Table 4 Empirical and conceptual transferability of findings on social harms related to HIVST

In the STAR QRN, one of the themes we set out to explore and describe in the three countries was that of social harms in relation to HIVST. Forced testing was an example of such harm. In Zimbabwe, respondents in a focus group with community members discussing the social harm of forced testing wondered why and how forced testing was bad. They asked focus group facilitators to explain why it was bad to force one’s child, spouse or relation, explaining that it was for the good of those being forced to test because that would lead to accessing proper care and treatment. It should be emphasized that these people did not actually force others to test; it was only an attitude or perception that they had. Such understanding is something we did not anticipate, and we called the phenomenon “compassionate-forced testing” (CFT) since the forced testing was done out of perceived compassion for the one being ‘forced’. Still in Zimbabwe, some respondents argued that some people, such as house servants who look after children, must be forced to test to protect the children. Although no reports of actual forced testing emerged, we termed this precautionary-forced testing (PFT) since the intention of the intended forced testing was to act as a precautionary measure to protect the children being looked after. Other terms that emerged in relation to the actions taken by people to make others test included ‘persuade’, and ‘convince’, which were less intrusive. Such concepts emerged inductively from the data, were common across contexts and had an agreed definition within the STAR QRN, allowing them to be incorporated into the common coding framework. CFT was empirically and conceptually applicable in Malawi among couples and in Zambia among families where some parents applied it to their children. PFT was empirically and conceptually transferable among married women in Malawi and youths in Zambia who reported the acceptability of PFT directed at their partners, albeit with the intention of being direct beneficiaries of the intended prevention rather than children as was the case in Zimbabwe. As was the case in Zimbabwe, CFT and PFT in Zambia and Malawi were based only on people’s attitudes and perceptions; actual forced testing did not occur. In the second phase of STAR initiative, we have employed community-led models of HIVST where communities decide on how, who, where and when HIVST should be delivered. Such community-led initiatives are some of the mesures to enhance sensitization around the need to ensure people take HIVST following informed consent.