Pre-Test Fear and Confidentiality in Premarital HIV Screening in Somalia

Somalia has a low-level HIV epidemic, but low prevalence does not necessarily mean that HIV testing is socially or psychologically low risk. This commentary examines "pre-test fear", defined here as anticipatory concern before HIV testing about possible health, relational, social, or confidentiality consequences of being tested or receiving a reactive result. Somalia-specific evidence documents HIV-related stigma, non-consented disclosure, misinformation, and confidentiality concerns, but direct evidence on pre-test fear and the prevalence or regulation of premarital HIV testing remains limited. Accordingly, the article distinguishes local evidence from contextual evidence drawn from other settings and does not present new patient-level data. It proposes a conceptual privacy-first framework for routine and premarital HIV screening built around voluntary informed consent, brief culturally appropriate pre-test information, confidential laboratory workflows, confirmatory testing, linkage to care, and community health literacy. The framework is intended to generate testable implementation questions rather than to represent an empirically validated intervention. For Somalia, the principal implication is that diagnostic quality should include not only analytical accuracy but also the conditions that make people willing to test, receive results, and continue into confirmatory testing and care. Prospective mixed-methods and implementation studies are needed to measure pre-test fear, characterize premarital testing practices, assess confidentiality, and evaluate whether privacy-centered counseling improves acceptability and linkage.