Low uptake of HIV self-testing among Black men who have sex with men living in a Southern U.S. city (Nashville, Tennessee): determinants and implications from a community-based study

Black men who have sex with men (BMSM) face a disproportionate HIV burden in the U.S. Yet, HIV self-testing (HIVST) uptake remains limited. We conducted a cross-sectional study with 203 BMSM in Nashville, Tennessee (2019-2020) to assess HIVST patterns, determinants, and barriers/facilitators. Overall, 29.6% reported ever using HIVST, with 9.8% using it in the past three months. Higher likelihood of HIVST use was associated with older age, higher income, condomless anal sex, knowing peers who used HIVST, and moderate to severe anxiety. Lower likelihood was associated with self-identifying as heterosexual, disclosing sexual orientation to healthcare professionals, and experiencing moderate to severe perceived stress. Top barriers included lack of emotional support (87.6%), uncertainty about what to do after a positive result (75.3%), medical mistrust (69.5%), limited knowledge in using HIVST (57.2%), and limited access to free kits (46.8%). Top facilitators included peer-led demonstrations (77.6%), linkage to Black LGBTQ+ support services (70.8%), integration of social media (65.3%), discreet home delivery (61.2%), and incentives (56.1%). Findings highlight modifiable individual and structural determinants that may inform culturally and contextually tailored interventions to enhance HIVST uptake among BMSM in the US.