CONTRIBUTORS
Caliph Kirui
Research Officer
In many parts of Kenya and beyond, accessing sexual and reproductive health services remains challenging. Women seeking screening services for sexually transmitted infections (STIs) still face stigma, long clinic queues, judgmental glances, or simply the inconvenience of rigid clinic hours. These barriers can delay or deter timely diagnosis and treatment, yet many STIs show no symptoms but can lead to serious health consequences if left untreated. But what if the future of STI testing isn’t limited to clinics?
A Shift in Approach
The World Health Organization recommends self-collection of samples as a viable approach for cervical cancer screening, particularly in low-resource or hard-to-reach settings. This method improves access and offers greater comfort, privacy, and autonomy, particularly for women who face barriers to visiting clinics. In one study in Nairobi, female sex workers found self-collection of vaginal swabs both easy and comfortable. Their results were highly reliable, closely matching those collected by health professionals. In Zimbabwe, about 61% of young women preferred self-collection, citing privacy as a significant reason.
A Counter-Revolution in STI Testing Access
The African Population and Health Research Center (APHRC) recently explored an innovative model through the FEMSAFE project—a pilot study assessing the feasibility of offering self-sampling for STI detection through local pharmacies. The study uncovered growing openness to alternative ways of delivering care through speaking with pharmacy staff across selected outlets. It was noted that women increasingly prefer pharmacies for sexual and reproductive health services. Why? Greater privacy, friendlier environments, no appointment required, and less fear of judgment. “Most women prefer privacy. This gives them the freedom to test at their convenience without walking into a clinic and explaining everything,” said one pharmacy staff member.
“I would recommend it—especially to women who are uncomfortable with being sampled by someone else. They can do it in the privacy and comfort of their home, which is important.”.
Many women expressed appreciation for the ease and comfort of the self-sampling approach. One participant shared, “I liked that I could do it myself. It felt more private and less embarrassing than going to the clinic.” Another noted, “This method gave me confidence to take charge of my health.” Others emphasized comfort and simplicity, with one saying, “I felt more comfortable collecting the sample myself instead of being examined,” and another adding, “The instructions were clear and simple—I was surprised how easy it was to do.”
Self-Sampling as a Gateway
Self-sampling, where a woman collects her specimen for STI testing using a simple swab, was overwhelmingly seen as user-friendly and empowering by pharmacy workers. They highlighted how it could especially benefit women juggling busy work or caregiving duties, adolescents and young women wary of stigma, and individuals living far from health facilities. As one pharmacist put it: “It’s an excellent idea. Many women fear stigma and value privacy. Some find the traditional methods uncomfortable, so self-sampling provides a more acceptable and private alternative.” Another added: “With traditional methods like Pap smears or vaginal swabs, many women feel shy or uncomfortable with a male doctor or any clinician taking the samples. With self-testing, that discomfort is greatly reduced.”
Practical Considerations and Realities
The FEMSAFE study also revealed the need for standardized protocols, training for pharmacy staff, and reliable linkages to diagnostic labs and follow-up care. But these concerns didn’t come across as barriers; they were seen as solvable challenges with the right partnerships, particularly between the public and private sectors. “It’s one of the best things to come forth… they’ll be able to do the testing and even have the results on their own without interference from a third party.” Still, some concerns were raised: “One challenge could be improper sample collection; some women might not know how to do it correctly. Another challenge could be convincing women to try the method, though I believe that can be overcome with proper sensitization.”. This, however, can be easily addressed by education and awareness creation.
Rethinking Health Touchpoints
The findings challenge us to reimagine where healthcare happens. Trusted and accessible pharmacies embedded in communities could serve as effective touchpoints for sexual health services. As the study suggests, this shift isn’t just logistical. It is about meeting women where they are, offering dignity, privacy, and removing obstacles that have long kept them from accessing care.
So, What’s Next?
In as much as Kenya has shifted HIV strategies effectively, non-HIV STIs remain widespread. Recent estimates by the Ministry of Health in Kenya show that the adult prevalence of the three most common STIs is approximately 35% for HSV-2 (genital herpes), 13–17% for chlamydia, and 7% for gonorrhea. As STI rates continue to rise, especially among young women, Kenya and other countries must consider new, stigma-free solutions like pharmacy-based self-sampling. Scaling up such options will require investment, policy support, training, and public awareness. The findings from the FEMSAFE project, while small in scope, points us in the right direction.
“The FEMSAFE study is a small but meaningful step toward that future. It reminds us that rethinking the ‘where’ and ‘how’ of healthcare is not just about convenience—it’s about equity and dignity.”