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Thursday 15 April 2010

Home HIV tests will "increase test rates" and "save lives"

Posted in: HIV
By Daily News staff - 8th November 2009

Part two of a three-part feature series

Head Start Testing has ruffled feathers at the NZ AIDS Foundation and set off a spirited gay community debate on the merits or otherwise of distributing its imported home-test HIV kits through New Zealand's adult shops.

Perhaps 'ruffled a few feathers' is an understatement... the usually measured tone of NZAF statements was ditched last week in favour of calling Head Start's initiative "irresponsible and unprofessional," and one that "preys on people who may be vulnerable, worried and at risk."

The NZAF thundered that "sex on site venues are appropriate places to have safe sex and adult shops are an appropriate place to purchase vibrators, butt plugs, nipple clamps and other toys for sex. Sex on site venues and adult shops are not appropriate places to purchase medical testing kits for HIV, or indeed any STI. The NZAF believes that most sex on site venues, adult shops, retailers and online outlets in New Zealand are responsible and we strongly recommend that they do not stock these testing kits."

But Head Start's Mike Colwill is having none of that. He does concede that the situation is complex but he believes that the principle that increased levels of testing for HIV saves lives overrides any concerns. "The issue of [a person] testing "themselves" is a complicated one," he feels, acknowledging the value of professional support as offered by the NZAF and other sexual health agencies and GPs. "As we point out to consumers they are bypassing valuable pre- and post-test counseling and support by testing at home and should, if this concerns them, test under supervision. However, if a person who would otherwise not test at all tests at home, it is one more person tested and with a known status."


Colwill says he himself was tested, "and I insisted on my new partner being tested as a responsible individual entering a new relationship. I believe strongly in more HIV testing."

"The home test kits give certain individuals previously put off by accessibility issues, cost, convenience or privacy a method by which to be tested. Apart from that, the same criteria exists as for medically supervised testing. Testing simply increases HIV status awareness for whatever reason the individual chooses to be tested."


As to whether the information Head Start and the manufacturer of the EZ-Trust kits provide with the test kit is sufficient to cover all contingencies regardless of test result, Colwill compares his HIV test kits to pregnancy test kits. "In as much as a pregnancy test kit can prepare a mother to be, then that is a very difficult requirement to quantify. In as much as we make all efforts to remind consumers they have bypassed the support process of voluntary counseling, then yes, the consumer must take responsibility for their decision to test in that environment and advise consumers."
He seems to throw doubt on existing sexual health agencies ability to manage the use of the results they produce. "It is important to remember, whilst this is a controversial subject, nothing prevents the total misuse of the current testing methods. The misuse occurs when the [90 day] window period is not respected."

"You can currently test a future partner today at the NZAF, instantly and anonymously. That negative result can be misused (as potentially there might have existed a high risk exposure last week for example) and it can be used as justification for unprotected sex. This is misuse of the test 'result', not the testing 'method.'" However, understands that NZAF and other councilors take great pains to ensure that their clients understand the limitations attached to negative test results.


Colwill's reliance on printed support information rather that trained counter staff - he has no plans to train retail staff to advise on the use of the kits - means understanding of the issues around test windows, follow up tests and support are left entirely in the hands of the purchaser. "The individual's actions or use of the product are not something anyone other than the individual can control," he says. "We can provide them with a test kit to test their HIV status in privacy, alert them to what they are bypassing such as support, to educate themselves more about HIV. But beyond that we can not, as can not a medical professional, control what they do with those results or how they behave following them."

Addressing the issue of point of sale staff not being expected to provide information about the tests' use, Colwill says his retailers are not aiming to replace the voluntary counseling method or offer an 'assisted' test. "The test kit comes with full instructions and also with information about the lack of voluntary counseling that exists in this method. A similar example, but a less complicated and less controversial subject, would be training the supermarket checkout staff on the use of the home pregnancy test kits."

Some readers have suggested that packaging the test kits in pairs might be a way of encouraging people to test twice. "The subject here is the window between infection and detectable antibodies. You can find more information on this and testing intervals in relation to the window of antibody detection on many websites. In summary," says Colwill, "it is twelve weeks to show up, although most show up in 4 weeks. After infection, your percentage possibility of not showing antibodies drops dramatically from 1-2-3 months. Depending on when was the risk you may choose to take 1 or 2 or 3 tests. As such we do not package them in sets nor does it reduce the accuracy of the test. A perfect scenario is a person tests 3 months after the risk, but a reality is it is better for them to test after 1 month, then 2 and then 3, as it reduces 2 months of potential risk of a positive infection going undetected."

Colwill says "inferior quality" HIV self test kits are already available in New Zealand, although and the NZAF are unaware of any retailers currently stocking them, including pharmacies. And he correctly points out  that some brands of test are available via mail from overseas internet websites. He prefers not to release information about how many retailers are already stocking Head Start's kits or how many kits have been released onto the market. "We are not releasing sales or distribution information," he says.

Colwill is clearly quite comfortable engaging on this controversy, his responses to's emailed questions arrived back within hours of the questions being sent. "I am happy to discuss this subject," he says. "Clearly it can be controversial, but there are two aspects to increasing testing frequency and volume through this method," he notes, going on to articulate Head Start's policy and objectives, over and above making a profit from a commercial transaction.

"Used correctly, more testing simply reduces positive individuals continuing to act as negatives. The accessibility will certainly lead individuals who previously chose not to be tested through health professionals (for several reasons) to be tested. At the same time, they lose the benefits they would have received with voluntary counseling."

"Abuse of the testing process," he reiterates, "or more accurately abuse of the testing result - as a negative result 3 weeks after exposure is not a reliable negative - is a subject that exists in both testing methods and is really another subject aside from home testing. Likewise the individuals with known HIV positive status can still be risking others. These subjects are not unique to self testing in any way. Our objective is to increase the number of individuals tested, to increase the overall awareness of HIV status in the community and to reduce the number of HIV+ individuals who do not know they are positive."

In closing he says "the current testing methods are leaving a percentage of at risk individuals who are for several reasons not testing through those methods. We aim to reduce that percentage."

Later this week in part three of this feature will discuss the matter with several adult shops and sex on site venues with a large gay and bi male clientele to gauge their position on whether or not to stock the kits.

[Editor's note, 10/11/09: As researched this story we addressed our initial enquiry to wholesaler Turkana Trading. Mike Colwill, who responded to those emailed questions, has now clarified that he represents the kit's importer Head Start Testing, not Turkana. Our coverage has been modified to reflect this.) Daily News staff - 8th November 2009

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