Table 3. Sociodemographic characteristics associated with increased HIV testing, barriers and facilitators of HIV testing by jurisdiction in Canada, 2009–2019.

Province/territory	Individual level	Healthcare provider level	Policy level
British Columbia
Sociodemographic characteristics and behaviours associated with increased HIV testing	• Younger age (24,34)      • Being more educated (34)      • White race/ethnicity (24)      • Living in an urban area (24,50)      • Engaging in risk behaviours (increased number of anal sex partners, inconsistent condom use, not engaging in serosorting (24,27), PWID (27))	• NA	• NA
Barriers	• Stigmatization of sex work (23)      • Immigrant status (lack of health insurance, linguistic and cultural barriers) (23,24,27)      • Low risk perception (of HIV acquisition and/or transmission) (24,26,50)      • Internalized homophobia (34)	• NA	• Criminalization of sex work (23)      • Collaboration between public health agencies and law enforcement creating mistrust of health outreach workers (23)
Facilitators	• Having a strong network in the gbMSM community (50)      • Having been previously tested for other STBBIs (24)	• gbMSM, queer and trans-competent sexual health care and HIV testing (50)      • HIV testing initiated/offered by healthcare providers (26)      • Non-judgmental and non-stigmatizing attitudes of healthcare providers (23)	• Availability of translators or multilingual health services (23)      • Mobile HIV prevention programs (27)      • Convenient and low-cost testing (e.g. free-of-charge, receiving results on site (26,30))      • Offering various HIV testing modalities: oral swab (26), couples voluntary HIV counselling and testing (53), peer-delivered post-test counselling (43)      • Offering HIV testing in different settings: sex work venues (23), dental hygiene clinics (26,30), emergency departments (52)      • Social media campaigns promoting HIV testing (32)

Manitoba
Barriers	• Fear of positive result; preferring not to know (39)      • Low risk perception (39)	• NA	• NA

Ontario
Sociodemographic characteristics and behaviours associated with increased HIV testing	• Older age (40)      • Male sex/gender (40)      • Having more experience with testing (38)      • Being an immigrant (60)      • Full-time employment; higher income (60)      • Engaging in risk behaviours (use of condoms, having multiple sexual partners, injecting drugs, sex work, having spent time in jail, drug use in jail (40,60))	• NA	• NA
Barriers	• Cultural barriers (labelling of women who test as promiscuous) (64)      • Difficulty accessing health/testing facilities (not knowing where to get an HIV test) (60,64)      • Fear of the testing process, the length of time to wait for the results, fear of positive results; preferring not to know (35,51,64)      • Fear of negative reaction from partner(s) upon disclosure of status (35,64)      • Lack of confidentiality in testing services (35,64)      • Insufficient knowledge HIV (transmission, testing, treatment) (64)      • Low risk perception (37,51)      • Misconception that HIV testing is associated with low masculinity (38,60)      • Potential nondisclosure prosecution (36,45,47)      • Stigma (grounded in taboos surrounding sexuality) and discrimination of same-sex sexual behaviour, PWID or alcohol use (38,60,64)      • Needing to convince healthcare providers by revealing stigmatizing identities/behaviours (38)      • Perceiving an offer of testing as a form of stereotyping or profiling) (38,60,64)	• Lack of knowledge of trans identities and health-related concerns among healthcare providers (51)      • Stigma from healthcare professionals (46)      • Low risk perception among healthcare providers (64)	• NA
Facilitators	• Anonymous testing (44,47,64)      • More information on the testing process (35)      • More information on mother to child HIV transmission (35)      • Individualized prevention approach (35)	• Access to trusted testers (51)      • Gender-responsive interventions (51)	• Integrating HIV testing with routine care (de-stigmatize and normalize HIV testing) (38,51,64)      • Increasing HIV knowledge and education in the community (e.g. via television and radio), particularly from government health agencies (64)      • Providing social connections with PLWHIV (64)

Québec
Sociodemographic characteristics and behaviours associated with increased HIV testing	• Higher number of sexual partners (61)	• NA	• NA
Barriers	• Fear of positive result, of being judged or rejected, and of disclosing status to partner(s) (58)      • Shame associated with requesting HIV test and responding to the pre-test questionnaire (e.g. disclosure of sexual information) (41,58)      • Lack of confidentiality in testing services (41,58)      • Insufficient knowledge of HIV testing services, locations and recommendations (61)      • Limited access to healthcare providers (61)      • Limited opening hours of HIV testing clinics (41)      • Low risk perception (61)      • Testing not covered by public health insurance (58)      • HIV stigma (58)	• NA	• Lack of health resources in rural regions (58)
Facilitators	• NA	• Healthcare providers never refusing a request for HIV testing from a patient (58)      • Unsupervised oral self-testing (48)	• Integrating HIV testing with routine healthcare without a pre-test questionnaire (e.g. on sexual behaviours) (58)      • Accessible, confidential, convenient (no need for appointment) testing services, including non-nominal testing, rapid testing (29,41,58)      • Offering a variety of HIV testing modalities: unsupervised oral self-testing (49)      • Offering HIV testing in various settings: in the community, at the pharmacy (58)      • Prevention efforts based on harm reduction principles, focusing on the person as well as the virus (58)      • Safe HIV testing setting (58)
Nova Scotia
Sociodemographic characteristics and behaviours associated with increased HIV testing	• Female sex/gender (31)	• NA	• NA
Barriers	• Fear of positive test result, of rejection and of being associated with promiscuity and PWID (56)      • Lack of confidentiality in testing services (42,56)      • Insufficient knowledge about HIV and testing (56)      • Stigma and discrimination with regard to gender, sexuality, sexual identity, sexual relationships and monogamy (31,56)	• NA	• Geographic barriers to accessing health care in rural and remote communities; absence of primary health care and HIV testing services in smaller communities; inconsistent access to medical transportation (56)
Facilitators	• Increasing availability and accessibility of HIV testing services (31,56)      • Being able to pay for point-of-care testing (42)	• NA	• Integrating HIV testing with routine health services (e.g. systematic prenatal HIV testing) (31)      • Normalizing of HIV testing (56)      • Availability of rapid testing (42)

Newfoundland and Labrador
Sociodemographic characteristics and behaviours associated with increased HIV testing	• MSM (heterosexual men diagnosed later than MSM) (25)	• NA	• NA
Barriers	• Hospital settings (e.g. patients in STBBI clinics diagnosed earlier than those in hospitals) (25)      • Fear of diagnosis; denial of risk (25)      • Negative interactions with the healthcare system (25)      • Stigma surrounding HIV and testing	• NA	• Insufficient knowledge of HIV among the general population (fear of HIV, misconceptions about HIV and drug use)      • Lack of adequate support for PLWHIV (25)
Facilitators	• Having been tested for other STBBIs previously (25)	• HIV testing initiated/proposed by healthcare providers (25)	• Integrating HIV testing with routine health services (25)      • Offering a broad range of HIV testing options (25)

Atlantic provinces
Barriers	• Difficulty accessing timely, gender-appropriate and youth-adapted HIV testing services (28)      • Lack of accessibility and confidentiality in small community settings (e.g. personal relationships between family and healthcare professionals) (28,62)      • Low risk perception; lack of HIV knowledge (62)	• NA	• Lack of personnel and resources for collaboration between Atlantic provinces (62)      • Lack of guiding policy for programs, resulting in discordance across sectors (28)
Facilitators	• HIV testing for youth in dedicated sexual health centres      • Increasing awareness, education and information about HIV; highlighting the importance of prevention, reducing misconceptions related to HIV to reduce stigma (28,62)	• Continuing education to deliver pre and post-test counselling and referrals to appropriate health services following testing (62)      • Increasing awareness, education and information about HIV; highlighting the importance of prevention, reducing misconceptions related to HIV to reduce stigma (28,62)	• Access to nonjudgmental and gender-responsive approaches (services without gender-based stereotypes or inequities) (28)      • Education and promotional materials adapted to youth (e.g. age-appropriate content, peer mentoring, social media, phone and Internet-based programs, art-based projects) (62)      • Increase awareness, education and information about HIV; highlighting the importance of prevention, reducing misconceptions related to HIV to reduce stigma (28,62)      • Increasing the number and types of testing sites, (e.g. clinics in schools, mobile testing sites) and modalities (e.g. point-of-care, anonymous testing) (62)      • Inter-organizational and intersectoral collaboration (28,62)      • Youth engagement in the development and implementation of HIV/HCV prevention initiatives (28,62)

Canada-wide or unspecified provinces/territories
Sociodemographic characteristics and behaviours associated with increased HIV testing	• Younger age (54)      • Being in a sexual minority group (54)      • Female sex/gender (54)      • Having casual partners (54,63)      • Potential exposure due to drug use (63)	• NA	• High jurisdictional HIV prevalence (54)
Barriers	• Anxiety and fear (due to long time between testing and obtaining results, being judged, sickness and death, family or community violence) (6,63)      • Difficulty accessing health/testing services (limited medical facilities) (6,63)      • Geographical barriers to accessing health care (6)      • Difficulty accessing testing services (63)      • Lack of confidentiality in testing services (6)      • Lack of pre and post-test counselling (6)      • Lack of trust in healthcare providers due to historical context of racism, colonization and homophobia (6,57)      • Low risk perception, lack of interest, feeling healthy (6,63)      • HIV-related stigma and criminalization of HIV nondisclosure (57)	• HIV-related stigma (57)      • Lack of trust in healthcare providers due to historical context of racism, colonization and homophobia (57)      • Low risk perception by healthcare providers (6)	• HIV-related stigma and criminalization of HIV nondisclosure (57)
Facilitators	• High self-perceived HIV knowledge (54)      • Routine testing for HIV (63)	• Training and sensitizing healthcare providers (6)      • Healthcare providers suggesting an HIV test (63)      • Unsupervised oral-self testing (48)	• Anonymous testing (6)      • Integrating HIV testing into routine medical care (63)      • Availability of different testing modalities: rapid testing (6), couples voluntary HIV counselling and testing (53), Internet-based HIV testing (33), unsupervised oral-self testing (48)      • Enhancing the capacity of health service providers (e.g. clinics, AIDS service organizations, community organizations) (6)      • Gender-responsive interventions and programs (6)      • Increasing awareness about HIV (e.g. via educational campaigns and tools) (6)

Abbreviations: AIDS, acquired immunodeficiency syndrome; gbMSM, gay, bisexual and other men who have sex with men; HCV, hepatitis C virus; HIV, human immunodeficiency virus; MSM, men who have sex with men; NA, not applicable; PLWHIV, people living with HIV; PWID, people who inject drugs; STBBI, sexually transmitted and blood-borne infection

Note: Missing provinces/territories indicate that no barriers or facilitators were documented in the available peer-reviewed or grey literature in these jurisdictions in the last decade