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<div class="timestamp">October 5, 2012</div>
<h1>Another Use for Rapid Home H.I.V. Test: Screening Sexual Partners</h1>
<h6 class="byline">By
<span>
<a href="http://topics.nytimes.com/top/reference/timestopics/people/m/donald_g_jr_mcneil/index.html" rel="author" title="More Articles by DONALD G. McNEIL Jr."><span>DONALD G. McNEIL Jr.</span></a></span></h6>
<div id="articleBody">
<p>
The first rapid home-testing kit for <a href="http://health.nytimes.com/health/guides/disease/aids/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about AIDS/H.I.V.." class="meta-classifier">H.I.V.</a>
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. </p>
<p>
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. </p>
<p>
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. </p>
<p>
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. </p>
<p>
The only <a title="Study abstract" href="http://www.springerlink.com/content/704pn53543w70j14/">study</a> of the practice — a small one involving 27 gay men who frequently had sex with virtual strangers without using <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/condoms/index.html?inline=nyt-classifier" title="Recent and archival health news about condoms." class="meta-classifier">condoms</a>
— found that it probably prevented some infections. The study was
published online in August by the journal AIDS and Behavior. </p>
<p>
“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 <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/psychology_and_psychologists/index.html?inline=nyt-classifier" title="Recent and archival health news about psychology." class="meta-classifier">psychology</a>
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.’ ” </p>
<p>
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. </p>
<p>
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 <a href="http://health.nytimes.com/health/guides/disease/gonorrhea/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Gonorrhea." class="meta-classifier">gonorrhea</a>. </p>
<p>
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 <a href="http://health.nytimes.com/health/guides/test/antibody-titer/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Antibody titer." class="meta-classifier">antibodies</a> that the test detects. </p>
<p>
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. </p>
<p>
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.) </p>
<p>
Twenty-three other partners refused testing. Two, after being asked, admitted knowing they were infected. </p>
<p>
Seven men got angry, and one stomped on the kit. One man walked out saying he wanted to be alone and broke off contact. </p>
<p>
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. </p>
<p>
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. </p>
<p>
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.” </p>
<p>
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.”
</p>
<p>
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.” </p>
<p>
The technology is similar to that in home <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/pregnancy/index.html?inline=nyt-classifier" title="Recent and archival health news about pregnancy." class="meta-classifier">pregnancy</a> kits, which sell for as little as $4 each. </p>
<p>
Larry Kramer, the longtime AIDS activist, called screening “a
potentially cool idea, but it depends on how the
partner/date/trick/stranger takes it.” </p>
<p>
If a test had been around 30 years ago, he added, “there would have been a lot more people alive today.” </p>
<p>
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. </p>
<p>
“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.
</p>
<p>
Then he reconsidered. </p>
<p>
“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.’ ” </p>
<p>
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. </p>
<p>
“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.” </p>
<p>
Steven Petrow, the author of “Complete Gay & Lesbian Manners,” argued against screening. </p>
<p>
“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.” </p>
<p>
But numerous studies have shown that many sexual partners do not. </p>
<p>
In a large <a title="Study abstract" href="http://www.ncbi.nlm.nih.gov/pubmed/17573594">2007 survey</a>
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. </p>
<p>
Men made many excuses, saying they believed that they were not infectious or felt it was the partner’s duty to ask. </p>
<p>
An equally large <a title="The study" href="http://www.rand.org/pubs/reprints/2005/RP1123.pdf">2003 study</a>
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.
</p>
<p>
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. </p>
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