Barriers and facilitators to STI and HIV testing among African and Caribbean heritage communities in high-income countries mapped to the behaviour change wheel: a scoping review.

backgroundAfrican and Caribbean communities in high-income countries face disproportionate sexually transmitted infection (STI) risks. In the US, the gonorrhoea rate among non-Hispanic Blacks is 7.7 times greater than that among non-Hispanic Whites, and the chlamydia rate is 5.6 times greater. In the UK, black Caribbeans have the highest gonorrhoea and chlamydia rates among all ethnic minority groups. Identifying barriers to and facilitators of HIV/STI testing is crucial for developing effective interventions. This scoping review maps current evidence on multilevel factors influencing STI testing behaviours among these populations onto the COM-B (Capability, Opportunity, Motivation-Behaviour) model, which posits that capability (i.e., knowledge/skill), opportunity (i.e., social and environmental influence), and motivation (i.e., confidence/beliefs) are essential for engaging in a behaviour (i.e., HIV/STI testing).

methodsMEDLINE and Embase were searched for studies published between 2013 and 2024 on STI testing barriers and facilitators among African and Caribbean populations in high-income countries. Qualitative, quantitative, and mixed-methods studies were included. The titles/abstracts were screened, the data were charted, and the findings were synthesised via COM-B as an organizing framework.

resultsFifty-eight studies were included. The key capability barriers were low STI knowledge and language difficulties. Social opportunity barriers included stigma, discrimination, and lack of support. Clinic times and locations impeded physical opportunities. The motivation barriers were fear of positive results, cost, risk perception, confidentiality concerns, and competing priorities. Key facilitators included awareness initiatives, treatment knowledge (capability), supportive networks, outreach (social opportunity), free testing, convenient options (physical opportunity), and risk perceptions, relationships, and incentives (motivation).

conclusionThis review highlights the complex interplay of COM-B factors influencing STI testing among African and Caribbean heritage communities, drawing attention to pervasive stigma and socioeconomic barriers. Multilevel interventions should enhance capability through education, opportunity via community coproduction and convenient testing, and motivation by addressing stigma and leveraging facilitators. Integrating an intersectionality lens and evaluating community-driven approaches are future directions for promoting sexual health equity.