July 25, 2012
MSM Able to Use Home HIV Tests to Screen Sex Partners and Lower Risk
by Trenton Straube
Men who have sex with men and are at “high, high risk” of HIV can successfully use in-home rapid HIV tests to screen their sexual partners for the virus, according to a study involving a sample of this MSM population. The research, by Alex Carballo-Dieguez, PhD, and his colleagues at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, was presented Tuesday, July 24, during an oral poster discussion at the XIX International AIDS Conference (AIDS 2012) in Washington, DC.
Participants in the study found the oral swab tests easy to use and “highly acceptable,” according to the researchers. The in-home tests helped these MSM identify high-risk partners—in fact, 10 men tested positive—and the tests helped the participants modify their own behavior so they were at lower risk of contracting HIV.
The topic of in-home HIV testing is no longer a hypothetical one. In July, the Food and Drug Administration approved the first such test, the OraQuick In-Home Rapid HIV test, which, according to the manufacturer OraSure, is expected to be available over the counter this October at “slightly more” than $17.50.
But would men who engage in high-risk sexual behavior—specifically, non-monogamous men who don’t use condoms when they have receptive anal sex with other men—be interested in testing their partners before hooking up? What would their motivations be? What problems—such as physical violence—could arise? In short, could the home tests be a successful harm-reduction technique?
To explore these topics, Carballo-Dieguez and his colleagues recruited 32 men in New York City to partake in a study. Each participant received 16 test kits to take home and use as an option. Carballo-Dieguez sought out men he characterized as “high, high risk”—they had multiple partners and reported never using condoms the last 10 times they had sex, or they had more than four partners in the past year and used condoms less than 80 percent of the time.
The average age of participants was 34. Forty-one percent were white, 33 percent were African American, and 19 percent were Latino. In the previous three months, participants had an average of 15 male sexual partners, 11 occasions of unprotected receptive anal intercourse and nine occasions of unprotected insertive anal intercourse. In addition, 48 percent had a lifetime history of sexually transmitted infections (STIs), 93 percent used alcohol in the previous three months, and 56 percent used marijuana during that same time period.
Before enrolling, participants performed a self-test using the home test in the researchers’ offices. During the three-month study period, they filed, via a phone system, weekly reports on their sexual behavior. And for the duration of the study, researchers set up a 24-hour hotline run by clinical psychologists.
Of the 32 men enrolled, 27 used the home tests to screen their partners. Of the nearly 140 sexual partners they encountered during the study period, 101 (72 percent) men agreed to take the home test, 23 (16 percent) men refused and 17 (12 percent) were not asked. The tests were used at home and, occasionally, in public.
Ten men tested positive for HIV; six of them did not know they were living with the virus. In addition, two partners disclosed that they were HIV positive once they were asked to take a home test. When a partner did test positive, the men did not have sexual intercourse. However, the researchers note, the participants did show empathy for their partners who tested positive.
There were four calls to the hotline, but Carballo-Dieguez said that all four calls were about clarifying the test results—for example, interpreting whether two lines meant a positive or negative reading.
He also noted that of the 124 partners asked to use the home test, there were seven instances of verbally aggressive reactions, but that no one resorted to physical violence.
In general, the researchers noted several other results: Participants liked having access to the home testing kits and found them easy to use, and they carried the kits around to various locations. Most partners were willing to take the test, and if they weren’t, the refusal was viewed as a warning sign. Often, mutual testing took place, and the period they waited for results gave them time to re-evaluate whether they really wanted to have unsafe sex. In most instances, substance abuse didn’t interfere with the home testing process. The tests had a high acceptability among ethnic minorities. And finally, participants said the experiences with home testing shifted their own awareness of HIV risk, which in turn led them to take fewer risks.
During the discussion period, audience members brought up concerns about using home testing to weed out HIV-positive sexual partners and thus lower risk. As one German conference delegate put it: “I remember a time when condom use was posed as a method to have sex with MSM without needing to know who was infected. Is that time over?”
“I think the [MSM] community is further ahead than we are as prevention workers,” Carballo-Dieguez replied. “Unfortunately we have a patronizing approach to people; we think we have to treat them like they’re fainting violets. These men are not! We have to catch up to where things are, and we have to empower people if we can.”
On the challenges of stigma and the window period—the highly infectious time shortly after a person contracts HIV but when the antibodies won’t show up on a home test—Carballo-Dieguez acknowledged that the home test isn’t 100 percent perfect. “When I talk about testing, I understand there is a risk for some people,” he said. “But it’s also an opportunity to empower people to put prevention in their own hands, and this is something people can do on their own. It’s technology that’s already available. It is something that can have an effect for some people—for certain people. If tools are there, we have to find a way to clarify [them]. For example, we can say, ‘This is how some people use [the test]. You make your choice.’ It is up to them.
“We are still giving people an efficient tool to screen [HIV risk],” he said. “Sometimes, because we want something that is optimal we don’t work with something that is good enough.”
In the written abstract of the study, the researchers conclude: “MSM at high risk can use [home tests] to screen sexual partners, and many partners will agree to take the test. Use of HT results in detection of previously unknown infections and avoidance of HIV exposure. Making [home tests] available within networks where high-risk sexual practices are common may be a cost-effective way to identify previously undetected cases. [Home tests] may become an important harm reduction technology.”
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comments 16 - 29 (of 29 total)
Daniel P, Dallas, 2012-07-31 16:47:01
These at home test kits are not reliable or 100% effective in testing even sexual partners before hooking up because results in most cases indicate the antibodies for HIV, if present 90-180 days ago. Test doesn't indicate if they have recently been exposed/infected with HIV within that time frame. The N.A.A.T./RNA test is more effective because it catches the virus within 10 days after a possible exposure/infection with HIV. This test is conducted in the county I reside in.
Jeton Ademaj, Harlem, NYC, 2012-07-30 16:42:53
i fear for people who test + in a "surprise" setting, especially for those facing violence n ostracism. more accurate tests that cost less WILL become available...all who defend non-disclosure can thank themselves for this Market Correction. YES, people have a RIGHT to "BAREBACK" without getting HIV...they also have a RIGHT to know the +status of their sexual partners, casual or LTR, condoms or not. those who conceal their + status from partners make stigma WORSE, leading to products like this.
Mitch, , 2012-07-30 03:28:45
No one is saying it's cool to lie about status, especially to a LTRs. There's a lot about this study that is implied by it's design. For starters, the relatively high activity levels of these people indicates that they're not testing "long term partners", they're testing their tricks. How would you feel if your 1st poz result had been followed by "get out of my bed"? Or if someone pulled out one of these at a bar before you were even certain YOU wanted to sleep with him, let alone disclose?
Frederick Wright, Coachelle Valley, 2012-07-28 17:20:06
I think this Home test is for the mature and adults.Will their be a age limit on purchasing this HIV Screening Kit. The comments from some seem to full of fear in adressing honest and truthful long term relationships. The network I belong to is planning on introducing this concept of OTC to empower the community and hope it will become common dinner conversation in America to educate and empower truthful sexual conversations. Hoping it will empower women,and men with a tool to stay HIV free.
Mitch, , 2012-07-27 13:45:15
Mico, if you're able to force someone to take a test, you can damn well force them to use a condom, and that's safer, cheaper and doesn't facilitate segregation or demolish those who are finding out their status. This is a horrifying application, and we have every right to be upset. We've jumped to worst-case scenario with this study. We're enabling discrimination for a less effective prevention paradigm, and its hitting the most vulnerable poz people hardest. Don't tell me to "shut up".
trent landers, Sparks, NV., 2012-07-26 15:58:12
What is the percentage of false positives and false negatives on this "Home" test? All "home" testing should be followed up with a certified laboratory blood draw and analysis with ELISA and Western Blot tests used to confirm the presence of HIV. It is a small chance but other "retroviruses" can give a false positive due to the nature of the retroviruses' genetic makeup. Exposure to HIV infection in less than 12-25 days before the "home" test may give a false positive or inconclusive results.
Horrified, , 2012-07-26 15:54:19
Is this supposed to be antagonizing? Do we care at all about people once they've tested positive, or is any cost ok so that the bareback party crowd can slightly decrease their risk? I especially hate the "testing in public" option, because nothing says "witch hunt" like being hit up by a guy with a kit at a bar. Hey, why not mandate screening just to get in the bar? They saw it as a warning if guys refused the test. I see it as ironic justice that this test has an 8% false negative rate.
Chris, Tampa, FL, 2012-07-26 15:32:50
I agree with the comments here. This is ridiculous. This absolutely gives a false sense of security and is the wrong direction. How is..."Excuse me sir, before we have sex I need to ask you a complete medical history and swab your mouth." any more progress than "Let's use a condom."
Mike, , 2012-07-26 08:46:39
This test will just create more prejudice toward us HIVers.
People should know that condoms work for them, not against them, especially, considering the false negative results and the window period.
Mico, Washington, DC, 2012-07-26 08:21:33
Sadly, the world we live in, doesn't allow everyone to have access to a clinical test & then placed on meds, without emotional costs, family costs, moral costs & financial costs.
Str8 to Gay, have sex, parties on all sides. Face reality, even bible bigots, hide their sexual trysts. At least, there is a home test. If it helps one, to change ways, passing it on, then good.
If this horrifies you, you are a moral police. Change your view or get out of the way.
Mitch, , 2012-07-25 14:43:55
Great for those MSM who can't be bothered to use a condom. "F YOU" to those poor guys who find out they're poz. This isn't progress!
"The men did not have sexual intercourse. (but), the participants did show empathy for their partners who tested positive."
Yeah, right, because nothing says "empathy" like "get out of my bed so I can be a cum dumpster for someone who is clean".
Just cure the damn virus before the before we're forcibly tatooed tatooed so they don't have to even bother.
Doug, New Castle, 2012-07-25 14:16:02
What about the window period? Not everyone understands that you have to wait at least twelve weeks before you get an accurate answer. The other problem is the cost. Are we going to give them the test for free if not it could cost a couple hundred dollars a week.
Mark L, San Diego, 2012-07-25 13:32:55
I found the study encouraging, but would like to see a broader study done in multiple cities.
What were the outcomes of the 10 men that tested positive. Was the hotline called? Was follow up attempted for treatment?
DenguyFL, Florida, 2012-07-25 11:26:26
comments 16 - 29 (of 29 total)
From experience I know I will test negative with OraSure even though i=I am positive. This seems to me to be a false sense of security if someone is determined to lie about their status.
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