Discussion
In this analysis, harm related to HIVST was extremely rare and experienced by 4% who completed exit surveys. Exploratory qualitative data suggest HIVST harms arise either from the technology itself, are generated by the intervention more broadly or emerge from individuals’ specific social circumstances. Harm could not always be attributed solely to HIVST, in some instances HIVST was merely a catalyst.It is inevitable due to technology limitations that some will experience false positive and false negative HIVST results, similar to other testing options.Harms emerging from intervention components resulted from the intervention functioning as theorised, but with a more extreme outcome than anticipated. The goal of risk assessment was to provide a reflective experience on sexual risks.Being pressured or persuaded to test during SELPHI was not always related to HIVST. Although unwanted pressure to test is likely to occur with other modalities, because self-testing is convenient and removed from clinical spaces, it may well lead to increases in acquiescence to testing pressure. For both individuals pressured to use an HIVST, if self-testing had not been available they likely would have used another modality. Further, both were ultimately happy they tested and, in line with other research from China, reported positive attitudes towards HIVST. Understanding pressure/persuasion in context is therefore important.Our findings are novel and, to our knowledge, the most in-depth from a high-income setting exploring HIVST harms.Given HIVST’s substantial benefits in providing MSM with an empowering testing option which increases testing uptake and diagnosis,