Title: Do men face greater barriers to accessing HIV testing services than women? Might HIV self-testing be the answer? Evidence from a longitudinal survey in east Zimbabwe (2018–2023)
Authors: Otambo W, Mandizvidza P, Moorhouse L, Inghels M, Moyo R, Okango E, Tsenesa B, Maswera R, Dzamatira F, Gregson S, Tanser F, Nyamukapa C, Mee P.
Journal: PLOS Global Public Health, 6:e0006125 (2026)
Abstract
HIV testing is crucial for prevention and treatment, yet barriers may disproportionately affect men in some sub-Saharan African settings. HIV self-testing (HIVST) may offer a promising solution, but its uptake remains under-explored. This study examines sex-specific barriers, HIV testing trends, and HIVST uptake in Manicaland, Zimbabwe, across three survey rounds pre-, during-, and post-COVID-19. We conducted longitudinal surveys 2018–2019 (pre- COVID-19), 2021 (during COVID-19), 2022–2023 (post-COVID-19), across six socio-economic zones (tea estates, rural villages, forestry areas, towns, roadside settlements, and urban areas) in eastern Zimbabwe. The study employed an open cohort design with repeated cross-sections, complemented by a sub-analysis among repeat participants to assess robustness. Data on socio-demographic characteristics, HIV testing, perceived barriers, and HIVST awareness and usage were analysed using generalized linear mixed-effects models. Men consistently had lower odds of HIV testing than women (2022–2023, aOR=0.74, 95% CI:0.67–0.81,
P
<?0.001). Barriers to HIV testing peaked during COVID-19 (2021), with men reporting three to five times higher barriers than women, including “judgmental staff” (24.5% vs. 4.7%,
P
=?0.005) and “lack of privacy” (21.5% vs. 5.1%,
P
=?0.032). Rural residents had reduced testing odds post-COVID-19 (aOR=0.82, 95% CI:0.69–0.99,
P
=?0.034). Although HIVST awareness increased, particularly among men compared to women, (66.7% vs 58.5%, aOR=2.21, 95% CI:2.09–2.33,
P
<?0.001), usage remained low (5.9%, vs 9.8%). Men report substantially greater barriers to HIV testing in Zimbabwe, exacerbated during the COVID-19 and are now further threatened by cuts to HIV funding. Although HIVST awareness expanded, its low uptake among men highlights the need for improved linkage-to-care mechanisms and tailored outreach such as peer-led distribution models.
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Citation: Otambo W, Mandizvidza P, Moorhouse L, Inghels M, Moyo R, Okango E, Tsenesa B, Maswera R, Dzamatira F, Gregson S, Tanser F, Nyamukapa C, Mee P. Do men face greater barriers to accessing HIV testing services than women? Might HIV self-testing be the answer? Evidence from a longitudinal survey in east Zimbabwe (2018–2023) PLOS Global Public Health, 6:e0006125 (2026).