A step toward putting a genie back in its bottle

The new rapid HIV test1 may play a part in putting the genie of a lethal infectious disease back in the bottle. In the United States, at least, people who feel they are at risk can go to a local pharmacy, obtain a home HIV test kit and send a capillary blood sample away to a private laboratory. While a positive test result requires further confirmation and a trip to their local physician, a negative result preserves their autonomy and privacy. As suggested in a CMAJ editorial,2 this would lead to earlier detection and treatment of HIV infections. If this prevents transmission of the virus to others it is certainly a step in the right direction.

While Richard Elliott of the Canadian HIV-AIDS Legal Network and others stress the value of pretest counselling,1 it has been obvious for years that elaborate pretest counselling as advocated in the Canadian Medical Association guidelines3 has been an effective roadblock to HIV screening. The harms of counselling (both to patient and physician) were not considered in the rush to be politically correct. How many people with early cases of HIV infection have been talked out of appropriate screening over the years, with tragic consequences for others?

The concerns of Richard Elliott and the Canadian HIV-AIDS Legal Network regarding rapid HIV tests are those of a special interest group. The wisdom of the general public in its search for privacy, personal autonomy and control will be the final arbiter of this debate.