Opinion: Rapid home tests stem HIV spread

By Dr. Mary Jane Rotheram,, Dr. Arleen Leibowitz
 and Kevin Farrell
 

August 24, 2009 
Atlanta Journal Constitution
 
In Atlanta this week, the nation’s public health strategy to eliminate HIV is being hotly debated.

Our public health leaders have strongly endorsed a strategy to test and treat all Americans: everyone is encouraged to get tested once for HIV as an adult; adults in communities with a high prevalence of HIV may need to be tested multiple times; and access to HIV treatment is to be guaranteed to all HIV-infected persons.

Decisions about who gets tested, where, when and how they get tested will have a major impact on the effectiveness of this strategy.

Universal testing would identify the 25 percent of HIV-infected persons who do not now know their HIV status and allow them to enter treatment.

This would be a great benefit, both to the individual and to society.

Adults who know they are HIV-positive usually protect their partners from acquiring HIV by stopping unprotected sex and needle sharing.

Furthermore, once HIV-infected persons take anti-retroviral medications, risky acts are far less likely to transmit the virus. The test and treat rationale makes common sense.
However, significant and dramatic shifts in where and how we conduct HIV testing may be necessary to reach the most affected populations.

Gay and bisexual men, who may be hiding their sexual orientation from loved ones, are the most likely to avoid HIV testing in a physician’s office.

In communities of color, HIV-infected persons typically do not find out they are infected until they are already showing symptoms of HIV, often 10 years after becoming infected.

To make HIV testing more accessible, cheaper and less stigmatized, we endorse wide availability of HIV rapid tests that the consumer can self-administer using a sample of tissue from the cheek or a sample of blood from a finger stick.

Screening oneself for HIV could be similar to testing oneself to find out about pregnancy.
Home-administered HIV antibody screening tests could be made available at a pharmacy for a cost substantially below the current $40 price for home HIV tests.

Read in the privacy of one’s own home, without the need to send samples to a laboratory and without the need to have another person read the test, home tests can maintain confidentiality.

Two rapid screening tests can confirm whether or not it is necessary to seek confirmation of HIV status from a physician.

Persons who test at doctor’s offices or community-based organizations today usually wait a year to start getting services.

With a home test, at least these persons will stop transmitting the virus when learning their HIV status.

To date, the FDA has required a third party to administer and/or interpret the HIV test results.
Perhaps these policies reflect pressure from groups with vested interests in maintaining the status quo: laboratories, community-based HIV testing sites or pharmaceutical agencies. In China, rapid tests cost less than $2.

Rapid, consumer-controlled HIV testing strategies have been blocked, similar to the way in which consumer-controlled pregnancy tests were blocked in the 1970s.

Pregnancy was considered too traumatic to learn without the support of their doctor. Today home, consumer-controlled pregnancy testing is routine.

Buying rapid HIV screening tests at your local drugstore may succeed in achieving broad use in urban inner cities and allow couples and families to find out their HIV status in the privacy of their home.

To have the greatest impact on HIV infection, let persons who are frequently exposed to HIV have an easy way to protect others, by finding out quickly that they are infected.

Health care reform, at every level, is going to require greater individual responsibility for maintaining our own health.

Let’s start with providing tools to those most likely to get HIV to take personal responsibility to protect themselves and others.

Dr. Mary Jane Rotheram, Dr. Arleen Leibowitz and Kevin Farrell are researchers at the Center for HIV Identification, Prevention and Treatments Services at UCLA.