Uptake and acceptability of assisted and unassisted HIV self-testing among men who purchase sex in brothels in Indonesia: A pilot intervention study

Luh Putu Lila Wulandari*, John Kaldor, Rebecca Guy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Background: Along with sexual partners of other high-risk groups, men who purchase sex (MWPS) represented 18% of new HIV diagnoses worldwide in 2018. They are therefore an important population for HIV prevention globally. Despite very low HIV testing coverage among MWPS in many countries, the role of HIV self-testing to increase testing coverage has not been explored. We, therefore, conducted a pilot intervention study to evaluate the uptake and acceptability of assisted and unassisted HIV self-testing among MWPS in Indonesia. Methods: MWPS attending seven brothels in Bali between December 2017 and January 2018 were recruited by lay health providers to participate in a brief health survey, and then invited to have a HIV self-test (assisted or unassisted) with an OraQuick® ADVANCE Rapid HIV-1/2 Antibody Test and complete a post-test acceptability survey. Results: A total of 292 men completed the health survey (response rate: 70%) and 188 (64.6%) accepted HIV self-testing. Of these men, 13.3% had ever tested for HIV and 58.9% reported condom use at their last sexual encounter with a brothel-based female sex worker. Nearly all men (98.9%) who accepted a HIV self-test preferred assisted HIV self-testing-of whom 83.9% preferred to be fully assisted and 16.1% opted to be partially assisted and read their results privately. Of the men who accepted the test and showed the result to the lay health providers, 4 (2.1%) received reactive results. Linkage following HIV self-test is a concern, as none of the four men with a reactive result attended HIV testing at the recommended referral HIV testing clinic over a two-month follow-up period. Conclusions: This study is the first to investigate the acceptance of HIV self-testing when offered to MWPS in brothels by lay health providers. The high uptake of HIV self-testing suggests that this testing model is acceptable and could increase the very low HIV testing coverage among MWPS. The strong preference for fully assisted HIV self-testing highlights the importance of involving lay health providers in future testing programs. When scaling up HIV self-testing programmatically, strategies to improve linkage-to-care should be considered and evaluated.

Original languageEnglish
Article number730
JournalBMC Public Health
Issue number1
Publication statusPublished - 19 May 2020
Externally publishedYes

Bibliographical note

Funding Information:
The study is funded by a National Health and Medical Research Council (NHMRC) Program Grant # APP1071269. The contents of the published material are solely the responsibility of the administering institution, a participating institution or individual authors and do not reflect the views of the NHMRC. The funding source had no role in the design of the study, and was not involved in data collection, data analysis, interpretation of the results, or writing of the manuscript.

Publisher Copyright:
© 2020 The Author(s).


  • Clients of sex workers
  • HIV self-testing
  • HIV testing
  • Indonesia
  • Lay workers
  • Men who purchase sex
  • Scale-up


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