Home HIV Testing -- The Good and the Bad

Recently a new option for HIV testing became available. You can now take the HIV test at home. However, home testing is not for everyone. The U.S. Food and Drug Administration (FDA)-approved HIV home tests are as accurate as the antibody tests done in doctors offices and health departments, and they use the same ELISA/Western Blot/IFA tests. However, not all home test kits are the same, and some companies are selling unapproved tests, the accuracy of which is unknown (see below). Like other antibody tests, these tests are subject to the same six-month waiting period in order for the tests to be fully accurate. The FDA-approved home tests are more than 99% accurate beyond six months after a possible exposure to the virus.

There are certain pros and cons to using home testing kits.

Pros:

• A person who's scared about being seen in a clinic can do the test without anyone outside their home knowing about it. They may feel more comfortable doing the test alone.

• These tests can be purchased in some stores, or ordered by phone or on the Internet, and can be an option for those who do not have transportation to local clinics, or who are home-bound due to disabilities.
  
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• The FDA-approved tests are as accurate as antibody tests commonly used in clinics around the country. However, keep in mind that, unfortunately, there are unapproved home HIV tests being sold to consumers (see below).

Cons:

• Home testing is more expensive than going to the local health department. Testing through local health departments, and some private agencies, is free or low-cost. Home test kits can cost up to $50.

• Another issue to be dealt with is confidentiality. If a person buys a home test kit in a store, everyone in the store will know that the person is taking an HIV test. Another option would be to purchase the kits by phone or through the Internet.

• When you order the tests (by phone or via the Internet), you must give your name and address. When you order by credit card, the charge for the test will appear on your credit card statement. Although your name is not linked to your test results, people who see your credit card statement may find out that you're being tested.

• When taking a test at home, after you're finished taking the test, all the packaging from the kit has to be well hidden in the garbage. If a garbage man empties your garbage, and sees the test kit packaging, they'll know you took an HIV test. Also, if your garbage gets ripped open by animals, or if the garbage can gets blown open by the wind (and gets blown all over your neighborhood), your neighbors can also know you've been tested. So for people taking the home test, I say "hide your garbage!"

• In a home test kit, a person has a test ID card that is used to identify the specimen by number. Anyone who has the number can get the test result over the phone. The person who is being tested has to make sure that nobody else sees the card. Otherwise, any person who sees the card or the number can get that other person's test results. So it's important that a person getting tested at home doesn't leave the ID number lying around the house, where other members of the household can see it. This differs dramatically from testing through the health department. To ensure confidentiality, health departments will usually not give test results over the phone or by mail. Test results through the health department are usually given in person.

• Getting test results over the phone can be hard to deal with, especially if the test is positive. A person can just hang up and never hear all the counseling and information they need to hear. For this reason test counseling is best done face-to-face, and is most effective this way.
  

• Using home testing, if a person is positive, there is no way to do partner notification (anonymously helping a person's sex/needle-sharing partners know they've been exposed). Partner notification is routinely done by local health departments around the country for HIV and other STDs. Home testing bypasses this important, and proven, preventive health measure.
  

• There are presently two home HIV testing companies that have received FDA approval for these types of tests, Home Access, and Confide, which is no longer on the market. Unfortunately I recently discovered at least three other companies that are selling home HIV tests that have not been approved by the FDA. The three companies I found were all advertising via the Internet. Beware of these unapproved kits and only use Home Access for now. (For more information, look at The Body's section on HIV Testing.)

  I have seen a growing number of home tests on the Internet, claiming accurate tests that can be done in the home, without sending a specimen to a laboratory. They often claim that results can be obtained in about 15 minutes. NONE OF THESE TESTS HAVE BEEN APPROVED, AND THE ACCURACY OF THESE TESTS IS UNKNOWN! Two of these tests used blood, and another used saliva. There is an FDA-approved saliva HIV antibody test (called Orasure), but it has not yet been approved for home use. You must go through your doctor to get a saliva antibody test.

  I have also seen on the Internet home chlamydia tests, home TB tests, home hepatitis B tests, home drug screening tests and a growing number of other unapproved home tests. This is a growing market, and there will always be people trying to make money off of home testing, by selling unapproved tests. Therefore, unless a home HIV test is from Home Access, the accuracy of the test is unknown.

I personally have tried the home testing kits. Since I live in a rural community in the United States, I had to be very careful regarding confidentiality, especially when it came to "hiding my garbage." Also, I can see some people having difficulty in doing a fingerstick to draw blood for the test.

The test itself takes about an hour to do (which includes time for the specimen to dry and to package up the sample to send to the lab). It also includes a lot of reading material. I therefore recommend about two hours to do the test at home. This includes all the time to read the materials, and to do the actual test.

It is up to you to decide whether home testing is for you. However, you must first understand the pros and cons of home testing. It has its benefits, but it also has its drawbacks, as discussed above. But if you decide to take a home test, make sure that it is sold by a legitimate company. Otherwise, you may be wasting your money, and possibly endangering your health.

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Do you want more information on AIDS, STDs or safer sex? Contact the U.S. Centers for Disease Control AIDS hotline, open 24 hours a day, seven days a week, at 1-800-CDC-INFO. Or visit The Body's Safe Sex and Prevention Forum.

Until next time . . . Work hard, play hard, play safe, stay sober!