Thirty years into the HIV epidemic, many people who are at high risk of HIV infection cannot or will not adopt safer sexual practices, such as abstinence and condom use. This means there is room in the market for alternative methods to reduce either exposure to or transmission of HIV among these individuals. One such strategy, HIV home testing (HT), is the subject of a recent study by Alex Carballo-Dieguez and his colleagues at the HIV Center for Clinical and Behavioral Studies at New York. Their work appears online in the journal AIDS and Behavior.
A number of biomedical strategies for the prevention of HIV transmission are being developed, many of which are costly and have limited success. Although rapid HIV tests have been available for some time, their potential as a screening tool for possible partners has not yet been studied. And now the possibility of screening partners is a reality with recent FDA approval of HT. Would individuals who choose to have unprotected sex be willing to use them and/or would they ask potential casual partners to take the tests before having unprotected sex?
Twenty-seven ethnically diverse men who have sex with men (MSM) completed the study. They were each given 16 HT kits to use with prospective sexual partners and were monitored weekly for three months and then interviewed in depth. Overall, the HT kits had a high level of acceptability with all men, including ethnic minority MSM, whose infection rates are high. Most men in the study wanted to continue to use these kits and to be able to buy them over the counter.
The in-depth interviews provided the most revealing insights into the significance of the HT kits. Often just the suggestion of using the kit opened up discussion about HIV status when it might not have been mentioned otherwise. In two cases, disclosure of an HIV-positive status was only given once the participant had proposed using the HT kit. Refusal to take the test prompted suspicion in participants who then either had sex with a condom or did not have sex with that potential partner. A positive HIV test resulted in no sex taking place.
Critics of the kits fear that their availability will reduce condom use. However, Carballo-Dieguez and his colleagues contend that it cannot impede condom use in those who already choose not to use condoms. In these individuals, HT would not replace an existing strategy but fill a gap where there is none. It is clear that in this study, HT proved to be a cost-effective, simple and acceptable tool to help prevent the spread of HIV infection in a high risk group.
The authors conclude that, importantly, "since the tactic is peer driven, it may empower individuals to take control of their behavior, develop a non-condom-based approach for communal, shared responsibility to prevent HIV transmission, and ultimately transform serosorting from a guessing game into a strategy based on objective evidence."
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Carballo-Dieguez A, Frasca T, Balan I, Ibitoye M, Dolezal C (2012). Use of rapid HIV home test prevents HIV exposure in high risk sample of men who have sex with men. AIDS and Behavior; DOI 10.007/s10461-012-0274-2