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Home testing

What Is the Role of HIV Testing at Home?

Is home HIV testing feasible?

Home-access testing for HIV met with virtually unanimous opposition when it was first proposed.1 Today, the Centers for Disease Control (CDC), leading clinicians, gay activists and AIDS advocates have all endorsed home access testing.2 The barriers to home access testing have not been technical, as feasibility studies have demonstrated.3 Home testing has been possible for more than a decade. Actually, “home testing” is a little misleading: customers don’t actually get on-the-spot results, the way they do with home test kits for glucose, cholesterol, blood pressure or pregnancy. The tests are really at-home “collection kits” to be purchased over the counter or through the mail. A test kit purchaser pricks his/her finger, puts a drop of blood on a piece of blotter paper, sends it off in the mail, then phones for results and counseling after a specified time. In the spring of 1996, the Food and Drug Administration (FDA) approved the first HIV home collection test kit, Confide. The kit, sold by a subsidiary of Johnson & Johnson, was later withdrawn from the market. The FDA later licensed Home Access HIV-1 Test System, manufactured by Home Access Health Corporation of Chicago. This remains the only home collection kit approved for sale by the FDA, although a dozen other unapproved home test kits have been advertised for sale in newspapers and via the Internet. The FDA cautions against the use of these unapproved test kits, which have not been fully evaluated and “do not have a documented history of delivering dependable results.”4

How is it different?

It’s an easy way for people to find out if they’re HIV infected. Traditionally, getting tested for HIV has meant a trip to a doctor or clinic, getting blood drawn, then returning for results and counseling. The new home testing kits save two trips to the doctor or clinic. It also makes testing accessible for people who live in rural areas, or inner cities where clinics are scarce, too busy, or a long bus ride away. Home testing also affords privacy. Some people are afraid to visit a clinic or doctor’s office because they fear they will be recognized by neighbors, friends, or family. In a number of studies, at-risk individuals have expressed preference for anonymous systems of HIV testing.5 Home testing has the potential for complete anonymity. Offering another testing option is a step toward solving the national problem of inadequate HIV testing. An alarmingly high proportion of those at risk has not been tested for HIV.6 Getting HIV test results becomes more and more important as means of bolstering the immune system and staving off opportunistic infections improve. Pregnant women are being encouraged to take voluntary HIV tests in light of studies showing that treating HIV-infected pregnant women with zidovudine (AZT) can reduce the rate of maternal/fetal transmission of HIV by two-thirds.7

Are the results reliable? private?

Millions of HIV antibody tests have been conducted using dried blood specimens.8 Such testing is highly accurate when laboratory protocols for confirmatory testing and quality assurance mechanisms are followed. False positive results do occur in HIV testing, but at a very low rate. Some test kit blotters mailed to the lab may not have enough blood to test. In such situations, telephone counselors have been trained to advise customers when results are unclear or need further confirmation. Each test comes with a unique identification number, which patients return to the lab with their blood samples. The lab never knows a name. When calling for results, patients identify themselves by this number alone.

Who will get tested at home?

Home access HIV testing may provide reassurance to the “worried well”-people for whom the risk of HIV infection may be quite remote, but are nevertheless seeking reassurance. If such individuals no longer rely on public sources of testing, resources may be freed up for more targeted interventions with those at highest risk.9 Sales of home test kits have not been quite as robust as might have been expected from surveys in which people expressed their attitudes and intentions regarding home testing. In its first year, Home Access Health’s sold 152,044 test kits; 148,039 people called to find out their results. The overall HIV seropositive rate was 0.9%.10 Beyond the denial and psychological barriers to seeking testing, many may find the $30-40 retail cost for home test kits prohibitive. Home test kit companies are working with a variety of public health and community agencies, selling kits at wholesale prices so that home access testing can become part of various prevention outreach strategies.

What are the concerns?

One concern is the adequacy of counseling. At a doctor’s office or clinic, test results are usually delivered in person. If a patient feels overwhelmed, or even suicidal, an expert is there to help. Companies selling home test kits make counselors available, but they will be miles away on the other end of a telephone. As one critic of home testing put it, “a 1-800 number can’t hug you when you’re crying."11 Yet for some people, the remoteness and anonymity afforded by telephone counseling makes it easier to reveal painful feelings or embarrassing information. There is a long tradition with telephone counseling in crisis intervention and suicide prevention. Telephone counseling must be compared to the actual experiences of current HIV testing. For many, counseling is already inadequate or missing altogether. According to data from the National Health Interview Survey (NHIS), a third of those who were tested for HIV antibodies got their results by mail (16%) or telephone (17%).12 About 2.5 million tests are performed annually at publicly funded test sites. In 1995, 25% of people who tested positive and 33% who tested negative failed to return for their results.13 In contrast, 97.4% of buyers of the home test kit called for test results.10 Another concern is potential abuse of home test kits. Some fear that employers, family members or health providers could send someone’s blood sample to be tested without the person’s knowledge. Laws already exist against testing without consent and discrimination on the basis of HIV status. These statutes need to be enforced; new legal protections may be needed once there is more experience with home test kits.

What are the limitations?

A positive HIV test result does not guarantee access to needed care. As the National Commission on AIDS wrote, “for many impoverished individuals gaining entry into a health care and social service system by means of a ticket stamped `HIV positive’ is still a cruel hoax.”  Nevertheless, this is no reason to discourage people from seeking testing. “The lack of good medical and social services for people with HIV infection is an argument for increasing those services, not denying people access to personal medical information.”15 HIV testing is not an end in itself. A comprehensive HIV prevention strategy uses multiple elements to protect as many people at risk of HIV infection as possible. The real challenge is to ensure that wherever people are tested they have access to follow-up counseling and care. If they are HIV positive they should receive care to stay healthy, and if they are HIV negative they should receive support to stay negative.

Says who?

  1. Anon. Banned at home: an FDA ruling on AIDS test. Time. 1989; April 18:26.
  2. Leary WE. Government panel hears call for expanded AIDS testing. New York Times. 1994;June 23:A18.
  3. Frank AP, Wandell MG, Headings MD, Conant MA, Woody G, Michel C. Anonymous HIV testing using home collection and telemedicine: a multicenter evaluation. Archives of Internal Medicine. 1997;157:309-314.
  4. Center for Biologics Evaluation and Research, Food and Drug Administration (FDA). Testing yourself for HIV-1, the virus that causes AIDS–Home test system is available. 1997;July 25. https://www.fda.gov/vaccines-blood-biologics/hiv-home-test-kits/testing…;
  5. Hirano D, Gellert GA, Fleming K, et al. Anonymous HIV testing: the impact of availability on demand in Arizona. American Journal of Public Health. 1994;84:2008-2010.
  6. Sweeney PA, Fleming PL, Karon JM, Ward JW. A minimum estimate of the number of living HIV infected persons confidentially tested in the United States. Presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) 1997;Sept.-Oct., Toronto, Canada.
  7. Conner EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. New England Journal of Medicine. 1994;331:1173-1180.
  8. Gwinn M, Redus MA, Granade TC. HIV-1 serologic test results for one million newborn dried-blood specimens: assay performance and implication for screening. Journal of Acquired Immune Deficiency Syndrome. 1992;5:505-12.
  9. Valdiserri RO, Weber JT, Frey R, Trends in HIV seropositivity in publicly finded HIV counseling and testing programs: implications for prevention policy. American Journal of Preventive Medicine. 1998;14:31-42.
  10. Home Access Health. http://www.homeaccess.com.
  11. Ocamb K. Home HIV testing is near. POZ. 1994;June-July:48-52. (quoting Dennis Ouellet, LA Free Clinic).
  12. Schoenborn CA, Marsh Sl, Hardy AM. AIDS knowledge and attitudes for 1992. Data from the National Health Interview Survey. Advance Data. 1994;243:1-15.
  13. Centers for Disease Control. Update: HIV counseling and testing using rapid tests–United States. Morbidity and Mortality Weekly Report. 1998;47: 211-5.
  14. National Commission on AIDS. Report of the Working Group on Social and Human Issues. Washington, DC: National Commission on AIDS, 1991.
  15. Bayer R, Stryker J, Smith MD. Testing for HIV infection at home. New England Journal of Medicine. 1995;332: 1296-1299.

Prepared by Jeff Stryker* *CAPS Updated August 1998. Fact Sheet #11Er

Reproduction of this text is encouraged; however, copies may not be sold, and the Center for AIDS Prevention Studies at the University of California San Francisco should be cited as the source of this information. For additional copies of this and other HIV Prevention Fact Sheets, please call the National Prevention Information Network at 800/458-5231. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. © August 1998, University of California.

Resource

Adolescents

What Are Adolescents’ HIV Prevention Needs?

Can adolescents get HIV?

Unfortunately, yes. HIV infection is increasing most rapidly among young people. Half of all new infections in the US occur in people younger than 25. From 1994 to 1997, 44% of all HIV infections among young people aged 13-24 occurred among females, and 63% among African-Americans. While the number of new AIDS cases is declining among all age groups, there has not been a comparable decline in the number of new HIV infections among young people.1 Unprotected sexual intercourse puts young people at risk not only for HIV, but for other sexually transmitted diseases (STDs) and unintended pregnancy. Currently, adolescents are experiencing skyrocketing rates of STDs. Every year three million teens, or almost a quarter of all sexually experienced teens, will contract an STD. Chlamydia and gonorrhea are more common among teens than among older adults.2 Some sexually-active young African-American and Latina women are at especially high risk for HIV infection, especially those from poorer neighborhoods. A study of disadvantaged out-of-school youth in the US Job Corps found that young African-American women had the highest rate of HIV infection, and that women 16-18 years old had 50% higher rates of infection than young men.3 Another study of African-American and Latina adolescent females found that young women with older boyfriends (3 years older or more) are at higher risk for HIV.4

What puts adolescents at risk?

Adolescence is a developmental period marked by discovery and experimentation that comes with a myriad of physical and emotional changes. Sexual behavior and/or drug use are often a part of this exploration. During this time of growth and change, young people get mixed messages. Teens are urged to remain abstinent while surrounded by images on television, movies and magazines of glamorous people having sex, smoking and drinking. Double standards exist for girls-who are expected to remain virgins-and boys-who are pressured to prove their manhood through sexual activity and aggressiveness. And in the name of culture, religion or morality, young people are often denied access to information about their bodies and health risks that can help keep them safe.5 A recent national survey of teens in school showed that from 1991 to 1997, the prevalence of sexually activity decreased 15% for male students, 13% for White students and 11% for African-American students. However, sexual experience among female students and Latino students did not decrease. Condom use increased 23% among sexually active students. However, only about half of sexually active students (57%) used condoms during their last sexual intercourse.6 Not all adolescents are equally at risk for HIV infection. Teens are not a homogenous group, and various subgroups of teens participate in higher rates of unprotected sexual activity and substance use, making them especially vulnerable to HIV and other STDs. These include teens who are gay/exploring same-sex relationships, drug users, juvenile offenders, school dropouts, runaways, homeless or migrant youth. These youth are often hard to reach for prevention and education efforts since they may not attend school on a regular basis, and have limited access to health care and service-delivery systems.7

Can education help?

Yes. Schools are an important venue for educating teenagers on many kinds of health risks, including HIV, STD and unintended pregnancy. Across the US and around the world, studies have shown that sexuality education for children and young people does not encourage increased sexual activity and does help young people remain abstinent longer. Effective educational programs have focused curricula, have clear messages about risks of unprotected sex and how to avoid risks, teach and practice communication skills, address social and media influences, and encourage openness in discussing sexuality.8 In addition, HIV prevention programs that are carefully targeted to adolescents can be highly cost effective.9

Are schools the only answer?

No. Young people need to get prevention messages in lots of different ways and in lots of different settings. Schools alone can’t do the job. In the US, many schools are being hampered by laws and funding that prohibit comprehensive sexuality education. The federal government earmarked $50 million per year for school-based abstinence-only programs which emphasize values, character building and refusal skills, but do not discuss contraception or safer sex.10 Although abstinence programs are effective at delaying the onset of sexual activity, they typically do not decrease rates of sexual risk activity among adolescents the way that safer sex interventions do.11 Youth who are not in school have higher frequencies of behaviors that put them at risk for HIV/STDs, and are less accessible by prevention efforts. A national survey of youth aged 12-19 found that 9% were out-of-school. Out-of-school youth were significantly more likely than in-school youth to have had sexual intercourse, had four or more sex partners, and had used alcohol, marijuana and cocaine.12 More intensive STD/HIV and substance abuse prevention programs should be aimed at out-of-school youth or youth at risk for dropping out of school. Programs targeting hard-to-reach adolescents at high risk for HIV are necessary in many different venues outside of schools. Programs based in venues such as residential child care facilities, alternative schools and youth detention centers are needed. Peer educators can use an empowerment-oriented approach targeted to youth aged 12-17 to teach about preventing HIV and STDs, and to mobilize and link resources for young people through social and community networks.13 Families play an important role in helping teenagers avoid risk behaviors. Frank discussions between parents and adolescent children about condoms can lead teens to adopt behaviors that will prevent them from getting HIV and other STDs. Research has shown that when mothers talked about and answered questions about condom use with their adolescents prior to sexual debut, the adolescents reported greater condom use at first intercourse and most recent intercourse, as well as greater lifetime condom use.14 The WEHO Lounge in Los Angeles, CA, is a coffee house and HIV testing and information center located between two of the busiest gay discos in town. It offers free confidential oral HIV testing, weekly community forums, peer counseling, drug adherence support groups, free condom distribution and a comprehensive youth and HIV resource library. The Lounge also sells coffee drinks. By placing this resource in the community and adapting it to the needs and habits of young gay men, the program has been highly successful with clients.15 Project VIDA in Chicago, IL, a community-based service organization, provides HIV prevention for high-risk urban Latina females, ages 12-24. Project VIDA incorporates empowerment and self-care themes into peer-facilitated street/community outreach and group interventions. They act on the belief that it is impossible to separate HIV risks from other cultural, environmental, interpersonal, and intrapsychic stressors that Latina youths face; and that coping skills can help manage the perplexities of these challenges.16

What needs to be done?

HIV prevention programs for adolescents must consider the developmental needs and abilities of this age group. Programs should focus on contextual factors that lead young people to engage in higher rates of sexual activity and lower rates of condom use, such as low self-esteem, depression, substance use, gang activity, stress of living in turbulent urban environments, or boredom/restlessness related to unemployment. Any program for adolescents should be interesting, fun and interactive, and involve youth in the planning and implementation. This is especially true for out-of-the-mainstream youth and youth from diverse cultures. Programs for hard-to-reach youth who are most at risk for HIV infection should be implemented in venues outside of schools, such as runaway/homeless youth shelters, shopping malls, detention facilities and recreation/community centers. Adolescents not only need correct information and practice in self-protective skills, but also easy access to condoms in order to keep themselves risk-free.

Says who?

1. Centers for Disease Control and Prevention. Young people at risk-epidemic shifts further toward young women and minorities. Fact sheet prepared by the CDC. July 1998. 2. Eng TR, Butler WT, eds. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press; 1996. 3. Valleroy LA, MacKellar DA, Karon JM, et al. HIV infection in disadvantaged out-of-school youth: prevalence for US Job Corps entrants, 1990 through 1996 . Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1998;19:67-73. 4. Miller KS, Clark LF, Moore JS. Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents . Family Planning Perspectives. 1997;29:212-214. 5. UNAIDS. Force for Change: World AIDS Campaign with Young People . Report prepared by UNAIDS, The Joint United Nations Programme on HIV/AIDS for World AIDS Day 1998. 6. Centers for Disease Control and Prevention. Trends in sexual risk behaviors among high school students-United States, 1991-1997 . Morbidity and Mortality Weekly Report. 1998;47:749-752. 7. Rotheram-Borus MJ, Mahler KA, Rosario M. AIDS prevention with adolescents . AIDS Education and Prevention. 1995;7:320-336. 8. UNAIDS. Impact of HIV and sexual health education on the sexual behavior of young people: a review update . Report prepared by UNAIDS, The Joint United Nations Programme on HIV/AIDS for World AIDS Day 1997. 9. Pinkerton SD, Cecil H, Holtgrave D.R. HIV/STD prevention interventions for adolescents: cost-effectiveness considerations . Journal of HIV/AIDS Prevention and Education for Adolescents and Children. 1998;2:5-31. 10. Associated Press. Sex education that teaches abstinence wins support. New York Times. July 23,1997:A19. 11. Jemmott JB, Jemmott LS, Fong GT. Abstinence and safer sex HIV risk-reduction interventions for African-American adolescents: a randomized controlled trial . Journal of the American Medical Association. 1998;279:1529-1536. 12. Centers for Disease Control and Prevention. Health risk behaviors among adolescents who do and do not attend school-United States, 1992 . Morbidity and Mortality Weekly Report. 1994;43:129-132. 13. Zibalese-Crawford M. A creative approach to HIV/AIDS programs for adolescents . Social Work in Health Care. 1997;25:73-88. 14. Miller KS, Levin ML, Whitaker DJ, et al. Patterns of condom use among adolescents: the impact of mother-adolescent communication . American Journal of Public Health. 1998;88:1542-1544. 15. Weinstein M, Farthing C, Portillo T, et al. Taking it to the streets: HIV testing, treatment information and outreach in a Los Angeles neighborhood coffee house. Presented at the 12th World AIDS Conference, Geneva, Switzerland; 1998. Abstract #43125. 16. Harper GW, Contreras R, Vess L, et al. Improving community-based HIV prevention for young Latina women. Presented at the Biennial Meeting of the Society for Community Research and Action, New Haven, CT; June,1999.

Prepared by Gary W. Harper, PhD MPH* and Pamela DeCarlo** *Department of Psychology, DePaul University, **CAPS

April 1999. Fact Sheet #9ER

Reproduction of this text is encouraged; however, copies may not be sold, and the Center for AIDS Prevention Studies at the University of California San Franciso should be cited as the source of this information. For additional copies of this and other HIV Prevention Fact Sheets, please call the National Prevention Information Network at 800/458-5231. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. © April 1999, University of California

Resource

Healthy Oakland Teens (HOT)

NOTE: The HOT Project ended in 1995. For a list of more recent, effective school-based sexuality/HIV education programs, please see:

 

The Center for AIDS Prevention Studies began providing innovative HIV prevention education in Oakland, CA in 1989. The Healthy Oakland Teens Project (HOT) began in the fall of 1992 at an urban, ethnically diverse junior high school. The project's goal was to reduce adolescents' risk for HIV infection by using peer role models to advocate for responsible decision making, healthy values and norms, and improved communication skills. The HOT program was very successful.

After extensive training, the ninth grade peer helpers delivered weekly interactive sessions in seventh-grade science classes, focusing on values, decision-making, communication, and prevention skills. The program trained 30 ninth grade peer helpers who in turn taught 300 seventh graders each year.

Each semester the peers designed their own group logo which was printed on T-shirts worn enthusiastically by the peer helpers. During eighth grade, the students received two "booster" sessions - a reminder of what they learned in seventh grade. HIV-positive young people visited each eighth-grade classroom helping the students realize that HIV infection does happen to teenagers. The eighth-graders also saw a theater presentation, Secrets, sponsored by the Kaiser Permanente Medical Center, which tells the story of a high school student who becomes infected with HIV.

Curriculum

NOTE: The HOT Project ended in 1995. For a list of more recent, effective school-based sexuality/HIV education programs, please see:

Staff

For more information e-mail: Maria Ekstrand Project Director Center for AIDS Prevention Studies [email protected]

Resource

Spring Summer 2017 [E-Newsletter]

Health disparities and HIV/AIDS

Health disparities exist across race/ethnic, gender, sexual orientation, socioeconomic and/or geographically defined population groups. This e-newsletter features CAPS/PRC research that discusses and addresses health disparities among impacted groups that are living with or at risk of acquiring HIV/AIDS. Shout out to our Visiting Professors for summer 2017 ! We welcomed two first-year professors and welcomed back eight returning professors who all improved their programs of HIV-related health disparities research.
In This Issue
  1. Local projects
  2. National projects
  3. International projects
  4. Fact sheets on PrEP and Opioid Use
  5. National HIV/AIDS Awareness Days: Research and Resources booklets
  6. Announcements
Resource

Latino gay men in the US

The ever changing mosaic of Latino demographics in the US creates unique challenges to address health disparities of the population, especially when it comes to HIV prevention needs. Latinos are the largest and fastest growing ethno racial minority group in the US, experiencing a 43% growth between 2000 and 2010. Data also show that Latinos are one of the fastest growing populations at risk for HIV transmission:

  • Latino men who have sex with men (MSM*) represent 81% of new infections among Latino men, and 19% among all MSM2
  • Latinos are 16% of the US population, but make up 17% of living HIV/ AIDS cases and 20% of new HIV infections each year
  • Youth (ages 13-29) accounted for 45% of new HIV infections among Latino MSM. In light of these data there is a need to identify culturally-specific health concerns of Latino gay men so that effective interventions may be developed to address current and prevent future disparities.

The US National HIV/AIDS Strategy highlights the call for HIV programs that reduce health inequities among both ethnoracial and sexual minority populations. Latino gay men have distinct cross-cultural identities that place them into both prioritized categories.