Home HIV test raises difficult questions

“I feel a lot better now that I know,” concludes a young woman in a TV commercial for Confide, the first do-it-yourself HIV test. Granted, for the overwhelming majority of people who will test negative for the virus, a convenient and confidential home test is a good way to put your mind at ease. But what about those who test positive? They sure wouldn’t feel “a lot better,” and they have to deal with the frightening news all alone. Confide, on shelves across the country now, and two other home tests soon to be marketed, allow people to determine their HIV status without a visit to a doctor or clinic. Test users prick their finger, deposit drops of blood on a card and mail it back to the manufacturer. A week later, they call in for their results. Those who test negative get an automated message, while live counselors respond to all positive tests. Although any service that provides HIV testing plays a role in preventing the spread of the virus, finding out over the phone that you have HIV raises serious questions.
What’s to keep someone from hanging up out of shock and fear the moment they hear a live voice on the other end of the line? Can you really get someone connected with a support structure and treatment options over the phone? Won’t anonymous diagnosis throw off national and state statistics about infection rates and the spread of the disease?
A lot of things can keep someone from going in for testing at a clinic: concerns that your partner, family, employer or insurance company will find out; social stigmas about the virus; or even just confronting the possibility you have HIV. The appeal of home tests is their total confidentiality — you can be tested without anyone knowing. But a positive diagnosis is a very traumatic experience, one which can lead to depression and even suicide. Nothing can take the place of face-to-face counseling to help people get over the initial shock and on the road to medical treatment.
Although Direct Access Diagnostics, the company that makes Confide, believes over-the-phone counseling is effective, a majority of health care professionals disagree, especially in Minnesota. Up to now, face-to-face notification was the only way to find out whether you had HIV in this state. Last year, Minnesota HIV/AIDS counselors voted unanimously against phone notification. But in other states notification via phone or mail is common, and that inconsistency was the deciding factor when the Food and Drug Administration approved over-the-counter tests earlier this year.
Without a doubt, home testing is a less than ideal method of diagnosis, but it is better than not being tested at all. In the end, any way of furthering HIV awareness, testing and treatment does good. The real problem is a society that has so stigmatized a disease that a service like this is even an option. We certainly wouldn’t have home testing for diabetes, cancer or heart disease. It’s tragic that anyone would have to find out alone that they are infected with HIV and not have a concerned, sensitive and trained professional in the same room to help them through one of the toughest moments anyone ever has to face. You can comfort, console and explain medical options over the phone, but you can’t give anyone a hug when they need it most.