Testing yourself for HIV - is that even possible? And how does it feel? Our author wanted to find out. Even though there are some arguments against it, he found the idea appealing: finding out quickly and easily at the kitchen table. The HIV home test - a self-experiment. From Max Mohnwitz*
I actually wanted to go to the Tropical Institute at the end of April. In my experience, the HIV test there is the most uncomplicated: you don't need to make an appointment, your turn comes quickly, you hardly get asked any questions and you remain completely anonymous. As I am familiar with HIV, I am happy to do without a detailed consultation. You are given a handwritten number and have blood taken from your vein. A few days later you pay 12 euros and get the result. An HIV test can be that simple.
But couldn't it perhaps be even easier? No travelling to the other side of town, two appointments less, no contact with doctors and nurses? Instead, certainty after half an hour at the kitchen table? I confess: that sounds tempting! That's why I recently made the decision: I'm going to try the HIV home test.
Even doctors sometimes have to practise taking blood samples for a long time
It's no secret: although home tests are not allowed to be sold to end consumers in Germany, various providers send the tests to Germany from abroad. However, Deutsche AIDS-Hilfe advises against such offers, as the quality of these test kits is not guaranteed.
Fortunately, I have a reputable source. A doctor I trust gave me three different test kits, approved for professional use in Germany, each in duplicate. If you're going to do it, do it. One of the tests works with oral fluid, the other two with blood. However, the doctor I trust weighs his head and warns: "Taking blood from the fingertip is not easy. Even doctors have to practise it first. Some even prefer to take blood from the vein because it's easier."
I let him talk and insist on taking the blood tests with me. When I do the home test, I test all the variants. And if a test is positive, I still have a few procedures in reserve to check the result. After all, such a test can also be falsely positive. "I just test myself until I get the right result," I jokingly say to a colleague.
By now I'm feeling a bit queasy: can I do this on my own? Will I even manage to prick my finger? Is the result reliable? And what if I should be positive? Well, I was also worried about this the last time I went to the Tropical Institute. And if that was the case, I'd rather be alone with this news. Otherwise I might have to encourage a complete stranger who finds it difficult to break bad news. I've experienced something like that before ("But doctor, syphilis like that isn't a broken leg!").
It's a slaughter
One Friday lunchtime, the time has come. I lock the cats out of the kitchen, pour a jute bag full of shrink-wrapped test kits, individually wrapped alcohol swabs and finger prickers onto the kitchen table and immerse myself in the instructions.
The Oraquick test, which is already approved as a home test in the USA, takes 20 minutes to give a result. It works with a swab of the oral mucosa. I think I'll do that first, then I can do one or two more blood tests while I'm waiting.
The instructions are a little complicated. Each step is described in great detail and as I know that errors in application can lead to incorrect results, I read everything three times. I'm nervous, but more relaxed than before the blood test at the tropical institute.
And off I go: I cover the workstation with an absorbent pad, as the instructions suggest. Then I open a small bottle of solution and place it in a small plastic stand. I take a small plastic spatula from a separate compartment in the test pack and run it along the gums above and below the teeth. The spatula is then placed upside down in the tube.
The result will soon appear in a display field. One bar means negative, two bars "reactive", i.e. positive. But first, as announced in the instructions, the entire display field turns pink. Everything is going according to plan. I now have time for the blood test.
Let's get this out of the way: it's carnage.
The pipette has not read the instructions
The good news: although I'm a needle-phobe, I manage to prick myself. A little rubbing of the finger to attract blood, then disinfection with a wipe - no problem. Then it gets a bit uncomfortable because you have to hold your hand below hip height - a suboptimal working height. Nevertheless, the prickers are designed so that you don't have to push the needle into your fingertip with your own strength, which would have caused me to hesitate for several minutes. You press a button to trigger a mechanism that then shoots the needle into the flesh. What a service.
I'm bleeding! Now I just have to hold a very thin pipette to it. It will automatically draw exactly the right amount of blood up to a mark on the tube. That's what the instructions say. But the pipette obviously hasn't read the instructions. It does not aspirate. Under no circumstances should you press on the small bellows at the end. So I hold the pipette at a slight angle. Maybe blood is running in? But the blood just runs down my finger. And it's already coagulating. Result: a sticky, bloody fingertip, an almost empty tube.
New prick, new tip, new pipette, new luck. Think again. Again, not enough blood flows into the tube. I press harder on my finger to get more blood. I know that you should only "milk" carefully, at the bottom of the fingertip, not around the puncture. Otherwise tissue fluid could dilute the blood and falsify the test result. In my case, however, that doesn't matter at all. Because none of it leaks into the tube. Sticky, bloody fingertip number 2.
While I'm thinking about my failure, I'm suddenly startled. I've completely forgotten to keep an eye on the Oraquick! What if it has long since shown two lines and I can't do any more tests? A glance at the clock tells me that the Tropical Institute is already closed. I would have to wait until Monday. Fortunately, the Oraquick only shows one line. I relax a little and make a third attempt with the last available finger prick.
Sticky-bloody fingertip, the third
And fail miserably again. This time I get really angry. With a rush of desperation, I squeeze the entire front phalanx. This is the last attempt, it just has to work! But the blood doesn't run into the tube. Bloody, sticky fingertip, the third.
Okay, I give up. My trusted doctor was right: it's not without blood. Or I'm too stupid. The result is the same: no result.
Fortunately, my Oraquick has remained at one line. However, I know that this test method is not particularly reliable. Application errors make the result even less reliable. The test misses seven out of 100 HIV infections when used by the user, and still misses two when used by professionals. Maybe I've done everything wrong here too? Maybe my negative Oraquick is worth nothing? It's a good thing I still have one. It works really easily, I don't even need the instructions. Only one line shows up again. Whew.
And yet my personal conclusion is: an uncertain Oraquick result is not enough for me. I'll be travelling to the tropical institute again soon. I prefer to have my blood taken by people who have learnt how to do it.
*The author actually has a different name and is an AIDS service organisation employee.
More information:
HIV tests for home use? The position of Deutsche AIDS-Hilfe
