As a gay man who works in sexual health, I’m sure you can imagine my inbox since the news came out that the FDA has approved an at-home, over-the-counter test for HIV.
Most people seem really excited that this will lead to increased availability of testing. I agree with them — easier access to testing is a necessary. Knowing your status is one of the most important lines of defense that we have. But I’m concerned about the implementation of these tests.
When you get an HIV test today, there’s an important component of the test, often maligned, that won’t be included with OraQuick test. Specifically: counseling. I remember going to my student health center, filling out a form and feeling like I was being slut-shamed over my number of sexual partners. In retrospect (or probably, now that I provide pre-test counseling myself), there are some really important parts of counseling that I’m concerned won’t be effectively communicated to people taking an HIV test at home.
The biggest danger is that there isn’t a pre-screening. I can’t tell you how many people I talk to where the conversation goes something like this:
Him: I want to take an HIV test.
Me: Certainly. May I ask why you’re concerned about HIV?
Him: Well, I had sex with someone recently, and I’m kind of concerned cause it wasn’t really the safest.
Me: Do you mind my asking, do you remember when this encounter was?
Him: Yeah, it was 4 days ago.
That’s a big red flag. A lot of people don’t understand how these tests work: They don’t measure HIV directly. They detect the antibodies that your body produces to fight off an infection. It takes a while for your body to notice that it’s infected. It takes a while to produce enough antibodies to be detectable. If you test too early you could get a false negative.
False negatives are a known risk of this test: As many as 3,800 people per year could get a false negative. It’d be easy to understate that, sure, it’s only 3,800 people who don’t know that they’re positive, there are many more people than that who don’t know that they’re positive walking around today. But that’s not the case with them. It’s 3,800 people who think they are negative, which is a much more dangerous position. People who know there’s a chance they might be positive are more likely to protect those they care about. People who know they’re negative might practice unprotected sex with other people who know they’re negative, a practice known as serosorting.
But serosorting only protects you if you have accurate results. If you test at an inappropriate time, but no one explains to you that this test is not conclusive, you’re in a dangerous position. You’re operating under imperfect information and making potentially hazardous decisions because of that.
It’s not that false negatives are the only thing that worry me, but they are what worry me the most, because of the risk they pose for increased transmission. But imagine that you take this test alone, at home. Do you really want to find out you have HIV and your only source of comfort is an 800 number?
There’s still a lot of misinformation out there about HIV. It’s not a death sentence. It’s a manageable condition. When a medical professional breaks the news of infection to you, they know how to give you hope. When a home test does, you’re left in the dark.
Our system is imperfect. People cannot get testing when they need it. Increased access to testing is a good thing. But improperly administered tests pose new dangers, and I’m concerned that improper information will lead to people acting more recklessly, and risking others to the virus.
Tweet Jonathan Cox at @jonvox.