Feature Story

A sign reading "Know your HIV status", promoting HIV testing in Livingstone, Zambia
Credit: Avert/Jon Rawlinson

The fact that fewer than half of people living with HIV do not know that they are infected with the virus is a huge barrier to treatment scale up and realizing the benefits of treatment for prevention. The situation in some of the worst affected areas is even more serious––a recent national study in Kenya showed only 16% of people living with HIV knew that they were infected.

Despite the advances in technology, testing is still approached with fear, accessing clinics is inconvenient and the experience of HIV testing is often stigmatizing. Stigma or anticipated stigma has been found to be a powerful barrier to testing uptake.

One option to radically shift test access is self-testing at home. The option for self-testing at a time and place of a person’s own choosing creates the potential to overcome some of the barriers of stigma, lack of confidentiality and difficulty in access that often apply to testing in test centres or clinics.

A strong advocate for home testing is Edwin Cameron, Justice of the Constitutional Court in South Africa, he said that knowing your HIV status “simply ought to be a part of life” and that “people have a right to access accurate tests and use them in the privacy of their own home; that won’t solve every problem of accessing treatment and care or negotiating safe sex, but is a simple and affordable way to take the first step.”

A variety of tests, from finger pricks to mouth swabs, can produce results in 1–20 minutes. The cost of these tests is now measured in pennies––yet most are still not yet available for use at home.

The availability of home self-testing would allow a significant number of people who would not otherwise know their HIV status to find out. The key consideration will be to facilitate the linkage into care of people who find themselves HIV positive on self-testing.

If accompanied by a comprehensive and fail-safe referral system so that people who test positive are immediately able to go for a confirmatory test and be linked into care, home testing could be an extremely effective way of allowing people to know their HIV status and access antiretroviral treatment. 

The United States Food and Drug Administration approved on 3 July a rapid test kit for HIV for over-the-counter sale in the United States, welcome news which will support the United States’ efforts to avert new HIV infections.

“The cycle of stigma and discrimination which prevents people from knowing their HIV status can now be broken,” said UNAIDS Executive Director Michel Sidibé. “Offering more HIV testing options is a significant move forward for the US’s response to HIV and provides a unique opportunity to further expand access to HIV prevention and treatment services.”

The UK also has support for legalizing HIV home-testing kits, particularly among gay men. In September 2011, the United Kingdom’s House of Lords select committee on AIDS recommended repealing laws that prohibit home HIV testing.

In March 2012, the Southern African HIV Clinicians Society, the Treatment Action Campaign and SECTION 27 hosted a meeting of health workers, counselling organisations, activists and the National Department of Health to consider how to improve HIV testing and counselling. As well as recognizing the historic effort of the South African government to support a mass testing campaign that has reached more than 10 million people since 2010, the meeting concluded HIV self-testing should be added to the mix of ways people can know their HIV status. Importantly, the gathering agreed it “is vital to have systems and public information that guards against abuse and misuse of self-testing in a home environment, particularly of women and children.”

As more and more attention shifts to people-centred AIDS responses, self-testing for HIV at home promises to be an important tool to enable people to take control of their HIV prevention options.