Finding new ways to encourage people to get tested is on the minds of many HIV and AIDS organizations – both in Philly and around the country. But as more individuals decide to explore the new in-home HIV test from OraSure called OraQuick, the AIDS Community Research Initiative of America (ACRIA), an HIV/AIDS research, prevention and advocacy organization, has some concerns.
It’s estimated that half of all new infections in the U.S. result from those who are unaware they are positive. And while in-home testing will surely increase the number of people who know their status (a great thing), ACRIA says there can be a few drawbacks, including lack of counseling and referral to care, misinterpretation of test results, testing for partner screening purposes, and the psychological impact a positive result can have in certain situations.
In fairness, OraSure has established a hotline to address these issues. But Dr. Daniel Tietz, ACRIA’s executive director, says it may not be enough.
“First and foremost is the lack of counseling tied to the test,” he says. “For this very reason, the FDA had been reluctant to approve home HIV tests that provide immediate results. HIV remains life-threatening and continues to be associated with enormous stigma. A home user that receives a reactive result, which must be confirmed but which will be taken as positive by many users, with no counselor present for emotional support or to answer questions might be devastated.”
ACRIA is also concerned about the lack of immediate referral to care. “Of the nearly 942,000 people who have tested HIV positive in the U.S., only 75 percent are in any way linked to care – a percentage that is certain to be lower when no counselor is available to make a referral,” he says. ACRIA believes that the strongest reason for offering in-home HIV testing is to get people with HIV into care as soon as possible, but HIV testing without providing care may defeat even the best intentions.
“Finally, and perhaps most concerning, is the likely use of the test to screen sexual partners,” says Tietz. “As has been shown by numerous studies, a significant number of individuals avoid condoms by questioning partners about their HIV status or by discriminating on the basis of race or appearance. All of these methods are deeply flawed and contribute to the stubbornly high number of new HIV infections in the U.S., as well as stigma and discrimination. Being able to actually test casual partners for HIV may seem to be a useful solution to this problem, but in reality the test is not at all useful for this purpose. Newly infected individuals can take up to six months to create the antibodies that are detected by the OraQuick test, and it is estimated that up to half of all new HIV infections are transmitted by people in this ‘window period’ – people who think they are HIV-negative but who in fact are more able to transmit the virus than at any time in the course of their disease due to extremely high viral loads.”
The organization also questions what negative results could mean for newly infected people who may actually be positive, but who may not be showing the antibodies. Could it mean that people will be less likely to practice safe sex and end up infecting partners by thinking they are HIV-negative?
“Perhaps most critical is the effect on casual partners who have a reactive result,” he says. A study of 27 gay men who were given testing kits to use with casual partners experienced some painful moments that not everyone was equipped to handle. One story went like this:
[I asked him], “Would you like to test with me?” [He said,] “Cool, that would be great.” And then he got the [positive] result [laughter] – he had no idea, I guess. He’s like, “What do you mean?” … And he got pretty upset, you know, it was hard to see that. I said. “Listen, I’ll go with you, if you want to go to another clinic and get retested.” He just said, “You know, I’d really like to just kind of take some time alone.”
Of the 101 casual partners tested in the study, 10 tested positive and six were unaware of their HIV status – a very high rate. The study provided no information on the eventual effect of the result on those six individuals or if they were able to access the counseling and care they needed.
“Even in cases where the test is used with long-term partners, significant concerns remain, not the least of which is domestic violence,” says Tietz. “This is not limited to physical violence, but also includes emotional abuse and eviction.”
So what can be done? ACRIA says it would like OraSure to become more involved in discussing some of these issues, and creating more of a support system for those taking the OraQuick in-home test.
“Anyone using the test should be urged to consider the possibility of a positive result, as well as the relatively high rate of false negative results, and what steps should be taken if that occurs,” says Tietz. “The possibility of a positive result must be considered beforehand, and planning who to speak with and where to get care in that event is absolutely essential.”
What do you think? Is in-home testing a good idea? Or do you prefer to visit a clinic or AIDS organization to get tested?