How Much Would You Pay to Know if Your Potential Sex Partner has HIV?
In a recent article published in the online open access science journal PLoS Medicine, researchers report their findings that giving people a choice between discovering their HIV status at a clinic or through a HIV home test, that the majority of people choose the HIV home test.
The significance of this finding is that because of a preference for anonymous and convenient HIV testing at home, more people at risk of HIV infection and AIDS will be motivated to learn whether they (or their partners) have HIV or not, and if so, then will potentially seek help and reduce the likelihood of spreading the infection to others. However, another significance not addressed in the research is that of where at-home HIV testing may lead and what it can mean to a consenting couple.
HIV/AIDS health experts report that up to 50-60% of people living with HIV worldwide do not know their HIV status. This is in large part due to that the fact that many do not have testing for HIV done because of a social factors such as embarrassment, shame, lack of confidentiality and the fear that others will find out their HIV status.
According to a NewsMedical.net interview with PLoS Medicine lead author Nitika Pant Pai, an Assistant Professor in the Department of Medicine at McGill University, stigma from HIV testing is real and can be averted with at-home HIV testing. She points out that health experts see this stigma as the root of AIDS as a silent killer.
"Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world," states UN Secretary General Ban Ki Moon on HIV related stigma.
To address the problem of fear of stigma, Dr. Pai and fellow researchers combed published data that focused on the effectiveness of using an HIV test similar in concept and design to home pregnancy tests commercially available at drug stores.
To accomplish this task, the researchers performed a systematic review of published studies that reported the effectiveness of either supervised or unsupervised self-testing for HIV through the use of minimally invasive oral tests kits that worked via swabbing the inside of the mouth. The data was gathered from individuals who were from both low and high risk HIV infection populations and of higher income settings.
What the review found was that with both self and supervised testing:
• The chance of an HIV-negative person receiving a negative test result as a true negative was high.
• The chance of an HIV-positive person receiving a positive test result as a true positive was high, but higher with supervised than with unsupervised testing.
• People preferred self-testing to facility-based testing and oral self-testing to blood-based self-testing.
• In one study, 96% of participants who self-tested positive sought post-testing counseling.
One example of a HIV home test kit available in the US that is licensed by the FDA is the OraQuick oral HIV test. The test kit is an HIV antibody detection test that consists of a swab with a padded end that is wiped around the upper and lower gums. After swabbing, the padded end is then placed inside a tube with a chemical that after 20 minutes will yield a single line for HIV-negative and two lines for HIV-positive results.
According to the manufacturer, in one study nearly 5,000 people were given the OraQuick test kit to take home and use and the results showed OraQuick was accurate in 99.9% of the cases.
Experts point out that people who take an HIV home test need to be aware that taking the test recently after having had unprotected sex with someone who they later discovered might have been HIV positive, will not be accurate until at least 90 days following sexual intercourse. This is due to that it takes time for seroconversion to occur for antibodies to be produced that can be detected by the oral test.
Furthermore, health experts recommend that if you do have a positive indication, it is important to reach out to a health care professional to confirm the results of the test. The makers of the OraQuick test offer information on what to do and who to contact in case of a positive result.
Today, the OraQuick test can be purchased online through Amazon.com for approximately $40. However, as public awareness of the OraQuick test or other HIV home test kits grows, experts expect that a Wal-Mart approach will bring the cost of such kits down to $20 making home testing easy and affordable for everyone.
And, if history is any indicator of the future, we can expect that the HIV test kits will eventually become increasingly sensitive where the 90-day wait period for taking the test will be narrowed significantly.
The social/sexual implications of this could be interesting. As if dating were not complex enough as it is, will deciding who pays for the HIV home test kit become part of condom negotiations between a consenting couple?
Image Source: Courtesy of PhotoBucket
PLoS Medicine “Supervised and Unsupervised Self-Testing for HIV in High- and Low-Risk Populations: A Systematic Review” PLoS Med 10(4): e1001414. doi:10.1371/journal.pmed.1001414; Pant Pai N, Sharma J, Shivkumar S, Pillay S, Vadnais C, et al. (2013).