title: Arguments for and against HIV self-testing.
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.
authors.affiliation: Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wood
authors.affiliation: Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Ballenger
authors.affiliation: Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA ; Public Health, Seattle and King County HIV/STD Program, Seattle, WA, USA.
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Stekler
keywords: AIDS; HIV; diagnosis; screening; self-testing
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