Brief Report: Beyond Testing: Exploring the Psychosocial Impact of HIV Self-Testing Among Ugandan Gender-Diverse Sex Workers.

Timothy M Kintu; Marvin Nnyombi; Raymond B Kihumuro; Andrew M Kanyike; Andrew Mujugira

doi:10.1097/qai.0000000000003907

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Brief Report: Beyond Testing: Exploring the Psychosocial Impact of HIV Self-Testing Among Ugandan Gender-Diverse Sex Workers.

Timothy M Kintu·Marvin Nnyombi·Raymond B Kihumuro·Andrew M Kanyike·Andrew Mujugira

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Abstract

BACKGROUND: The psychosocial effect of HIV self-testing (HIVST) on sex workers' self-esteem, depression, alcohol misuse, perceived sex work stigma, and empowerment remains poorly characterized. We hypothesized that HIVST would reduce sex work stigma and improve these psychosocial outcomes by enabling private, autonomous testing and reducing exposure to stigmatizing healthcare encounters. SETTING: Kampala, Uganda. METHODS: We conducted a secondary analysis of the Empower study (NCT03426670), an open-label randomized trial in which 117 cisgender female, transgender female, and cisgender male sex workers were assigned 1:1 to monthly HIVST plus quarterly clinic-based testing, or to quarterly clinic-based testing alone, and followed for 12 months. Self-esteem (Rosenberg Self-Esteem Scale), depressive symptoms (PHQ-2), alcohol misuse (RAPS4), perceived sex work stigma (adapted Female Sex Worker Stigma Scale), and empowerment were assessed quarterly. Mixed-effects regression models, adjusted for baseline values, evaluated intervention effects. RESULTS: Data from 117 participants were analyzed, including 7 early disenrollments. Over 12 months, HIVST participants reported significantly lower perceived sex work stigma than standard of care participants (β = -0.38, P = 0.04; monthly reduction P = 0.003), although the rate of decline did not differ significantly between arms (interaction P = 0.08). Self-esteem and depressive symptoms improved in both arms, with no between-arm differences (interaction P = 0.41 and 0.32). Alcohol misuse and empowerment showed no significant arm differences. CONCLUSION: HIVST may reduce sex work stigma without adverse psychosocial effects, supporting its integration into combination HIV prevention for gender-diverse sex workers in sub-Saharan Africa.

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Humans Female Sex Workers Uganda HIV Infections Adult Male Social Stigma Depression Self Concept HIV Testing Young Adult HIV self-testing mental health sex work stigma sex workers Journal Article Randomized Controlled Trial

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Timothy M Kintu, Marvin Nnyombi, Raymond B Kihumuro, Andrew M Kanyike, Andrew Mujugira. 2026-10-01. Brief Report: Beyond Testing: Exploring the Psychosocial Impact of HIV Self-Testing Among Ugandan Gender-Diverse Sex Workers.. https://doi.org/10.1097/qai.0000000000003907

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Journal Article; Randomized Controlled Trial resource Adult subject Depression subject Female subject HIV Infections subject Humans subject Journal Article subject Male subject Mental Health subject Randomized controlled trials study

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