The first in-home HIV testing kit, OraQuick, was approved for use less than a year ago. The kit retails for $40 and is available for purchase from Amazon and most major pharmacies. The test itself is completely painless (no need for blood and needles) and simply involves taking a quick swab inside the mouth. Results are provided in just 20 minutes and are pretty accurate (although, as with any medical test, it is not perfect). All of this certainly sounds good; however, there are some who are asking just what effect this test will ultimately have on people's health and behavior.

On the one hand, most people in the medical and public health communities would agree that anything we can do to break down barriers to testing for HIV and other STIs is a good thing. For example, we know that one reason many people do not get tested for sexual infections is because a certain stigma goes along with visiting a clinic. Some people see getting tested as evidence that you are promiscuous or that you did something wrong, and this may scare others away from testing. Consistent with this idea, one study found that among men who had never previously been tested for HIV, 59% reported that the reason they had not done so was because they feared the social consequences [1]. The primary advantage of OraQuick is that people can get tested in the privacy of their own home without the potential embarrassment of showing up at an STI clinic or visiting the doctor. The end result is that some people who wouldn’t have otherwise gotten tested might do so with this kit.

On the other hand, there are legitimate concerns to be raised about what happens to someone who uses this kit and receives a positive result, but doesn’t have anyone there to provide help and counseling. OraQuick offers a toll-free hotline people can call in order to speak with a “trained professional.” The company also provides free reading material on their website to help people understand their results. However, we don’t know how likely people are to take advantage of these resources and whether they are as effective as what someone might receive at a doctor’s office or clinic. We know that an HIV diagnosis can be psychologically devastating, so it is vital that newly diagnosed persons get the counseling and follow-up care that they need.

In addition, there is the concern that people may use this test on themselves (or use it as a screening tool for potential partners) and, on the basis of a negative result, choose to engage in riskier behaviors. The problem here is that while the test reportedly produces very few “false positives” (i.e., it is correct 99.9% of the time at providing a negative result when that is the correct decision), it produces a reasonably high number of “false negatives” (i.e., it is only correct 91.7% of the time at providing a positive diagnosis when that is the correct decision). In other words, 1 out of every 12 HIV-positive persons will mistakenly receive a negative result. In addition, if a person with HIV is newly infected (i.e., they were exposed to the virus within the last three months or so), it is highly likely that the test will provide them with a false negative. This is because OraQuick (like the most commonly used HIV tests administered at health clinics) bases its results on the presence of HIV antibodies, which the body does not usually produce until three to six months after the initial infection. As a result, it would be extremely ill-advised to use this test before having sex with a new partner and, on the basis of a negative result, decide to forego protection.

My view is that anyone who has had unprotected sex, sex with multiple partners, or sex with partners of unknown status should be tested for HIV (and if you participate in these activities regularly, you need to get tested regularly). Ideally, this testing will occur in a medical setting where appropriate counseling and resources are immediately available and you can get tested for other STIs at the same time. HIV isn't the only sexual infection you should be screened for routinely, so please do not look at OraQuick as a substitute for visiting your doctor! That said, if you have concerns about privacy, confidentiality, or embarrassment specific to HIV testing, use of OraQuick is definitely a viable alternative and is far more desirable than not getting tested at all. Lastly, there is nothing wrong with using OraQuick to screen potential partners as long as you realize that the result provided is not guaranteed to identify every HIV-positive partner, nor is it an excuse to stop using condoms with new partners.

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[1] Stall, R., Hoff, C., Coates, T.J., Paul, J., Phillips, K.A., Ekstrand, M., ... & Diaz, R. (1996). Decisions to get HIV tested and to accept antiretroviral therapies among gay/bisexual men: Implications for secondary prevention efforts. Journal of Acquired Immune Deficiency Syndromes, 11, 151-160.

Image courtesy of OraQuick

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