The At-Home HIV Test Provides Another Prevention Tool

The world of HIV testing received a breakthrough last week, when the Food and Drug Administration approved the first over-the-counter at-home rapid HIV test on July 3. The oral swab kit yields results in as little as 20 minutes and is set to hit drugstore shelves across the country this October.

"I think that in theory, the more people that know their status and have access to know their status is a positive, it's another tool in the tool box for combating the epidemic," said Darrel Cummings, chief of staff at the Los Angeles Gay & Lesbian Center.

Los Angeles alone has 30,000 residents living with HIV/AIDS, with some of that number unaware they are infected. Nationally, one in five people with HIV are unaware they have it, according to the Centers for Disease Control and Prevention. The hope is that the wide availability of an at-home test could curb that number.

But for all the potential advantages an HIV test taken in the privacy of one's home has to offer, Cummings and other prevention advocates worry it has the potential to create more disadvantages. Starting with accessibility.

"The question I have that's a big one is how much is this going to cost," Cummings said. "Something like this is only as valuable as it is accessible."

Orasure, the maker of the OraQuick test, has yet to announce a price tag, but there is speculation it will be under $60. Those who can afford to get tested at home are then doing so without the assistance of a trained professional.

"We've trained counselors to deal with that initial administering of a positive result to someone, so this takes the counselor out of the equation," said Jeffrey King, executive director of In the Meantime Men's Group, Inc., a nonprofit supporting gay African-American men in Los Angeles. "The individual is left to their own sort of way of dealing with it."

OraSure is required by the FDA to run a call center, where bilingual representatives are available 24/7 to answer questions about HIV/AIDS and refer consumers to care. The company also said it will launch a website with resources and referrals to counseling and treatment.

But those in the field question whether an 800 number can really fulfill the role of professionals, or of interpersonal support.

"I've had people who have literally broken down crying in my lap or are in such a state of shock, they've walked into a wall," said Xavier Mejia, an LA-based activist and certified HIV test administer with more than 10 years in the field. "There have been many experiences that have allowed me to see that having some basic level of support is vital to getting past that moment of obtaining initial information."

And those clients who walk in for a test likely have more mental readiness than someone opting to take the test at home.

"I can see how people may have enough concern to want to take a test at home in private and I can see how that can provide relief, but I also see how that could create more damage," Mejia said. "If the decision is already a fear-based decision, the idea of potentially seeing a positive result can be a bit disturbing."

Since professionals log information about those who test positive, he added, the at-home test could cause them to lose data that helps determine government funding.

"My concern is if someone tests on their own at home, that can derail the whole system," Mejia said. "I feel this could be a Band-Aid solution."

Another major concern is the test's accuracy. While negative results are 99 percent accurate, positive results are only 92 percent accurate. Additionally, an infection contracted within three months may not show up on the test. Albeit rare, things like climate and over saturation of the swab can also potentially cause a false read.

Prevention advocates agree that following up a positive result with a confirmatory doctor's test and getting connected to care as soon as possible are key. Bridging the disconnect created by the at-home test will be the focus of their work.

"People who use the test really ought to one way or the other get a confirmatory test so that they can be armed with the best information they have," Cummings said.

The Center has plans to add a comprehensive section to its website with information and resources for anyone taking the test at home. In the Meantime Men's Group is holding an upcoming forum on the topic.

King thinks the HIV community still has a lot of work to do in combating misinformation and stigma that prevents people from learning their status in the first place.

"I think what we have now is a huge gap between the advancements in technology and science and the community and constituents," said King. "We have an undereducated, under informed constituency base who will now have access to this new technology."

Despite all of the questions and concerns raised by the test, at the end of the day, King and others recognize it as another option and tool.

"It's an option and we have to celebrate that," he said. "Now it's a matter of bringing a community of younger people who are distracted to focus their attention on what this means for them and their partners."