In certain locations in China, it’s now as easy to purchase an HIV test kit as it is a snack. But are rapid HIV self-tests the next big thing, or a big bust?
Of all the interesting things one can purchase from a vending machine, perhaps one of the most unexpected is an HIV test kit. Yet, at five college campuses in China, people can do just that. For just a few dollars, users can press a button, retrieve the kit, disappear into the nearest restroom, deposit a urine sample into a container that is then reinserted back into the vending machine, which generates results that can be viewed online within 10 to 15 days. The entire process is completely anonymous.
Easy? Sure. Convenient? Definitely. But why would someone want to do this kind of self-testing when they could simply go to a clinic and get potentially more accurate results as well as support?
Unfortunately, at-risk individuals often fear a backlash if they pursue testing or treatment. According to Celia Fisher, PhD, who directs the HIV/Drug Abuse Prevention Research Ethics Training Institute at Fordham University in New York, “[We] have found that persons with substance abuse problems from various ethnic/racial communities in the US and sex workers in other countries often resist HIV testing in a healthcare setting for fear they will test positive and will face discrimination, violence, criminal procedures, or loss of employment if their HIV status becomes known.” They also worry about loss of family support, loss of their partner if their positive status is revealed, and the cost of HIV treatment. “The delay in testing because of discrimination or other fears often results in a delay of medical care and resultant exacerbation of health problems for LGBT persons and others,” she says. For this reason, anonymous testing, such as that offered through the vending machines, can be a boon to these marginalized groups. In China, where homosexuality is still not openly discussed and people with HIV and AIDS allege that they are often turned away for testing and treatment at clinics and hospitals, the vending machines could provide a particularly valuable service to at-risk individuals.
China is not the only locale to offer vending-machine HIV tests, however. In 2013, a group of researchers at UCLA investigated whether it was feasible to offer oral rapid HIV test kits from machines in Los Angeles County. The team had determined that for some people self-testing was preferable to getting tested at a clinic, according to lead researcher Sean Young, PhD, executive director of the University of California Institute for Prediction Technology and the UCLA Center for Digital Behavior, as well as associate professor of family medicine at UCLA. A vending machine seemed to be a good way to distribute test kits while ensuring anonymity.
The researchers partnered with the Los Angeles Gay and Lesbian Center to come up with an appropriate location for a machine, very close to one of its clinics. Test instructions were designed to be extremely user-friendly, and contact information was offered for testers who needed help or advice following results. This type of post-test counseling is incredibly important, experts say, and should not be overlooked simply because someone is administering a self-test.
“Counseling lets people know that testing HIV-positive is not a ‘death sentence’ and that there are medications that now make HIV a chronic rather than fatal disease,” says Dr. Fisher. “It is critical, therefore, that companies that offer anonymous testing have a call-in line that not only offers counseling, but can direct individuals to service providers who can prescribe medication within the economic limitations of potential users. Pre- and post-test counseling is also important if people test negative. There is concern that testing negative can lead individuals to believe they are ‘AIDS safe’ and therefore increase sexual risk taking (eg, failing to use a condom).”
Although the convenience and speed offered by rapid oral self-tests are intriguing, experts warn that the tests are not perfect and may offer false positives or negatives. The goal, they say, is for people who might otherwise not test at all to have access to testing in the privacy of their home or a nearby bathroom. Follow-up testing is usually recommended.
So, has the vending-machine method of dispensing HIV tests taken off?
At this point, few tests appear to have been purchased on the Chinese campuses—and it’s impossible to know whether any of the purchased tests have actually been used. As for the vending machine in Los Angeles, it appeared to stir interest: locals who were surveyed were intrigued by it and liked the idea of self-testing, but they preferred that HIV test kits be mailed to them rather than being dispensed from a machine, according to Dr. Young.
Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.
Feature Picture Source: Reuters