDs emphasized the time-saving aspect of HIVST: "It’s fast, and you can do it anytime." (FGD) "It saves transportation costs, but hospital tests are free." (FGD) Among the ARMSWs, the ability to conduct an immediate test before engaging with clients was considered an important protective measure by some participants: "For some situations, like if you’re a sex worker and a client asks for unprotected sex, you can use the test to check. It’s good for business and provides privacy." (FGD) Participants in IDIs also echoed similar sentiments, particularly regarding the speed and simplicity of the test: "Hmm, I think that is a good development for people who don't have time to go to the hospital, and it can be done at any time. And also, you can do it even before sex with anyone." (IDI) "It’s very simple and it’s done within less than 30 minutes, so the urge can wait for 30 minutes and you run this test and you confirm what you have to do." (IDI) "I wish I could have one right now to test myself and see my results." (IDI) Privacy and Confidentiality. The ability to conduct an HIV test privately was a key facilitator of willingness for some participants. Many ARMSWs noted that going to a hospital for an HIV test often meant exposing themselves to social scrutiny, which discouraged testing. HIVST, by contrast, offered a discreet and stigma-free alternative where they can test at home, see results in private without seeing any unwanted persons: "I think it’s easy to use and gives you confidence to run the test at home." (FGD). "Yes, because I will test myself and see my result again alone myself without meeting strange faces every day." (IDI). "And in our home so we can have this, and this will help to reduce the rate of HIV." (IDI) Several participants from FGDs acknowledged that hospital visits were often stressful and could expose them to judgment from others: "I like that it can be done in private; sometimes going to the hospital is stressful, and people might see you there." (FGD) Occupational Relevance and Safety. ARMSWs in both IDIs and FGDs recognized HIVST as a valuable tool for managing their health and ensuring safety in their profession. Several emphasized the importance of frequent self-testing due to the nature of their work: "As a sex worker who travels a lot, I need the kit to be safe for myself and my clients. Every three months, I check myself to know whether to continue or take care of myself." (FGD) "And we can even use it to test on our clients." (IDI) Some participants viewed HIVST as an essential tool for all sex workers, with one IDI participant stating: "This can be owned by every sex worker that is going around… every sex worker that really wants to do sex working and is interested in a life like this traffic client, should have this sex working kit." (IDI). Similarly, an FGD participant emphasized the unpredictability of client interactions, highlighting the need for accessible self-testing: "It’s useful for those of us who meet different clients. You don’t know who has what." (FGD) Perceived Effectiveness and Ease of Use. After seeing HIVST demonstration video, the RMSWs responded positively to the demonstration video, noting that HIVST appeared easy to use and required minimal effort: "From what you are saying now, it doesn’t take much time and isn’t complicated." (FGD) "I like that you don’t need to go to the hospital to do it. You can just do it and know your status." (FGD) Others expressed enthusiasm about its modernized approach, stating that it could significantly improve HIV testing uptake: "It’s very modernized… And in our home so we can have this, and this will help to reduce the rate of HIV." (IDI) "I’m so happy about the team, the communication, the project, and the HIV test itself. It’s so easy to use, and I love that." (IDI) Empowerment and Control Over Health. A sense of personal responsibility and empowerment was also a driving factor in WTU HIVST. Participants saw the test as a way to take control of their own health and make informed decisions: "It’s important to know your status so you can take action." (FGD) "I really need it; it’s very, very important." (IDI) "I’m willing to try it. I’ve never seen this type of test before, and I’m curious." (FGD) "If I have the opportunity to test myself, I will." (FGD) Others noted that their diverse sexual networks made frequent testing a necessity rather than an option: "I work with both men and women—so I can’t say I don’t need it." (IDI) "I’m really happy about it. It’s very good, and I love it." (IDI) Concerns and barriers to HIVST among ARMSWs. The primary barriers to HIVST adoption included difficulty obtaining self-testing kits (32.2%), concerns about the accuracy of self-testing (27%), fear of receiving a positive result without immediate support (21%), and lack of knowledge about HIVST (10%). A smaller proportion (7%) preferred traditional hospital-based HIV testing. Despite these concerns, 20% of respondents indicated that nothing would stop them from using an HIVST kit. Table 3: Barriers to HIVST uptake Variable (n=115) Frequency (n) Percentage (%) What might stop you from using an HIV self-testing kit? Nothing stops me 23 20.00 Worries about how accurate self-testing is 31 26.96 Not easily getting a self-testing kit 37 32.17 Afraid of getting a positive result without support 24 20.87 I don't know enough about self-testing 12 10.43 I Prefer testing at the hospital 8 6.96 Qualitative findings on Barriers to HIVST uptake Qualitative findings revealed similar concerned including fear of the result, concerns about accuracy, stigma associated with being seen with an HIVST kit and the assumption that one is HIV-positive, cost concerns and lack of awareness Fear of the Test Result and Emotional Distress. A recurring concern among participants was the emotional impact of receiving an HIV-positive result, particularly when testing alone. Many worried about the lack of immediate support and feared the psychological toll of knowing their status: "My concern is that in the hospital, if you test positive, they support you. At home, you might harm yourself if you’re alone." (FGD) "I’m scared of the result." (FGD) "Some people are afraid of doing the test because if they find out they are positive, they might commit suicide." (FGD) Several participants from IDIs echoed this fear, with one stating : "If I do this test alone and I see a bad result, I don’t know how I will react. I might break down." (IDI) Another participant reflected on the psychological burden of uncertainty while waiting for results: "What will come to your mind while waiting for the result?" "I’d have doubts about whether it’s positive or negative." (FGD). For some, avoiding testing altogether was a way to avoid distress : "If I don’t check, I won’t have to worry about it." (IDI) Concerns About Accuracy and Need for Confirmation. Participants expressed skepticism about whether a saliva-based test could be as reliable as traditional blood tests. Several questioned whether HIVST was truly accurate: "I see it as a good innovation, but I’m still not clear. I think I’ll do more research on how it functions. We’ve always known that tests require blood samples, so I’m a bit confused." (FGD) "It’s strange to get a result from a test with just saliva." (FGD "In the hospital, if you test positive, they will tell you what to do. But if I do this test at home and see a positive result, I might not know what steps to take." (FGD) Similarly, some participants feared that false positives or incorrect results could lead to unnecessary panic: "What if the test says I am positive and it’s not true? That will destroy me emotionally." (IDI) "I think the person should try the test again. If they still aren’t clear, they can go to the hospital to check their viral load." (FGD) Stigma and Fear of Being Seen with an HIVST Kit . Although HIVST provides privacy, some participants feared being seen with the kit. Simply owning a test kit could lead to assumptions about their HIV status, particularly for those living in shared spaces: "What if you take the test kit home and your friends or parents see it? What would you say to them?" "Sincerely, if anyone sees it with me, they might think I have HIV." (FGD) "People will spread rumors regardless of what you tell them." (FGD) An IDI participant shared a similar concern about perceptions of HIV testing in their community: "If someone sees you with a self-test, they assume you must have been exposed to HIV. They won’t believe you’re just checking." (IDI) This fear was reinforced by past experiences of discrimination, making some hesitant to even discuss HIV testing: "In Africa, if someone tests positive, their family avoids them. They put food at their door instead of handing it to them directly." (FGD) "Even in hospitals, doctors sometimes shout results in crowded places. It's not professional." Cost as a Potential Barrier. While some participants were willing to pay for HIVST kits, many believed the test should be free or highly subsidized, especially for migrant and refugee populations: "The story of HIV is public knowledge. They should make it accessible. In Africa, many people don’t want to spend money on health issues." (FGD) "Here in Italy, they should make it affordable for immigrants who might not have jobs." (FGD) "It should be free. If I have to pay, I might just go to the hospital instead since it’s free there." (IDI) Suggested price points varied, with some participants willing to pay between €5 and €15, while others insisted HIVST should be entirely free: "For me, 10 euros." (FGD) "Five euros." (FGD) "I wouldn’t want to pay for it." (FGD) One participant compared the cost to hospital testing, questioning the added value of HIVST: "Yes, it saves transportation costs, but hospital tests are free. Why should I pay for this?" (FGD) Insufficient knowledge . Some participants were concerned that insufficient education could lead to misuse or misinterpretation of results: "I think you have to train people on how to use this test. Not everyone knows what to do if the result is positive." (IDI). One participant highlighted the lack of community outreach in Italy compared to their home country: "In Africa, I belonged to an association that provided support to people with diseases. They gave out condoms and gels. But here in Italy, I haven’t seen such services." (FGD) Similarly, misinformation or lack of trust in medical institutions led some participants to avoid HIV testing altogether: "Some people don’t test because they believe that knowing their status will change their life in a bad way." (FGD) "There are people who don’t believe HIV is real. They say, ‘If I can’t see it, then I don’t have it.’" (IDI) Objective 2: What factors are associated with WTU HIVST among ARMSWs? Bivariate Analysis of factors Associated with WTU HIVST among ARMSWs Table 4 presents chi-square test results examining associations between sociodemographic factors, healthcare access, testing behavior, sex work-related characteristics and WTU HIVST among ARMSW Table 4: Chi-square Analysis of factors Associated with WTU HIVST among ARMSWs Variable WTU to use HIVST (n=115) Yes (n=51, 44.4%) No (n=64, 55.6%) P-value Age 0.796 Young Adult (18 -24) 8 (57.14) 6 (61.90) Adult (25+) 53 (41.09) 76 (58.91) Education 0.156 Primary or less 32 (40.00) 48 (60.00) Secondary or more 19 (54.29) 16 (45.71) Gender Identity 0.370 Man 51 (44.74) 63 (55.26) Transgender 0 (0.00) 1 (100) non-binary Marital Status 0.843 Unmarried 32 (45.07) 39 (54.93) Married 19 (43.18) 25 (56.82) Number of Children 0.251 No children 27 (50.00) 27 (50.00) One or more children 24 (39.34) 37 (60.66) Religious Affiliation 0.000* No religion 1 (5.00) 19 (95.00) Belong to a religion 50 (52.63) 45 (47.37) Rank of Religiosity 0.205 Not religious 4 (28.57) 10 (71.43) Religious 47 (46.53) 54 (53.47) Length of Stay in Italy 0.780 A year or less 18 (46.15) 21 (53.85) More than a year 33 (43.42) 43 (56.58) Sexual Orientation 0.107 Gay 32 (39.51) 49 (60.49) Bisexual 19 (55.88) 15 (44.12) What role do you play during sex? 0.107 Top 32 (39.51) 49 (60.49) Bottom 19 (55.88) 15 (44.12) Versatile (Verse) Any other job apart from sex work 0.650 Yes 13 (48.15) 14 (51.85) No 38 (43.18) 50 (56.82) HEALTHCARE ACCESS & TESTING BEHAVIOR FACTORS Distance to Healthcare Facility (Km) 0.014* 1 – 5km 34 (54.84) 28 (45.16) 6km or more 17 (32.08) 36 (67.92) Healthcare frequency 0.018* Never 7 (25.00) 21 (75.00) Have ever 44 (50.57) 43 (49.43) Health Insurance status <0.001* Yes 35 (64.81) 19 (64.81) No 16 (26.23) 45 (73.77) Immigration challenge in healthcare access 0.049* Yes 26 (55.32) 21 (44.68) No 25 (36.76) 43 (63.24) Experienced stigma or discrimination at the hospital 0.052* Yes 22 (56.41) 17 (43.59) No 29 (38.16) 47 (61.84) Do you know where to go for STI/HIV testing and care? 0.000* Yes 35 (64.81) 19 (35.19) No 16 (26.23) 45 (73.77) Tested for STI 0.000* Never tested 8 (18.60) 35 (81.40) Ever tested 43 (59.72) 29 (40.28) Tested for HIV 0.201 Never tested 26 (50.98) 25 (49.02) Ever tested 25 (39.06) 39 (60.94) HIV test frequency 0.007* Once a year or less 20 (34.48) 30 (65.52) More than once a year 18 (58.06) 13 (41.94) Awareness of HIVST 0.000* No 19 (29.23) 46 (70.77) Yes 32 (64.00) 18 (36.00) Ever used HIVST 0.000* No 7(30.43) 16(69.57) Yes 25(92.59) 2(7.41) SEX WORK RELATED FACTORS Venue for meeting client 0.253 Offline 49 (45.79) 58 (54.21) Online 2 (25.00) 6 (75.00) No. of client in past 2month (Men) 0.001* Less than 20 37 (58.73) 26 (41.27) 20 or more 14 (26.92 38 (73.08) No. of client in past 2month (Women) 0.520 Less than 10 20 (52.63) 18 (47.37) 10 or more 1 (33.33) 2 (66.67) Vaginal sex 0.270 Yes 30 (40.54) 44 (59.46) No 21 (51.22) 20 (48.78) Condom use for vaginal sex 0.550 Sometimes/Never 28 (42.42) 38 (57.58) Always 10 (50.00) 10 (50.00) Anal sex 0.968 Yes 40 (44.44) 50 (55.56) No 11 (44.00) 14 (56.00) Condom use for anal sex 0.328 Sometimes/Never 48 (40.68) 70 (59.32) Always 10 (52.63) 9 (47.37) Lubricant use for anal sex 0.136 Yes 33 (42.86) 44 (57.14) No 15 (60.00) 10 (40.00) Transactional condomless sex 0.008* No 41 (67.21) 20 (32.79) Yes 31 (42.59) 23 (42.59) Factors significantly associated with WTU of HIVST included religious affiliation (χ² = 15.19, p < 0.001), and religiosity (χ² = xx, p < 0.001), healthcare-related factors such as distance to a healthcare facility (χ² = 5.99, p = 0.014), healthcare frequency (χ² = 5.6, p = 0.018), health insurance status (χ² = 17.28im, p < 0.001), and immigration-related healthcare challenges (χ² = 3.88, p = 0.049). Additionally, prior knowledge of where to access HIV testing (χ² = 21.15, p < 0.001), ever tested for STI (χ² = 18.44, p < 0.001), HIV test frequency (χ² = 9.84, p < 0.007), awareness of HIVST (χ² = 13.84, p < 0.001), and previous use of HIVST (χ² = 20.83, p < 0.001) were associated with WTU HIVST. Sex work-related factors influencing willingness included the number of male clients in the past two months (χ² = 11.67, p = 0.001) and engagement in transactional condomless sex (χ² = 7.04, p = 0.008) Multivariate logistic regression analysis of factors influencing WTU HIVST Table 5 presents the results of crude (unadjusted) and adjusted multiple logistic regression models assessing factors associated with WTU HIVST. In the unadjusted model, significant predictors of WTU HIVST included religious affiliation (belong to a religion: cOR = 21.11, 95% CI: 2.71 – 164.12, p = 0.004), distance to a healthcare facility (≥6 km: cOR = 0.389, 95% CI: 0.18 – 0.83, p = 0.001), healthcare frequency (ever accessed healthcare: cOR = 3.07, 95% CI: 1.18 – 7.96, p = 0.021), health insurance status (insured: cOR = 5.32, 95% CI: 2.60–10.86, p < 0.001), immigration related healthcare access challenges (yes: cOR = 2.13, 95% CI: 1.00 – 4.54, p = 0.050), Experienced stigma or discrimination at the hospital (yes: cOR = 1.68, 95% CI: 0.89 – 3.20, p = 0.050), knowledge of STI/HIV testing and care center (yes: cOR = 7.37, 95% CI: 2.99– 18.17, p = 0.000), tested for STI (ever tested: cOR = 6.49, 95% CI: 2.63 – 15.97, p once per year: cOR = 4.5, 95% CI: 0.85 – 23.95), p = 0.000), awareness of HIVST (cOR = 4.57, 95% CI: 1.95 – 9.45, p = 0.001), ever used HIVST (yes: cOR = 4.57, 95% CI: 2.02 – 10.36, p = 0.000), number of male clients in the past two months (≥20 clients: cOR = 0.47, 95% CI: 0.24–0.92, p = 0.027), and engagement in transactional condomless sex (yes: aOR = 2.76, 95% CI: 1.29 – 5.90 p = 0.009), In the adjusted model, six factors remained significantly associated with WTU HIVST. Religious affiliation (belong to a religion: aOR = 78.27, 95% CI: 71.77 – 345.83, p = 0.024), health insurance status (insured: aOR = 14.56, 95% CI: 10.88 – 23.92, p = 0.051), immigration related healthcare access challenges (aOR = 16.93, 95% CI: 14.22 – 20.15, p = 0.025), HIV test frequency (> once a year: aOR = 20.37, 95% CI: 18.98-48.61, p = 0.04), awareness of HIVST (aOR = 20.37, 95% CI: 18.98-48.61, p = 0.04), and Ever used HIVST (yes: aOR = 3.12, 95% CI: 1.93 – 9.21, p = 0.04), Table 5: Crude and adjusted multiple logistic regression Analysis of factors influencing WTU HIVST WTU HIVST Unadjusted Model Adjusted Model cOR (95% CI) P-value aOR (95% CI) P-value Religious Affiliation No religion Ref Ref Ref Ref Belong to a religion 21.11 (2.71 – 164.12) 0.004* 78.27 (71.77 – 345.83) 0.024* Distance to Healthcare Facility (Km) 1 – 5km Ref Ref 6km or more 0.389 (0.18 – 0.83) 0.015* 3.11 (0.39 – 26.30) 0.30 Healthcare frequency Never Ref Ref Ref Ref Have ever 3.07 (1.18 – 7.96) 0.021* 4.08 (0.37 – 6.78) 0.252 Health Insurance status No Ref Ref Ref Ref Yes 5.18 (2.33 – 11.51) 0.000* 14.56 (10.88 – 23.92) 0.051* Immigration challenge in healthcare access No Ref Ref Ref Ref Yes 2.13 (1.00 – 4.54) 0.050* 16.93 (14.22 – 20.15) 0.025* Experienced stigma or discrimination at the hospital No Ref Ref Ref Ref Yes 1.68 (0.89 – 3.20) 0.010* 0.50 (0.14 – 1.78) 0.282 Do you know where to go for STI/HIV testing and care? No Ref Ref Ref Ref Yes 7.37 (2.99 – 18.17) 0.000* 4.83 (0.71 – 32.75) 0.106 Tested for STI Never tested Ref Ref Ref Ref Ever tested 6.49 (2.63 – 15.97) 0.000* 6.02 (0.65 – 7.36) 0.113 HIV test frequency (n=150) Less than once a year Ref Ref Ref Ref More than once a year 4.5 (0.85 – 23.95) 0.078 20.37 (18.98-48.61) 0.04* Awareness of HIVST (n=150) No Ref Ref Ref Ref Yes 4.30 (1.95 – 9.45) 0.000* 3.24 (0.36 – 9.29) 0.03* Ever used HIVST No Ref Ref Ref Ref Yes 28.57 (5.26– 55.17) 0.000* 4.12 (1.90 – 10.11) 0.03* No. of client in past 2month (Men) (n=150) Less than 20 Ref Ref Ref Ref 20 or more 0.47 (0.24 - 0 .92) 0.027* 0.15 (0.019 – 1.77) 0.071 Transactional condomless sex No Ref Ref Ref Ref Yes 2.76 (1.29 – 5.90) 0.009* 0.44 (0.050 – 3.77) 0.451 cOR (Crude odds ratio); aOR(Adjusted odds ratio); 95% CI – (95% Confidence interval); *(P≤ 0.05) DISCUSSION To our knowledge, this is the first study to assess WTU HIVST among ARMSWs in Italy, a key population with high vulnerability to HIV. Through quantitative and qualitative analyses, we uncovered a complex interplay of individual perceptions, structural barriers, and community dynamics shaping attitudes toward HIVST. Applying the Health Belief Model (HBM), we examine how perceived risks, benefits, and barriers influence self-testing decisions (Green et al., 2020; Jones et al., 2015; Rosenstock, 1974). Willingness was moderate, driven by convenience, privacy, and stigma avoidance, while concerns about accuracy, access, and emotional distress remained key barriers. Healthcare access factors, religious affiliation, past HIV/STI testing, and sex work-related characteristics also played a role. Below, we connect quantitative patterns with qualitative narratives to provide a holistic view of HIVST adoption in this marginalized population. Our study found that 44.4% of participants were willing to use HIVST, a moderate level of acceptance that highlights some hesitation among the majority which corresponds with some previous studies among marginalized persons elsewhere (Shrestha et al., 2020). Although this result may appear low relative to studies of HIVST interest in key populations in the United States (68%)(Lippman et al., 2016),Thailand (99.3%) (Girault et al., 2021), Peru (95%)(Bustamante et al., 2017), Cambodia (100%) (Pal et al., 2016), Benin (100%)(Boisvert Moreau et al., 2022b), Nigeria (Tun et al., 2018b), and Botswana (Shava et al., 2020), our finding demonstrates that a solid base of ARMSWs would be willing to adopt HIVST as an alternative HIV testing modality. The moderate WTU HIVST in our study may, in part, be explained by the low levels of awareness and limited education about HIVST among our target population. Previous studies have shown that settings, where educational campaigns have been implemented, show much higher WTU HIIVST because users are more familiar with its procedures and potential advantages (e.g., confidentiality and convenience) (Laxmeshwar et al., 2024) The decision to use HIVST appeared to be driven by a balance between perceived benefits and perceived barriers, both of which were deeply embedded in participants’ lived experiences. From an HBM perceived benefits perspective, HIVST was seen as an opportunity to test in a manner that is both discreet and private, thus avoiding the stigma and unwanted scrutiny often associated with conventional, facility‐based HIV testing(Green et al., 2020; Jones et al., 2015; Rosenstock, 1974). Our quantitative data indicated that nearly half of those willing to use HIVST cited convenience and privacy as their primary motivation. This aligns with the HBM, as perceived susceptibility to social stigma increased the attractiveness of self-testing as a protective behavior. In other settings, similar motivations have been reported; participants often choose self‐testing because it allows them to manage their health on their own terms, without the perceived barriers of judgment or exposure at health facilities (Abu-Ba’are et al., 2024; Figueroa et al., 2018; Morshed Hemel et al., 2024; Shava, et al., 2020). Thus, highlighting the importance of consistent engagement with care as a determinant for HIVST. For instance, among these participants, HIV testing behaviors strongly influenced WTU HIVST. Participants who had tested for HIV more than once annually were more likely to express WTU HIVST, as were those already aware of HIVST or with prior experience using it. These findings reflect the HBM’s concept of “cues to action,” where previous behaviors and exposure reduce uncertainty and foster positive attitudes toward health innovations (Rosenstock, 1974). Similar associations have been reported in Southeast Asia and sub-Saharan Africa, where HIVST awareness and prior use were among the strongest predictors of future uptake (Figueroa et al., 2015; Myint et al., 2021; Zeleke et al., 2024). This suggests that expanding awareness and providing opportunities to try HIVST may increase demand, especially among those with testing experience. Conversely, several perceived barriers significantly discouraged WTU HIVST among participants. More than half of respondents expressed unwillingness to self-test, citing concerns related to test accuracy, emotional preparedness for a positive result, and limited access to kits. These findings align with prior studies that identify psychological and logistical barriers as major deterrents to HIVST uptake (Njau et al., 2019). Concerns about test reliability, particularly skepticism toward saliva-based tests, mirror findings from other settings where individuals associate diagnostic accuracy with blood-based testing, viewing oral tests as inferior (Abu-Ba’are, Shamrock, et al., 2024; Njau et al., 2014; Steehler & Siegler, 2019). Fear of emotional distress, particularly the anxiety of dealing with a positive result alone, was another central barrier. This highlights low self-efficacy, a key HBM element, where individuals doubt their capacity to cope with testing outcomes without immediate psychosocial support (Lin et al., 2017; Steehler & Siegler, 2019). Similar concerns have been documented in studies with other key populations, where the absence of pre-and post-test counseling diminished confidence in managing HIV test results (Hamilton et al., 2021; Tun et al., 2018a; World Health Organization, 2009). This highlights the importance of integrating HIVST with supportive services, such as hotlines or linkage-to-care platforms. Furthermore, structural barriers also played a role. Difficulty accessing kits, reported by nearly one-third of participants, reflects systemic gaps in awareness about the availability and distribution of HIVST, particularly among marginalized and undocumented groups in Italy. This finding is consistent with studies that show a lack of information among migrants and undocumented populations about healthcare entitlements, including free HIV testing and treatment, due to poor communication from authorities and language barriers (Chiarenza et al., 2019; Mona et al., 2021b). Health literacy plays a crucial role in individuals' ability to navigate healthcare systems and understand their rights and available services (Coughlin et al., 2020). In the case of HIV testing, lower health literacy can hinder individuals from seeking or properly utilizing testing services, as they may not be aware of their eligibility for free or subsidized tests, or the procedures involved in accessing them(Coughlin et al., 2020; Naidoo & Taylor, 2015; Zhai et al., 2023) This is particularly important for migrant populations, where culturally appropriate health education is essential to ensure effective communication about HIV testing and prevention(European Centre for Disease Prevention and Control, 2011; Puthoopparambil et al., 2021). Increasing health literacy, particularly through community-based programs that provide culturally tailored information, can help bridge these gaps and empower individuals to make informed decisions about their health(Abubakari et al., 2021a). Within these structural determinants, stigma remained a powerful deterrent, even within the supposedly private context of self-testing. Participants expressed concerns about being seen with an HIVST kit, suggesting that HIV-related stigma persists not only in healthcare settings but also in personal and community spaces. This aligns with the broader literature on HIV-related stigma, which continues to act as a cue to inaction and a major barrier to testing among sex workers and other key populations (Ekstrand et al., 2018; Yang et al., 2015). These insights emphasize the need for discreet, stigma-sensitive HIVST interventions that consider the social context in which testing occurs. Moreover, our multivariable analysis identified several key predictors of WTU HIVST among ARMSWs, including access to healthcare, prior HIV/STI testing behaviors, and HIVST awareness and experience. Access to healthcare, in particular, played a key role in shaping HIVST willingness. Participants with health insurance were substantially more likely to express WTU HIVST. These findings suggest that individuals more integrated into the healthcare system may develop greater self-efficacy and trust in health innovations, making them more receptive to HIVST. This aligns with previous research showing that frequent engagement with healthcare services enhances familiarity with HIV prevention tools and reduces testing-related anxiety (Conserve et al., 2017; McDaid et al., 2016; Patel et al., 2023). Interestingly, those who had experienced immigration-related healthcare challenges were 17 times more likely to be willing to use HIVST, possibly reflecting their preference for private, self-directed testing options that circumvent the barriers they faced in formal health settings. This aligns with literature showing that migrants and key populations who encounter stigma, discrimination, or fears of legal repercussions in traditional healthcare settings may view HIVST as a safer, more accessible alternative (Abu-Ba’are, Shamrock, et al., 2024; Fakoya et al., 2017). Qualitative narratives further reinforce this, with participants expressing a strong desire for confidential, community-based approaches that avoid the institutional gatekeeping often encountered in mainstream services. Relatedly, cost also emerged as a significant determinant of WTU HIVST. Although some participants were open to paying modest amounts (€5–€15), many emphasized that HIVST should be free or heavily subsidized, particularly for migrants and refugees experiencing economic vulnerability. This cost-sensitivity reflects broader structural inequities that shape healthcare access for marginalized groups. Similar findings have been reported in studies across SSA and Asia, where WTU HIVST dropped significantly when users had to pay for kits and advocating for free HIVST kits, especially among low-income populations (Abubakari et al., 2021; Figueroa et al., 2015; Hamilton et al., 2021; Myint et al., 2021; Zeleke et al., 2024). Financial barriers have consistently been linked to reduced uptake of HIV-related services, with affordability being a critical factor influencing healthcare decisions among key populations (Abubakari et al., 2021; Ogunbajo et al., 2018). As such, the cost of self-testing kits should be a central consideration in program design, especially in contexts where free or low-cost facility-based testing is already available. Perhaps one of the most critical insights emerging from our study is the pressing need for community-based education and support services to accompany HIVST implementation among ARMSWs in Italy. Community-based approaches (CBAs) have proven effective in other settings by providing culturally appropriate education, building trust, and delivering services in ways that resonate with marginalized populations (Abu-Ba’are, Torpey, et al., 2024; Abubakari et al., 2021b; Chakrapani et al., 2024; Stein et al., 2015; Wilton et al., 2009). In contexts where migrants and sex workers often face systemic exclusion from mainstream healthcare, CBAs, particularly those that integrate peer educators and trusted local organizations, can act as critical enablers of health behavior change (Benoit et al., 2017; Martinez-Damia et al., 2024; Riza et al., 2020). By offering pre- and post-test counseling, information on HIVST procedures, and linkage to care, such models not only promote correct use of self-testing kits but also help alleviate the emotional burden associated with testing alone. Strengthening partnerships with migrant-led organizations and tailoring HIVST programs to the specific needs and realities of ARMSWs could thus serve as a key strategy to boost uptake and ensure that HIVST delivers on its promise of expanding access to timely diagnosis and care. LIMITATIONS Our study has several limitations. Recruitment through Circolo Pink and snowball sampling may have introduced selection bias, as participants engaged with support networks might have different healthcare experiences than those without such access. Additionally, self-reported data on HIVST willingness and testing behaviors may be subject to social desirability bias, as participants may have provided responses they perceived as more acceptable. While we ensured confidentiality and conducted interviews in safe spaces, future research could incorporate biomarker testing or behavioral tracking to validate self-reports. Furthermore, our cross-sectional design limits causal interpretations, preventing us from determining whether factors like healthcare access, sex work-related experiences, or prior testing history directly influence HIVST willingness over time. Due to privacy protections, we did not collect identifiable personal data, which prevented us from linking individual responses across survey and interview components. While this approach ensured participant safety, it limited our ability to track longitudinal changes in attitudes and behaviors. Lastly, as our study was conducted in northern Italy (Verona and Turin), findings may not fully capture the experiences of MSWs in other regions with different healthcare policies or migration dynamics. Despite these limitations, our study remains one of the first to examine HIVST willingness among African refugee MSWs in Italy, offering critical insights that can inform future research and tailored interventions. CONCLUSION Our study highlights the complex interplay of individual, structural, and occupational factors influencing HIVST willingness among African refugee MSWs in Italy. While convenience, privacy, and stigma avoidance emerged as key facilitators, concerns about test accuracy, emotional distress, access barriers, and structural vulnerabilities limited uptake. Healthcare access, prior testing experiences, religious affiliation, and sex work-related factors also played a significant role in shaping HIVST attitudes. Applying the Health Belief Model, our findings underscore the need for targeted, community-driven interventions that address both individual perceptions and systemic barriers to HIV testing. Expanding education, peer-led outreach, and subsidized access to HIVST could enhance uptake and improve HIV prevention efforts within this highly marginalized population. 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Nelson","email":"","orcid":"https://orcid.org/0000-0002-2630-602X","institution":"School of Nursing, Yale University, New Haven, Connecticut, USA","correspondingAuthor":false,"prefix":"","firstName":"LaRon","middleName":"E.","lastName":"Nelson","suffix":""}],"badges":[],"createdAt":"2025-04-10 16:04:05","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6421791/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6421791/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80504198,"identity":"c097f388-eb3b-44ff-b053-82442d372645","added_by":"auto","created_at":"2025-04-14 04:29:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2479016,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6421791/v1/d2273638-cedc-4e50-96c6-3d4a0c257b81.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eStigma, privacy concerns, sexual behaviors, and testing history shape willingness to use HIV self-testing among African refugee male sex workers in Italy – A mixed method study - BGSH-023\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDespite global advancements in HIV prevention and care, testing uptake remains suboptimal among some of the most marginalized populations, including migrants, refugees, men who have sex with men (MSM), sex workers (SW), and racial minorities. (UNAIDS, 2024). These groups experience significant barriers to HIV testing, treatment, and care due to a combination of legal, financial, and social constraints. Migrants and refugees often face restrictive healthcare policies and economic hardship that limit access to HIV testing services. (Ekerin et al., 2024; Ndumbi et al., 2018). While MSM and SWs experience heightened stigma and discrimination that deter them from seeking HIV testing (Babel et al., 2021; Schweitzer et al., 2023), racial minorities experience structural inequalities, including systemic racism in healthcare settings, further limiting their access to HIV testing services (Pattillo et al., 2023). Understanding how these barriers intersect is crucial for designing targeted interventions that improve HIV testing uptake across diverse populations.\u003c/p\u003e \u003cp\u003eImmigrants and refugees from Sub-Saharan Africa (SSA) in Europe, particularly MSMs and SWs, have heightened vulnerability to HIV, mirroring that of SSA (Hessou et al., 2019). Due to intersecting structural, social, and economic barriers, many experience severe marginalization, stigma, and discrimination, which limit their access to essential healthcare services, including HIV prevention and testing (Brandenberger et al., 2019; Nakakawa et al., 2025; Zigah et al., 2023a). For migrants, fear of deportation further discourages engagement with healthcare systems (Galanis et al., 2022; Mona et al., 2021a). Additional obstacles include language barriers, financial hardship, and the lack of culturally competent providers (Puthoopparambil et al., 2021). For SWs in particular, societal and internalized stigma suppress interest in routine HIV testing, leading to undiagnosed infections and ongoing transmission (Reeves et al., 2017; Weitzer, 2018)\u003c/p\u003e \u003cp\u003eAlthough male sex work has existed throughout history (Kaye, 2014), it has rarely been the focus of HIV research in Europe due to the prioritization of female sex workers (FSWs) in research and intervention efforts. There is well-documented information on FSWs' HIV prevalence and their experience due to gendered policy approaches to sex work, and the greater visibility of FSW networks. (Giomi et al., 2022; Platt et al., 2013; Segala et al., 2024; Trani et al., 2006). As a result, male sex workers (MSWs), particularly those from refugee and immigrant backgrounds, have been largely overlooked despite their documented vulnerability to HIV and other sexually transmitted infections (STIs) (Brandenberger et al., 2019; Ekerin et al., 2024; Pattillo et al., 2023; Segala et al., 2024). The limitations extend to social policies and intervention programs, creating a significant gap in understanding the unique challenges faced by African immigrant and refugee male sex workers (ARMSWs). This research gap limits the development of tailored interventions that address the specific barriers RMSWs encounter, such as stigma, legal restrictions, and lack of targeted healthcare services. Without focused research on their experiences, policies and programs risk being ineffective or exclusionary, further marginalizing this population within the broader HIV prevention and care landscape.\u003c/p\u003e \u003cp\u003eHIV testing services are essential for managing Italy's HIV epidemic (Galli et al., 2020). (Scognamiglio et al., 2018; WHO, 2012). In Italy, most testing occurs through client-initiated approaches, where individuals seek testing at healthcare facilities, community centers, or outreach programs as well as through provider-initiated testing in clinical settings, where healthcare professionals routinely recommend tests, especially for patients with conditions associated with higher HIV vulnerability (European Centre for Disease Prevention and Control, 2023; Galli et al., 2025; Scognamiglio et al., 2018). Yet, barriers persist: stigma, fear of discrimination, confidentiality concerns, low awareness of testing options, apprehension about a positive result, and limited access, particularly among undocumented migrants, refugees, and marginalized groups, keep many unaware of their HIV status (Alvarez-del Arco et al., 2014; Deblonde et al., 2010; den Daas et al., 2016; Fakoya et al., 2017; Lagi et al., 2023; Mirandola et al., 2017). Moreover, research indicates that many MSWs in Italy engage in transactional sex under risky conditions, often with little ability to negotiate safe practices due to economic necessity and power imbalances between the MSWs and their clients (Scott et al., 2021). Criminalization and policing further force these men into hidden networks, restricting their access to HIV prevention and treatment services (UNAIDS, 2022). Despite the availability of services, low awareness and limited willingness to undergo routine testing remain significant challenges, as global studies consistently highlight substantial barriers to HIV testing and care for this population (Baral et al., 2012; Dada et al., 2024; Dakpui et al., 2024; Gallego et al., 2022; Rodriguez-Rincon et al., 2020; Shamrock et al., 2023; Zigah et al., 2023b)\u003c/p\u003e \u003cp\u003eGiven these persistent barriers, alternative testing strategies such as the HIV self-testing (HIVST) remain essential in improving HIV testing among RMSWs in Italy. HIVST has proven promising in expanding testing access, particularly among populations facing entrenched healthcare disparities(Abu-Ba\u0026rsquo;are, Shamrock, et al., 2024; Figueroa et al., 2018; Jamil, Guy, et al., 2017; Jamil, Prestage, et al., 2017; Wang et al., 2018). HIVST allows individuals to test privately, addressing concerns related to stigma, discrimination, and confidentiality breaches (World Health Organization, 2016). Recognizing its potential, the WHO strongly recommends HIVST as a key strategy for increasing diagnosis rates, and Italy approved its use in 2016 (Pittalis et al., 2017; World Health Organization, 2016).\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe current study.\u003c/b\u003e Despite the growing recognition of HIVST\u0026rsquo;s potential, little is known about the willingness to use (WTU) HIVST among SSA RMSWs in Italy. Studies on other key populations, including MSMs and female sex workers, have shown that WTU HIVST is often influenced by stigma, privacy concerns, and previous experiences with healthcare discrimination (Boisvert Moreau et al., 2022a; Dirisu et al., 2020; Lippman et al., 2018; Shava, Manyake, Mdluli, Maribe, Monnapula, Nkomo, Mosepele, Moyo, Mmalane, \u0026amp; B\u0026auml;rnighausen, 2020). These findings suggest that similar factors may shape the willingness of RMSWs to engage in self-testing, yet no research has specifically examined this population in the Italian context. Studying this group in Italy is particularly relevant given the country\u0026rsquo;s role as a major entry point for SSA migrants and refugees into Europe, as well as the structural challenges they face in accessing healthcare services. The intersection of migration policies, legal barriers, and social exclusion uniquely shapes the healthcare experiences of RMSWs, necessitating targeted research to understand their HIV testing behaviors and inform effective interventions. To address these gaps, we employed a mixed-methods approach to measure associations between key factors and WTU HIVST, as well as the lived experiences and perceptions that influence the WTU HIVST among RMSWs in Italy. \u003cb\u003eOur specific research questions are: 1) Are African RMSWs in Italy willing to use HIVST?\u003c/b\u003e and \u003cb\u003e2) What factors are associated with WTU to use HIVST among African RMSWs in Italy.\u003c/b\u003e The insights gained can help inform targeted interventions, such as community-based HIVST distribution, peer-led support programs, and policy recommendations aimed at reducing stigma and improving access to testing within this population.\u003c/p\u003e \u003cp\u003e\u003cb\u003eTheoretical framework\u003c/b\u003e: This study is guided by the Health Belief Model (HBM), a widely used framework for understanding health behaviors(Alizade et al., 2021; Appau et al., 2024; Seif et al., 2025). The HBM is a psychological framework used to explain and predict health behaviors by examining individuals' beliefs about health risks and the benefits of preventive actions. (Green et al., 2020; Jones et al., 2015). It consists of six key constructs: perceived susceptibility (belief about the risk of contracting a disease), perceived severity (belief about the seriousness of the condition and its consequences), perceived benefits (belief in the effectiveness of a health behavior), perceived barriers (obstacles preventing action), cues to action (triggers that encourage behavior change), and self-efficacy (confidence in one's ability to perform the behavior)(Green et al., 2020). In the context of HIVST, the HBM helps us understand how risk perception, stigma, access barriers, and personal agency shape WTU self-testing, offering insights into how interventions can be designed to improve uptake among vulnerable populations. Based on the model, we posit that individuals' willingness to engage in health-related behaviors, such as HIVST, is influenced by their perceptions of disease susceptibility (e.g., HIV). The severity of its consequences, the perceived benefits of an action, and potential barriers to engagement.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e\u003cstrong\u003eResearch Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe employed a mixed-method sequential exploratory design, integrating qualitative and quantitative approaches to comprehensively examine WTU HIVST among African RMSWs in Italy. The qualitative component provided in-depth insights into individual perceptions and decision-making processes regarding the use of HIVST, while the quantitative component allowed us to analyze descriptive statistics and predictors of WTU HIVST. By combining these methods, we strengthened the study by offering a more comprehensive understanding of the barriers and facilitators affecting HIVST uptake among RMSWs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted this study in collaboration with Circolo Pink (Pink Refugees), a community-based human services nonprofit with established access to the target population in Italy. Data collection took place in safe and accessible locations within their office spaces in Verona and a sister institution in Turin, Northern Italy. To be eligible for the study, participants had to meet the following inclusion criteria: (1) be a refugee from the SSA \u0026nbsp;region, (2) currently reside in Italy, (3) be at least 18 years old, (4) speak and understand English or Italian fluently, (5) self-identify as a sex worker, and (6) have engaged in sex work within the past six months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcess.\u0026nbsp;\u003c/strong\u003eIn the qualitative phase, we conducted 20 in-depth interviews (IDIs) and two focus group discussions (FGDs) with African RMSWs to explore their experiences, barriers, and facilitators related to HIV testing and WTU HIVST. Based on insights from these interviews, we developed and administered a structured survey to 150 RMSWs to assess the generalizability of the qualitative findings on WTU HIVST. We used RedCap, a secure mobile survey platform, to collect quantitative data, while all FGDs and IDIs were conducted in person at Pink Refugees and its sister location, audio-recorded (with consent), and supplemented by detailed field notes. Given the hidden nature of RMSWs, we employed a venue-based and snowball recruitment strategy through Pink Refugees. Two peer-research assistants, who were also RMSWs, facilitated recruitment by identifying and engaging their peers during weekly meetings at Pink Refugees. Additional participants were recruited through referrals from FGD participants for IDIs and online surveys.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNature of Questions.\u0026nbsp;\u003c/strong\u003eThe primary outcome of this study was WTU HIVST, assessed through both qualitative and quantitative methods.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFor the qualitative assessment, we used a semi-structured interview guide to explore themes related to HIV testing behaviors, prior experiences, and WTU HIVST. Participants viewed a short demonstration video of the OraQuick HIV self-test, after which we asked:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;Would you be willing to use an HIV self-testing kit in the future?\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;What factors would influence your decision to use or not use HIVST?\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eParticipants also responded to open-ended questions about their perceptions of HIVST, previous testing experiences, and potential facilitators or barriers to self-testing.\u003c/p\u003e\n\u003cp\u003eFor the quantitative survey, we assessed WTU HIVST using structured questions. Participants first received a brief description of the HIV self-test:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u0026quot;\u003cem\u003eThe Oral HIV self-test is a convenient method that allows individuals to perform the test themselves using oral saliva. It eliminates the need for laboratory equipment and can be conducted at home or any preferred location. However, if the test result is positive, confirmation through additional testing at a healthcare facility is necessary for appropriate guidance and further steps.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFollowing this, we measured WTU HIVST using the question:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;Would you be willing to use an HIV self-testing kit in the future?\u0026quot;\u003c/em\u003e (Response options: Yes/No).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eWe assessed WTU HIVST as the primary outcome, coded as a binary variable (1 = Yes, 0 = No). Key independent variables included socio-demographic factors (age, education, marital status, religious affiliation), healthcare access and testing behavior (health insurance status, prior HIV/STI testing, experiences of stigma), and sex work-related characteristics (client volume, condom use, engagement in transactional condomless sex). Variables were coded as categorical or binary, as detailed in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Descriptions of measurements\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5556%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.284%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 99.6914%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary Outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 0.308642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eWTU HIVST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.284%;\"\u003e\n \u003cp\u003eWilling to use HIVST in the future\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e1 = Yes, 0 = No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 99.6914%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocio-Demographic \u0026amp; Structural Factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 0.308642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.284%;\"\u003e\n \u003cp\u003eParticipant\u0026apos;s age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e0 = 18-24, 1 = 25+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eGender Identity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eSelf-identified gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e1 = Man\u003c/p\u003e\n \u003cp\u003e2 = Transgender\u003c/p\u003e\n \u003cp\u003e3 = non-binary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eHighest level of education completed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e1 = Primary or less\u003c/p\u003e\n \u003cp\u003e2 = Secondary or more\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eCurrent marital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e0 = Unmarried\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 = Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eNumber of Children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eNumber of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e0 = No children\u003c/p\u003e\n \u003cp\u003e1= One or more children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eReligious Affiliation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eWhether participant belongs to any religion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e0 = No religion\u003c/p\u003e\n \u003cp\u003e1 = Belong to a religion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eRank of Religiosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eHow religious the participant is\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e0 = Not religious\u003c/p\u003e\n \u003cp\u003e1 = Religious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eLength of Stay in Italy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eHow long participant has been in Italy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e0 = A year or less\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 = More than a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eSexual Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eParticipant\u0026rsquo;s sexual orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e0 = Gay\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 = Bisexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eSex role\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eSexual role preference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e0 = Top\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 = Bottom\u003c/p\u003e\n \u003cp\u003e2= Versatile (Verse)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eEmployment Beyond Sex Work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eAny other job apart from sex work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27.0062%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 99.6914%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare Access \u0026amp; Testing Behavior\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 0.308642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eDistance to Healthcare Facility (Km)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eDistance in kilometers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = 1 \u0026ndash; 5km\u003c/p\u003e\n \u003cp\u003e1 = 6km or more\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eHealthcare frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eFrequency of accessing healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Never\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 = Have ever\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eHealth Insurance status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eCovered by health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eImmigration challenge in healthcare access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eEncountered difficulties in access healthcare due to immigration status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eExperienced stigma or discrimination at the hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eExperienced stigma or discrimination at the hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eAwareness of testing facilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eDo you know where to go for STI/HIV testing and care?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eTested for STI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eEver tested for any STI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Never tested\u003c/p\u003e\n \u003cp\u003e1 = Ever tested\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eTested for HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eEver tested for HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Never tested\u003c/p\u003e\n \u003cp\u003e1 = Ever tested\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eHIV test frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eFrequency of HIV testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Once a year or less\u003c/p\u003e\n \u003cp\u003e1 = More than once a year\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eHIV test result\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eSelf-reported HIV test result\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Negative\u003c/p\u003e\n \u003cp\u003e1 = Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eAwareness of HIVST\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eEver heard of HIV self-testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eEver used HIVST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eUsed an HIV self-test before\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 99.6914%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex Work-Related Factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 0.308642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eVenue for meeting client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eWhere participants find clients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Offline\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 = Online\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eNo. of client in past 2month (Men)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eNumber of male clients in the past 2 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Less than 20\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 = 20 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eNo. of client in past 2 month (Women)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eNumber of female clients in the past 2 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Less than 10\u003c/p\u003e\n \u003cp\u003e1 = 10 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eVaginal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eEngaged in vaginal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eCondom use for vaginal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eConsistency of condom use for vaginal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Sometimes/Never\u003c/p\u003e\n \u003cp\u003e1 = Always\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eAnal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eEngaged in anal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eCondom use for anal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eConsistency of condom use for anal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Sometimes/Never\u003c/p\u003e\n \u003cp\u003e1 = Always\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eLubricant use for anal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eConsistency of lubricant use for anal sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = Sometimes/Never\u003c/p\u003e\n \u003cp\u003e1 = Always\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\n \u003cp\u003eTransactional condomless sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\n \u003cp\u003eEngaged in unprotected transactional sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 27.1605%;\"\u003e\n \u003cp\u003e0 = No\u003c/p\u003e\n \u003cp\u003e1 = Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.5556%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42.284%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 26.8519%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 0.154321%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used descriptive statistics to summarize the socio-demographic characteristics of respondents, reporting categorical variables as frequencies and percentages, and continuous variables as means with standard deviations or medians with interquartile ranges.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eTo analyze WTU HIVST, we dichotomized responses as 1 (willing to use) and 0 (not willing to use).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eWe first conducted chi-square analyses to examine associations between WTU HIVST, and independent variables. Variables showing statistical significance (p \u0026lt; 0.05) in chi-square analysis were included in a multiple logistic regression model to explore their relationship with WTU HIVST. Statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003eFor qualitative data, we transcribed IDIs and FGDs verbatim and analyzed them using a summative content analysis process. To ensure interrater reliability, two independent researchers reviewed each transcript, summarized recurring themes related to HIVST acceptability and willingness, and wrote independent summaries. The researchers then met to consolidate their independent summaries into a single summary for each transcript, ensuring all salient themes were captured and discrepancies addressed through discussion. The lead author then reviewed each summary, categorized key themes, and iteratively refined them by revisiting transcripts. The final themes were organized based on our research questions to provide context for the quantitative findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethics approval from the National Ethics Committee for Clinical Trials, Italian Ministry of Health, number AOO-ISS - 04/07/2023 - 0031228. We obtained written informed consent from all participants prior to data collection and adhered to Italy\u0026rsquo;s requirements for anonymous data transfer and use for vulnerable groups. Written informed consent was sort from all IDI and FGD participants before data collection commenced. Participation in the survey was voluntary, and informed consent was implied through the completion and submission of the survey after participants reviewed an online information sheet outlining the study\u0026apos;s purpose, confidentiality, and their rights.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic Characteristics of Respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 150 male sex workers participated in the study. The mean age was 30.6 years (SD = 5.9), with the average age at which they commenced sex work being 23.3 years (SD = 4.6). The majority (96.67%) identified as men, while the remaining 3.3% identified as others or non-binary. More than half (57.33%) were single, while 35.33% were married to females. Educational attainment varied, with 49% having completed senior high school or vocational training, 26% having tertiary education, and 4.67% having no formal education. Most participants (87.33%) were refugees, and 57.33% originated from Nigeria. In addition to the survey, 35 ARMSWs participated in the qualitative phase of the study. Participants in the IDIs had an average age of 28 years, while the 15 participants in the FGDs had an average age of 32.1 years. Participants were primarily from Nigeria and Cameroon, with a few from C\u0026ocirc;te d\u0026apos;Ivoire\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective 1: Are ARMSWs in Italy willing to use HIVST?\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA significant proportion (44.4%, n = 51) expressed WTU an HIVST kit in the future. The most common reasons included convenience and privacy (n = 24, 47.06%), avoidance of stigma and discrimination at healthcare facilities (n=12, 23.53%), concern about potential HIV exposure (n = 6, 11.76%), and ease of use (n=8, 15.69%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Willingness to Use HIVST among ARMSWs\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.9244%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.958%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.9244%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.958%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.9244%;\"\u003e\n \u003cp\u003eWould you be willing to use an HIV self-testing kit in the future? (n=115)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.958%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9244%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.958%;\"\u003e\n \u003cp\u003e44.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9244%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.958%;\"\u003e\n \u003cp\u003e55.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.9244%;\"\u003e\n \u003cp\u003eWhat are the reasons you would consider using an HIV self-testing kit in the future? (51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.958%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.9244%;\"\u003e\n \u003cp\u003eIt\u0026apos;s convenient and private\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.958%;\"\u003e\n \u003cp\u003e47.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.9244%;\"\u003e\n \u003cp\u003eWorried about potential HIV exposure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.958%;\"\u003e\n \u003cp\u003e11.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.9244%;\"\u003e\n \u003cp\u003eI want to avoid stigma and discrimination at hospitals/clinics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.958%;\"\u003e\n \u003cp\u003e23.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.9244%;\"\u003e\n \u003cp\u003eIt\u0026apos;s easy to use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.958%;\"\u003e\n \u003cp\u003e15.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.9244%;\"\u003e\n \u003cp\u003eI can\u0026apos;t easily go to the hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.1176%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.958%;\"\u003e\n \u003cp\u003e15.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative findings on WTU HIVST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in both IDIs and FGDs expressed strong interest in HIVST, highlighting various factors that influenced their WTU the test. These factors included convenience, privacy, occupational safety, perceived effectiveness, and a sense of empowerment over their health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConvenience and Accessibility.\u0026nbsp;\u003c/strong\u003eOne of the most frequently cited reasons for WTU HIVST was its convenience, as it will allow ARMSWs to test at any time and in any location of their choice. Many participants noted that the ability to conduct an HIV test independently, without visiting a hospital or clinic, was highly beneficial.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants from FGDs emphasized the time-saving aspect of HIVST:\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;It\u0026rsquo;s fast, and you can do it anytime.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;It saves transportation costs, but hospital tests are free.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003eAmong the ARMSWs, the ability to conduct an immediate test before engaging with clients was considered an important protective measure by some participants: \u003cem\u003e\u0026quot;For some situations, like if you\u0026rsquo;re a sex worker and a client asks for unprotected sex, you can use the test to check. It\u0026rsquo;s good for business and provides privacy.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003eParticipants in IDIs also echoed similar sentiments, particularly regarding the speed and simplicity of the test: \u003cem\u003e\u0026quot;Hmm, I think that is a good development for people who don\u0026apos;t have time to go to the hospital, and it can be done at any time. And also, you can do it even before sex with anyone.\u0026quot;\u003c/em\u003e (IDI) \u003cem\u003e\u0026quot;It\u0026rsquo;s very simple and it\u0026rsquo;s done within less than 30 minutes, so the urge can wait for 30 minutes and you run this test and you confirm what you have to do.\u0026quot;\u003c/em\u003e (IDI) \u003cem\u003e\u0026quot;I wish I could have one right now to test myself and see my results.\u0026quot;\u003c/em\u003e (IDI)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrivacy and Confidentiality.\u0026nbsp;\u003c/strong\u003eThe ability to conduct an HIV test privately was a key facilitator of willingness for some participants. Many ARMSWs noted that going to a hospital for an HIV test often meant exposing themselves to social scrutiny, which discouraged testing. HIVST, by contrast, offered a discreet and stigma-free alternative where they can test at home, see results in private without seeing any unwanted persons: \u003cem\u003e\u0026quot;I think it\u0026rsquo;s easy to use and gives you confidence to run the test at home.\u0026quot;\u003c/em\u003e (FGD). \u003cem\u003e\u0026quot;Yes, because I will test myself and see my result again alone myself without meeting strange faces every day.\u0026quot;\u003c/em\u003e (IDI). \u003cem\u003e\u0026quot;And in our home so we can have this, and this will help to reduce the rate of HIV.\u0026quot;\u003c/em\u003e (IDI)\u003c/p\u003e\n\u003cp\u003eSeveral participants from FGDs acknowledged that hospital visits were often stressful and could expose them to judgment from others: \u003cem\u003e\u0026quot;I like that it can be done in private; sometimes going to the hospital is stressful, and people might see you there.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOccupational Relevance and Safety.\u0026nbsp;\u003c/strong\u003eARMSWs in both IDIs and FGDs recognized HIVST as a valuable tool for managing their health and ensuring safety in their profession. Several emphasized the importance of frequent self-testing due to the nature of their work: \u003cem\u003e\u0026quot;As a sex worker who travels a lot, I need the kit to be safe for myself and my clients. Every three months, I check myself to know whether to continue or take care of myself.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;And we can even use it to test on our clients.\u0026quot;\u003c/em\u003e (IDI)\u003c/p\u003e\n\u003cp\u003eSome participants viewed HIVST as an essential tool for all sex workers, with one IDI participant stating: \u003cem\u003e\u0026quot;This can be owned by every sex worker that is going around\u0026hellip; every sex worker that really wants to do sex working and is interested in a life like this traffic client, should have this sex working kit.\u0026quot;\u003c/em\u003e (IDI). Similarly, an FGD participant emphasized the unpredictability of client interactions, highlighting the need for accessible self-testing: \u003cem\u003e\u0026quot;It\u0026rsquo;s useful for those of us who meet different clients. You don\u0026rsquo;t know who has what.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Effectiveness and Ease of Use.\u0026nbsp;\u003c/strong\u003eAfter seeing HIVST demonstration video, the RMSWs responded positively to the demonstration video, noting that HIVST appeared easy to use and required minimal effort: \u003cem\u003e\u0026quot;From what you are saying now, it doesn\u0026rsquo;t take much time and isn\u0026rsquo;t complicated.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;I like that you don\u0026rsquo;t need to go to the hospital to do it. You can just do it and know your status.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003eOthers expressed enthusiasm about its modernized approach, stating that it could significantly improve HIV testing uptake: \u003cem\u003e\u0026quot;It\u0026rsquo;s very modernized\u0026hellip; And in our home so we can have this, and this will help to reduce the rate of HIV.\u0026quot;\u003c/em\u003e (IDI) \u003cem\u003e\u0026quot;I\u0026rsquo;m so happy about the team, the communication, the project, and the HIV test itself. It\u0026rsquo;s so easy to use, and I love that.\u0026quot;\u003c/em\u003e (IDI)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmpowerment and Control Over Health.\u0026nbsp;\u003c/strong\u003eA sense of personal responsibility and empowerment was also a driving factor in WTU HIVST. Participants saw the test as a way to take control of their own health and make informed decisions: \u003cem\u003e\u0026quot;It\u0026rsquo;s important to know your status so you can take action.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;I really need it; it\u0026rsquo;s very, very important.\u0026quot;\u003c/em\u003e (IDI) \u003cem\u003e\u0026quot;I\u0026rsquo;m willing to try it. I\u0026rsquo;ve never seen this type of test before, and I\u0026rsquo;m curious.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;If I have the opportunity to test myself, I will.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003eOthers noted that their diverse sexual networks made frequent testing a necessity rather than an option: \u003cem\u003e\u0026quot;I work with both men and women\u0026mdash;so I can\u0026rsquo;t say I don\u0026rsquo;t need it.\u0026quot;\u003c/em\u003e (IDI) \u003cem\u003e\u0026quot;I\u0026rsquo;m really happy about it. It\u0026rsquo;s very good, and I love it.\u0026quot;\u003c/em\u003e (IDI)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcerns and barriers to HIVST among ARMSWs.\u0026nbsp;\u003c/strong\u003eThe primary barriers to HIVST adoption included difficulty obtaining self-testing kits (32.2%), concerns about the accuracy of self-testing (27%), fear of receiving a positive result without immediate support (21%), and lack of knowledge about HIVST (10%). A smaller proportion (7%) preferred traditional hospital-based HIV testing. Despite these concerns, 20% of respondents indicated that nothing would stop them from using an HIVST kit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Barriers to HIVST uptake\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.4861%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable (n=115)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.1042%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4097%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.4861%;\"\u003e\n \u003cp\u003eWhat might stop you from using an HIV self-testing kit?\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1042%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4097%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.4861%;\"\u003e\n \u003cp\u003eNothing stops me\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.1042%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4097%;\"\u003e\n \u003cp\u003e20.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.4861%;\"\u003e\n \u003cp\u003eWorries about how accurate self-testing is\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.1042%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4097%;\"\u003e\n \u003cp\u003e26.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.4861%;\"\u003e\n \u003cp\u003eNot easily getting a self-testing kit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.1042%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4097%;\"\u003e\n \u003cp\u003e32.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.4861%;\"\u003e\n \u003cp\u003eAfraid of getting a positive result without support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.1042%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4097%;\"\u003e\n \u003cp\u003e20.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.4861%;\"\u003e\n \u003cp\u003eI don\u0026apos;t know enough about self-testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.1042%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4097%;\"\u003e\n \u003cp\u003e10.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.4861%;\"\u003e\n \u003cp\u003eI Prefer testing at the hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.1042%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4097%;\"\u003e\n \u003cp\u003e6.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative findings on Barriers to HIVST uptake\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative findings revealed similar concerned including fear of the result, concerns about accuracy, stigma associated with being seen with an HIVST kit and the assumption that one is HIV-positive, cost concerns and lack of awareness\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFear of the Test Result and Emotional Distress.\u0026nbsp;\u003c/strong\u003eA recurring concern among participants was the emotional impact of receiving an HIV-positive result, particularly when testing alone. Many worried about the lack of immediate support and feared the psychological toll of knowing their status: \u003cem\u003e\u0026quot;My concern is that in the hospital, if you test positive, they support you. At home, you might harm yourself if you\u0026rsquo;re alone.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;I\u0026rsquo;m scared of the result.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;Some people are afraid of doing the test because if they find out they are positive, they might commit suicide.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003eSeveral participants from IDIs echoed this fear, with one stating\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;If I do this test alone and I see a bad result, I don\u0026rsquo;t know how I will react. I might break down.\u0026quot;\u003c/em\u003e (IDI) Another participant reflected on the psychological burden of uncertainty while waiting for results: \u003cem\u003e\u0026quot;What will come to your mind while waiting for the result?\u0026quot;\u003c/em\u003e \u003cem\u003e\u0026quot;I\u0026rsquo;d have doubts about whether it\u0026rsquo;s positive or negative.\u0026quot;\u003c/em\u003e (FGD). For some, avoiding testing altogether was a way to avoid distress\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;If I don\u0026rsquo;t check, I won\u0026rsquo;t have to worry about it.\u0026quot;\u003c/em\u003e (IDI)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcerns About Accuracy and Need for Confirmation.\u0026nbsp;\u003c/strong\u003eParticipants expressed skepticism about whether a saliva-based test could be as reliable as traditional blood tests. Several questioned whether HIVST was truly accurate:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;I see it as a good innovation, but I\u0026rsquo;m still not clear. I think I\u0026rsquo;ll do more research on how it functions. We\u0026rsquo;ve always known that tests require blood samples, so I\u0026rsquo;m a bit confused.\u0026quot;\u003c/em\u003e (FGD)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;It\u0026rsquo;s strange to get a result from a test with just saliva.\u0026quot;\u003c/em\u003e (FGD\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;In the hospital, if you test positive, they will tell you what to do. But if I do this test at home and see a positive result, I might not know what steps to take.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003eSimilarly, some participants feared that false positives or incorrect results could lead to unnecessary panic: \u003cem\u003e\u0026quot;What if the test says I am positive and it\u0026rsquo;s not true? That will destroy me emotionally.\u0026quot;\u003c/em\u003e (IDI) \u003cem\u003e\u0026quot;I think the person should try the test again. If they still aren\u0026rsquo;t clear, they can go to the hospital to check their viral load.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStigma and Fear of Being Seen with an HIVST Kit\u003c/strong\u003e. Although HIVST provides privacy, some participants feared being seen with the kit. Simply owning a test kit could lead to assumptions about their HIV status, particularly for those living in shared spaces: \u003cem\u003e\u0026quot;What if you take the test kit home and your friends or parents see it? What would you say to them?\u0026quot;\u003c/em\u003e \u003cem\u003e\u0026quot;Sincerely, if anyone sees it with me, they might think I have HIV.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;People will spread rumors regardless of what you tell them.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003eAn IDI participant shared a similar concern about perceptions of HIV testing in their community: \u003cem\u003e\u0026quot;If someone sees you with a self-test, they assume you must have been exposed to HIV. They won\u0026rsquo;t believe you\u0026rsquo;re just checking.\u0026quot;\u003c/em\u003e (IDI) This fear was reinforced by past experiences of discrimination, making some hesitant to even discuss HIV testing: \u003cem\u003e\u0026quot;In Africa, if someone tests positive, their family avoids them. They put food at their door instead of handing it to them directly.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;Even in hospitals, doctors sometimes shout results in crowded places. It\u0026apos;s not professional.\u0026quot;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCost as a Potential Barrier.\u0026nbsp;\u003c/strong\u003eWhile some participants were willing to pay for HIVST kits, many believed the test should be free or highly subsidized, especially for migrant and refugee populations:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;The story of HIV is public knowledge. They should make it accessible. In Africa, many people don\u0026rsquo;t want to spend money on health issues.\u0026quot;\u003c/em\u003e (FGD)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;Here in Italy, they should make it affordable for immigrants who might not have jobs.\u0026quot;\u003c/em\u003e (FGD)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026quot;It should be free. If I have to pay, I might just go to the hospital instead since it\u0026rsquo;s free there.\u0026quot;\u003c/em\u003e (IDI)\u003c/p\u003e\n\u003cp\u003eSuggested price points varied, with some participants willing to pay between \u0026euro;5 and \u0026euro;15, while others insisted HIVST should be entirely free:\u0026nbsp;\u003cem\u003e\u0026quot;For me, 10 euros.\u0026quot;\u003c/em\u003e (FGD)\u003cbr\u003e\u003cem\u003e\u0026quot;Five euros.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;I wouldn\u0026rsquo;t want to pay for it.\u0026quot;\u003c/em\u003e (FGD) One participant compared the cost to hospital testing, questioning the added value of HIVST: \u003cem\u003e\u0026quot;Yes, it saves transportation costs, but hospital tests are free. Why should I pay for this?\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInsufficient knowledge\u003c/strong\u003e. Some participants were concerned that insufficient education could lead to misuse or misinterpretation of results: \u003cem\u003e\u0026quot;I think you have to train people on how to use this test. Not everyone knows what to do if the result is positive.\u0026quot;\u003c/em\u003e (IDI). One participant highlighted the lack of community outreach in Italy compared to their home country: \u003cem\u003e\u0026quot;In Africa, I belonged to an association that provided support to people with diseases. They gave out condoms and gels. But here in Italy, I haven\u0026rsquo;t seen such services.\u0026quot;\u003c/em\u003e (FGD)\u003c/p\u003e\n\u003cp\u003eSimilarly, misinformation or lack of trust in medical institutions led some participants to avoid HIV testing altogether: \u003cem\u003e\u0026quot;Some people don\u0026rsquo;t test because they believe that knowing their status will change their life in a bad way.\u0026quot;\u003c/em\u003e (FGD) \u003cem\u003e\u0026quot;There are people who don\u0026rsquo;t believe HIV is real. They say, \u0026lsquo;If I can\u0026rsquo;t see it, then I don\u0026rsquo;t have it.\u0026rsquo;\u0026quot;\u003c/em\u003e (IDI)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective 2: What factors are associated with WTU HIVST among ARMSWs?\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBivariate Analysis of factors Associated with WTU HIVST among\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eARMSWs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 presents chi-square test results examining associations between sociodemographic factors, healthcare access, testing behavior, sex work-related characteristics and WTU HIVST among ARMSW\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Chi-square Analysis of factors Associated with WTU HIVST among ARMSWs\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"616\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWTU to use HIVST (n=115)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=51, 44.4%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=64, 55.6%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eYoung Adult (18 -24)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8 (57.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6 (61.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eAdult (25+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e53 (41.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e76 (58.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003ePrimary or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e32 (40.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e48 (60.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eSecondary or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e19 (54.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e16 (45.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender Identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e51 (44.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e63 (55.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eTransgender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003enon-binary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e32 (45.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e39 (54.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e19 (43.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e25 (56.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eNo children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e27 (50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e27 (50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eOne or more children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e24 (39.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e37 (60.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligious Affiliation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eNo religion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e19 (95.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eBelong to a religion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e50 (52.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e45 (47.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRank of Religiosity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eNot religious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (28.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10 (71.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eReligious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e47 (46.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54 (53.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of Stay in Italy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eA year or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18 (46.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e21 (53.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eMore than a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e33 (43.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e43 (56.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual Orientation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eGay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e32 (39.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e49 (60.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eBisexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e19 (55.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15 (44.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat role do you play during sex?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eTop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e32 (39.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e49 (60.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eBottom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e19 (55.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15 (44.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eVersatile (Verse)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny other job apart from sex work\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13 (48.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14 (51.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e38 (43.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e50 (56.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 616px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHEALTHCARE ACCESS \u0026amp; TESTING BEHAVIOR FACTORS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistance to Healthcare Facility (Km)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 5km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e34 (54.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e28 (45.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e6km or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e17 (32.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e36 (67.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7 (25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e21 (75.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eHave ever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e44 (50.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e43 (49.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Insurance status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e35 (64.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e19 (64.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e16 (26.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e45 (73.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmigration challenge in healthcare access\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e26 (55.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e21 (44.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e25 (36.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e43 (63.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperienced stigma or discrimination at the hospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.052*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e22 (56.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e17 (43.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e29 (38.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e47 (61.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know where to go for STI/HIV testing and care?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e35 (64.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e19 (35.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e16 (26.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e45 (73.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTested for STI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNever tested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 (18.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e35 (81.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eEver tested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e43 (59.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e29 (40.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTested for HIV\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNever tested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e26 (50.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e25 (49.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eEver tested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e25 (39.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e39 (60.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV test frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eOnce a year or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e20 (34.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e30 (65.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eMore than once a year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e18 (58.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e13 (41.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAwareness of HIVST\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e19 (29.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e46 (70.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e32 (64.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e18 (36.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver used HIVST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e7(30.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e16(69.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e25(92.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2(7.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 616px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSEX WORK RELATED FACTORS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVenue for meeting client\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eOffline\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e49 (45.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e58 (54.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eOnline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2 (25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e6 (75.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of client in past 2month (Men)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eLess than 20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e37 (58.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e26 (41.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e20 or more\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e14 (26.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e38 (73.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of client in past 2month (Women)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eLess than 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e20 (52.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e18 (47.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e10 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2 (66.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVaginal sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e30 (40.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e44 (59.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e21 (51.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e20 (48.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCondom use for vaginal sex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eSometimes/Never\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e28 (42.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e38 (57.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e10 (50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e10 (50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnal sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e40 (44.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e50 (55.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e11 (44.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e14 (56.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCondom use for anal sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eSometimes/Never\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e48 (40.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e70 (59.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e10 (52.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e9 (47.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLubricant use for anal sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e33 (42.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e44 (57.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15 (60.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e10 (40.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransactional condomless sex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e41 (67.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e20 (32.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e31 (42.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e23 (42.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 321px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFactors significantly associated with WTU of HIVST included religious affiliation (\u0026chi;\u0026sup2; = 15.19, p \u0026lt; 0.001), and religiosity (\u0026chi;\u0026sup2; = xx, p \u0026lt; 0.001), healthcare-related factors such as distance to a healthcare facility (\u0026chi;\u0026sup2; = 5.99, p = 0.014), healthcare frequency (\u0026chi;\u0026sup2; = 5.6, p = 0.018), health insurance status (\u0026chi;\u0026sup2; = 17.28im, p \u0026lt; 0.001), and immigration-related healthcare challenges (\u0026chi;\u0026sup2; = 3.88, p = 0.049). Additionally, prior knowledge of where to access HIV testing (\u0026chi;\u0026sup2; = 21.15, p \u0026lt; 0.001), ever tested for STI (\u0026chi;\u0026sup2; = 18.44, p \u0026lt; 0.001), HIV test frequency (\u0026chi;\u0026sup2; = 9.84, p \u0026lt; 0.007), awareness of HIVST (\u0026chi;\u0026sup2; = 13.84, p \u0026lt; 0.001), and previous use of HIVST (\u0026chi;\u0026sup2; = 20.83, p \u0026lt; 0.001) were associated with WTU HIVST. Sex work-related factors influencing willingness included the number of male clients in the past two months (\u0026chi;\u0026sup2; = 11.67, p = 0.001) and engagement in transactional condomless sex (\u0026chi;\u0026sup2; = 7.04, p = 0.008)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate logistic regression analysis of factors influencing WTU HIVST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 presents the results of crude (unadjusted) and adjusted multiple logistic regression models assessing factors associated with WTU HIVST. In the unadjusted model, significant predictors of WTU HIVST included religious affiliation (belong to a religion: cOR = 21.11, 95% CI: 2.71 \u0026ndash; 164.12, p = 0.004), distance to a healthcare facility (\u0026ge;6 km: cOR = 0.389, 95% CI: 0.18 \u0026ndash; 0.83, p = 0.001), healthcare frequency (ever accessed healthcare: cOR = 3.07, 95% CI: 1.18 \u0026ndash; 7.96, p = 0.021), health insurance status (insured: cOR = 5.32, 95% CI: 2.60\u0026ndash;10.86, p \u0026lt; 0.001), immigration related healthcare access challenges (yes: cOR = 2.13, 95% CI: 1.00 \u0026ndash; 4.54, p = 0.050), Experienced stigma or discrimination at the hospital (yes: cOR = 1.68, 95% CI: 0.89 \u0026ndash; 3.20, p = 0.050), knowledge of STI/HIV testing and care center (yes: cOR = 7.37, 95% CI: 2.99\u0026ndash; 18.17, p = 0.000), tested for STI (ever tested: cOR = 6.49, 95% CI: 2.63 \u0026ndash; 15.97, p \u0026lt; 0.001), HIV test frequency (\u0026gt;once per year: cOR = 4.5, 95% CI: 0.85 \u0026ndash; 23.95), p = 0.000), awareness of HIVST (cOR = 4.57, 95% CI: 1.95 \u0026ndash; 9.45, p = 0.001), ever used HIVST (yes: cOR = 4.57, 95% CI: 2.02 \u0026ndash; 10.36, p = 0.000), number of male clients in the past two months (\u0026ge;20 clients: cOR = 0.47, 95% CI: 0.24\u0026ndash;0.92, p = 0.027), and engagement in transactional condomless sex (yes: aOR = 2.76, 95% CI: 1.29 \u0026ndash; 5.90 p = 0.009),\u003c/p\u003e\n\u003cp\u003eIn the adjusted model, six factors remained significantly associated with WTU HIVST. Religious affiliation (belong to a religion: aOR = 78.27, 95% CI: 71.77 \u0026ndash; 345.83, p = 0.024), health insurance status (insured: aOR = 14.56, 95% CI: 10.88 \u0026ndash; 23.92, p = 0.051), immigration related healthcare access challenges (aOR = 16.93, 95% CI: 14.22 \u0026ndash; 20.15, p = 0.025), HIV test frequency (\u0026gt; once a year: aOR = 20.37, 95% CI: 18.98-48.61, p = 0.04), awareness of HIVST (aOR = 20.37, 95% CI: 18.98-48.61, p = 0.04), and Ever used HIVST (yes: aOR = 3.12, 95% CI: 1.93 \u0026ndash; 9.21, p = 0.04),\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Crude and adjusted multiple logistic regression Analysis of factors influencing WTU HIVST\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"661\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWTU HIVST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnadjusted Model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligious Affiliation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNo religion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eBelong to a religion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e21.11 (2.71 \u0026ndash; 164.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e78.27 (71.77 \u0026ndash; 345.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistance to Healthcare Facility (Km)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 5km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e6km or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.389 (0.18 \u0026ndash; 0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.11 (0.39 \u0026ndash; 26.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare frequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNever\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eHave ever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3.07 (1.18 \u0026ndash; 7.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.021*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.08 (0.37 \u0026ndash; 6.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Insurance status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e5.18 (2.33 \u0026ndash; 11.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e14.56 (10.88 \u0026ndash; 23.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.051*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmigration challenge in healthcare access\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2.13 (1.00 \u0026ndash; 4.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.050*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e16.93 (14.22 \u0026ndash; 20.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.025*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperienced stigma or discrimination at the hospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.68 (0.89 \u0026ndash; 3.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.50 (0.14 \u0026ndash; 1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know where to go for STI/HIV testing and care?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e7.37 (2.99 \u0026ndash; 18.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.83 (0.71 \u0026ndash; 32.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTested for STI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNever tested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eEver tested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e6.49 (2.63 \u0026ndash; 15.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e6.02 (0.65 \u0026ndash; 7.36)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV test frequency (n=150)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eLess than once a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eMore than once a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;4.5 (0.85 \u0026ndash; 23.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.078\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e20.37 (18.98-48.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAwareness of HIVST (n=150)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4.30 (1.95 \u0026ndash; 9.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.24 (0.36 \u0026ndash; 9.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver used HIVST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e28.57 (5.26\u0026ndash; 55.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.12 (1.90 \u0026ndash; 10.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of client in past 2month (Men) (n=150)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eLess than 20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e20 or more\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.47 (0.24 - 0 .92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.15 (0.019 \u0026ndash; 1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransactional condomless sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2.76 (1.29 \u0026ndash; 5.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.44 (0.050 \u0026ndash; 3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ecOR (Crude odds \u0026nbsp;ratio); aOR(Adjusted odds ratio); 95% CI \u0026ndash; (95% Confidence interval); \u0026nbsp; *(P\u0026le; 0.05)\u003c/strong\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTo our knowledge, this is the first study to assess WTU HIVST among ARMSWs in Italy, a key population with high vulnerability to HIV.\u0026nbsp;Through quantitative and qualitative analyses, we uncovered a complex interplay of individual perceptions, structural barriers, and community dynamics shaping attitudes toward HIVST. Applying the Health Belief Model (HBM), we examine how perceived risks, benefits, and barriers influence self-testing decisions (Green et al., 2020; Jones et al., 2015; Rosenstock, 1974). Willingness was moderate, driven by convenience, privacy, and stigma avoidance, while concerns about accuracy, access, and emotional distress remained key barriers. Healthcare access factors, religious affiliation, past HIV/STI testing, and sex work-related characteristics also played a role. Below, we connect quantitative patterns with qualitative narratives to provide a holistic view of HIVST adoption in this marginalized population.\u003c/p\u003e\n\u003cp\u003eOur study found that 44.4% of participants were willing to use HIVST, a moderate level of acceptance that highlights some hesitation among the majority which corresponds with some previous studies among marginalized persons elsewhere (Shrestha et al., 2020).\u0026nbsp;Although this result may appear low relative to studies of HIVST interest in key populations in the United States (68%)(Lippman et al., 2016),Thailand (99.3%) (Girault et al., 2021),\u0026nbsp;Peru (95%)(Bustamante et al., 2017), Cambodia (100%) (Pal et al., 2016), Benin (100%)(Boisvert Moreau et al., 2022b), Nigeria (Tun et al., 2018b),\u0026nbsp; and Botswana (Shava et al., 2020), our finding demonstrates that a solid base of ARMSWs would be willing to adopt HIVST as an alternative HIV testing modality. The moderate WTU HIVST in our study may, in part, be explained by the low levels of awareness and limited education about HIVST among our target population. Previous studies have shown that settings, where educational campaigns have been implemented, show much higher WTU HIIVST because users are more familiar with its procedures and potential advantages (e.g., confidentiality and convenience)\u0026nbsp;(Laxmeshwar et al., 2024)\u003c/p\u003e\n\u003cp\u003eThe decision to use HIVST appeared to be driven by a balance between perceived benefits and perceived barriers, both of which were deeply embedded in participants\u0026rsquo; lived experiences. From an HBM perceived benefits perspective, HIVST was seen as an opportunity to test in a manner that is both discreet and private, thus avoiding the stigma and unwanted scrutiny often associated with conventional, facility‐based HIV testing(Green et al., 2020; Jones et al., 2015; Rosenstock, 1974). Our quantitative data indicated that nearly half of those willing to use HIVST cited convenience and privacy as their primary motivation. This aligns with the HBM, as perceived susceptibility to social stigma increased the attractiveness of self-testing as a protective behavior. In other settings, similar motivations have been reported; participants often choose self‐testing because it allows them to manage their health on their own terms, without the perceived barriers of judgment or exposure at health facilities (Abu-Ba\u0026rsquo;are et al., 2024; Figueroa et al., 2018; Morshed Hemel et al., 2024; Shava, et al., 2020). Thus, highlighting the importance of consistent engagement with care as a determinant for HIVST. For instance, among these participants, HIV testing behaviors strongly influenced WTU HIVST. Participants who had tested for HIV more than once annually were more likely to express WTU HIVST, as were those already aware of HIVST or with prior experience using it. These findings reflect the HBM\u0026rsquo;s concept of \u0026ldquo;cues to action,\u0026rdquo; where previous behaviors and exposure reduce uncertainty and foster positive attitudes toward health innovations (Rosenstock, 1974). Similar associations have been reported in Southeast Asia and sub-Saharan Africa, where HIVST awareness and prior use were among the strongest predictors of future uptake (Figueroa et al., 2015; Myint et al., 2021; Zeleke et al., 2024). This suggests that expanding awareness and providing opportunities to try HIVST may increase demand, especially among those with testing experience.\u003c/p\u003e\n\u003cp\u003eConversely, several perceived barriers significantly discouraged WTU HIVST among participants. More than half of respondents expressed unwillingness to self-test, citing concerns related to test accuracy, emotional preparedness for a positive result, and limited access to kits. These findings align with prior studies that identify psychological and logistical barriers as major deterrents to HIVST uptake (Njau et al., 2019). Concerns about test reliability, particularly skepticism toward saliva-based tests, mirror findings from other settings where individuals associate diagnostic accuracy with blood-based testing, viewing oral tests as inferior (Abu-Ba\u0026rsquo;are, Shamrock, et al., 2024; Njau et al., 2014; Steehler \u0026amp; Siegler, 2019).\u003c/p\u003e\n\u003cp\u003eFear of emotional distress, particularly the anxiety of dealing with a positive result alone, was another central barrier. This highlights low self-efficacy, a key HBM element, where individuals doubt their capacity to cope with testing outcomes without immediate psychosocial support (Lin et al., 2017; Steehler \u0026amp; Siegler, 2019). Similar concerns have been documented in studies with other key populations, where the absence of pre-and post-test counseling diminished confidence in managing HIV test results (Hamilton et al., 2021; Tun et al., 2018a; World Health Organization, 2009). This highlights the importance of integrating HIVST with supportive services, such as hotlines or linkage-to-care platforms.\u003c/p\u003e\n\u003cp\u003eFurthermore, structural barriers also played a role. Difficulty accessing kits, reported by nearly one-third of participants, reflects systemic gaps in awareness about the availability and distribution of HIVST, particularly among marginalized and undocumented groups in Italy. This finding is consistent with studies that show a lack of information among migrants and undocumented populations about healthcare entitlements, including free HIV testing and treatment, due to poor communication from authorities and language barriers (Chiarenza et al., 2019; Mona et al., 2021b). Health literacy plays a crucial role in individuals\u0026apos; ability to navigate healthcare systems and understand their rights and available services (Coughlin et al., 2020). In the case of HIV testing, lower health literacy can hinder individuals from seeking or properly utilizing testing services, as they may not be aware of their eligibility for free or subsidized tests, or the procedures involved in accessing them(Coughlin et al., 2020; Naidoo \u0026amp; Taylor, 2015; Zhai et al., 2023) This is particularly important for migrant populations, where culturally appropriate health education is essential to ensure effective communication about HIV testing and prevention(European Centre for Disease Prevention and Control, 2011; Puthoopparambil et al., 2021). Increasing health literacy, particularly through community-based programs that provide culturally tailored information, can help bridge these gaps and empower individuals to make informed decisions about their health(Abubakari et al., 2021a).\u003c/p\u003e\n\u003cp\u003eWithin these structural determinants, stigma remained a powerful deterrent, even within the supposedly private context of self-testing. Participants expressed concerns about being seen with an HIVST kit, suggesting that HIV-related stigma persists not only in healthcare settings but also in personal and community spaces. This aligns with the broader literature on HIV-related stigma, which continues to act as a cue to inaction and a major barrier to testing among sex workers and other key populations (Ekstrand et al., 2018; Yang et al., 2015). These insights emphasize the need for discreet, stigma-sensitive HIVST interventions that consider the social context in which testing occurs.\u003c/p\u003e\n\u003cp\u003eMoreover, our multivariable analysis identified several key predictors of WTU HIVST among ARMSWs, including access to healthcare, prior HIV/STI testing behaviors, and HIVST awareness and experience.\u0026nbsp;Access to healthcare, in particular, played a key role in shaping HIVST willingness. Participants with health insurance were substantially more likely to express WTU HIVST. These findings suggest that individuals more integrated into the healthcare system may develop greater self-efficacy and trust in health innovations, making them more receptive to HIVST. This aligns with previous research showing that frequent engagement with healthcare services enhances familiarity with HIV prevention tools and reduces testing-related anxiety\u0026nbsp;(Conserve et al., 2017; McDaid et al., 2016; Patel et al., 2023). Interestingly, those who had experienced immigration-related healthcare challenges were 17 times more likely to be willing to use HIVST, possibly reflecting their preference for private, self-directed testing options that circumvent the barriers they faced in formal health settings. This aligns with literature showing that migrants and key populations who encounter stigma, discrimination, or fears of legal repercussions in traditional healthcare settings may view HIVST as a safer, more accessible alternative \u0026nbsp;(Abu-Ba\u0026rsquo;are, Shamrock, et al., 2024; Fakoya et al., 2017). Qualitative narratives further reinforce this, with participants expressing a strong desire for confidential, community-based approaches that avoid the institutional gatekeeping often encountered in mainstream services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRelatedly, cost also emerged as a significant determinant of WTU HIVST. Although some participants were open to paying modest amounts (\u0026euro;5\u0026ndash;\u0026euro;15), many emphasized that HIVST should be free or heavily subsidized, particularly for migrants and refugees experiencing economic vulnerability. This cost-sensitivity reflects broader structural inequities that shape healthcare access for marginalized groups. Similar findings have been reported in studies across SSA and Asia, where WTU HIVST dropped significantly when users had to pay for kits and advocating for free HIVST kits, especially among low-income populations (Abubakari et al., 2021; Figueroa et al., 2015; Hamilton et al., 2021; Myint et al., 2021; Zeleke et al., 2024). Financial barriers have consistently been linked to reduced uptake of HIV-related services, with affordability being a critical factor influencing healthcare decisions among key populations (Abubakari et al., 2021; Ogunbajo et al., 2018). As such, the cost of self-testing kits should be a central consideration in program design, especially in contexts where free or low-cost facility-based testing is already available.\u003c/p\u003e\n\u003cp\u003ePerhaps one of the most critical insights emerging from our study is the pressing need for community-based education and support services to accompany HIVST implementation among ARMSWs in Italy. Community-based approaches (CBAs) have proven effective in other settings by providing culturally appropriate education, building trust, and delivering services in ways that resonate with marginalized populations (Abu-Ba\u0026rsquo;are, Torpey, et al., 2024; Abubakari et al., 2021b; Chakrapani et al., 2024; Stein et al., 2015; Wilton et al., 2009). In contexts where migrants and sex workers often face systemic exclusion from mainstream healthcare, CBAs, particularly those that integrate peer educators and trusted local organizations, can act as critical enablers of health behavior change (Benoit et al., 2017; Martinez-Damia et al., 2024; Riza et al., 2020).\u0026nbsp;By offering pre- and post-test counseling, information on HIVST procedures, and linkage to care, such models not only promote correct use of self-testing kits but also help alleviate the emotional burden associated with testing alone. Strengthening partnerships with migrant-led organizations and tailoring HIVST programs to the specific needs and realities of ARMSWs could thus serve as a key strategy to boost uptake and ensure that HIVST delivers on its promise of expanding access to timely diagnosis and care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLIMITATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study has several limitations. Recruitment through Circolo Pink and snowball sampling may have introduced selection bias, as participants engaged with support networks might have different healthcare experiences than those without such access. Additionally, self-reported data on HIVST willingness and testing behaviors may be subject to social desirability bias, as participants may have provided responses they perceived as more acceptable. While we ensured confidentiality and conducted interviews in safe spaces, future research could incorporate biomarker testing or behavioral tracking to validate self-reports. Furthermore, our cross-sectional design limits causal interpretations, preventing us from determining whether factors like healthcare access, sex work-related experiences, or prior testing history directly influence HIVST willingness over time. Due to privacy protections, we did not collect identifiable personal data, which prevented us from linking individual responses across survey and interview components. While this approach ensured participant safety, it limited our ability to track longitudinal changes in attitudes and behaviors. \u0026nbsp;Lastly, as our study was conducted in northern Italy (Verona and Turin), findings may not fully capture the experiences of MSWs in other regions with different healthcare policies or migration dynamics. Despite these limitations, our study remains one of the first to examine HIVST willingness among African refugee MSWs in Italy, offering critical insights that can inform future research and tailored interventions.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur study highlights the complex interplay of individual, structural, and occupational factors influencing HIVST willingness among African refugee MSWs in Italy. While convenience, privacy, and stigma avoidance emerged as key facilitators, concerns about test accuracy, emotional distress, access barriers, and structural vulnerabilities limited uptake. Healthcare access, prior testing experiences, religious affiliation, and sex work-related factors also played a significant role in shaping HIVST attitudes. Applying the Health Belief Model, our findings underscore the need for targeted, community-driven interventions that address both individual perceptions and systemic barriers to HIV testing. Expanding education, peer-led outreach, and subsidized access to HIVST could enhance uptake and improve HIV prevention efforts within this highly marginalized population.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003eThe authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbu-Ba\u0026rsquo;are, G. R., Shamrock, O. W., Agbemedu, G. R. K., \u0026amp; Dakpui, H. D. 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T., Nelson, L. E., \u0026amp; Torpey, K. (2023a). \u0026ldquo;For my safety and wellbeing, I always travel to seek health care in a distant facility\u0026rdquo;\u0026mdash;the role of place and stigma in HIV testing decisions among GBMSM \u0026ndash; BSGH 002. \u003cem\u003eHealth \u0026amp; Place\u003c/em\u003e, \u003cem\u003e83\u003c/em\u003e, 103076. https://doi.org/https://doi.org/10.1016/j.healthplace.2023.103076\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZigah, E. Y., Abu-Ba\u0026rsquo;are, G. R., Shamrock, O. W., Dakpui, H. D., Apreku, A., Boyd, D. T., Nelson, L. E., \u0026amp; Torpey, K. (2023b). \u0026ldquo;For my safety and wellbeing, I always travel to seek health care in a distant facility\u0026rdquo;\u0026mdash;the role of place and stigma in HIV testing decisions among GBMSM\u0026ndash;BSGH 002. \u003cem\u003eHealth \u0026amp; Place\u003c/em\u003e, \u003cem\u003e83\u003c/em\u003e, 103076.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"National Institute of Mental Health","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Marginalized populations, HIV self testing, African Immigrant, Sex workers, HIV","lastPublishedDoi":"10.21203/rs.3.rs-6421791/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6421791/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMarginalized populations such as African refugee male sex workers (ARMSWs) in Italy face systemic barriers to HIV testing, including stigma, privacy concerns, and structural inequities. Despite the potential of HIV self-testing (HIVST) to overcome these barriers, limited research exists on its acceptability among ARMSWs. This study examines HIVST willingness and associated factors among ARMSWs to inform targeted interventions A mixed-methods sequential exploratory design was employed, combining quantitative surveys (n\u0026thinsp;=\u0026thinsp;150) with qualitative interviews (20 in-depth interviews, 2 focus group discussions) among ARMSWs in Italy. Participants were recruited through venue-based and snowball sampling in partnership with a community organization. Quantitative findings revealed moderate willingness (44.4%) to use HIVST, driven by convenience (47.1%), privacy (23.5%), and stigma avoidance. Key barriers included concerns about test accuracy (27.0%), emotional distress from positive results (20.9%), and limited kit access (32.2%). Qualitative insights emphasized occupational relevance, empowerment, and fears of community stigma if seen with kits. Multivariate analysis identified religious affiliation (aOR\u0026thinsp;=\u0026thinsp;78.27), health insurance (aOR\u0026thinsp;=\u0026thinsp;14.56), prior HIV testing (aOR\u0026thinsp;=\u0026thinsp;20.37), HIVST awareness (aOR\u0026thinsp;=\u0026thinsp;3.24), and HIVST prior usage (aOR\u0026thinsp;=\u0026thinsp;4.12) as significant predictors of willingness. Structural challenges, such as immigration-related healthcare barriers, amplified interest in HIVST as a discreet alternative. The study calls for community-driven interventions addressing accuracy concerns, subsidized access, and psychosocial support. Integration of HIVST with peer-led education and linkage-to-care services could enhance uptake. Policymakers should prioritize stigma reduction and equitable distribution strategies to align with global HIV targets for marginalized populations.\u003c/p\u003e","manuscriptTitle":"Stigma, privacy concerns, sexual behaviors, and testing history shape willingness to use HIV self-testing among African refugee male sex workers in Italy – A mixed method study - BGSH-023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-14 04:21:19","doi":"10.21203/rs.3.rs-6421791/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb86ed57-1b97-4292-b9d2-2173b410cd69","owner":[],"postedDate":"April 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":46987951,"name":"Infectious Diseases"},{"id":46987952,"name":"Sociology"}],"tags":[],"updatedAt":"2025-04-14T04:21:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-14 04:21:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6421791","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6421791","identity":"rs-6421791","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}