In Malawi where poverty and unemployment remains high, many women turn to sex work in order to support themselves and their families. Malawi has one of the worlds highest rates of HIV and while the country has made huge strides in fighting the epidemic, female sex workers remain extremely exposed, with much lower access to health information and healthcare in the community (MSF.2014). A study conducted by Tokar, Broerse, Blanchard and Roura (2018) in Uzbekistan states that, in as far as testing is concerned, female sex workers are either too afraid to seek out for sexual health services for fear of discrimination, or are prevented from accessing them , for example, a nurse may refuse to treat them after ?nding out about their occupation.
Some have the perception that they are at a low-risk of infection and that there is little bene?t from knowing their status, some female sex workers have fears over HIV test con?dentiality.
Furthermore study indicate that FSWs who started sex work before the age of 18 were less likely to testand in Canada older age of sex work initiation was positively associated with recent testing, FSWs who engaged in sex work for a longer time had a higher uptake of testing and willingness to test, FSWs employed for shorter periods were less likely to test.
Having a lower number of clients/sexual partners was associated with HIV testing in China, but was reported to decrease testing in Vietnam, Iran and Uzbekistan. The study identified drug use and alcohol consumption to impede HIV testing.
Still, in Iran and Canada drug use among FSWs did not hinder testing(Tokar. Broerse, Blanchard,Roura, 2018). In addition Rao, G. et al (2008) indicated that a womans subordinate status can a?ect her ability to negotiate condom use while a lack of infrastructure such as transport, prevents many people from accessing health clinics. By successfully addressing these structural barriers, individuals are empowered and able to access HIV prevention services.
However, because offering the service alone has failed to increase uptake of testing in many parts of subSaharan Africa (Matovu & Makumbi, 2007), more efforts have to be undertaken to understand the underlying factors that may affect the willingness of individuals to be tested. Although structural variables, such as type and quality of testing services, have been increasingly explored (Coovadia, 2000; de Cock, Bunnell, & Mermin, 2006; Matovu & Makumbi, 2007; van Dyk & van Dyk, 2003)few studies have investigated psychosocial variables that function as barriers to or facilitators of testing in sub-Saharan Africa (Fako, 2006).In addition Berendes, Rimal,(2011) published a journal suggesting several psychosocial factors associated with willingness of the people to get tested for HIV, such as gender and education, lack of awareness, risk perception, and knowledge (Fylkesnes & Siziya, 2004; Iliyasu, Abubakar, Kabir, & Aliyu, 2006; Jereni & Muula, 2008; Mwamburi, Dladla, Qwana, & Lurie, 2005). The journalalso suggested stigma toward persons living with HIV infection as a key barrier to HIV testing (Ayenew et al., 2010; Babalola, 2007; Hutchinson & Mahlalela, 2006; Kalichman & Simbayi, 2003; Sambisa et al., 2010; Weiser et al., 2006; Wolfe et al., 2006). Self-efficacy, which refers to a persons perception of his or her ability to execute behaviours necessary for achieving specific goals, is another important psychosocial factor in HIV testing.
In addition. Musheke, M et al. (2013) A systematic review of qualitative ?ndings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa a study on factors preventing HIV testing in sub-Saharan Africa found that, although the increasingly wide availability of life-saving treatment is an incentive to test, the perceived psychological burden of living with HIV still stops people from testing. Other barriers include the direct and indirect ?nancial cost of accessing HIV testing, and gender inequality which undermines womens ability to choose for themselves whether or not to get tested.As a result, there is growing awareness that is pioneering approaches which are needed to increase HIV testing, particularly among those populations who feel unable to come forward for regular testing such as sex workers (UNAIDS, 2017).