The FDA recently approved the first at home rapid HIV test. Truvada has a demonstrated ability to lower the rate of infection. Yet with HIV endemic in America and infection rates rising among certain demographics, do medications and self-administered home tests help or hurt the effort to fight HIV?

If these measures end up protecting some individuals while encouraging others to engage in (and be infected by) risky behavior, are they, on balance, a good idea? Are they ethical?

That sort of "moral hazard" idea has always been a concern with public health (the same argument is made for circumcision-as-HIV-prevention in Africa), especially sexual public health. There is nothing for it but to see, and we don't have data yet.

As a rule, though, I am skeptical of "keeping things from you for your own good" as a public health position, even when it's just the difference between home health tests and going into a clinic, let alone actually denying someone MEDICATION on unproven fears of moral hazard. It is not only patronizing, it is coercively so.

I'm not sure the comparison to circumcision is apt. In this case a potential test/treatment would be witheld because it provides an incorrect sense of security for some users (any partner infected in the past three months will show up as negative).

Without proper counseling it's easy to imagine a fraction of users (even if it's just 1/10th of 1%) becoming infected due to either a misunderstanding of how the test works or an improperly administered test. Similarly, Truvada will mostly decrease risk. But those who do not take the medication correctly (and a high # of those in the trial did not) will not receive the same degree of benefit.

What about a middle ground? Require a prescription to purchase the test at the pharmacy?

I just read over this article by Judy Stone which had one key point I think helps make my case: "Bottom line: one out of every 12 test results would be falsely negative."

That's exactly what happens with some African circumcised adults: many believe it creates immunity, an incorrect sense of security.

The risks you're talking about are the same for any medical test or treatment. Some people will use it improperly, just like with oral birth control or diabetes control. That doesn't justify withholding it from responsible users.

Requiring a prescription is an adequate political compromise, but it doesn't resolve the fundamental condescension involved. There is something very wrong in trying to withhold public health resources in an epidemic.

If you have a problem with 1 in 12 false negatives, take it up with the FDA's decision to approve it; it's a safety, not a distribution, issue.

Isn't there still a safety issue even after the FDA approves it?

Another way to frame the question (and one I certainly struggle with) is whether there should there be an age limit on it. Are 15 year olds capable of understanding the finer points of the instructions? (I believe there's an 18+ limit on the morning after pill, if memory serves). Should a 16 year old be prescribed Truvada?

The FDA is responsible for considering the safety and, if released, to decide the parameters of patient protection (prescription, OTC, etc)

For the home test, it should be as available as a pregnancy test is because the issues of use are the same (even if the consequences aren't). For Truvada, it depends on the physical risk of the medication, just as we do for anything not subject to Republican contraceptive paternalism.

If it were to be a prescription rather than OTC, a physician may prescribe pretty much however they want as long as it is medically justifiable and the prescription is not a controlled substance like Ritalin or Xanax. Age wouldn't be a factor.

I feel the argument against home HIV testing is far too similar to that against allowing women free access to birth control. As we have seen with birth control, I suspect giving people the ability to monitor and control their own health will not result in a huge explosion of new HIV infections because of sexual carelessness. Part of my reasoning here is that, regardless of the means of testing, HIV is still a life-long virus. Given this, I'd like to assume the majority of people will view these home tests as another means of monitoring, not a means of protection. After all, a test will not protect anyone from HIV, it will simply allow people to monitor their HIV status easier and on their own terms. I don't see this as a bad thing.

Aaron raised a great question: How will people actually use the home test? For me, it's not an option that makes sense to use for regular tests, since local clinics are free and not particularly inconvenient.

At the same time, Max's analogy to at home birth control is apt. Having one or two at home is useful for the same reason, in situations where, perhaps for a friend of mine or if I'm just feeling lazy, a quick verification might be the hurdle between getting tested or not.