by Gus Cairns
www.guscairns.com
19 January, 2007
The government should be taking steps to legalise home-testing kits for HIV, an editorial in the influential medical journal, the Lancet, says.
Lucy Frith, lecturer in Health Care Ethics at the University of Liverpool, says that since effective HIV treatment became available, many of the arguments against home testing – that it is a death sentence, or that people won’t be able to cope with the result – are out of date.
She also says the outlawing of home testing flies in the face of other government policies, which lay greater emphasis on “greater self-diagnosis and screening” amongst patients.
People “can make informed decisions without direct interventions from healthcare professionals,” she says.
“The restriction of HIV testing to clinical settings in unwarranted, because it prevents individuals from fully exercising their autonomy.”
She also says that legalising home testing “would increase the uptake of HIV testing – a major government health target”.
At present an estimated one-third of the people with HIV in the UK don’t know it, and the more people that do the better (although there is some evidence that the people who use home tests may be the ones least at risk – the ‘worried well’ – and that people who suspect they are at high risk either avoid testing or go to a clinic).
It has been an offence since 1992 to sell or otherwise provide a member of the public with any form of self-test for HIV in the UK. Despite this, any internet search will quickly turn up non-UK sites offering home test kits for as little as £5.00. How many people in fact self-test before going to a clinic, or instead of going, is unknown.
Frith acknowledges there are several issues to be sorted out before widespread home testing could be feasible in the UK.
The most important one is probably that at present we don’t have an easy-to-use test that’s accurate enough. Blood tests are, and in the USA it has been legal since the mid-1990s to sell so-called home-sampling kits.
These consist of a small lancet to get a fingertip sample of blood with, and a collection tube in which to collect it, but the sample has to be posted off to a lab to get the test result, and they would appear to offer little advantage to a clinic test.
Widespread home testing would need a saliva-based test.
Until late 2005 the US Food and Drug Administration was considering legalising the so-called OraSure oral-fluid test for home use. However they reconsidered this when a couple of community HIV centres that started using the test in the USA reported a higher-than-expected rate of false positive results.
However Frith says that more reliable tests are being developed and will be available soon, and that we should be considering legislative changes before they arrive.
Then there’s the requirement for counselling support.
Frith says that pre-test counselling “can actually deter people from being tested” and that the government is already trying to extend the use of ‘opt-out’ testing in which an HIV test becomes a normal part of any sexual health checkup and GUM clinics “should stop pre-rest counselling” and restrict discussion purely to the obtaining of informed consent for the test.
However she does acknowledge that anyone who gets a positive result at home would need counselling support, especially, perhaps, if the result is unexpected.
She says that when the US authorised home-sampling kits, a a requirement of sale was that there had to be a 24-hour phone counselling line available for support. In the UK this could be provided by Sexual Health Link, the new name for what used to be the National AIDS Helpline, which is still available on a 24-hour basis on 0800 567 123.
She reaffirms that people who get a positive result would need to go to a clinic to take a confirmatory test, and acknowledges that some people might be too scared to do this.
But this already happens with clinic testing: a recent survey from New York found that one in five people who get a positive same-day-test result at clinics don’t return for a confirmatory test.
The last objection to home testing being freely available is one that Frith describes as “an undoubted drawback”. This is the possibility of abuse, namely that someone could somehow test someone without their consent.
Frith points out that such a possibility already exists, not just in terms of internet HIV tests, but with other tests such as DNA testing to determine child paternity.
In the latter case, what the government has done is to bring in a law making non-consensual testing illegal.
“Although such a law could not prevent testing,” says Frith, “It could stop the results being used legally (eg for employment dismissal).”
She said that if HIV home-testing was legalised, they would have to be piloted and any potential for abusive use closely monitored.
Ultimately, however, she says the arguments in favour of patient freedom outweigh these reservations.
She says: “If practitioners truly believe in patient autonomy, people should be allowed to choose where, when and how they are tested for HIV.”
(With thanks to Gay.com/HIV News)
January 2007
Body Positive Lincs
