Home HIV Testing: Good News but Not a Game Changer

detect antibodies to HIV types 1 and 2. This test will soon be available for sale both online and at more than 30 000 retail outlets nationwide. This is the first truly over-the-counter home HIV testing kit, the same test that profes-sionals have used in health care and community-based set-tings since its approval in 2004. The test provides simple, accurate, in-home detection of HIV infection in 20 min-utes using an oral fluid sample (1, 2). Public response to the FDA announcement was swift and overwhelmingly enthusiastic. Supporters labeled the approval decision a victory for personal empowerment (3). National authorities predicted that OraQuick would elim-inate the stigma and inconvenience of HIV testing in pro-fessional settings, remove barriers to lifesaving care, and help bring the domestic AIDS epidemic under control (4). Our reaction is more tempered. On balance, we ap-plaud the FDA’s decision to promote healthy sexual behav-iors by making HIV tests more available and more conve-nient. However, we doubt that OraQuick will have much effect in either lowering barriers to care or reducing HIV transmission. A $40 home HIV test is not even likely to make an appreciable dent in the number of undetected HIV infections; rather, it will attract a predominantly af-fluent clientele composed of persons at low risk for HIV infection (the “worried well ” and new sexual partners), per-sons with very recent (and therefore undetectable) high-risk exposures, and persons with known HIV infection seeking to monitor therapy or to pursue a misperception that treatment has reversed their seropositivity (5–7). We offer the following cautious suggestions to providers when counseling their patients about the use, misuse, and antic-ipated benefits of home HIV testing.