[Vision2020] Unintended, but healthy consequences

[Art Deco]

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October 5, 2012
Another Use for Rapid Home H.I.V. Test: Screening Sexual Partners By DONALD
G. McNEIL Jr.<http://topics.nytimes.com/top/reference/timestopics/people/m/donald_g_jr_mcneil/index.html>

The first rapid home-testing kit for
H.I.V.<http://health.nytimes.com/health/guides/disease/aids/overview.html?inline=nyt-classifier>has
just gone on sale for $40, marketed as a way for people to find out
privately if they have the virus that causes AIDS.

But some experts and advocates say that another use, unadvertised, for the
OraQuick test — to screen potential sexual partners — may become equally
popular and even help slow an epidemic stuck at 50,000 new infections each
year in the United States.

There are reasons to think that screening might make a difference. Studies
have found that a significant minority of people who are H.I.V.-positive
either lie about their status or keep it secret, infecting unsuspecting
partners.

And though the manufacturer, OraSure Technologies, is not promoting the use
of the test for screening, 70 percent of the 4,000 men and women in the
company’s clinical trials said they would either definitely or very likely
use it that way. Some even suggested that the company sell boxes of two so
couples could be tested together.

The only study <http://www.springerlink.com/content/704pn53543w70j14/> of
the practice — a small one involving 27 gay men who frequently had sex with
virtual strangers without using
condoms<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/condoms/index.html?inline=nyt-classifier>—
found that it probably prevented some infections. The study was
published
online in August by the journal AIDS and Behavior.

“If it becomes a community norm, people may start testing their partners,”
said Alex Carballo-Diéguez, the lead author of the study, who is a
psychology<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/psychology_and_psychologists/index.html?inline=nyt-classifier>professor
at Columbia University and the associate director of the H.I.V.
Center for Clinical and Behavioral Studies at the New York State
Psychiatric Institute. “On sex sites now, men advertise themselves as
‘drug-and-disease-free.’ They could start saying ‘D-and-D-free, and willing
to prove it.’ ”

Other AIDS experts had doubts. Some thought $40 was too much for people who
need to screen multiple partners. Others said that men and women who are
not comfortable demanding that their partners wear condoms would be unable
to insist on a test.

And some, including Anthony S. Fauci, the country’s best-known AIDS doctor,
worried that a negative test could lead partners to forgo condoms, removing
the barrier to both H.I.V. and other diseases like
gonorrhea<http://health.nytimes.com/health/guides/disease/gonorrhea/overview.html?inline=nyt-classifier>.


The OraQuick test is imperfect. It is nearly 100 percent accurate when it
indicates that someone is not infected and, in fact, is not. But it is only
about 93 percent accurate when it says that someone is not infected and the
person actually does have the virus, though the body is not yet producing
the antibodies<http://health.nytimes.com/health/guides/test/antibody-titer/overview.html?inline=nyt-classifier>that
the test detects.

The men in Dr. Carballo-Diéguez’s study were given 16 tests each and
followed for three months. None of them had unprotected sex with anyone who
tested positive.

Of the 101 partners they tested, 10 were positive. In six cases, it was how
the partner first learned he was infected. (Ten percent is a very high
success rate for H.I.V. testing, experts said.)

Twenty-three other partners refused testing. Two, after being asked,
admitted knowing they were infected.

Seven men got angry, and one stomped on the kit. One man walked out saying
he wanted to be alone and broke off contact.

Asking usually did not ruin the moment’s intimacy, the men said. Some pairs
did the tests together, swabbing each other’s gums. Some passed the
20-minute wait talking, playing video games or in foreplay. One 47-year-old
man found the wait helpful, telling the researchers, “It gives you that
extra 20 minutes to decide, ‘O.K., if this comes back negative, am I really
ready to bareback?’ ” — slang for having sex without a condom.

Dr. Carballo-Diéguez said people’s decision about whether to screen would
depend on various factors, including the test’s price and how comfortable
they were with its imperfect accuracy.

OraSure appears ambivalent about partner screening. AIDS experts said the
company might fear lawsuits by people infected by partners who got false
negatives — a possibility it declined to comment on. In an interview, its
president, Douglas A. Michel, said, “We’re supportive, as long as it’s
between consenting adults.”

But he also said the label would warn that the test “should not be used to
make decisions that might put the user at risk of contracting H.I.V.”

Asked about the price of the test, he said market research indicated that
most users would buy it once or twice a year, so $40 was “appropriate.”

The technology is similar to that in home
pregnancy<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/pregnancy/index.html?inline=nyt-classifier>kits,
which sell for as little as $4 each.

Larry Kramer, the longtime AIDS activist, called screening “a potentially
cool idea, but it depends on how the partner/date/trick/stranger takes it.”

If a test had been around 30 years ago, he added, “there would have been a
lot more people alive today.”

Hunteur Vreeland, a professional party organizer who arranges “gay porn
harbor cruises” and “underwear erotic parties” at Paddles, a dungeon-themed
club in New York, said he would even consider selling home tests at his
events. He now offers free H.I.V. testing at them in conjunction with the
Men’s Sexual Health Project of Bellevue Hospital Center.

“Knowledge is never a bad thing,” he said. He added that if a potential
partner unexpectedly pulled out a test kit, he would probably leave.

Then he reconsidered.

“But if the dude was hot, and maybe I was on the cusp of getting tested
anyway — well, then, maybe I’d be, ‘All right, I’ll take it.’ ”

Justin Goforth, the director of medical adherence for Whitman-Walker
Health, a clinic in Washington with many AIDS patients, said he doubted
that screening would help his clientele.

“It’s expensive,” he said. “People who can afford it already have
strategies for avoiding infection. It won’t help women whose men refuse to
use condoms, because he’ll refuse to take the test, too. And the same for
young black men — they usually get infected by older men, and the power
dynamic is not in their favor.”

Steven Petrow, the author of “Complete Gay & Lesbian Manners,” argued
against screening.

“Nobody should take this test and 20 minutes later go have unprotected
sex,” he said. “The art of talking to a partner is the primary thing. You
have to respect each other and tell the truth.”

But numerous studies have shown that many sexual partners do not.

In a large 2007 survey <http://www.ncbi.nlm.nih.gov/pubmed/17573594> led by
Dr. Robert Klitzman, also of Columbia University and the New York State
Psychiatric Institute, nearly 20 percent of infected gay men admitted to
having had unprotected sex with at least one partner without revealing
their status.

Men made many excuses, saying they believed that they were not infectious
or felt it was the partner’s duty to ask.

An equally large 2003
study<http://www.rand.org/pubs/reprints/2005/RP1123.pdf>led by Dr.
Daniel H. Ciccarone of the University of California, San
Francisco, found that about 9 percent of H.I.V.-positive heterosexual men
and women and about 14 percent of infected gay or bisexual men had recently
had unprotected sex with someone they either knew was uninfected or were
unsure about, without revealing their own infection.

The authors estimated that in the six months their study covered, 17,000
infected gay men across the country and almost 5,000 infected heterosexual
men and women had sex without telling the truth.


-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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