Acceptability, barriers, and associated factors for HIV self-testing among men who have sex with men in Colombo, Sri Lanka

Background: HIV self-testing (HIVST) offers a discreet and empowering approach to increase HIV testing coverage, particularly among key populations such as men who have sex with men (MSM). This strategy can help overcome stigma and improve case detection rates.
Objective: To assess the acceptability, barriers, and associated factors influencing HIVST among MSM attending the Central Sexually Transmitted Disease (STD) Clinic in Colombo, Sri Lanka.
Methods: A cross-sectional analytical study was conducted from October 2022 to September 2024 among 233 systematically selected MSM. Data were collected using a pre-tested, assisted self-administered questionnaire. Statistical analysis included descriptive and inferential methods using SPSS software.
Results: The mean age was 30.2 years; the majority were Sinhalese (91.4%) and single (82.8%). A significant proportion (98.3%) reported multiple sexual partners, with 29.2% engaging in unprotected anal sex and 87.6% in unprotected oral sex. Awareness of HIVST was high (83.7%), but only 34.3% had ever used it. Willingness to use HIVST in the future was 82.8%. Common barriers included limited kit availability (40%), lack of procedural knowledge (25.3%), confidentiality concerns, and absence of post-test support. Acceptability was significantly associated with higher education, multiple partners, alcohol use during sex, group sex, awareness of HIV risk, and prior knowledge of HIVST (p < 0.05).
Conclusion: HIVST is a promising approach for expanding HIV testing among MSM in Sri Lanka. Addressing access, education, and confidentiality concerns through targeted community-based interventions can improve uptake and support national HIV prevention goals.