Wood Brian R, Ballenger Carl, Stekler Joanne D
Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA ; Public Health, Seattle and King County HIV/STD Program, Seattle, WA, USA.
HIV AIDS (Auckl). 2014 Aug 2;6:117-26. doi: 10.2147/HIV.S49083. eCollection 2014.
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.
约60%的人类免疫缺陷病毒(HIV)感染者并不知道自己已被感染,而耻辱感和歧视仍然威胁着全球范围内HIV检测服务的接受度。HIV自我检测多年来一直备受争议,随着2012年美国一种即时检测试剂获批可在柜台销售,这场争论再度燃起。在此,我们列出支持和反对HIV自我检测的观点。支持HIV自我检测的理由包括:这种方式非常容易被接受,尤其是在风险最高的人群中;自我检测赋予使用者权力,有助于使检测常态化;伴侣双方相互检测有可能提高风险意识,避免抗体不一致的伴侣之间发生无保护性行为。反对HIV自我检测的理由包括:成本限制了最需要检测的人群获得检测的机会;假阴性结果,尤其是在窗口期内,可能会导致错误的安心感,并可能促使抗体不一致的伴侣在传染性最强的时候发生性行为;可能会错过咨询、获得治疗以及诊断其他性传播感染的机会;自我检测可能会导致伴侣之间出现强迫行为。需要开展研究,以更好地界定自我检测的风险,尤其是随着检测方法性能的提高,同时还要明确旨在改善自我检测试剂盒获取途径的项目的益处,因为这种检测方式有众多潜在的优缺点。
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