Home AIDS testing

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The FDA is considering whether to allow home HIV testing. This has been possible for years, but the FDA has blocked it because of concerns about how people who discovered they had HIV would react:
The test, called OraQuick Advance Rapid HIV Antibody Test, is presently sold only to doctors and clinics. It has already proven to be effective, safe and easy to use. So the remaining hurdles are decisions by the F.D.A. about whether approving such a device is a good idea and whether people can understand the product's label well enough to administer it to themselves.

A 1987 application for an at-home AIDS test kit led to years of controversy. At the time, AIDS advocates and public health officials predicted that such a test would cause widespread suicides, panic and a rush to public health clinics.

At hearings, AIDS advocates handed out copies of an obituary of a San Francisco man who jumped off the Golden Gate Bridge after discovering that he was infected with HIV. An official for the Centers for Disease Control and Prevention told the F.D.A. that such tests could lead to "a sudden increase in referrals to already overburdened health clinics," according to an F.D.A. document.

Federal regulators stalled the application for nine years, and at-home AIDS testing never caught on.

Currently there are three main options for getting HIV testing:

  • Getting tested by a doctor. Unfortunately, your doctor creates a permanent record, which isn't something you necessarily want if you're HIV+.
  • In-person confidential testing. This isn't necessarily available in all locations, and even if it is but it still requires going somewhere and having someone actually see who you are and that you're HIV+ (assuming you are). This probably isn't a big deal in a big city, but what if you live in a small town where there's no confidential testing clinic or where the people working in the clinic have a reasonable chance of knowing you.
  • "At-home" testing. Actually, this is mail-in testing, where you get your results by phone (where, presumably, you can be offered counseling). This is confidential (assuming you don't buy the kit with a credit card), but a serious pain in the ass.

Clearly, this test is substantially better. But for 18 years you haven't been allowed to have it because the FDA doesn't trust you to be able to handle the truth.

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I, too, believe there should be a very, very strong presumption in favour of making medical technology available to the general public. Indeed, I would support the immediate abolition of the FDA if I were an American and it were on the agenda.

That said, you have misrepresented the underlying issue just a teensy bit (and in a way that is surprising coming from you). The concern of the authorities is not with "people who discovered they had HIV", but with "people who got an AIDS diagnosis." These are not the same thing. As I understand it, the current generation of quick, cheap AIDS tests produce false positives about 1/200 of the time. The figure was presumably greater as long ago as 1987; if the false positive rate were as high as 1%, you can maybe see how a regulator would have misgivings about permitting OTC sale. The deliberate inculcation of panic about AIDS amongst heterosexuals increases the danger of psychological harm from the technology; even today people who had nothing like a 0.5% chance of having AIDS would be getting tested and freaking out when two little lines popped up instead of one. (Or just screwing up the damn directions on the box.)

"A sudden increase in referrals to... public health clinics" is a completely bogus reason to restrict sale, of course: it amounts to saying that the people who are afraid to get tested in a clinic deserve to die. "The American public has been driven crazy about AIDS and is shit-thick when it comes to math" is a better reason for the policy, but not one that anyone can state aloud.

At some point, I think you just get to a fundamental disagreement here. I recognize that giving people more information about their own bodies, especially in probability form, can worry them. I understand some people will do something stupid with these results, but I just don't see how you justify taking away the option to get that information.

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