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May 2012

Over The Counter HIV Testing

Housing Works supports strategies that will increase the number of people knowing their 

HIV status and have the tools they need to make good decisions for their lives. Over the

counter testing will be one more strategy among the many that exist to increase thenumber of people who know their status. This intervention is not meant to replace or 

supplant those evidence based interventions that have already been proven to be effective

such as free testing in health departments, testing in the presence of your physician andfree outreach testing programs – but to add to the number of options available.

Among the many aspects of over the counter testing easy accessibility and enhancing

ones’ self determination are two attributes that this strategy will provide. Researchers believe that home testing (HT) could be valuable "in empowering individuals to manage

their HIV risks; in helping couples to learn their partners' HIV status before the initiation

of sexual relations; and in addressing the three principal barriers to wider HIV-test

acceptance: stigma, convenience, and privacy" (Walensky & Paltiel, 2006, p. 461).People would be able to purchase a testing kit at their local pharmacy and assuming they

take the proper precautions with the wrapping material can conduct the test in the privacyof their own home, maintaining their anonymity. Disclosure to their insurance company

would be the individual’s choice.

Over the counter testing may also be a test of choice for discordant couples who would

want to test regularly, couples and individuals who have minimal risk but prefer to test

regularly, as well as people with multiple risk factors and would like to privately and

regularly monitor their status. Studies indicate that this may be the test of choice for  people who meet and may want to engage in sexual activity with the comfort of knowing

their potential partners status – a quick swab and 20 minutes later can show someone’sstatus at that moment (not accounting for activity in the window period). This also may be an effective intervention for sex workers as another tool for them to be able to protect

themselves.

Roll out and implementation of over the counter testing should ensure that are systems in

 place that would assure for easy access to care and support for those receiving

unanticipated test results. There should be a well published and posted 800 number with

live counselors. Retail staff should be knowledgeable about the 800 number and where people can get more information in their communities. There cannot be an assumption

that HIV education efforts have been generalized making over the counter testing for 

HIV a normal activity.

As we move to over the counter HIV testing, package inserts need to be developed that

are clear, age appropriate, written at an educational level that the majority of targetaudience can understand, inclusive of education regarding need for confirmatory testing

for any positive result, basic information regarding HIV and AIDS and how people can

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get connected to care. This information should be available in multiple languages.

Current packaging assumes testing is being done by clinical personnel.

It is worth noting that concern does exist on how over the counter testing for HIV will

impact domestic violence rates and the mental health of those who are alone when

obtaining their self-administered results. Receiving results without support couldseriously impact the safety and security of individuals not prepared to deal with the

information, couples who had believed they were in safe, monogamous relationships and

 people who believe they were put at risk even while casually dating. In addition, personswho test positive may need assistance identifying resources. For all these reasons, we

 believe that access to confidential counseling is critical. We believe that these issues can

 be addressed by enhanced education efforts and a robust 800 number with live

counselors, available to people with immediate concerns.

Conclusion:

Given the goal of reducing HIV infection rates, over the counter testing adds anadditional tool to our prevention tool kits. They enhance self-determination and control

over ones HIV risk. They increase people’s ability of learning their status and, assuming proper care is taken with packaging materials, can protect people’s privacy. Packaging

information needs to provide all necessary information so that people can make informed

decisions on how they chose to get tested as well as to how they can access care.Systems need to be put in place to increase likelihood of access to care and support

should test results warrant immediate attention. If we truly want to see and AIDS free

generation it is incumbent upon us to effectively use every tool available.