HOME HIV TESTING -- BLESSING OR CURSE

Carol Sarff is one of the counselors at the Cape Girardeau County Health Center who talk with people to determine whether HIV testing is needed.

With HIV and AIDS being discussed more openly than ever, more people who put themselves at risk wonder if they have it.

A trip to the doctor's office, especially in a small town, may mean facing familiar patients and medical staff. HIV testing is free at government-sponsored clinics, but again, one may run into acquaintances or relatives.

Anonymity is the key factor used to promote home HIV tests recently placed on the market. Eye-catching television advertisements stress that the test may be done whenever and wherever the buyer wants. The ads end with a toll-free number to call and order a test.

One such number, 1-800-THE-TEST, leads to a Johnson & Johnson office. An operator answers the telephone and can take orders for a test -- called Confide -- which costs $49 plus tax. The buyer puts three droplets of blood on a card and sends it to the testing company. All the equipment and a postage-paid envelope are included.

The operator who answered the line Tuesday said test results are ready seven days after buyers drop their blood samples in the mail. The buyers are identified with a 14-digit number, and they use it when calling in for results. Negative results are delivered by a computerized message system, but callers have an option to speak with a counselor.

Positive results must be delivered by a counselor, who is available to answer questions and give advice.

Another television advertisement gives the number 1-800-HIV-TEST. That leads to Home Access, which also markets a home HIV test. The testing process is much the same, but for $54.95, buyers receive an express kit and can get results in three days. The standard kit is $39.95.

The Home Access operator said some states are carrying the tests in stores, where they are less expensive. Missouri isn't one of those states. The Johnson & Johnson operator said the Confide tests are being marketed nationwide.

Calls to five Cape Girardeau pharmacies revealed that none are carrying the tests, but a few plan to do so in the future. So far, wholesalers haven't been offering them, one pharmacist said.

The question is whether a home HIV test, with results delivered over the telephone, is as good as one done in a doctor's office.

One Cape Girardeau person with AIDS (PWA), who preferred to remain anonymous, said he has mixed feelings about the new tests.

He discovered he had HIV in 1985, following a car accident. His blood was tested without his knowledge, and a doctor delivered the news. The hospital's staff psychologist came in right away for counseling.

The PWA also was surrounded by friends, which helped him accept his condition.

"I think that anything that causes people to be tested and become aware of their status is good," he said. "But I don't know if people's psychological needs are being met. The companies providing the tests say they are providing adequate counseling over the phone, but I don't know."

He said a medical professional delivering test results face-to-face may be able to assess a person's reaction better.

"I've heard so many people say that if they tested positive, they would just kill themselves," he said. "I am afraid that these are the kind of people who would do a home test. Would they really know that they aren't alone? Would they know there are ways to live a long, relatively healthy life with HIV?"

Although the Cape Girardeau County Public Health Center hasn't taken an official stance on the issue, nursing supervisor Jane Wernsman said she would prefer people come in for HIV testing. The tests are free and given every Tuesday from 9 a.m.-3 p.m.

At the health center, each test is preceded by some counseling. It determines whether the patient truly is at risk or has unfounded fears about HIV transmission. Patients who are tested receive numbers to identify themselves, and they are called by number to get results. Initially, patients give their names to the intake nurse.

When the test results are delivered two weeks later, positive or negative, there is more counseling. HIV positive persons are directed what steps to take. HIV negative persons are given information about how to prevent getting the disease.

About 100 people a month come to the STD clinics at the health center.

"Some individuals will prefer to do the test at home because they remain anonymous," Wernsman said. "But what if the test is positive? I don't think people who order them on the phone think that through. A positive result is a lot to deal with if you're on your own."

The home tests may have a negative effect on AIDS dollars in the state. Sharon Louise, counseling intervension program manager for the Bureau of HIV/STD prevention, said state law provides for three completely anonymous test sites. They are in St. Louis, Kansas City and Springfield.