Are home tests for HIV a good idea?

People have been encouraged for a number of years to find out whether or not they have HIV, the virus that can lead to a full-blown case of AIDS. Yet, long waiting periods for an appointment and the fears about confidentiality have kept many people from being tested.

Now, tests can be done quickly, privately and anonymously at home. And that is causing havoc in some states. Those who want to know if they are HIV positive can go to a local drugstore anywhere in the United States, purchase an HIV home test kit, take a small blood sample by sticking their finger and send it to the kit manufacturer to get the results.

Home collection kits are supported by many state health departments, but some states prohibit anonymous tests or allow testing only by medical professionals. These states are faced with a dilemma: Uphold the law (to help maintain a close watch on HIV rates), get rid of the law (to allow anonymous HIV testing) or look the other way.

California and New York have requested a re-examination of the Food and Drug Administration's approval of home test kits. They question whether the approval preempts their state laws requiring a medical professional to order or conduct HIV tests. According to the Department of Health and Human Services it does. Section 521(a) of the Federal Food, Drug and Cosmetic Act overrides these states' laws because the tests are run by approved out-of-state laboratories and because they are safe and accurate.

For some states that do not allow anonymous HIV testing, the FDA approval has wreaked havoc. Iowa recently passed legislation to repeal the requirement that only a physician or other medical professional could conduct an HIV test. The kits are a major concern in Mississippi where the health department believes anonymous testing weakens both statistical collection and HIV education efforts.

"Home collection provides no public health value. If we do not vigorously oppose [home collection testing], then doctors will say it's OK not to report," says Craig Thompson, assistant director of the HIV/AIDS Prevention Program in Mississippi. The state attorney general will be reviewing the issue sometime this year.

In the very near future, on-site rapid testing for HIV is likely to be approved by the FDA and could possibly be approved for home as well as clinical use. Since HIV counseling and testing sites in most states have a patient return rate of less than 50 percent, rapid HIV testing in a clinical setting could be an asset with counseling and referral offered immediately. However, many HIV counselors fear the approval of true "home testing" that would allow patients to know their HIV status without counseling and support. Also, this type of home testing could further impede the state's efforts in surveillance, partner notification and funding for HIV-infected citizens.