A review of government policy about self-testing for HIV is needed in the UK in order to increase the uptake of HIV testing, according to a Viewpoint in this week's Lancet.
An estimated 31% of people in the UK are unaware of their HIV-positive status. But early diagnosis is important to manage the illness effectively, and so that people who are HIV positive can reduce the risk of transmitting the virus to others. Since 1992 it has been illegal to sell or provide any self-test for HIV to any member of the public in the UK.
Lucy Frith (Division of Primary Care, University of Liverpool, UK) challenges the case against self-testing for HIV in light of new technologies that enable rapid and accurate HIV testing, advances in antiretroviral therapy, and the increasing emphasis on patient autonomy. She notes that the trend in health care towards an emphasis on patient autonomy has led to greater self-diagnosis and screening. People have been encouraged to take responsibility for their own health and to make informed decisions without direct intervention from health-care professionals. She argues that if self-testing for HIV is not harmful, there should be no grounds for keeping it in a clinical setting. She discusses the most common arguments against self-testing-the absence of counselling before and after the test, the accuracy of self-tests, the ability of people to provide adequate samples and interpret the test correctly, and the possibility of abuse or testing someone without their consent-and recent changes in practice and advances in technology that undermine these arguments.
The author concludes: "If practitioners truly believe in patient autonomy, people should be allowed to choose where, when, and how they are tested for HIV, where the technology exists. When appropriate self-test kits become available, the UK needs to be in a position to benefit from their use."
Journal
The Lancet