Can you accurately perform the test and correctly interpret the result? What does a positive test really mean? What does a negative test mean? If you test positive, what does that mean for your health and your life? Are you going to die soon? Are there any medicines or treatments that can help you?
Test kits can give false positive results. This means that the test tells you that you are HIV positive and you really are not. From what we know about other types of rapid HIV tests, this could happen possibly if the test hasn’t been stored properly or may be close to expiration. Sometimes, individuals with other types of infections (e.g. malaria and other parasites) will get a positive test for HIV infection, but they may be negative. We do not yet know how big a problem this could be with these kits.
You could also get a false negative test. In this case, the test tells you are negative but you are in fact infected. These tests are based on the presence of HIV antibodies. After infection, it may take several weeks to months for the body to develop enough of these antibodies to become detectable by these tests. So a recently infected person may have a negative test, but really be positive. The test should be repeated in 3 and then 6 months, but, the person is likely to have had other unprotected sexual encounters during that time. If for whatever reason you suspect you are infected and not testing positive, your doctor can do other tests, such as a viral load, that can detect infection earlier than standard tests.
Confirmation of test results by more accurate sensitive laboratory test (e.g. Western Blot or ELISA) is mandatory for any positive test. Repeating the results later is also necessary if the test is negative.
What if the test is negative? No problem, right? Wrong. Many people play Russian-Roulette. They engage in regular unprotected sex and the hold their breath while nervously awaiting their tests results. But when they get a negative test result, they breathe a sigh of relief and then resume their risky behaviors all over again. They never change. Individuals who are tested in a medical setting or through testing programs and receive a negative result are counseled on how to stay negative. They receive suggestions on how to refrain from high-risk behaviors. Can a home-test kit do that?
So let’s go back to the scenarios at the beginning.
How much increased domestic violence and suicide will result from using or misusing this kit? Clearly we don’t know, and I pray that it will not be a serious problem. However, the potential is real and must be considered. Domestic violence is already common in many of our communities and is considered a risk factor for HIV transmission. In African counties and the Caribbean, gender-based violence around HIV testing and disclosure is a serious problem. Those who get tested through traditional means can often solicit the help of medical professionals and social workers in communicating bad news to a partner. They can also be referred to counseling and other assistance if they are victims of domestic violence.
HIV infections are common among individuals with mental health challenges. I think we are all aware that substance abuse and addiction increase the chance of HIV infection either through increased high-risk sexual practices or through the use of injection drugs (heroin use and sharing needles). Many individuals with substance use problems have underlying depression, PTSD, bipolar disease or schizophrenia. There is the possibility that someone with psychiatric problems could use this test and maybe especially vulnerable to a positive test result. They may decide to inflict harm on themselves or others.
The key is to educate yourself before using it and have a plan in place for getting good advice and guidance when you get results, whatever they may be. Since many of the kits will be sold in pharmacies, pharmacists must take the lead in educating themselves about the test and preparing to deliver effective counseling for their clients. They are the most accessible health care professionals and should be able to counsel on how to use the tests and what the results mean. They should also be prepared to make referrals for clients to get confirmatory tests and care, particularly for people who do not have a primary care physician.
I suspect that a high proportion of the 20% of individuals who do not know that are HIV infected are in our communities. This test could potentially remove a major barrier to reducing this 20% which is also important to controlling the AIDS epidemic. If we use this test properly in our communiies, then Magic could be right. It could definitely be a “Game-Changer” for us!