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HIV AIDS (Auckl). 2014 Aug 2;6:117-26. doi: 10.2147/HIV.S49083. eCollection 2014.

Arguments for and against HIV self-testing.

Author information

1
Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
2
Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA ; Public Health, Seattle and King County HIV/STD Program, Seattle, WA, USA.

Abstract

Approximately 60% of human immunodeficiency virus (HIV)-infected individuals are unaware of their infection, and stigma and discrimination continue to threaten acceptance of HIV testing services worldwide. Self-testing for HIV has garnered controversy for years and the debate reignited with the approval of a point-of-care test for over-the-counter sale in the US in 2012. Here, we present arguments for and against HIV self-testing. The case in support of HIV self-testing contends that: the modality is highly acceptable, especially among the most at-risk individuals; self-testing empowers users, thus helping to normalize testing; and mutual partner testing has the potential to increase awareness of risk and avert condomless sex between discordant partners. Arguments against HIV self-testing include: cost limits access to those who need testing most; false-negative results, especially during the window period, may lead to false reassurance and could promote sex between discordant partners at the time of highest infectivity; opportunities for counseling, linkage to care, and diagnosis of other sexually transmitted infections may be missed; and self-testing leads to potential for coercion between partners. Research is needed to better define the risks of self-testing, especially as performance of the assays improves, and to delineate the benefits of programs designed to improve access to self-test kits, because this testing modality has numerous potential advantages and drawbacks.

KEYWORDS:

AIDS; HIV; diagnosis; screening; self-testing

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