- An Ontario study looked at differences in HIV self-testing between cisgender women and men
- Test positivity rates were similar, but cisgender women were less likely to report their results
- Cis women reported lower uptake of testing for HIV than other sexually transmitted infections
HIV testing is an important step to better health. A person with a positive HIV test can get connected to care and treatment. HIV treatment today is highly effective and safe, and it can be taken as simply as one pill daily or as an injection once every two months.
A person with a negative HIV test can have a discussion with a healthcare provider about options for staying negative, including HIV pre-exposure prophylaxis (PrEP). Such options can include a daily pill or an injection once every two months.
Self-testing could be one way to bring more cisgender women into care, whether it’s for HIV treatment or to facilitate access to PrEP.
The GetaKit Study
A research team from the University of Ottawa conducted a study called “GetaKit.” In this study, participants could obtain free HIV self-testing kits. The study was promoted via social media and the Internet as well as through in-person community events and on posters in local HIV service organizations.
Participants were adults who visited the study website, reviewed and digitally signed online consent forms and registered themselves, providing their contact information to the team. Participants completed an HIV risk survey, and those at risk for HIV could subsequently receive a free self-test kit via mail or pick it up at a participating HIV service organization, pharmacy or sexual health clinic. The test kits required a finger prick to get access to blood. Researchers supplied the INSTI kit made by BioLytical.
The researchers had registered nurses associated with the study contact participants who reported a positive HIV test result. The nurses connected these participants to in-person confirmatory testing services as well as psychosocial support.
Study details
The researchers analyzed data collected between April 2021 and May 2023. During this time there were orders for test kits from the following populations:
- cisgender men – 3,934
- cisgender women – 1,277
- nonbinary people – 379
- transgender people – 145
In this report, we mostly focus on cisgender women.
The average profile of cis women who accessed the self-testing kits was as follows:
- Ontario residents – 94%
- main sexual orientation: heterosexual – 71%; TSLGBTQIA+ – 24%
- main ethno-racial groups: White – 41%; African, Caribbean or Black – 29%; Southeast or East Asian – 14%; Arab/West Asian – 6%; Hispanic – 4%; Indigenous – 3%; South Asian – 3%
- engaged in sex work – 8%
- injected drugs – 9%
- no prior HIV testing – 40%
- prior sexually transmitted infection (STI) diagnosis – 28%
- common past diagnosis of STIs: chlamydia – 81%; gonorrhea – 17%
Results
A total of 736 out of 1,277 cis women (58%) reported their test results to the “Get a kit” website. This proportion was less than what researchers found with cis men (70%). However, the difference in overall rate of positive test results—0.2% for cis women and 0.3% for cis men—was not statistically significant.
As mentioned earlier, all people who reported positive test results were linked to confirmatory testing and care by nurses associated with the study.
Bear in mind
For 40% of cis women, there was no history of previous HIV testing. Among cis women who had previously undergone HIV testing, this testing was done relatively long ago.
The researchers noted that the finding about HIV testing among cis women did not apply to STI screening, “suggesting that this lack of access to testing truly only applies to HIV. It does appear that cisgender women are seeking sexual health services, but—for a number of intersectional reasons, including stigma, cultural barriers, geographic location, low perceived risk for HIV, lack of knowledge related to HIV, limited access to healthcare, fears around disclosure, experiences of violence—are not completing, or are not able to complete, laboratory-based HIV testing.”
The researchers stated that “ensuring access to testing among [cisgender] women needs to be prioritized.” They added that making HIV testing more easily available is a simple way to help Canada achieve the WHO/UNAIDS targets for 2025:
- 95% of people with HIV know their infection status
- 95% of people who test positive are offered and use HIV treatment (ART)
- 95% of ART users have a suppressed viral load
These three targets, or goals, are collectively called 95-95-95.
When used as directed, ART helps to suppress the level of HIV in a person’s blood (viral load). Studies have found that, all other things being equal, people with a suppressed viral load can lead healthy lives and have a near-normal life expectancy. Another benefit from ART is that well-designed clinical trials have found that people whose HIV is suppressed do not pass on the virus to their sexual partners. This is why achieving 95-95-95 (and higher) is so important.
The researchers emphasized that testing is an important point of entry to care and treatment for people who are positive and for HIV prevention services for people who are negative. Such services can include counselling about HIV risks, access to testing in the future and the option of access to HIV PrEP.
Another finding from the present study is that online risk-based assessments and websites can be a useful way to “appropriately increase HIV testing among [cisgender] women.” The researchers stated that online portals that help to provide risk assessment and HIV test kits could be important tools “in our collective efforts to achieving UNAIDS 95-95-95 targets.”
Although the present analysis was focused on cis women, the researchers called for future analyses of data from transgender women and nonbinary people. In this way, the sexual health needs of these populations can be met.
—Sean R. Hosein
Resources
2025 AIDS Targets – UNAIDS
HIV self-testing – fact sheet
What are the challenges and opportunities associated with implementing HIV self-testing in Canada? – Prevention in Focus
HIV testing technologies – fact sheet
REFERENCE:
Orser L, Musten A, Newman H, et al. HIV self-testing in cis women in Canada: The GetaKit study. Women’s Health. 2025 Jan-Dec; 21:17455057251322810.