Background: The adoption of the Test and Treat strategy has transformed global HIV care by promoting immediate initiation of antiretroviral therapy (ART) following diagnosis. While this approach has improved ART coverage, its effectiveness is shaped by socio-cultural and structural determinants. This study explores how stigma, gender dynamics, and health system factors influence the implementation of Test and Treat in the South West Region of Cameroon.

Methods: A qualitative study using in-depth interviews and focus group discussions was conducted among PLHIV, community members, and health care providers. Data were analyzed using thematic analysis. An interpretive approach was applied to examine the interaction between individual experiences and broader social and structural determinants.

Results: A total of 18 PLHIV and 37 service providers. took part in the study, 18 IDIs and 5 FDGs conducted. Five key themes emerged: (1) persistent HIV-related stigma affecting testing and treatment uptake; (2) gendered power relations influencing access and adherence; (3) structural and economic barriers; (4) health system constraints affecting service delivery; and (5) coping strategies and resilience among PLHIV. While Test and Treat improved early ART initiation, its outcomes were mediated by entrenched social and systemic inequities.

Conclusion: The effectiveness of Test and Treat in Cameroon is constrained by intersecting social, gender, and structural factors. Addressing these requires a shift from purely biomedical approaches to integrated, rights-based, and socially responsive HIV programming.