Friday, October 5, 2012
The Future of HIV
We've been talking a lot about the health system at a macro level and I just thought it might be interesting to look at how policy and technology interact in the context of a specific disease. Recently, two new products received FDA approval that have far-reaching implications for HIV/AIDS. The first is called PrEP (which stands for Pre-Exposure Prophylaxis) which essentially is an antiretroviral that uninfected people take daily to help guard their chances of infection. My colleague at CREGS recently wrote about the implications for PrEP as a "cure" for HIV, especially for young men of color.
The second product is home testing for HIV. While this test was invented for the purpose of testing yourself privately in your own home (the idea being that many at-risk folks won't get tested in public), the NY Times just looked at an obvious "off label" use of the test: to screen potential sex partners. A test costs about $40 -- you can order it online so as not to shame yourself at the drug store.
The emergence of such products is still relatively novel, but I'm curious as to how the use of these products will play out in marginalized communities and within communities of privilege. Think of all the over-the-counter products we might have in the future... Perhaps we don't need medical intervention for such things. Maybe preventing HIV/AIDS, which still infects approximatley 50,000 new cases annually in the U.S., is just important enough to require them. And yet, I can't help but think that we are somehow jumping the gun. I won't be surprised if there is some law or regulation that limits the use of one or more of these interventions down the road.
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2 comments:
Such an interesting topic! I think the cultural stigma that exists within many communities, especially those of color, around HIV testing works against our efforts to control the spread of HIV and a home test is one way to improve access to information. However, my fear lies in the test's unaccuracies. On one hand, we want as many people to get tested as possible, but if we are encouraging home tests for HIV as a way to screen a potential new sexual partner, I'd worry about false negatives and the perceived sense of security one might get from being able to get an instant result. It might lead to people not using other forms of protection and could subject those otherwise diligent individuals to infection. It seems to me that until we have a home test that is exceptionally accurate, there should be serious warnings against false positives/negatives.
I have an opinion some what similar to Noemi. I do believe that greater access to HIV testing is important and home testing is an incredible way of improving access to testing. Currently there is a requirement in most states to report positive HIV results to the DPH, I wonder what home testing might mean in terms of - 1. reporting HIV status to DPH, for purposes of prevalence etc. 2. treatment/testing of other related STD's that might occur simultaneously but are not tested for by the rapid home test, 3. counseling regarding high risk behavior and exposure of partners.
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