Over-the-counter HIV test has drawbacks.

Byline: GUEST VIEWPOINT By Diane Lang and Kelly Moore For The Register-Guard

For most people, finding out that they are HIV positive is a life-changing event. Despite the fact that HIV has become a medically manageable disease, many still think that an HIV diagnosis is a death sentence. People with HIV continue to be stigmatized by those who perceive it as a "gay disease." A diagnosis of HIV continues to be a source of shame for people who may feel they have let family or friends down, or that they could have prevented their infection.

Today, people are able to test and receive an HIV diagnosis only from a doctor or health professional. The new HIV Rapid test, currently pending approval for over-the-counter sales by the U.S. Food and Drug Administration, would enable people to determine their HIV status in just 20 minutes in the comfort of their own homes.

Many are excited about the implications of fast, over-the-counter, at-home testing. Because people would be able to test themselves quickly and in private with the Rapid test, the numbers of people getting tested could increase dramatically. Research has shown that if people know they have HIV, they are likely to get treatment and change their behaviors to avoid spreading it to others, which is a very good outcome.

But the excitement surrounding the Rapid test ignores the realities faced by people receiving an HIV-positive result alone. That outcome may not be so good.

While initial reactions to a positive reading vary, it is not uncommon for people to have suicidal thoughts or to feel as though they have lost control of their lives. Depression and denial are common during the weeks, months and years following a positive diagnosis.

Because of depression and denial, they may not seek health care for a long time. They consequently end up with a faster progression of HIV to AIDS, and fewer treatment options.

People who come into the HIV Alliance for testing receive vital one-on-one counseling. Our trained staff dispels myths and addresses individual client concerns. The counseling we provide includes basic HIV education, assessment of the client's mental and emotional readiness to potentially receive a positive result, assessment of the client's risk behaviors and risk-reduction counseling. Our counselors also provide appropriate referrals and ongoing support for clients who test positive.

Our major concern is that people who learn that they are HIV positive will not receive this important counseling and access to services by opting for the over-the-counter test.

Orasure, the company that produces the Oraquick Rapid Test, includes information with its test packets and provides customers with a hot line in case of a positive result. But support services provided over the phone lack the quality of attention, engagement and counseling that can be provided in person. It is doubtful that a phone operator will be familiar with local resources.

The damage that can be done by allowing a person to receive such life-changing information all alone is great, and much worse if there is no one available who can help facilitate links to local treatment and care.

While an over-the-counter Rapid test poses certain problems, the HIV Alliance is very excited about the increasing availability of this breakthrough test for health service organizations.

By providing immediate results, the test holds enormous potential benefits for curbing the spread of HIV in the United States. It typically takes one or two weeks to obtain results from the HIV tests currently in use; that waiting period is so stressful and produces so much anxiety that some people don't even consider taking the test. Currently, of those who do take the test, one out of three never return for their results.

The consequence of this failure is serious: People who are unaware of their HIV status currently transmit 75 percent of new infections. That is a problem that we hope will be addressed and remedied by implementation of the Rapid test in health service organizations throughout the country.

While the Rapid test is a breakthrough in HIV care, uninformed use will leave many people who test positive unprepared to receive their results and unapprised of their medical, financial and other resources.

While HIV Alliance supports wider availability of Rapid tests, we stress that over-the-counter tests are not an easy solution to treating HIV and will not eliminate the great need for HIV care and services - services that are at the heart of HIV prevention and treatment.

Diane Lang is executive director of HIV Alliance Inc. Kelly Moore is the agency's HIV counseling and testing director.