Strategies for improving HIV testing suggested by and for men who have sex with men in West Africa: a focus group study in Burkina Faso, Côte d’Ivoire, Mali and Togo

Abstract Background It is estimated that HIV prevalence among men who have sex with men (MSM) in West Africa is 8% and that about 80% of MSM living with HIV are unaware of their status. The objective of this study was to explore experiences with HIV testing among MSM in Burkina Faso, Côte d’Ivoire, Mali, and Togo and to identify strategies to improve HIV testing. Methods We conducted 12 focus group discussions (FGDs) with 78 MSM. We conducted three per country using purposive sampling: with MSM less than 25 years old, with MSM 25 years or older, and one with male sex workers. Participants were recruited via community leaders, MSM-friendly venues and social media. Analysis was guided by a grounded theory approach, focusing on experiences, barriers to testing and identifying strategies for improvement. Results Participants explained that barriers for taking up testing in their communities were insufficient HIV awareness, reduced fear of HIV, and fearing test results, which led them to suggest more HIV awareness-raising and information campaigns. While they valued that community HIV clinics were well adapted to the needs of MSM, they also mentioned room for improvement (e.g. ensuring confidentiality). Diversifying testing strategies (e.g. self-testing) was considered crucial to reach a wider range of MSM. They explained that post-test actions such as a confirmation test in a clinic, or partner-notification presented difficulties due to fears for stigma or social exclusion, while they valued peer support in such situations. Conclusion Together, these findings show that, even where MSM-friendly community clinics are valued, HIV testing uptake remains shaped by limited awareness of HIV, misconceptions, confidentiality concerns, and the social risks attached to testing positive or being identified as MSM. Improving HIV testing therefore requires accurate and non-stigmatising HIV information, ensuring confidentiality, diversified testing options (including self-testing), and strong peer support within a more enabling social and legal environment.