its assessment of the test on a
statistic called the Positive
Predictive Value, an estimate of
the number of positive test

results that would be false given
the rate of HIV in any given pop-
ulation. The problem with the
VDH’s logic is that the HIV
sero—prevalence for everybody
living in the state of Vermont and
the HIV sero—prevalence of
Vermont’s gay men are widely
differing values.

Approximately one of a
thousand Vermonters is HIV-pos-
itive, compared to perhaps one of
every 16 gay men in Vermont.
(Incidentally, VDH refuses to
state publicly an official rate of
HIV for gay men in Vermont.
The rate referred to here is the
‘middle of the road’ value for the

‘rate of HIV when looking at the

aggregate of surveys of Vermont
gay men that ask their HIV sta-

' tus.) At this level of HIV sero-

prevalence, only 2-4 percent of
positive results would be false,
resulting in the test being accu-
rate 99.6 percent of the time, a

level of accuracy on par with that

- of other available tests.

Ultimately, however,
pointing to the accuracy of the
test is a smokescreen. There is
not much difference in the accu-
racy of OraQuick compared to
traditional, lab-based testing.

A study published by
the CDC in January 2004 con-
cluded OraQuick “produced sub-
stantially fewer false-positive
results than traditional lab-based
HIV tests.” Documents from the
Food and Drug Administration
state the test “provides screening
results with over 99 percent
accuracy.” .
“Rapid testing tools are
widely accepted by the CDC,”
said Karlie Stanton, spokesper-
son for the CDC’s National
Center of HIV, STD, TB
Prevention, who expressed
‘shock’ that a public health offi-
cial would make such a claim of
an FDA approved test.

A slightly more believ-
able claim is the cost of imple-
menting the new test, but even

this explanation does not pan out.

“Cost definitely plays a
part, because it’s not only the test
but the test counselors and quali-
ty assurance. The CDC has not
made any funds available to -
make it happen,” said Weller.

In fact, the CDC is. giv-
ing away test kits and actively
training test providers.

“To date, the CDC has
purchased and distributed
500,000 finger stick rapid tests
and trained more than 475 people
at twenty regional training ses-
sions,” said Stanton. “Ten to 15
additional trainings are planned
this year.”

The primary issue
appears, to be the willingness of
VDH to offer the test.

‘‘I wouldn’t say it’s not
on the radar,” said Bill Apao,
VDH Director of Surveillance.
“We absolutely see the impor-
tance of a rapid test. It’s not that
we don’t_ want to do it, we don’t
want to cut the legs out from
under our outreach workers.”

But organizations who

employ those outreach workers

.can’t wait for the test.

“I knew the CDC was
pushing the rapid testing, and
we’d love to be part of it," said
Vermont CARES’s Jacobsen.
“We’re willing to send our staff .
to training using general dona-
tions.”

“We would certainly
support rapid testing because it
reduces the barriers gay men face
at getting tested and getting their
results,” said ‘R.U. 1 .2?’s
Kaufman.

Perhaps the real issue in
not offering the testis VDH’s
lack of awareness of what’s
important to gay men.

“The Department of
Health does have the communi-
ty’s best interest at heart, but
they don’t always have accurate
information about what the com-
munity needs and what it’s like
for the average gay man who is
concerned about HIV,’.’ said
Kaufman. “It would be great if
the Health Department could lis-
ten more carefully to men who

 

are at risk — which is not neces-
sarily those who participate in
the community planning group.”

The VDH
Comprehensive HIV Prevention
Plan governs prevention activi-
ties of the state’s AIDS program.
Twice it directs public health
officials to “consider and evalu-
ate the adoption of rapid testing
technologies to increase the like-
Iihood that people who access
antibody testing will recgaive
accurate results in the most time-
ly manner possible."

When asked if VDH
had assessed the impact the test
would have on people getting
tested for HIV in Vermont, per-
formed a cost/benefit analysis of
providing the test, or document-
ed the cost of training HIV test
counselors, Apao’s response was
“Nothing formal.”

In the meantime, gay
men wait. V

Ric Kasini Kadour is a gay men is
health advocate and freelance
writer living in Shoreham.

Approximately one out of a thousand
  Vermonters is HIV-positive, compared
toperhaps one of every 16 gay men in

Vermont . . . Over one third of people
tested in the traditional, lab-based way

I   do notreturn, and thus never-
discover their sero-status.