HIV testing uptake and its association with behavior related stigma among key populations in western province, Sri Lanka: a cross-sectional study

Introduction: Key populations are at the highest risk of acquiring and transmission of HIV. They are female sex workers, men who have sex with men, drug users, and the transgender community. Since these groups are hard to reach, they have a low HIV testing uptake. A probable reason for this could be the stigma and discrimination vested upon them. Objective: The objective of this study was to assess the HIV testing uptake among the KP groups in the Western province in Sri Lanka and their association with behavior related stigma. Methods: Four hundred and ninety-eight drug users, 508 female sex workers, 564 men who have sex with men, and 40 transgender people from Colombo, Gampaha, and Kalutara districts were included in the study using respondent-driven sampling. HIV testing uptake was assessed as ever being tested for HIV which was included in the questionnaire to assess factors associated with stigma among key populations. The level of stigma was evaluated by using the behaviour related stigma tool developed and validated by the same researchers. Statistical analysis was done using RDS-A version 7 and SPSS version 22. Results: HIV testing uptake among female sex workers was 85.6% (95% CI: 82.3– 88.6) in the sample and the population proportion was 87.1% (95% CI: 84.4 – 89.7). The sample proportion among drug users was 43.0% (95% CI: 38.6 – 47.5) and was 38.6% (95% CI: 31.2 – 46.0) among their estimated total population. High level of behaviour related stigma was negatively associated with HIV testing uptake. It was statistically significant only among men who have sex with men (p= 0.04). Conclusion: Highest HIV testing uptake was reported from female sex workers and the lowest was reported from drug users. Association between the level of behaviour-related stigma and the HIV testing uptake was significant only among men who have sex with men