HIV testing at pharmacies increases accessibility, but creates challenges as well

Pharmacists must be equipped to deal with negative and positive test results

WHAT IT MEANS AND WHY IT'S IMPORTANT — Retail pharmacies have been offering testing for diseases ranging from high cholesterol to cancer for years, but offering HIV testing presents a whole new realm of possibilities and challenges.

(THE NEWS: Walgreens to provide free HIV testing in CDC pilot. For the full story, click here.)

On the one hand, HIV testing traditionally has taken place at physician offices and community health centers, but offering it at the pharmacy — not to mention a Food and Drug Administration panel's recent endorsement of the over-the-counter availability of the OraQuick in-home HIV test — expands the range of services people can get with a simple walk to the neighborhood store.

At the same time, while any chronic disease tends to be a private and emotionally charged issue, HIV is especially so, considering the long history of stigmatization of people with the virus due in part to its frequent association with intravenous drug users, LGBT people and sex workers; United Nations secretary-general Ban Ki Moon has called stigmatization the single most important barrier to public action. In the gay community, for example, stigmatization has led to what many call a divide between HIV-positive and HIV-negative people, and one of the first questions encountered in gay chat rooms and on dating sites is "Are you clean?" while signs decrying HIV stigmatization were included at New York's annual gay pride parade last month.

According to a Centers for Disease Control and Prevention article published in 2006, medical systems' treatment of HIV as an "exceptional" disease has helped to feed stigma, resulting in infected people often not getting tested  until they're already sick. That year, the CDC released revised recommendations to regard HIV/AIDS as a treatable disease, and one of the goals of the Walgreens-CDC pilot program is to reduce the stigma associated with the virus. Perhaps making HIV testing something people can do at the same place they buy cold medications, magazines and toothpaste rather than at a clinic can help make it seem more routine.

But if routine HIV testing is to become a common feature at retail pharmacies, there are some other considerations as well. In addition to anonymity, it's important to provide services like prevention counseling and referrals, as well as counseling and emotional support for patients who test positive. Stigmatized or not, HIV remains a life-threatening and life-changing disease. According to the CDC article, while 70% of people tested at publicly funded sites received their results and test information, fewer received counseling or referrals, and the figures were even lower for people tested in private settings. The FDA Blood Products Advisory Committee also expressed concern about lack of access to counseling when recommending OTC approval of the OraQuick test. For this reason, it's important that pharmacies be equipped to help HIV-negative patients stay that way and help HIV-positive patients overcome the emotional shock they may have.

WHAT DO YOU THINK? Do you think HIV testing at drug stores will encourage more people to get tested or enhance the stigma associated with HIV/AIDS? Post your comments below.

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