My friend’s father is a practicing anesthesiologist, and he has been one for over 30 years. He is a great doctor, but his profession exposes him to health risks every day. One afternoon, he was anesthetizing an HIV-positive patient when his hand slipped and he had an accidental stick with a dirty needle.
As you can imagine, he was very concerned. He followed hospital protocol and reported the stick, then went to the diagnostic laboratory for HIV testing. Fortunately, he was not infected, but it was an emotionally disturbing experience for him.
Listening to him tell the tale made me strikingly aware of the difficulty of being tested for HIV. HIV is a widespread disease; as of 2006, the CDC has recommended that all adults be screened for it routinely. And most of us have had sexual partners, with no way of knowing for sure whether or not those partners are infected.
For decades, HIV testing has required a visit to the phlebotomist for a blood draw, followed by a stressful delay while the test is performed by a diagnostic lab. Today, there is another option: an oral HIV test that is highly accurate and can be performed in the comfort of your own home, with immediate results. I cannot help but wonder how much pain, stress, and worry my friend’s father would have been saved, and how much less he would have had to control his lifestyle immediately after the accidental needle stick, had this test been available to him.
The oral HIV test is available at most drug stores and consists of a test strip and an enzymatic developing reagent. It is simple to use. The user simply swabs his or her cheeks and gums with the test strip, then places it in the developer. The entire process is private, non-invasive, and takes about 20 minutes to get a result. The test strip is treated with a noninfectious substance that mimics the molecular structure of the HIV virus.
It does not react to saliva; rather, it uses “oral mucosal transudate,” the components of blood that tend to seep out naturally from the tissues of the cheeks and gums. If the user has been exposed to HIV, he or she will produce antibodies to the virus in the blood, and these antibodies will be excreted in the oral mucosal transudate. They will attack and bind to the HIV-like substance on the test strip, and the strip will change color in the presence of the developer. Because this test is based on similar technology to that used by traditional HIV blood tests, it is very nearly as accurate as a blood test, and the user can get a result much faster and without the embarrassment of a doctor visit and blood draw. The oral HIV test is available over the counter, without a prescription, and is a discreet and accurate way of determining HIV status.
Oral HIV testing at home has obvious advantages related to its speed and ease of use. Individuals at risk of contracting HIV can test at home frequently and be more cognizant of their HIV status. In turn, if a person is aware of his or her infection quickly after contracting the virus, he or she can limit his sexual activity to avoid spreading the disease, and can contact recent sexual partners to ensure that they are aware of the potential infection. The positive implications for public health are clear. However, no diagnostic test should ever be interpreted in a vacuum.
A single positive HIV test of any kind is not diagnostic for HIV, and it should be confirmed with a second test, obtained from a physician, to ensure that the positive result is real before treatment begins. As such, as a home HIV test, the oral test is best used as a screening test to catch cases of HIV early, while home testing should not be used to confirm infection and a physician should be consulted.
My friend’s father is surprisingly sensitive to needles for a physician, and he is distrustful of other physicians’ abilities to draw his blood and interpret his test results properly. If the hospital that employed him did not have a clear protocol for HIV testing in place, I don’t think it is likely that he would have gotten himself tested. I think he would have lived his life afraid that he might be infected but unwilling to find out for sure, and I think there are more people in the world just like him than most people realize.
The availability of an in home HIV test would have been so much more discreet and less painful for him than the traditional testing process was, and he would have known his results almost immediately. The benefits to his peace of mind would have been incalculable. If there is any chance that someone is avoiding being tested due to a fear of needles or embarrassment, or if time constraints are making scheduling an appointment for a blood draw difficult, the in home HIV test is a good option to benefit both personal and public health.