New “peer navigator” program encourages at-home HIV testing

A new study using networks of friends as “peer navigators” will soon be launched in the East Bay to reach men who may be vulnerable to the AIDS virus. It’s part of an effort to make better use of confidential in-home HIV testing in order to reach at-risk populations in Oakland.

In 2013, the U.S. Food and Drug Administration approved OraQuick, an in-home test that involves detecting HIV by taking a oral swab containing saliva. The kits, which provide preliminary results in 20 to 40 minutes, are available at drug stores for people age 17 and older.

According to the U.S. Centers for Disease Control and Prevention, about 1.2 million people in the U.S. are living with HIV, and about 1 in 5 of those people don’t know they’re infected. More than 200 new cases of HIV are diagnosed in Alameda County every year and Oakland is the most affected city. In 2013, there were about 220 new cases in Alameda County, and about 115 of those were in Oakland. “Overall, the county’s epidemic is driven by the Oakland epidemic,” said Neena Murgai, the director of the HIV epidemiology and surveillance unit at the Alameda County Public Health Department.

Although Murgai said that the number of newly-reported HIV infections has been virtually the same for each of the past three or four years, there are many boundaries that prevent people from getting tested. The in-home test technology allows individuals to have confidentiality and control over their own test results, said Marguerita Lightfoot, director of the Center for Aids Prevention Studies (CAPS) at the University of California, San Francisco. But price and discretion still pose obstacles to their use. At about $40 apiece, the price of an in-home test is “steep,” compared to a $15 pregnancy test, Lightfoot said. “The price point is pretty high for many men, and absolutely high for those who are potentially more vulnerable to HIV,” she said.

Many people don’t know even know that the product exists. “I don’t think there’s been a lot of education or outreach about this new, innovative way to get tested for HIV,” said Emily Arnold, associate professor at UCSF and CAP

Packaging also poses a problem. Lightfoot has received feedback from focus groups of men that the in-home test is relatively small compared to the box that it is packaged in. Those purchasing the product might not want to be seen carrying it around, and its large size makes it “harder to keep it undercover, as it were,” she said.

The focus groups have also said that they sometimes find the instructions difficult to understand, and that the sheer volume of pamphlets in the kit can be overwhelming. Although the kit contains a 1-800 number and a website that can help one find the nearest clinic, people might not know what to do if they get a positive test result. People who test positive should go to a test site to get a confirmatory blood based test, Arnold said.

Lightfoot said the small pilot study in Alameda County will test using social networks as a new strategy for identifying hard-to-reach men who haven’t been tested for HIV but may be at risk for the disease. The target group is men who have sex with men, mainly in the African American and Latino communities, she said.

Ten chosen men will receive in-home test kits and training, and will be asked to give the kits to five of their friends. These “peer navigators” will not only help to reach people that the study would otherwise not be able to contact, but will be trained to help those who test positively. The goal is to get at least 50 people tested in each round of the study; there will probably be two or three rounds.

CAPS is partnering with Alameda County Health Department. If the strategy is successful, the department will be more likely to use it in the future, Lightfoot said. Funding for the study is coming from the California HIV Research Program through the University of California.

Arnold said there’s a “huge emphasis” on HIV testing for two reasons. First, when someone knows their HIV status, they may change their behavior by using condoms and reducing their number of sexual partners, which limits the possibility of spreading the disease. Second, someone who knows they have HIV is more likely to be prescribed medication, and to live a healthier life. If you’re diagnosed early, “you can live a very long, healthy, productive life,” Arnold said.

Still, lack of information is a social barrier to testing. “Some folks don’t know they’re at risk, so they don’t seek out an HIV test,” Lightfoot said.

And people with little money or no means of transportation might have difficulty getting to testing sites, Arnold said, which is why she thinks increasing funding for mobile testing would be beneficial.

Additionally, Arnold said, most local HIV testing takes place in brick and mortar testing sites that could have a stigma within the community. If tests are only available at gay-identified venues, that might make it difficult for some to get an HIV test. “We need to be creative in how we’re getting the word out and information out,” she said. Offering information at venues like churches and job training programs is a step in the right direction, she said.

Understanding that anyone who has sex can get HIV, and making HIV tests a normative part of routine check-ups for sexually-transmitted infections, would help to get rid of some stigma, Lightfoot said.