I draw blood from the tip of my finger, transfer it to a plastic diskette, add six drops of a clear chemical solution and wait for five minutes while a red blush spreads across an area marked T (for test) and C (for control). No vertical bar appears on the T, meaning that I am HIV-negative.
Or does it? The insert which comes with U-Test Aids informs me that a negative result does not necessarily mean I am virus-free. Equally, a positive result does not mean I have HIV/Aids. If the results are positive, I must go to a clinic to test and confirm the result, I am told. If negative, I may be in the window period and will need another test in three months. At R58 a kit, why bother?
Home Aids test kits may be news in the United States, but they have been available from local pharmacies for several years — and HIV/Aids professionals are sceptical about their benefits. ”They still require a person to go through the system. I’m not quite sure what their purpose is,” says Fatima Hassan, an Aids Law Project attorney.
Home tests may seem quicker and cheaper than being tested at a clinic, but the reality is different, argues Natalya Dinat, the director of palliative care at Wits University. ”It’s unlikely to save resources. If a person goes to a clinic for treatment, they have to be tested again.”
To be fair, DIY kits seem to be quite reliable. João Carapinha, the director of the pharmaceutical economics and policy programme at Wits, says most home-testing kits on the market are 98,9% accurate.
But testing is also about counselling. It is supposed to be the point where the authorities advise people on how to deal with an HIV-positive status and sexual behaviour change.
Carapinha stresses that pharmacies supplying self-test kits to the public without offering counselling could be subject to disciplinary action by the Pharmacy Council of South Africa. But, the kits are readily available over the counter in many pharmacies. ”People come in quietly, ask for it and disappear,” says Heather Murton from Mays Pharmacy in Melville, Johannesburg.
HIV self-test kits were offered in the late 1990s by three or four companies piggybacking on the growth of the epidemic, explains Carapinha.
In response, the Department of Health developed regulations that made pre- and post-test counselling a legal requirement for people testing for HIV. ”South Africa is the only country in Africa with robust policies on testing and counselling,” he says. Testing must be conducted by trained practitioners in accredited facilities.
Dinat suggests that rapid negative test results might ”endorse previously risky behaviour” and give people a false sense of security.
”It is difficult to control testing when it becomes as ordinary as buying rice or potatoes,” says Hassan. ”We want more voluntary counselling and testing, but not where people don’t have the tools to understand the implications of the result.”
Kgosi Letlape, chairperson of the South African Medical Association, says South Africa is not ready for DIY testing and that ”the potential for abuse is great”. In a patriarchal society, men could force their wives to take the test without undergoing tests themselves. Dinat is also aware of cases where employers have forced domestic workers to take a test. Testing at clinics and by a doctor provides some protection.
”Home tests may be appropriate in a low-prevalence society with high access to health care, but we have the reverse in South Africa,” says Dinat. ”I don’t think they are appropriate and they could compromise human rights.”
US approves home testing
The first rapid, home test kit for HIV has been approved in the United States after a long period of controversy. For almost 20 years, experts and activists have agonised over tests that allow people to find out their HIV status in privacy, but also in isolation, without access to counselling.
HIV infection was seen as a death sentence in the 1980s, before anti-retrovirals took off. The US passed legislation outlawing home kits in 1988, but lifted the ban in 1995.
The new kit is as simple as a pregnancy test, and the US Food and Drugs Administration (FDA) has decided that its usefulness in alerting people quickly to their HIV status, so that they can avoid infecting others, outweighs any harm. The rapid test, called OraQuick, analyses saliva and gives a result in 20 minutes. One blue line is good news, but two indicates HIV.
The technology has been around for some time. A company applied to license a home test 18 years ago, but there was concern about the impact of the diagnosis, which then looked like a death sentence. Today, HIV/Aids is managed so well that, in most cases, people live normal lives. — Sarah Boseley Â