I've been asked recently my thoughts about Qpid.me, a service that notifies authorized users of a member's HIV status.

To some degree, I think these services, and I believe there are several, are already obsolete because of Orasure's home test kits, but this is what I think.

Many men are worried about such aps making stigma worse.  I disagree.  There is just a certain population of men that is going to act on the abstract fear of winding up like "Philadelphia," and you cannot reach them.  The guy who turns and runs from a text would already have turned and run when you just told him, as you were going to do, anyway.   It still stings, but Qpid would only alter the timing.  

On the other hand, there some essential problems with any text-based ap that attempts to identify people with or without HIV:

Of the estimated 1.2 million HIV infected people in the USA, 240,000, or 20% are unaware of their infection.  For gay men in urban areas, the figure is 44%.  16% of these had NEVER been tested.   Of recently infected gay men "unaware" of their status, 45% had been tested within Qpid's 12 month window.  Dependence on any 12 month old lab result is highly likely to lead to new infections, not to prevent them.

I'm sure the prevalence of texting phones is high in gay men, but it is not universal, and any service that requires testing within 12 months is going to face the same issues that testing itself faces.  Fear of a positive result will discourage people from signing up.  Positive men have no reason to sign up in the first place, no matter how honest they are about disclosure.  If the percentage of users remains small, the value of the service is low, even if the test results given were immediate and accurate. Qpid offers zero protection against those who lie about their status, as they simply won't be subscribers, and given the "low penetration" of the service," someone who uses it is going to find a lower percentage of users than "certified negatives."  I simply cannot imagine many men saying, "Since you don't have Qpid, I won't go home with a horny man who looks like a Colt Model."  Sexual decisions are, for better or worse, almost never that mathematical. 

I suppose it's possible it might encourage a few kind of nerdy and paranoid men to be tested, and that's a good thing.  The bottom line is that only safer sexual practices, honest discussion, and education can really help.

In short, I think Qpid cannot deliver reliable laboratory information that increases safety, because it depends on old results in a population with lots of recent infections.  I do not believe it could ever reach a percentage of users that would allow it to be of use in the first place…

and I hope they have a team of lawyers specialized in HIPAA issues, because they're going to need it.

Home HIV tests

The FDA recently approved a home test kit for HIV that will allow you to buy a test, and get a result within an hour.   There is a number to call to get information and counseling, but the result will be right there.

There are, as with anything, plusses and minuses.   For people who cannot be seen getting tested, and there are many, this test will be a huge advance.  They will be able to get result, and move forward to seek therapy on their own.   It is thought that this will be a particular help to communities where "stigma" deters people from testing.   If it works out that way, it is estimated that up to 40,000 new HIV infections will be avoided every year.

I have concerns for sexually active gay men.   While the test is good, and based on the "orasure" technology that has been used for years, there are a couple of problems.   First, these tests only measure antibodies, unlike the latest blood tests, which also measure virus itself.   The home test has a three month window period.   Tests done in a medical lab using blood have reduced the window to a week or so.   In young people hooking up on the net, this is vital.

Secondly, when done at home, this test has a very significant false negative rate.  For every 12 truly positive tests, there will be one person who gets a negative result, but who is, in fact, positive.   Using this test to screen sex partners for bareback sex could easily allow lots of new infections.

I do not believe this test is ideal for sexually active gay men, and it is a very bad idea to use test results from the home HIV test to make decisions about bareback sex.