In the past, when somebody wanted to get an AIDS test there was only one way to go about it -- needles. Puncturing the skin and drawing blood was the sole avenue to the cells that could alert doctors about HIV antibodies in a person's system. That was then... And this is now. New testing has doctors tossing the needle and asking patients to open their mouth and say ahhh...
Carol Tucker is a health educator at the University of Michigan, where an oral method of HIV testing is administered to students at a price of ten dollars. Tucker wants to be very clear about how the new test, called OraSure, works. She says, "Even though it's oral, the test is actually not a saliva test. It is a test of oral mucosal transudate. That is, it's the fluid from inside the cells of the mouth that is tested for HIV."
The new test does have obvious advantages over the traditional blood testing. First of all, there are no needles involved - goodbye pain and goodbye accidents. That's good news for both the testee and the tester.
"It does provide a nice option for people who are uncomfortable with needles or blood-drawn testing. It also means there is not a risk of infection for the tester that comes with the sharps (needles). People who are not trained to do puncture can do this oral test," says Tucker.
The new HIV testing is easily administered. A cotton swab is placed between the cheek and gum of a patient. It is left there for two to five minutes. When the time is up, the swab is removed from the mouth, placed in a vial and taken to the lab to be analyzed. According to Tucker, the results are just as accurate as those of traditional blood-drawn techniques.
The oral method appears to be a competent tool in diagnosing HIV infections, but a bigger question looms - will it encourage college students to get tested?
Jessica Tuttle, a senior at Ithaca College in New York, wasn't aware of the new oral testing method, but she does believe as word spreads it will encourage some to investigate their HIV status. "Actually, I've been tested. And the needle part of it was not a big deal," says Tuttle. But, she adds, collegians need more than just a newfangled procedure to get them to their university health centers. "People are not that open to getting tested. It's not something that is talked about. And getting people to get tested is not an issue that comes up."
Adam Johnson, a senior at North Carolina State University, sings a similar tune. He agrees that the new method will encourage a few to get tested, but, again, that's not the only issue. "I personally have been tested a couple times. But some people out there, they would prefer not to know, so it doesn't weigh on your mind if you did know and the outcome was poor. Plus, Johnson adds, a lot of times Generation X feels: AIDS... Not me. "College students -- when they're young -- they feel a bit invincible and that can be a stumbling block to getting tested."
Aside from some students' indifference to testing, one drawback to OraSure is its price. The old blood and needle practice is free at some university health centers, but the new method will cost students on average about $10.
At Western Michigan University, Christine Zimmer, the director of the office of health promotion and education, believes money and fear are two of many factors that may keep students from getting tested. "Cost has something to do with it. You and I spend money on things that are important to us. It is important to invest in yourself and have the courage to get tested," she says.
Tuttle also thinks cost will be a factor for the college crowd, saying, "Free just sounds better."
Zimmer brings up another critical point. There is more to reducing risk than just getting tested. All the new methods in the world won't solve one problem that many testing facilities run into. "It's one thing to get tested and another thing to come back and get the results," she says.
Programs around the country face a problem of disappearing testers. People get the initial test but then worry can set in and they never return for the findings.
"It seems like, from what I've heard and seen, there's really a lot of anxiety that surrounds testing," says Joseph Richards, a junior at Central Washington State University.
That anxiety can lead to a lot of no-shows on result day. According to the Centers for Disease Control, in 1995 there were about 2.5 million people tested for HIV infection at publicly funded counseling and testing programs. Of those who tested positive, 25 percent never returned for their results.
Zimmer recognizes the courage it takes to get tested and the courage it takes to come back to find out what the outcome is. She explains, though, that here is still another step in the process. "It's not good enough to just get [results] and then not do anything about it. ...We judge a program's effectiveness based on whether or not people come back for results and then make a plan for risk reduction. It's not just a 50,000-mile checkup. People need to make healthier, safer choices about sexuality."
Matthew Bryant is a senior at Eastern Tennessee State University. Despite the myriad of challenges facing HIV testing, he does feel new methods such as OraSure go a long way in enabling students to get at the truth. And although Bryant doesn't deny that anxiety has an impact on the testing process, he says that doesn't mean new technology can't also make a difference.
"Some people are going to [avoid the results], but you have to present the opportunity to allow people to find out what their status is. The easier you make the process, the more likely people are going to be informed."
Even though the oral testing provides another window to diagnose those who are potentially infected, it's evident that there are still other hurdles that need to be cleared before students can completely face the music. Tucker says, "When it comes to all types of sexually transmitted diseases, people think that it won't happen to them, but we know for a fact it does. I think culturally, on the college campus and in other areas, the bigger concern should have to do with just getting people to realize they should be tested."