Free HIV tests could help fill gaps, but advocates say better access needed

Nova Scotia sexual health advocates say the free rapid HIV testing being offered this year as part of a national study helps fill a gap, but more needs to be done to help people get tested.

The Community-Based Research Centre, a non-profit based in Vancouver, is for the first time mailing out 15,000 free self-test HIV kits as part of its annual Sex Now survey, which collects physical and mental health data.

Kirk Furlotte, Atlantic manager for the centre, said people with a family doctor could get blood work done for an HIV test, but that's not an option for everyone. 

Tens of thousands of people in Nova Scotia are without a doctor or nurse practitioner. Parts of Nova Scotia don't even have HIV testing services through rural walk-in clinics or local hospitals.

Furlotte said there's still stigma around HIV and AIDS, and the only options for those who want an anonymous test are the Halifax Sexual Health Centre or the Ally Centre of Cape Breton. 

"I don't think you should have to drive four hours for an HIV test, but a lot of people do it," Furlotte said.

As part of this year's Sex Now survey, 5,000 people in Canada can get up to three of the kits from the research centre. They can use them all, or share with friends or partners.

Furlotte noted even rapid testing is nothing new — most cities in the rest of the country have offered point-of-care HIV tests for years through clinics and doctors' offices.

These are very similar to the at-home kits, where a patient pricks their finger and within a few minutes there's a result, with a professional on hand to talk through next steps.

The lack of testing in Nova Scotia echoes issues some in the province are having getting pre-exposure prophylaxis, or PrEP, which is a drug taken daily to help prevent HIV infection.

For Furlotte, any upfront investment from the province to help more people access PrEP or testing will save money in the long run because someone becoming HIV-positive is going to cost "a lot more."

The COVID-19 pandemic itself shows just how effective widespread, free, rapid testing can be, Furlotte said, adding he'd love to see that type of energy brought to testing for HIV and other sexually transmitted infections or diseases.

Abbey Ferguson of the Halifax Sexual Health Centre said she was happy to see more testing access, but this move doesn't get at the root issues.

Their centre offers testing for HIV and other blood-related STIs once a week, where they usually get about 10 people. Appointments book up fast, and Ferguson said the demand is there to fill up plenty of more days if they had the capacity.

The kits would save lots of time and energy for anyone who gets a negative result at home and can stop there, Ferguson said, but anyone with a positive result still needs a full confirmation test — which could mean hours on the road.

It's hard to tell right now what the impact of these at-home kits might be for the sexual health centre, Ferguson said.

"For anyone who does get a … positive result, if they are in any sort of distress or looking for that confirmatory testing, they obviously are going to want to do it as soon as possible. And that might fall in our laps," Ferguson said.

She added that more clinics providing testing and sexual health resources in rural areas is the best way to make sure people are not driving hours at a time, several times a year. Ferguson said ideally people should be tested after every new partner, or at least every three months if one has multiple partners.

In previous years, the province has seen about 15 to 17 new HIV cases annually. In 2018, that number rose to 31, and in 2019 it dipped to 19.

As of 2016, there were more than 63,000 Canadians living with HIV, one in seven of whom were unaware of their condition, according to estimates released by the Public Health Agency of Canada in 2018.

Nathan Lachowsky, research director for the Community-Based Research Centre and principal investigator for the Sex Now survey, said they decided to offer the kits since the COVID-19 pandemic has led to limited clinic hours and lower testing rates across Canada.

By delivering directly to people's doors, Lachowsky said there's a new chance to reach people who have a hard time getting tested in rural parts of the country, including the Atlantic region.

Even if someone in a rural part of the province doesn't have support nearby, Lachowsky said the kits come with information on how to contact peer support through texting or calling so people don't feel alone.

The survey is open to gay, bi, trans, two-spirit, queer men and non-binary people, since they make up the largest portion of HIV cases in the country. But, Lachowsky noted that there are more studies coming soon from Toronto's St. Michael's Hospital that will be open to anyone.

Languages include English, French, Spanish, Punjabi, traditional Chinese and simplified Chinese.

Lachowsky is hopeful the study results could push Atlantic governments to take these gaps in testing seriously, and help inform policies across the country.

Marla MacInnis, a spokesperson with the Health Department, confirmed in an email that rapid HIV self-testing is not available outside a research context in Nova Scotia.

A national HIV self-testing program and study funded by the federal government is expected to launch in May, MacInnis said. The program will be aimed at reaching undiagnosed HIV-positive people across Canada and those who are at high risk of acquiring HIV.

MacInnis said people who participate will have access to free HIV self-tests. Those who test positive will have access to supports to help them link to the existing HIV testing service to confirm the results, as well as treatment and care.