Table 4. Barriers to and facilitators of HIV testing: qualitative findings.

Domain: Barriers to getting tested for HIV
Major theme	Subtheme	Indirect Quote
Stigma	Community stigma and social isolation	We are socially integrated, so people are afraid the community will know about our status, . . .[and] many people in my community care a lot about what people know and think about them. [If someone is diagnosed with HIV], their social engagement will be affected, and many families will not want their children to socialize with that particular person. In general stigma is an issue. 54-year old Ethiopian male taxi driver
		[Those sharing their HIV positive diagnosis] will be shamed, isolated, victim of gossip . . .not official denial of participation but people will isolate them. 43-year old Ethiopian female educator
		A member of my community in their right mind will not publicly share a positive HIV diagnosis. They will be isolated, people will not engage with him/her. People in the community will be uneasy around them. They wouldn’t be invited to eat with others from the same plate. 24-year old Kenyan female student
	Associate HIV diagnosis with death sentence	Another unique aspect is the knowledge the community has about the disease—it is still scary and considered as death sentence—so that worsens stigma . . .So [if someone in my community finds out about someone’s positive HIV status] they will be shocked, as the impression the community has about the disease and the reality about the disease are different. 58-year old Eritrean male health professional
	Health systems	I think the unique aspect that can worsen stigma is the difficulty of creating rapport with health providers. But once rapport and trust is created with the health care providers, stigma will be less of an issue . . .[But the] absence of trust between community members and health care providers is a major issue. 58-year old Eritrean male health professional
Lack of awareness	Knowledge about HIV, risk perception	Misconception about the disease makes people to be scared about their disease and not considering yourself at risk . . . 37-year old Ethiopian male health professional
		People think it won’t happen to them, they consider themselves exceptional 26-year old Ethiopian female student
		There are also gender differences in expectations…worse for women to be HIV+ because we are already expected to not have many partners, and people think that they have had many partners if HIV+, even if they have only had one partner and got it from them. 18-year old Ethiopian female student
	HIV-related services	Most people don’t know where to go, especially to places that offer free HIV testing. Most people think it costs a lot of money to get HIV testing. 38-year old female Ethiopian community health worker
Prioritizing work over health		Being busy at work and lack of access to services like not having insurance. 41-year old Ethiopian male airport attendant
Domain: Facilitators for improving HIV testing rates
Increasing education or awareness		Many are scared to know their result because they are so intimidated by the disease…Education and creating awareness is the way to solve it. 32-year old Somali female health professional
Location of testing		Maybe it’s too much, but maybe go to home of person . . . 56-year old Mexican female apartment manager
		If the testing is provided in a community setting, there will be some issues about their neighbors knowing specially if they are from the same community, but I believe the benefits outweigh negatives as long as the tests are done in private rooms. 54-year old Ethiopian male taxi driver
Health systems	Culturally appropriate services	Culturally appropriate services, developing support groups which has social workers, lawyers, volunteer, donors and community members . . . Friendly, short, high confidentiality, interventional, with proper pre and post-test counseling. 58-year old Eritrean male health professional
	Integrating HIV testing into routine care to destigmatize it	Other healthcare services will be welcome but stigma can potentially be an issue with HIV so integrating them may help. 60-year old Ethiopian female health professional
		It would help if they make HIV testing more as a regular check-up. Don’t put a “sticker” on it [motioning to shirt where a nametag would be], like this is special. Should be regular like cholesterol–you test cholesterol, you test HIV. We as society make stigma by not treating HIV testing as part of routine care. 56-year old Mexican female apartment manager