Background
infections, self-harm
INFECTIONS
HIV self-testing (HIVST) involves a person collecting their own sample, processing their test and interpreting their result.In the UK, policy makers and commissioners have been reluctant to endorse HIVST which was banned in 1992 because of concerns over test quality and the potential for self-harm in the absence of pre-and-post-test counselling and effective HIV treatment.Since legalisation in 2014, HIVST has been provided sporadically across the UK through pilot and demonstration projects and through our online randomised controlled trial (RCT) in England and Wales.SELPHI provided the BioSure HIV self-test and had two randomisations. Randomisation A assessed whether provision of one free HIVST could increase confirmed diagnoses of prevalent infections, and found no significant difference between HIVST and standard of care.Despite significant concern from policy makers and in values and preferences research (conducted primarily with people who had not used HIVST), evidence about actual harms from HIVST use is scant. Research has focused on social harms (eg, coercion, intimate partner violence (IPV)) rather than harms from tests themselves (eg, false positives/negatives).A recent meta-analysis investigating HIVST outcomes in key populations found no reports of harm in seven RCTs recruiting MSM and trans people, and very few in three RCTs including female sex workers.As the biggest HIVST RCT in a high-income setting and the largest including MSM to date, SELPHI provides a unique opportunity to investigate and characterise harms to guide HIVST implementation.The aim of this study is to understand the relationship between HIVST and harm in SELPHI by exploring specific types of harm (relationship, well-being, pressure/persuasion to test and false positive/negative results), and the experiences of individuals who reported harm.