HIV testing among sub-Saharan African migrants in the Netherlands: a comprehensive analysis of barriers and facilitators

In the Netherlands, sub-Saharan African migrants (SSAM) are disproportionately affected by HIV, and late HIV diagnoses remain a significant challenge. Using a socioecological framework, we explored barriers and facilitators to HIV testing from the perspectives of a diverse group of 32 SSAM and 13 key informants (KI) through semi-structured interviews. Interview data were analyzed using inductive thematic analysis. Identified barriers to HIV testing included risk perception, limited availability of HIV-related information and awareness of testing possibilities and opportunities, loss of social capital concerns, HIV testing-related stigma, intersectional stigmas, cultural norms, and difficulties in accessing HIV testing services at the primary care level. Our analysis revealed the prominent overarching influence of HIV stigma operating both directly and indirectly across socioecological levels. Identified gaps in community collaboration, mobilization, and ownership regarding testing interventions acted as barriers but, conversely, also as facilitators to HIV testing when implemented in practice. SSAM and KI perspectives aligned, except for views regarding the availability of HIV-related information. Our findings indicate a critical need for integrated, multi-level, community-driven interventions, including healthcare strategies and policies that foster increased testing uptake among SSAM.