Table 2:

Quotes by Level of Socio-Ecological Model

Level	Representative Quotes
Functionality	Accuracy – Distrust, disbelief of results Quote 1: In the saliva, how does it work with saliva? Saliva and blood, me, I see that those are different things. Saliva and blood, aren’t they different? Blood is in the veins, that is, it’s in your whole body. This is just saliva, it comes from the belly, no? That’s why I don’t believe that it’s true that saliva can say that I am such-and-such [HIV-positive], no. With what reason? In the past, they said that if a person swaps saliva, jeez, you can’t get AIDS, isn’t it so? Wasn’t it like that? But me, like that, I don’t believe it. Saliva, me, I wouldn’t use it to see if I am pregnant, [nor if] I have whatchamacallit, or I don’t have whatchamacallit, AIDS. No, I don’t trust saliva. (FSW, Tanzania) Quote 2: Even if [the self-test] says it is [positive] or not, I donť believe in that. I believe it when I do it in a hospital. You understand me? That is the same as the pregnancy test, I just think when I go to a hospital, ‘let me go do the test,’ but [I need to see] it in a tube [blood for lab tests]. (FSW, DR) Usability – Convenient, easy, get results quickly Quote 3: A lot will use it because it’s not a piercing method. You know, many are afraid of having blood taken through piercing the vein. You’ll hear, ‘Oh! Give my finger to be pricked? Oh, me, no!’ Or, ‘Me, give my arm to have blood taken from my vein? Oh, ha, me, no!’ But if you tell her, ‘Man, yeah, this test you hold yourself, just put it in your mouth, and then you watch and read it,’ she will agree. A lot will use it, I mean, a lot of working women [FSW] will use this test. It’s an easy method. (FSW, Tanzania)
Individual	Risk Perception – Good idea given occupation; FSW have high risk self-perception Quote 4: ‘Of course, [the self-test] would be advantageous because that way you have security, because you do not know [who has HIV]. And sometimes you put the condom on the men and sometimes they break, and there is a lot of risk.’ (FSW, DR) Autonomy – Time & space to process on one’s own Quote 5: Everyone likes to know her status. And again, especially to test yourself, I feel many people will use it. Because a person thinks, ‘I just go buy that test, I test myself, and I know what my health status is.’ So, the person goes to buy it. She tests herself. (FSW, Tanzania) Knowledge – Misunderstandings about antibodies & window period Quote 6: I would test at the hospital. There, there’s more certainty. I don’t read [the results] myself. Me, I will test myself just me, as me? It’s different for me who has no education. The doctor has education. (FSW, Tanzania) Quote 7: Oh, it is good, because that way, you realize what you have, at least, you know? But that is when you have knowledge of how, umm, the test that you see is: when you have it, when you donť you have it, do you understand me? To do it, well, you have to have an example to know how to read the result. (FSW, DR) Emotional Wellbeing – Strong emotional reaction if test is reactive Quote 8: When I was tested, even if I didnť do anything, even if I had relationships with people with a condom, that is scary, I was scared and until--if for example I get a positive [result], you even think about killing yourself. (FSW, DR) Quote 9: For this test, oh, maybe, some people have high blood pressure, and can look like this. She says, ‘Oh, already [I’m infected]!’ It means, now some people, you know, they feel bad, she can tell you ‘fine’ but [she’s really thinking] ‘me, now, I’m already dead! Whoa, I have AIDS? I didn’t know I had the AIDS infection! Humph!’ She starts to give up that very day. (FSW, Tanzania) Quote 10: If you realize that you have [HIV], if you realize that you have that alone, one is even able to kill oneself. But if someone else tells you, talks to you there at the moment, you try to not do a bad thing. But if you are alone you are capable of doing anything.’ (FSW, DR) Quote 11: There’s one disadvantage, maybe. Someone can test and get a shock, she herself. Meaning, if you go to the hospital, aren’t you counselled, yeah? And then you are tested and given your results. (FSW, Tanzania)
Interpersonal	Community-level stigma – Confidentiality/privacy from others & from providers, decreased gossip, and discrimination Quote 12: I have supported that idea because you find that others are afraid to go to the hospital. They say, ‘Dah! If I go to the hospital to test […] the other people who I will meet there will also know that I am doing this test somewhere,’ right? ...Others are…scared, they are filled with fear. If such a test is available, one is not afraid because she knows that she will shut herself inside and I will test on my own to check and see how I am. (FSW, Tanzania) Quote 13: Just in case if I go and have HIV—I hope to God that doesn’t happen—I will be the only one to know. Even if I die right there and I have a [heart attack], but at least only I will know, and so nobody will make fun of me. (FSW, DR) Quote 14: If there is a colleague who [gets a positive test], immediately [she] will change [her] face and you will realize, ‘Damn, this girl came out looking weird from this [the test].’ They will know that you have that [HIV] and the witch hunt begins, and they begin to make comments to the clients and those things. But if you do it [the HIV self-test] only you [know], nobody is going to see you. You are going to take your [own body] and [you] will react and nobody is going to be watching you and you are going to do it in your house.’ (FSW, DR) Quote 15: There will be stigma for that person, I mean, from that person who doesn’t know what it’s used for… who doesn’t have education about it. If a person comes and asks you, ‘What’s this thing?’ And you tell her, ‘It’s an HIV test.’ ‘Oh, now you walk around with it in your bag? Does that mean you already have it [HIV], or?’ I mean, isn’t that how it is for someone who doesn’t know? You tell her ‘This thing, no, but it’s for testing.’ ‘Oh, for testing, and you walk around with it in your bag? You are—it is possible that you are already infected, but you are just hiding it from us!’ (FSW, Tanzania) As a screening tool Quote 16: Perhaps she might tell her lover to go and get tested. She could just say that there are some tests that are using saliva, that are sold. She can just buy them, and they can test themselves there instantly. (FSW, Tanzania) Quote 17: Some will do it themselves at first secretly, because some people have a husband and are going outside the marriage. Now you totally know that ‘Now, I have gone outside the marriage, I have it [HIV] now.’ Now you know this man [husband] is harsh…I know he’ll come and beat me and murder me for nothing. Because if I tell him, ‘Man, I already tested and we are infected,’ he will kill me. Just wait, I’ll test myself alone, and if I see I am infected, I’ll take the medicine alone, until I come to advise him carefully, while I have already started the meds. (FSW, Tanzania)
Structural	Referrals/Linkages – Pre- & post-test counselling is essential, no linkage/referral if test is reactive Quote 18: The disadvantage is that someone might test and find out that she is infected and not go to enrol in a clinic and get medicine.[… ] It is different from the one which you go to the hospital and get tested there. If you have the infection, you get counselling. You start straightaway in the service [HIV care and treatment]. You start [antiretroviral] therapy.’ (FSW, Tanzania) Quote 19: Of course [I prefer going to the doctor’s], if necessary, if you get [HIV], God forbid, [I would] follow my normal life; because [HIV] doesnť kill, there is treatment and things. Doctors have told me when I have been tested: ‘AIDS does not kill,’ because there is treatment, do you understand me?’ (FSW, DR) Providers’ roles – Need for trained, educated, knowledgeable provider to conduct test Quote 20: I do not see what the advantage is, because if you go to a doctor and the doctor will tell you…God forbid [you are positive]…the doctor will follow up…But you do your test in your house and you see [you’re positive], you are going to remain silent. [You are going] to die of the suffering and say, ‘I have AIDS!’ and go crazy and shut up. Because that is what happens to most.’ (FSW, DR) Quote 21: No, I donť see an advantage […] because I want to go to a [health] centre, to a centre that prepares you mentally. (FSW, DR) Quote 22: It’s different from that to go in to test, you can go test and then you meet the doctor herself isn’t trustworthy, and she tells you, ‘Hey, that person, that person knows how to make herself look good, but I met her as a patient that one day! […] That person is sick, she is!’ It’s not true. It’s just better if you can test yourself. (FSW, Tanzania)