HIV Peer Testing Center in Time of Transition

Oberlin’s HIV Peer Testing has been unable to offer private, free HIV tests for the past semester due to state-level changes in health funding and newly-updated standard practices around HIV testing. They anticipate that they will not be able to continue these services until spring 2021.

The state level changes affect the group’s ability to utilize the Ohio Department of Health’s resources to confirm positive test results. Oberlin HIVPT has historically only been able to perform oral HIV tests, which are slightly less accurate than blood tests. Oral tests can produce false positives or inconclusive results, meaning a consequent blood test must be used to confirm results.

“[Previously] in the case of a positive result, we would reach out to the Disease Intervention Specialist for Lorain County,” said HIVPT Co-Coordinator and College junior Sadie Munter. “But now that policies have shifted, that is no longer going to be a possibility. They are moving towards encouraging those who do testing to have their own capabilities to have confirmatory testing and connect people to care.”

Before the change, the state allocated one DIS per county. Now there will only be one DIS per every five counties.

“All of our tests are considered preliminary positives because of type of test we use,” said HIVPT Co- Coordinator and College senior Joey Flegel-Mishlove. “If we ever get a test that comes up reactive, we have to do another confirmatory test. And because we haven’t been allowed to use blood tests as students, and a confirmatory test has to be a blood test, we’ve had to bring in someone else to do that confirmatory test.”

Under new policies, HIV testing programs are expected to perform their own confirmatory tests. Oberlin peer testers have spent the last semester trying to determine a path forward for the organization.

“We realized that we are not comfortable continuing testing until we can find a way to get students connected to a confirmatory blood test in the same day as their initial test, should the initial test be reactive,” Flegel-Mishlove wrote in an email to the Review. “We are working with several groups … to establish the relationships and resources we need to make this a reality. In the meantime, we cannot continue testing knowing that we are not providing Oberlin students the best care possible.”

One option is to have students administer a finger-prick test. However, this presents several difficulties, including receiving approval from the College, additional training, and ensuring peer testers’ comfort with blood.

Additionally, HIV cannot be transmitted through saliva, but switching to a blood test could expose peer testers to a slight risk of transmission.

Best practice guidelines have also changed to encourage groups like Oberlin HIVPT to deliver results within the same appointment. Previously, after a student would come to the peer testers to receive an oral HIV test, they then had to schedule a second appointment to pick up their results.

Oberlin’s HIV Peer Testing Center does not receive funding from the Ohio Department of Health and are not required to follow this guideline, however, they still view it as an important goal of the organization.

“There is a chance that somebody could have a reactive test and not come back for their result appointment,” Flegel-Mishlove said. “We would have this information about them that we would need to get to them, but we would have no way [of ] getting it to them because most of our tests are anonymous.”

College first-year Zoë Martin del Campo also views this as an important change for the testers because when she got tested, she received inconclusive results. She got a call from the school telling her she would need to be retested by the DIS.

“[Receiving results immediately] definitely would have been nice at least for my experience,” Martin del Campo said. “It was scary just because I didn’t know what was going to happen.”

Currently, the group is discussing a partnership with Student Health Services to arrange confirmatory testing. However, Flegel-Mishlove explains that this too presents challenges.

“Student Health would need to get trained to do rapid tests, but the main problem with Student Health is that they don’t feel like they have the capacity to take that on,” Flegel-Mishlove said. “It would require them to be on call whenever we are open … and they have a pretty small staff, and they often have people in appointments with them.”

Other options include sending students to Mercy Allen Hospital, but Flegel-Mishlove is hesitant about this.

“We know so many students have had really bad experiences at Mercy [Allen Hospital],” Flegel-Mishlove said. “We are not particularly excited about that idea. … We also like that all of our tests are free, and we want to keep that a part of our mission, and we aren’t sure what it would [cost if we directed students to the hospital].”

Though the in-house HIV testing will be discontinued until a solution can be found, the group has plans to provide resources in alternative ways. Last Thursday, members of the Lorain County Health Department came to campus to administer tests. Over the next few semesters, HIVPT hopes to bring in more outside testers. The group also hopes to focus on educational efforts, including bringing in speakers and hosting events on drugs that can lower the chance of contracting HIV either before or after exposure to the virus, such as PrEP and PEP.