OraQuick, a home HIV test, has hit the news with its recent approval by the Federal Drug Authority in the USA.
As reported in The Washington Post: “The OraQuick test detects the presence of HIV antibodies using a mouth swab and returns a result in 20 to 40 minutes. FDA officials said the home HIV test is designed for people who might not otherwise get tested.”
Currently in the USA it is thought that 1 in 5 people infected with the HIV virus are not aware of their infection. It is hoped that these tests may help decrease this rate.
Currently in Australia there is a very limited availability of rapid HIV tests, with HIV testing done by doctors and trained nurses. Recently I attended my own sexual health screen and I 100 percent agree that waiting a week for results can be a very long time. For people who are very anxious and concerned this wait may be too long, and they would rather not be tested than sit in limbo for seven days.
My concern for this testing is two-fold. First, the test is not accurate enough. The manufacturers themselves report that the false negative rate is 1 in 12. So if 12 people take the test and all have undiagnosed HIV infection, one will be told they are HIV negative. What happens then?
Without correct context around the testing, we can never know why people seek a home HIV test. Are they doing it as part of routine screening? Or perhaps, just perhaps, there are some people who will use this test as a way to show potential sexual partners “they are clean” before encouraging unsafe sex?
With the risk of 1 in every 12 home HIV tests completely missing a HIV infection, you can see how this could lead to increase the spread of HIV, not reduce it.
Perhaps the most important reason I can’t advocate a home HIV test is that supportive counselling is essentially removed from the loop.
Home HIV testing is very different to say a pregnancy test. HIV infection is unlikely to result in the popping of champagne corks like a positive pregnancy test. So while it’s great OraQuick have “trained call-center operators bilingual in English and Spanish, [who have] gone through 160 hours of training on HIV counselling”, is that going to be enough to deal with the impact of a positive HIV test? Or worse, what if a person takes the test, gets a positive result and misunderstands, thinking that positive is good, reassuring everything is ok?
I agree we have a way to go with testing for HIV infection. We need to have increased access to rapid HIV testing. Importantly these tests must be given in a supportive and understanding way. Alone, at home and frightened is not ideal for HIV testing and is certainly not the way to learn of a HIV infection.
For this reason I will always advocate for HIV testing, whether rapid or slow to be done in conjunction with careful assessment and counselling by a trained professional.
By DR GEORGE FORGAN-SMITH